Finally, now that you have looked at your
parent’s abilities, let’s look at Well Being and Safety. Taking an honest
look at how your parent functions in the surrounding world (given their functional
abilities that we have reviewed) can give you an idea of where the critical areas impact
your loved one’s safety and well being.
Answer the following Yes or No
| Y |
N |
My family member has been hospitalized
because of medication interactions or making mistakes with medications |
| Y |
N |
My family member has fallen several
times and was injured or could not get up without help |
| Y |
N |
If my loved one were home alone and
there was a fire, he/she could get out of the house safely |
| Y |
N |
My family member has had a recent
illness that has impacted his/her ability to care for self |
| Y |
N |
My family member can look up telephone
numbers and dial the telephone without help |
| Y |
N |
Does my family member have a problem
with alcohol or drugs (prescription and otherwise)? Are they a careless smoker? |
| Y |
N |
My family member has a personal
emergency response system in the home |
| Y |
N |
The lighting is adequate and there is
minimal clutter |
| Y |
N |
The outside and interior stairs are in
good repair and there are handrails for safety |
| Y |
N |
My family member’s home is in need
of major repair |
If I were in an
accident or seriously ill or was called out of town in an emergency with no advance
notice, would my family member be able to manage?
| a. |
Yes, absolutely |
| b. |
I’d ask other family,
friends or neighbors to look in several times a week, and would call to be sure all is
well |
| c. |
I would need to hire
someone to look after my family member |
| d. |
I would have to arrange
specialized nursing care |
| e. |
No, they cannot be left
alone |
Who is your loved
one’s Health Care Power of Attorney? Legal Guardian?
Click here to move on to Section V, Time
Management |
1 | 2 | 3
| 4 | 5 |
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