Assisted Living Level-of-Care Assessment Questionnaire

Welcome to Our Care Needs Assessment

This questionnaire is designed to help determine the appropriate level of care for individuals considering assisted living options. By answering the following questions honestly and accurately, you'll receive a personalized assessment of care needs.

This comprehensive evaluation covers various aspects of daily living, health, and well-being, including:

• Activities of Daily Living (ADLs)
• Cognitive function
• Medical conditions
• Behavioral and emotional health
• Safety and supervision needs

Your responses will be used to generate a score that corresponds to a recommended level of care. This assessment is a valuable tool in the decision-making process, but please remember that it should be used in conjunction with professional medical advice and personal preferences.

The questionnaire will take approximately 5-10 minutes to complete. If you're filling this out on behalf of someone else, please answer as accurately as possible based on their current condition and abilities.

Let's begin the assessment to better understand the level of care needed.