Which care option is best for you?

Fill in our 5-minute Care Evaluation Questionnaire to help us determine what type of senior care is best suited to you, or a loved one.

Upon completion, we will put you in touch with one of our Certified Placement Experts to schedule an appointment and discuss which options in your area are the best fit for your unique circumstances.

Disclaimer: The Options for Senior Living Care Assessment results should be seen as a guideline for determining the right care for yourself, or your aging loved one and should be discussed with your trusted family physician first. The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and his or her physician or other care provider.

I am taking this Care Evaluation Questionnaire on behalf of:

Myself My Parent My Spouse A Patient or Client Someone Else

Where are you or your aging loved one based?

State

City

Submit your email address below so we can send you a digital copy of your Options for Senior Living Care Assessment results Email

Do you, your loved one, or client require care and support 24 hours a day?

Yes No

Are you, your loved one, or client experiencing any of the following?
(You can select more than one option if applicable. If none apply, you can proceed to the following question)

Loss of Sight

Loss of Hearing

Depression

Falling

Difficulty Eating

Difficulty Walking

Have you, your loved one, or client been admitted to any of the following in the last 6 months?
(You can select more than one if applicable. If none apply, you can proceed to the next question.)

Assisted Living Facility

Memory Care

Hospital

In-patient Stay

Skilled Rehab Facility

Are you, your loved one, or client currently under a physician’s prescribed care plan?

Yes No

Do you, your loved one, or client require assistance with any of the following?
(You can select more than one if applicable. If none apply, you can proceed to the next question.)

Bathing

Bathroom Assistance

Dressing

Meal Preparations

Medication Reminders

Transport to Physician’s Appointments and Other

Do you, your loved one, or client have difficulty remembering everyday tasks, such as eating, paying bills or going shopping for groceries?

Yes No

Have you, your loved one, or client been diagnosed with dementia or Alzheimer’s?

Yes No

Have you, your loved one, or client ever driven or wandered from a familiar location and felt lost or disoriented?

Yes No

Options Care Evaluation Questionnaire

Not sure which type of senior care you need?

Receive a Service Evaluation from the Options Team

Options Care Evaluation Questionnaire

Not sure which type of senior care you need?

Which care option is best for you?

I am taking this Care Evaluation Questionnaire on behalf of:

Where are you or your aging loved one based?

Do you, your loved one, or client require care and support 24 hours a day?

Are you, your loved one, or client experiencing any of the following? (You can select more than one option if applicable. If none apply, you can proceed to the following question)

Have you, your loved one, or client been admitted to any of the following in the last 6 months? (You can select more than one if applicable. If none apply, you can proceed to the next question.)

Are you, your loved one, or client currently under a physician’s prescribed care plan?

Do you, your loved one, or client require assistance with any of the following? (You can select more than one if applicable. If none apply, you can proceed to the next question.)

Do you, your loved one, or client have difficulty remembering everyday tasks, such as eating, paying bills or going shopping for groceries?

Have you, your loved one, or client been diagnosed with dementia or Alzheimer’s?

Have you, your loved one, or client ever driven or wandered from a familiar location and felt lost or disoriented?

Receive a Service Evaluation from the Options Team

Are you, your loved one, or client experiencing any of the following?
(You can select more than one option if applicable. If none apply, you can proceed to the following question)

Have you, your loved one, or client been admitted to any of the following in the last 6 months?
(You can select more than one if applicable. If none apply, you can proceed to the next question.)

Do you, your loved one, or client require assistance with any of the following?
(You can select more than one if applicable. If none apply, you can proceed to the next question.)