San Diego Elder Care Services, Care Management,
Placement Assistance, Home Care,
Assisted Living and Alzheimer's Care.

A. Are you worried about your loved one’s safety?
 Yes    No

1. Is he/she falling, have bruises or have mentioned that they have fallen?
 Yes    No
2. Is their home disheveled and becoming unsafe?
 Yes    No
3. Is their driving questionable?
 Yes    No

B. Are you worried about your loved one’s physical or mental health?
 Yes    No

1. Are they losing weight?
 Yes    No
2. Are they sleeping?
 Yes    No
3. Does there seem to be a sudden or increased memory loss or confusion?
 Yes    No
4. Do you suspect that they are drinking excessive amounts of alcohol?
 Yes    No

C. Are you concerned about their financial issues?
 Yes    No

1. Who is paying the bills?

2. Who has access to their identity, i.e. social security number, checking account number or credit card numbers? Identity theft is a huge problem especially among the elderly.

3. Are they contributing inappropriate amounts of money, either large or small to anyone who asks?
 Yes    No
4. Do they have a companion who is an independent contractor with no professional supervision.
 Yes    No

D. Are you concerned about their well being?
 Yes    No

1. Are they isolated, or becoming isolated. Often close friends, spouses or other family members have died or moved in with their families or to long term care facilities.
 Yes    No
2. Do they appear unkempt with spots on their clothing or their hair not combed?
 Yes    No
3. Are they bathing and attending to personal hygiene on a regular basis.
 Yes    No

E. Are you worried about the quality of their life?
 Yes    No

1. Do they get out on a regular basis? Is there someone to take them to Church, doctor’s appoints, to the park or to the library?
 Yes    No
2. Do they engage in activities that they have enjoyed in their life, i.e. playing cards, visiting museums and listing to music.
 Yes    No
3. Have they stopped pursuing those activities and social events that gave them pleasure?
 Yes    No