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Home Care for seniors in Phoenix, Tucson & Sun City

Contact Us24 Hrs

Senior Home Care
Locations
About Us
Careers
Blog
Contact Us
Call (623) 977-2223

In Home Care Assessment | Adultcare Assistance Homecare

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In Home Care Assessment

In Home Care AssessmentJason Chagnon2024-04-19T14:01:11-07:00

FREE ONLINE HOME CARE ASSESSMENT

This online tool assists families in recognizing and understanding potential care needs. We respect your privacy and do share your confidential information with anyone.

Free-Alzheimers-Disease-Screening

Step 1 of 12

8%

1. Are you deciding on care options for:*
- Yourself
- Family
- Friend

2. Have they had home health care in the past?*
- Yes
- No

3. Have they had an emergency room or hospital visit within the last 30 days?*
- Yes
- No

4. Have they had a recent fall, or a history of falls?*
- Yes
- No

5. How often do they have trouble taking medications the way they have been told to take them?*
- They do not have to take medicine
- They always take them as prescribed
- Sometimes they take them as prescribed
- They seldom take them as prescribed

6. Are they currently taking 5 or more medications?*
- Yes
- No

7. Have they been diagnosed with any of the following?*
- Alzheimer’s / Dementia
- Stroke
- Parkinson’s/MS/ALS
- COPD or other respiratory condition
- CHF or shortness of breath
- Cancer
- Diabetes
- Back or joint pain
- Other
- None of the above

8. In the past 2 weeks, did they struggle with any of the following everyday activities?*
- Making meals
- Bathing or showering
- Grooming
- Walking safely
- Getting dressed
- Using the toilet
- Household chores
- Getting out of bed
- Getting out of a chair
- None of the above

9. When was their last appointment with their Primary Care Physician?*
- With the past month
- 1-3 months ago
- More than 3 months ago

10. Over the past two weeks, how often have they felt down, depressed, or hopeless?*
- Not at all
- Some days
- More days than not
- Nearly every day

11. Are they able to leave their home?*
- No difficulty leaving the home
- Requires a walker or wheelchair
- Requires help from another person
- Physically unable to leave the home

Name*
First Last
Phone*
Email

CONTACT US

Phoenix Homecare
1616 E Indian School Rd
Suite #450
Phoenix, AZ 85016
Phone: (602) 455-1118

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Sun City Homecare
10615 West Thunderbird Blvd
Suite B-300
Sun City, AZ 85351
Phone: (623) 977-2223

Get Directions

Tucson Homecare
7040 N Oracle Rd B
Tucson, AZ 85704
Phone: (520) 575-8000

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