Logo
98849 45900 | enquiry@athulyaseniorcare.com
  • Home
  • Services
    • Assisted Living
    • Dementia Care
    • Transition Care
    • Rehab & Physio
    • Home Health Care
    • Palliative Care
    • Home Lab Collection
    • Design for Aging
    • Academy
  • Locations
  • About us
  • Home
  • Services
    • Assisted Living
    • Dementia Care
    • Transition Care
    • Rehab & Physio
    • Home Health Care
    • Palliative Care
    • Home Lab Collection
    • Design for Aging
    • Academy
  • Locations
  • About us

Services

Assisted Living Dementia Care Transition Care Rehab & physio Home Health Care Palliative Care Home lab Collection Design for Aging Academy

Contact

Chennai Bengaluru Kochi Coimbatore Hyderabad

About us

Team CSR Media Center Partner with us Academy Enrilment Careers Speaker Availability Event Calendar Knowledge center

Share

In the news

Athulya receives $9.7 Million funding from JP Morgan Chase

Athulya Lanchues services in Kochi

Enquiry
 

98849 45900 | enquiry@athulyaseniorcare.com

Terms & Conditions | Privacy Policy

Assisted Living Questionnaire for Caregivers

This questionnaire is for caregivers to assess the need for professional assisted living services for their loved ones.

"*" indicates required fields

My loved one has experienced falls or near-falls in recent months.*
I worry about my loved one's safety when they are alone.*
My loved one could benefit from regular socialization and structured activities.*
The health of my loved one has been declining, and they need more care than I can provide.*
My loved one's nutritional needs are not being met due to difficulty in preparing meals.*
I am not able to assist my loved one with their daily living activities as much as they need.*
My loved one has been feeling isolated or depressed at home.*
I have noticed that my loved one is not managing their personal care well.*
My loved one would benefit from a community that offers health monitoring and assistance.*
I believe that an assisted living environment would improve my loved one's quality of life.*
Hidden
This field is for validation purposes and should be left unchanged.

Assisted Living Questionnaire for Seniors

This questionnaire is designed to help seniors and their families determine if assisted living is the right choice. Please indicate your level of agreement with each statement:

"*" indicates required fields

I find maintaining my home independently challenging.*
I require assistance with daily activities such as dressing, bathing, and medication management.*
I sometimes feel lonely and would benefit from more social interaction.*
I am not eating as healthily as I should because cooking has become difficult.*
I would feel safer with 24/7 support available in case of an emergency.*
Managing my own medications has become confusing and sometimes overwhelming.*
I don't drive / ride anymore, and I find it hard to get around for errands or appointments.*
I would appreciate having my housekeeping and laundry done for me.*
I am interested in having access to educational, fitness, and recreational activities.*
I want to live in a community with peers of my age and with similar interests.*
Hidden
This field is for validation purposes and should be left unchanged.