Is Home Care Right for Me? — Survey Questionnaire

We have put together some questions for you to review that may help in the decision of, "Is home care right for me?" Select the most appropriate response the 15 questions. After selecting your answers, please click the "Evaluate Responses" button .

1. Due to a change in health, am I needing to consider a move to assisted living or could I live at home with a few hours of assistance per week?
Yes
Not now but in the next few months
No

2. My family members help me as much as possible but they have jobs or other responsibilities too that don't allow enough time for all the little things I need assistance with on a daily or weekly basis. Would an extra hand be able to help us out and make me more comfortable at home?
Yes
Maybe
No

3. Do you despise the thought of moving somewhere else?
Yes
No

4. Are you happy at home in your comfortable environment?
Yes
Usually
No

5. Would you like to have a personal driver take you to appointments and other places, someone you know and trust?
Yes
Sometimes
No

6. When at appointments would it be helpful to have someone listening to the doctor's instructions as a second set of ears?
Yes
Sometimes
No

7. Do you have a loving pet that you can't bear to give up, but need some assistance in her care?
Yes
No

8. Are you lonely at meal times or other times of the day and would like someone to visit, talk to, play checkers or scrabble with you?
Yes
Sometimes
No

9. Are you unsure of yourself in the kitchen, but would love a home cooked meal from your recipes?
Yes
Sometimes
No

10. Do you love to send out birthday and holiday cards but can't write very easily due to health?
Yes
No

11. You value your independence at home. Would trusted caretakers make your life a little bit easier to maintain that independence?
Yes
No

12. Considering the cost of assisted living facilities, would it be easier on my budget to have some help at home?
Yes
No

13. Is it important that potential caregivers are matched to my needs and that I will not have to be concerned about their payroll taxes and worker's compensation?
Yes
No

14. Do I prefer that caretakers in my home have been thoroughly screened, bonded, and insured?
Yes
No

15. Would I benefit from hiring a company like At Home Elder Care; one that is managed by an honest & trustworthy family that took care of their elderly parents?
Yes
Maybe
No