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Angels on Earth Home Care > Needs Assessment

Needs Assessment

Try our interactive needs assessment tool to get an idea of the level of care you may need.

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Welcome to your Needs Assessment

In each category, check the item that most closely describes the person's highest level of functioning.

Toilet

Care for self at toilet completely; no incontinence

Needs to be reminded, or needs help in cleaning self, or has rare (weekly at most) accidents

Soiling or wetting while asleep more than once a week

Soiling or wetting while awake more than once a week

No control of bowels or bladder

None

Feeding

Eats without assistance

Eats with minor assistance at meal times an d/or with special preparation of food, or help in cleaning up after meals

Feeds self with moderate assistance and is untidy

Requires extensive assistance for all meals

Does not feed self at all and resists efforts of others to feed him or her

None

Dressing

Dresses, undresses, and selects clothes from own wardrobe

Dresses and undresses self, with minor assistance

Needs moderate assistance in dressing and selection of clothes.

Needs major assistance in dressing, but coop erates with efforts of others to help

Completely unable to dress self and resists efforts of others to help

None

Grooming (neatness, hair, nails, hands, face, clothing)

Always neatly dressed, well -groomed, without assistance

Grooms self adequately with occasional minor assistance, eg, with shaving

Needs moderate and regular assistan ce or supervision with grooming

Needs total grooming care, but can remain well-groomed after help from others

Actively negates all efforts of others to maintain grooming

None

Physical Ambulation

Goes about grounds or city

Ambulates within residence on or about one block distant

Ambulates with assistance of person or device

Sits unsupported in chair or wheelchair, but cannot propel self without help

Bedridden more than half the time

None

Bathing

Bathes self (tub, shower, sponge bath) without help.

Bathes self with help getting in and out of tub.

Washes face and hands only, but cannot bathe rest of body.

Does not wash self, but is cooperative with those who bathe him or her.

Does not try to wash self and resist s efforts to keep him or her clean.

None

Ability to Use Telephone

Operates telephone on own initiati ve; looks up and dials numbers.

Dials a few well-known numbers.

Answers telephone, but does not dial.

Does not use telephone at all.

None

Shopping

Takes care of all shopping needs independently.

Shops independently fo r small purchases.

Needs to be accompanied on any shopping trip.

Completely unable to shop.

None

Food Preparation

Plans, prepares, and serves adequate meals independently.

Prepares adequate meals if supplied with ingredients.

Heats and serves prepared meals or pr epares meals, but does not maintain adequate diet.

Needs to have meals prepared and served.

None

Housekeeping

Maintains house alone or with occasional assistance (eg, heavy-work domestic help).

Performs light daily tasks such as dishwashing, bedmaking.

Performs light daily tasks, but cannot maintain acceptable level of cleanliness.

Needs help with all home maintenance tasks.

Does not participate in any housekeeping tasks.

None

Laundry

Does personal laundry completely.

Launders small items; rinses socks, stockings, etc.

All laundry must be done by others.

None

Mode of Transportation

Travels independently on public transportation or drives own car.

Arranges own travel via taxi, but does not otherwise use public transportation.

Travels on public transportation when assisted or accompanied by another.

Travel limited to taxi or automobi le with assistance of another.

Does not travel at all.

None

Responsibility for Own Medications

Is responsible for taking medication in correct dosages at correct time.

Takes responsibility if medication is prepared in advance in separate dosages.

Is not capable of dispensing own medication.

None

Ability to Handle Finances

Manages financial matters independently (b udgets, writes checks, pays rent and bills, goes to bank ); collects and keeps track of income.

Manages day-to-day purchases, but needs help with banking, major purchases, 1 etc.

Incapable of handling money.

None

Time's up

Family is not an important thing.
It's everything.
~ Michael J. Fox

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