How will I know when my family member needs help?
1. Does your family member miss meals?
yes no maybe
Due to forgetfulness? yes no maybe
Has difficulty using hands/arms? yes no maybe
Has a swallowing problem? yes no maybe
2. Is your family member unable to evacuate home in case of an emergency?
yes no maybe
Due to limited physical capability? yes no maybe
Due to mental capability? yes no maybe
3. Is your family member unable to get in and out of a chair and/or bed alone?
yes no maybe
Due to limited physical capability? yes no maybe
Due to limited mental capability? yes no maybe
4. Is your family member unable to use the commode alone?
yes no maybe
Due to limited physical capability? yes no maybe
Due to limited mental capability? yes no maybe
5. Is your family member unable to groom hair and self?
yes no maybe
Due to limited physical capability? yes no maybe
Due to limited mental capability? yes no maybe
Scoring Interpretation:
- A "yes" answer indicates your family member could benefit from some assistance with their
Active Daily Living (ADLs) for a few hours, two or more days per week.- Two to four "yes" answers indicate a definite need for assistance with their ADLs on a
daily basis for a minimum of four hours per visit.- Five or more "yes" answers indicate a definite need for daily assistance, eight to 24 hours
per day to ensure the individual's safety and well being.- "Unsure" answers indicate a need to monitor the suggested area for one week to determine
if a "yes" or "no" answer would be appropriate and why.For additional information and assistance, please contact Share the Care Network or
call (323) 280-3586.