Mother and daughter

HALO SENIOR CARE’S TEST
HOW DO YOU KNOW IF SOMEONE NEEDS HELP?
 Scoring:  1 = Strongly Disagree  2 = Disagree  3 = Agree  4 = Strongly Agree
 My loved one is in control of their mental faculties
 Do they act impulsively 1 2 3 4
 Are they able to recall time, place and local 1 2 3 4
 Are they forgetting to take their medications 1 2 3 4
 Are they forgetting to keep or make appointments 1 2 3 4
 Do they pay their bills on time 1 2 3 4
 Are they withdrawn or depressed 1 2 3 4
 Are they still active in their social events 1 2 3 4
 Do they call you frequently for assistance 1 2 3 4
 My loved one is in control of their physical functions:
 Able to prepare meals 1 2 3 4
 Able to feed self 1 2 3 4
 Able to dress self 1 2 3 4
 Able to toilet self 1 2 3 4
 My loved one is safe:
 No vehicle accidents (even small ones) 1 2 3 4
 Gets lost driving or walking 1 2 3 4
 Leaves pots and pans on stove still cooking 1 2 3 4
 Allow strangers in the house/Lock themselves out 1 2 3 4
 Is you’re loved at risk for a fall:
 Are they taking four or more medications 1 2 3 4
 Do they have a history of falling 1 2 3 4
 Do they use an assistive device to walk 1 2 3 4
 Have they been hospitalized in the past 12 months 1 2 3 4
Scoring
0-40 points minimal assistance needed
41-60 points’ moderate assistance needed
61-80 points’ high-level assistance needed