Elder Services Assessment

Answer a few questions to identify potential needs for older adults and connect with local resources for support.

Does the older adult need help staying safe or independent at home?

Yes, they need assistance with daily activities or safety

No, they are managing well at home

Are they missing meals or having trouble getting enough food?

Yes, they are skipping meals or having difficulty

No, they have adequate food and nutrition

Do they have difficulty getting rides to appointments or stores?

Yes, they need help with transportation

No, they can get around independently

Are they having trouble getting medications or seeing doctors?

Yes, they need help with healthcare access

No, they can access healthcare independently

Do they often feel lonely or disconnected from others?

Yes, they feel isolated or lonely

No, they have good social connections

Are there signs of memory loss, confusion, or getting lost?

Yes, there are concerns about memory or confusion

No, their memory and cognition seem normal

Are you worried someone may be hurting or taking advantage of them?

Yes, there are concerns about abuse or exploitation

No, they are safe from abuse or exploitation

Is their current home too hard to manage or unsafe?

Yes, the home needs modifications or is unsafe

No, their home is safe and manageable

Is a family caregiver feeling overwhelmed or burned out?

Yes, the caregiver needs support and respite

No, the caregiver is managing well

Do they need help understanding benefits, bills, or legal paperwork?

Yes, they need assistance with legal or financial matters

No, they can manage legal and financial matters

What is your ZIP code?

We'll use this to find local resources near you.

Any additional details about the situation? (Optional)

This helps us provide more personalized recommendations.