Geriatric Assessments

We understand that due to mobility issues it may be hard to bring your loved one to an assessment. That is why our clinicians provide assessment services in the comfort of your own home, as well as at our center. We try our best to assess individuals in a timely manner while providing quality interactive services.

Our caring staff looks forward to meeting you and creating a personalized plan that will foster happiness and instill dignity in every member.

Free Respite Provided
Every 2nd and 4th Wednesday, 1:00 p.m. - 2:30 p.m.
Every 2nd and 4th Tuesday, 6:00 p.m. - 7:30 p.m.

 

Geriatric Assessment

First Name *
Last Name *
Person Completing This Form *
Email *
Contact Number *

Driving*
   No issues
   Very few issues driving
   Issues driving because of ailments or vision issues
   Poor decisions, errors, or becomes lost when driving

Caregiver Stress*
   No issues
   Disturbed sleep pattern due to emotional strain
   Feelings of being overwhelmed
   Physical strain from lifting, transferring, etc.

Proximity*
   Live in the same household
   Live in the same neighborhood or within walking distance
   Live in the same general area, but it's difficult to visit on a daily basis
   Live in different states

Mobility*
   No issues
   Unsteady on their feet and slower in their movements
   Having a hard time climbing the stairs or is afraid
   Frequent falls and/or fractures

Medications*
   No medications
   Someone is managing medications already
   Multiple medications are prescribed with no management
   Recent medication changes and/or hospitalization

Nutrition*
   No weight changes
   Recent weight loss or gain
   Refrigerator contains expired or little food
   Recent illness or hospitalization

Home Environment*
   Does not live at home
   Multiple scattered rugs and clutter
   Stairs or multiple levels in the home
   Cannot return to home environment due to recent cognitive or physical changes

Hygiene*
   No issues
   Bad breath, unbrushed hair, body odor, and food stained clothes
   Underwear and clothes worn multiple days in a row
   Fecal/urine stained clothing

Injuries*
   Has not had any injuries in the past year
   Falls with no injury
   Noticeable wounds such as bruises, burns, scrapes, or is limping
   Recent hospitalization for an injury

Memory*
   No issues
   Somewhat forgetful
   Hard time remembering names and/or recognizing faces
   Signs of agitation or paranoia

This assessment is designed specifically to gather information. It is not a diagnosis or treatment of a mental health or physical condition. If this is a medical emergency, please contact your physician or go to the nearest emergency room.

 

Kathelene’s Compassionate Adult Day Health Services
25820 Orchard Lake Rd., Farmington Hills, MI 48336-1248
(248) 313-2275 • info@farmingtonhillsadultdaycare.com
Homepage for Kathelene's Compassionate Adult Day Health Services in Farmington, IL