Assessment Assessment Guide If you think your loved one may have care needs, please complete our Care Needs Assessment. Upon completion of the Assessment, we will provide you with results based on your responses. Reflecting on the past few months, have you noticed that your loved one has experienced any of the following:Changes in eating habits like skipping meals on a regular basis, struggling with shopping or preparing meals, or keeping stale or expired food in the kitchen?*YesNoIs losing weight?*YesNoForgets to take prescription medications as directed?*YesNoNeglects personal care, ranging from appearing unkempt to signs of not bathing or wearing the same clothes repeatedly without washing?*YesNoHas cuts or bruises that could have resulted from a fall?*YesNoShows signs of mobility issues like having difficulty navigating stairs, struggling to move around the house or challenges getting in and out of bed?*YesNoExperiences trouble communicating with others both in person and over the phone?*YesNoShows signs of confusion or disorientation?*YesNoHas shown signs of changes in personality like withdrawing from friends and social activities, giving up hobbies, rarely leaving the house or not showing interest in things they used to enjoy?*YesNoLetting things go around the house like neglecting household chores, allowing clutter to accumulate, piles of laundry, spoiled food, dirty dishes, overflowing trash or mail piled up in the mailbox?*YesNoHaving trouble with finances such as forgetting to pay bills, overdrawn bank accounts or calls from creditors, unopened personal mail or large volumes of receipts or thank you letters from charitable organizations?*YesNoDriving issues like traffic tickets, unexplained dents or scratches in the car, etc.?*YesNoNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.