Peacefyl

Let's Determine the Right Care Options

Answer these questions to help us recommend the most appropriate care services for your situation.

1. What is the primary reason you're exploring care options? *

(Select all that apply)

I/my loved one needs help with daily activities (e.g., bathing, dressing) I/my loved one wants a community setting with some support but mostly independence I/my loved one requires intensive medical care or monitoring I/my loved one needs end-of-life care or pain management I'm struggling with grief or emotional distress after losing a loved one

2. How much assistance is needed with daily activities like eating, dressing, or mobility? *

Minimal or none; mostly independent Some help needed a few hours a day (part-time) Significant help needed throughout the day (full-time) Constant care or medical supervision required

3. What is the current medical condition of the person needing care? *

Generally healthy, no major medical issues Manageable chronic conditions (e.g., diabetes, arthritis) Complex or serious conditions requiring frequent medical attention Terminal illness or advanced disease needing comfort-focused care

4. Does the person needing care have specific medical equipment or treatment needs? *

(e.g., oxygen, IV therapy)

No, no specialized equipment or treatments needed Some equipment or occasional treatments needed Regular medical equipment or skilled nursing care required Focused on comfort care, not curative treatments

5. What type of living environment is preferred? *

Staying at home with support A community with private living spaces and social activities A facility with round-the-clock medical staff A setting focused on comfort and emotional support

6. What level of social interaction is desired? *

Prefer staying at home with familiar surroundings and visitors Enjoy social activities and community engagement with peers Limited interest in socializing due to medical or emotional needs Focused on family support and minimal external interaction

7. Are you or your loved one experiencing emotional challenges, such as grief or depression, after a loss? *

Yes, I/we need help processing grief or emotional distress No, emotional health is stable I'm unsure but open to exploring support options

8. What is your budget for care services (monthly estimate)? *

Under $2,000 $2,000–$5,000 $5,000–$10,000 Over $10,000 or covered by insurance/Medicare

Care Needs Assessment

Let's Determine the Right Care Options

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