Do I Need Home Care? Our checklist will you identify if it is time to consider home care for yourself or a loved one. Name* First Last Email* Phone*Forgetful, Confused or Lost?Do you or someone you love ever experienced forgetfulness, feeling confused or lost? Yes No I don't know MedicationsDo you or someone you love frequently mix up or forget to take medications? Yes No I don't know Doctors AppointmentDo you or someone you love have difficulty remembering or getting to doctor appointments? Yes No I don't know SafetyHave you or someone you love ever fallen at home? Yes No I don't know Eating RightDo you or someone you love have a difficult time grocery shopping, cooking or remembering to eat? Yes No I don't know Clean HomeDo you or someone you love struggle with day to day cleaning and organization. Yes No I don't know Lonely/DepressedDo you or someone you love seem lonely or depressed? Yes No I don't know Changes in BehaviorsHave you or someone you love lost interest in things that were previously enjoyed? Yes No I don't know Social InteractionDo you or someone you love avoid people and social interactions? Yes No I don't know Self CareDo you or someone you love have a difficult time, walking, dressing, eating or bathing? Yes No I don't know InteractionsDo you or someone you love have a difficult time having a conversation or frequently tell the same story over and over again? Yes No I don't know Sleep PaternsDo you or someone you love seem to sleep more, have less energy or experiences changes in sleep patterns? Yes No I don't know Personality ChangesHave you or someone you loved experienced personality or behavioral changes such as suspiciousness, delusions or compulsive, repetitive behavior like hand wringing or tissue shredding? Yes No I don't know