Energy level

• low
• moderate
• high

Cooking

• you cook for your loved one daily, at least twice per week
• you cook a few times a week and stock the freezer 
• you feel confident they cook regular, well-balanced meals for themselves

Social Engagement

• you visit daily and are their social life
• they will go to social events once per month, or you take them
• they visit with friends regularly, but you must take them for safety

Driving

• you drive them everywhere they need to go
• they drive only a couple times a week and only on sunny days or you drive them
• you never worry about their ability to drive safely

Bathing

• you must assist them with baths due to safety issues
• they bathe a few times a week and only when you are there
• they are perfectly safe in the shower alone?

Grooming

• you must regularly remind or physically assist them to brush teeth, shave, shampoo or fix their hair
• you need to be there when they brush teeth shave, shampoo or fix their hair once per week 
• you are confident they regularly brush teeth, shave, shampoo or fix their hair with no issue

Medication

• you visit multiple times per day to ensure they take their medications properly, you give them the meds if necessary
• you set up a med planner once a week and check in several times per week to make sure they take them
• you are confident they never have an issue with remembering to take their meds.

Getting around

• you visit daily to ensure their safety to/from the bathroom
• you check on them several times per week to make sure they haven’t fallen 
• or you never worry about their mobility in the home alone

Concerns

• You worry about their safety and cannot sleep well at night
• You dread any late-night phone calls
• You cannot leave town on a trip with your family due to fear of leaving them with no support
• You adjust your life in order to meet their daily needs
• Nobody can take care of my loved one better than me

Energy level

• low
• moderate
• high

Cooking

• never cooks for their self, therefore doesn't really eat much
• cooks only a little bit, tending to open something pre-packaged
• loves to cook daily with variety and good nutrition

Social Engagement

• prefers to be left alone in front of the TV all day 
• occasionally attends a social group, but has slowed down due to mobillity
• often attends or even leads social groups, attends church weekly

Driving

• cannot drive, it's just not safe
• drives only short distances only on sunny days and only a couple times per month
• drives regularly to errands and social events around town

Bathing

• rarely bathes due to low energy or safety concerns, it's too much trouble
• bathes self a few times a week but will call you to let you know
• loves a daily shower and has no safety concerns

Grooming

• won't brush teeth, shave, shampoo/fix hair because it's just too difficult or they don't remember
• brushes teeth, shaves, shampoos or fixes hair only once or twice per week but they need help
• brushes teeth and shaves daily, washes and fixes hair with no issue

Medications

• cannot manage medications correctly without help as arthritis makes it painful, missed meds occur often causing health issues 
• can manage if med planner is set up but someone must call daily to remind make sure they are taken
• manages own medications daily without issue and can successfully work with the pharmacy

Getting around

• gets up only to go to the bathroom, otherwise stays seated all day, has had many falls
• has difficulty walking long distances, strength and balance is poor ,falling is a strong possibility
• walks briskly inside and outside the house and exercises daily to stay in shape

Adaptive devices

• uses a wheelchair in the house or when going out
• uses a walker/cane around the house or when going out
• walks with no adaptive device