Section A
- Are you able to do all the maintenance
required with your current home (snow shoveling, misc. repairs, lawn mowing,
painting, washing and changing storm windows, trimming trees and bushes,
etc.)?
- Are you able to keep up with routine home chores
such as scrubbing floors, vacuuming, changing bed linens, laundry, ironing,
and other household duties?
- Do you feel safe and secure in your home?
- Do you prepare and eat regular, and nutritious
meals?
- Do you feel you could handle an emergency in your
home such as a fire, flood, accident, or major health emergency?
- Do you have social contact with other people at
least once per week?
- Are you able to run all your own necessary errands
and go where you need to go ?
- If you are married, is your spouse in fairly good
health? (If you are not married, skip to question 9)
- Are you in fairly good health?
- Do you have a compelling reason to get up and
dressed every day?
- Do you have children or grandchildren or other
close family now living in the same town as you?
- Would you like to maintain your independence, but
still have ready access to services if needed?
- Are there times when due to weather or for other
reasons, you'd like to have someone else do your driving for you?
- Do you feel isolated in your home due to weather
conditions, lack of transportation, or lack of interesting activities?
- Are you worried about being a burden to your
family and/or friends?
- Do you sometimes wish you could spend more time
with other people?
- Do you worry about maintaining your health?
- Do you travel frequently and have to leave your
home unattended for long periods of time?