Care Needs Assessment

A simple questionnaire to help determine the best care options for your loved one

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📱 Session ID: ⏰ Started:

💡 Tip: Hover over the ❓ icons next to questions for detailed explanations and clinical context

Patient Information

Basic Information

🧠Memory and Thinking

How well can they remember recent events and conversations? ❓ Memory Assessment (MMSE Component)
This helps assess cognitive function similar to clinical memory tests.

Scale Meaning:
• Excellent (5) = MMSE 28-30 (Normal)
• Good (4) = MMSE 24-27 (Mild issues)
• Fair (3) = MMSE 20-23 (Some concern)
• Poor (2) = MMSE 12-19 (Moderate impairment)
• Very Poor (1) = MMSE 0-11 (Severe impairment)
Think about remembering what they had for breakfast, recent visits, or conversations from yesterday
How well can they follow conversations and understand instructions? ❓ Comprehension Assessment (MoCA Component)
This evaluates understanding and processing ability.

Clinical Significance:
Combined with memory, this helps determine cognitive status and appropriate care level.
Can they follow a TV show, understand directions, or participate in family discussions?

🏃Daily Activities

How well can they handle personal care (bathing, dressing, using the bathroom)? ❓ Activities of Daily Living (ADL Scale 0-6)
This measures basic self-care independence.

Scale Conversion:
• Independent (5) = ADL 6 (Fully independent)
• Mostly Independent (4) = ADL 5
• Some Help (3) = ADL 4
• Much Help (2) = ADL 2-3
• Fully Dependent (1) = ADL 0-1

Impact: Lower ADL scores often indicate need for higher levels of care.
Think about their ability to maintain personal hygiene and dress appropriately
How well can they manage household tasks (cooking, cleaning, shopping, managing money)? ❓ Instrumental Activities of Daily Living (IADL Scale 0-8)
This measures complex daily tasks requiring cognitive and physical ability.

Scale Conversion:
• Independent (5) = IADL 8 (Manages everything)
• Mostly Independent (4) = IADL 6
• Some Help (3) = IADL 4
• Much Help (2) = IADL 2
• Cannot Do (1) = IADL 0

Impact: IADL difficulties often appear before ADL problems and indicate need for supportive services.
Consider their ability to prepare meals, handle finances, do laundry, and shop for groceries

⚖️Safety and Mobility

How well can they move around safely? ❓ Mobility and Fall Risk Assessment
This determines mobility level and fall risk for care planning.

Mobility Levels:
• Very Safe/Mostly Safe = Independent mobility
• Some Concerns = May need walker
• Safety Concerns/High Risk = May need wheelchair or assistance

Fall Risk:
• Very Safe/Mostly Safe = Low fall risk
• Some Concerns = Medium fall risk
• Safety Concerns/High Risk = High fall risk
Consider their ability to walk, use stairs, and move around without falling

😊Mood and Social Connection

How is their overall mood and emotional well-being? ❓ Depression Screening (GDS Scale 0-15)
This assesses emotional well-being and depression risk.

Scale Conversion:
• Very Good (5) = GDS 0-2 (No depression)
• Good (4) = GDS 3-4 (Minimal)
• Fair (3) = GDS 5-6 (Mild depression)
• Poor (2) = GDS 7-10 (Moderate depression)
• Very Poor (1) = GDS 11-15 (Severe depression)

Impact: Depression affects care needs and placement decisions.
Consider their general happiness, interest in activities, and emotional state
How much family and social support do they have?
Think about family visits, friends, community connections, and available help

Analyzing care needs...