LONG-TERM CARE DECISION SUPPORT SYSTEM

LONG-TERM CARE
DECISION SUPPORT SYSTEM

This assessment will help determine the most appropriate long-term care options based on individual needs and preferences.
Please answer all questions honestly for the best recommendations.

Choose a long term care community

Home Health

Adult Medical Day Care

Adult Day Care

Independent Living

Assisted Living

Skilled Nursing Facility

Rehabilitation Center

Hospice

Please tell us more about yourself.

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ACTIVITIES OF DAILY LIVING ASSESSMENT

Bathing (getting in/out of shower or bath)

Dressing (including selecting appropriate clothing)

Toileting (using the toilet and maintaining hygiene)

Transferring (moving from bed to chair)

Continence (controlling bladder and bowel functions)

Eating (feeding oneself)

COGNITIVE AND MEMORY ASSESSMENT

Bathing (getting in/out of shower or bath)

Dressing (including selecting appropriate clothing)

Toileting (using the toilet and maintaining hygiene)

Transferring (moving from bed to chair)

Continence (controlling bladder and bowel functions)

Eating (feeding oneself)