This questionnaire can help you assess the needs of a person who requires help. Going through the questionnaire categories with your loved one may stimulate ideas, allow you to dismiss some preconceived notions, and help guide you both toward the issues that seem most important. It's helpful to speak with a variety of other people as well, including the following:

• The primary caregiver
• Any doctors, social workers, or professionals involved in the person's care
• Other people in a position to know about day-to-day needs, such as neighbors, friends, and relatives
• A geriatric care manager, if you're working with one (he or she may opt to use other professional assessment tools instead of this questionnaire).

While it's not exhaustive, the questionnaire can help you decide where assistance or more information would be helpful. You may wish to make copies of it to use again as circumstances change. Some issues, such as physical and mental health concerns or questions about forgetfulness and dementia, should be discussed with a doctor.

Print a Caregiver Questionnaire

Source: from Caregiver’s Handbook, Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.  Use of Content | Medical Disclaimer