Senior Home Care Assessment: Understand Your Loved One’s Needs at Home

Helping an aging loved one remain safe, comfortable, and independent at home isn’t always easy, and knowing when it’s time to seek help can be even harder.

That’s why we created this senior home care assessment: to help families identify areas where support may be needed and to start an informed, compassionate conversation about care options.

If you’re unsure where to begin, feel free to contact us to talk through your situation, or continue below to complete the assessment.

Contact Us

An elderly man takes a home care assessment with the help of his adult daughter.

Start Your Elderly Care Needs Assessment

This worksheet acts as a practical elderly care needs assessment, helping you evaluate important factors such as:

  • Ability to perform activities of daily living (ADLs) like bathing, dressing, or meal preparation
  • Cognitive and memory challenges that may impact daily routines
  • Home safety risks such as falls, medication management, or mobility concerns
  • Emotional or social needs that may benefit from companionship or support

We recommend completing the assessment together if possible. If your loved one is unable to go through the worksheet on their own, a family member can complete it on their behalf and use it as a starting point for a conversation with Families Choice Home Care. The insights gathered here help us tailor a care plan that fits your family’s unique needs.

We’ll be in touch to talk about your loved one’s needs and how we can help. Your submission is confidential, and there’s no obligation—just a caring conversation about how we can support your family.

When you’re ready, use the form below to request a professional in-home assessment and take the next step toward compassionate support.

Request an Assessment

  • This field is for validation purposes and should be left unchanged.

  • Please rate the level of assistance for each of the independent activities of daily living (IADLS) described below:

  • Are there unpaid bills? Bounced checks? Messages from creditors? Is there a stack (or many stacks) of unsorted mail?
  • Have there been traffic accidents - including fender benders? Are you uncomfortable as a passenger in their car? Have they stopped driving at all? Do you feel safe? Any close calls or unusual variations in speed? Any signs of confusion about where to go?
  • Are they continually missing essential household items or do they have large amounts of the same item?
  • Have they stopped making meals? Are they making poor decisions in what they eat- on a consistent basis? Is there spoiled food in the refrigerator or cabinets?
  • Do they answer the phone when you call? Do phone messages go unanswered?
  • Are they taking too many or too few of their prescribed medicines? Are they unsure what to take or why they are taking it?
  • Is the home so cluttered you are concerned they may fall? Has the furniture been dusted, floors vacuumed or mopped? Are there dirty dishes? Are there safety issues due to lack of maintenance- burned out light bulbs, shaky hand railings?

  • Please rate the level of assistance for each of the activities of daily living (ADLS) described below:

  • How well can they get around? If in a wheelchair, can they propel on their own?
  • Can they feed themselves? Can they cut their meat?
  • Are there issues with getting to the bathroom on time? Are clothes/bed sheets stained with urine or feces?
  • Are their outfits appropriate for the season? Are the buttons closed appropriately? Clothes are not inside out?
  • Are there body odors? Are they taking showers or tub baths? Is hair washed and combed neatly? Are nails dirty?

  • Your Contact Information:

  • Senior's Contact Information:

    If you are completing this assessment for a senior, please provide their contact information.

  • Evaluating Your Score:

    0-7 Support services may not be needed at this time
    8-14 Consider support services for safety and to maintain independence
    15-20 Support services strongly recommended for safety and to maintain independence
    >20 Support services highly recommended as soon as possible

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