Should your relative live alone?

Mark the check box next to any question you would answer "yes" to.

Safety Needs
Yes
Has your relative had accidents because of weakness, dizziness, or inability to get around?
Has use of the stove, oven or appliances become a safety problem because of forgetfulness?
Are there hazardous conditions in his/her home, such as the bathroom and bedroom being on separate floors?
Does your relative refuse to use a wheelchair, walker, or other devices necessary for safety?
Does your relative express a desire to die, or seem to be depressed, apathetic, or without an interest in living?


Nutritional Needs

Yes
Is there a demonstrated nutritional problem (weight loss, illness, anemia, etc.)?
Does your relative eat only inappropriate foods that will not supply nutritional needs?
Does your relative "forget" to eat?


Personal Needs
Yes
Is your relative unwilling or unable to get to the toilet when necessary?
Is your relative unable to change clothing or bed linens as necessary to remain clean and dry?


Medical Needs

Yes
Does your relative forget to take necessary medications?
Is it likely that your relative would take an inappropriate dose of medicine, purposely or accidentally?
Is your relative physically unable to handle medications (spills or drops them) or to give injections?
Is your relative physically unable to obtain help in case of need?


Social Needs

Yes
Is your relative unable to handle money?
Does your relative get lost in familiar situations?
Has your relative left home without a destination?
Does your relative often behave inappropriately?
Does your relative have mental or emotional problems which might be a threat to self or others?


1. If you answered "Yes" to 5-9 of these questions, you should be thinking of, and planning for the probability that your relative will need additional care and support in the future.


2. If you answered "Yes" to 10 or more of these questions, support services are very likely immediately necessary.


If you're interested in having one of our professionals to perform a safety evaluation on a loved one or a loved one's home please contact us at (800) 860-9823 or (847)-444-1222.

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