Senior Care Survey

Has your loved one been diagnosed with any chronic conditions (e.g., diabetes, heart disease, arthritis)?

Have they had any recent surgeries or hospitalizations?

Have they fallen recently?

Have they been diagnosed with dementia or early-onset Alzheimer's?

How would you describe their ability to walk or move around?

Do they have trouble getting up from a seated position?

Have you noticed any difficulty with their balance, walking, coordination, or gait?

Have you observed any signs of memory loss or confusion?

Do they have difficulty communicating their needs clearly or following conversations?

Are they forgetting to take medications, taking more than the prescribed dosage, or resist taking them with no good reason?

Are there stacks of unopened mail or an overflowing mailbox? Have you received late payment notices, bounced checks, or calls from bill collectors?

Do they appear uncertain or confused when performing tasks they used to do regularly?

Have you noticed spoiled food in the house?

Are they showing signs of a poor diet or unexplained weight loss?

Have you noticed any unpleasant body odor, infrequent showering or bathing infrequently, or decline in grooming habits and personal care?

Are his/her clothes dirty, worn inside out, wearing the same clothes and shoes as last time? Do they have the dexterity or mobility to change clothes?

Have you observed unexplained dents or scratches on their car?

Have you noticed any unexplained bruising on their body?

Have they lost interest in hobbies or activities they once enjoyed?

Are they unusually fatigued?

Have you noticed changes in their mood, or extreme mood swings?

Is the house dirty or unkempt? Are there signs of clutter blocking walkways, or dirty laundry piling up?

Are the lights, appliances, HVAC in working order?