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Care Quiz

May 27, 2025

stevenmiceli25@gmail.com

Welcome to your Care Quiz

1. How well are you (or loved one) able to move around?

I (or my loved one) can move around independently.

I (or my loved one) can move around with assistance from a can, walker or wheelchair.

I (or my loved one) can move around but need occasional assistance from others.

I (or my loved one) CAN'T move around without assistance from others.

None

2. Can you (or your loved one) transfer in and out of bed or the toilet Independently?

Yes.

I occasionally need assistance.

No.

None

3. How often do you (or your loved one) experience falls?

I (or your loved one) haven't fallen in the last 2 years.

I (or your loved one) occasionally fall but can get up.

I (or your loved one) occasionally fall but can't get up.

I (or your loved one) fall often

None

4. How much help do you (or your loved one) need with transportation?

I (or your loved one) can independently drive or use pubic transportation.

I (or your loved one) use assistance from others for my transportation needs.

I (or your loved one) require professional transportation services due to physical restrictions or confusion.

None

5. How much help do you (or your loved one) need during meals?

None.

I (or your loved one) need help getting to the dinning room.

I (or your loved one) have hard time using utensils.

I (or your loved one) relies on someone else to assist during meals.

None

6. How well are you (or your loved one) able to dress and undress?

I (or your loved one) can independently dress and undressing myself.

I (or your loved one) need assistance dressing and undressing myself.

None

7. How well are you (or your loved one) able to groom yourself and perform proper hygiene?

I (or your loved one) can independently bathe and groom myself.

I (or your loved one) can independently bathe and groom myself, but occasionally need reminders.

I (or your loved one) can bathe and groom myself, but need supervision.

I (or your loved one) need physical assistance bathing and groom myself.

None

8. How well are you (or your loved one) able to use the restroom?

I (or your loved one) can independently use the toilet and maintain proper hygiene.

I am (or your loved one is) incontinent but able to maintain hygiene with proper supplies.

I (or your loved one) needs occasional assistance with problems related to incontinence or hygiene

I am (or your loved one) is unable to manage incontinence and need physical assistance with bathroom use.

None

9. How well are you (or your loved one) able to manage your own medications?

I (or your loved one) can independently take all recommended medications.

I (or your loved one) need occasional reminders to take medications.

I (or your loved one) need physical assistance in measuring correct doses or applying medication.

I (or your loved one) need complete assistance.

None

10. How good is your (or your loved ones) memory?

I (or your loved ones) recognize and remember people, and know dates and time without reminders.

I (or your loved ones) have difficulty remembering names, the date and/or time of day.

I (or your loved ones) have trouble remembering things that happened recently.

I (or your loved ones) don't recognize familiar people and unable to recognize dates, and time.

None

11. If you (or your loved one) can walk and get around independently, have you ever experienced any of the following situations?

Being somewhere without any recollection of how you arrived there.

Taking longer than usual to return home from a walk or a drive.

Feeling like you needed to be someplace even though you were at home.

Forgetting directions to familiar places, either inside or outside.

I (or they) have NOT experienced any of these situations.

None

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Lorem Ipsum has been the industrys standard dummy text ever since the 1500s, when an unknown prmontserrat took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged.