Wellness Assessment

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About Us
- About
- Mission
- GFC Team
- Contact
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Wellness Guide
CareScreen
Career
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- Caregivers

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Are you worried about the safety of your senior loved one? Use our free Senior Care Needs Assessment Tool to determine if it’s time to explore senior living options.

Take Our Wellness Assessment for a Personalized Recommendation

If you have questions or concerns about your loved one’s safety, use our free Senior Care Needs Assessment Tool for a personalized recommendation on whether it’s time to explore senior living options. To begin, simply fill out the form below and then complete the answers on the following screens.

First Name *

Last Name *

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Phone *

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Safety *Can safely remain alone for up to 24 hours without supervision.Requires regular check-ins and is not safe to be alone for a full day.High risk of falls; needs frequent monitoring and close supervision.

Mobility *Moves independently and may use a cane or walker. Able to evacuate without assistance in an emergency.Generally independent but requires occasional assistance with mobility (with or without a cane or walker). May need help evacuating in an emergency.Requires full assistance to get up and move. Needs help evacuating in an emergency.

Nutrition *Independently prepares meals and eats without assistance.Can make simple meals or snacks but requires help with main meals; may receive meal deliveries.Unable to prepare meals and may require feeding assistance.

Mental Status *Normal cognitive function with occasional forgetfulness. Able to recognize and respond to environmental needs.Experiences occasional confusion and requires some reminders for orientation. May have Mild Cognitive Impairment or early signs of dementia or Alzheimer’s.Diagnosed with Alzheimer’s or another form of dementia. Needs significant assistance with orientation, reminders, and daily activities. Memory may be severely impaired.

Toileting *Fully independent and continent, or able to manage personal care using appropriate supplies.Occasionally experiences incontinence; may use a bedside commode or incontinence supplies and may need some assistance with proper use.Fully incontinent and may have difficulty communicating toileting needs.

Communicating *Independently uses a phone, looks up numbers, and receives calls without assistance.Can call emergency numbers but may need help looking up contacts or dialing. May have difficulty speaking.Unable to use a phone independently.

Medications *Independently manages and safely administers medications.Can self-administer but may need reminders. Family or a nurse may need to organize medications and assist. May occasionally forget scheduled doses.Unable to manage or take medications, even with supervision.

Bathing, Dressing & Grooming *Independently bathes, dresses, and prepares for the day.Needs assistance with one or two tasks.Requires help with more than two tasks.

Managing Finances *Manages finances independently but may need occasional help with shopping or bill payments.Struggles with shopping or light housework; requires assistance with managing finances and is at high risk for fraud.Fully dependent on others for financial management, housekeeping, and shopping.

Contact with Medical Providers *Independently schedules and attends medical appointments as needed.Has chronic health concerns and may need on-site medical access. May struggle with scheduling and attending appointments.Requires regular oversight from medical personnel.

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