Needs assessment

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This assessment is designed to quickly evaluate your care needs. There are 12 questions; please answer as many as you can. You don't need to answer all the questions, but you must answer question 2. It should take you between five and 10 minutes to complete the assessment.

When you finish, click the 'Submit' button for recommended care options to meet your needs. Then you can learn about each option, select those that seem most appropriate and find care providers anywhere in Oregon.

1. I am seeking care for:
   

  Myself
  My parent
  My spouse
  Another relative
  My friend
  Other


2. I prefer to receive services (check all that apply):
   

  In my home or a loved one's home
  In the community
  At a licensed residential care facility
  In a nursing facility
  I'm not sure


3. I require help with the following tasks:
   

  Eating
  Dressing/grooming
  Transferring (from bed into a wheelchair)
  Toileting
  Bathing
  Medication reminders or supervision
  None of the above


4. I require help with the following household chores:
   

  Cooking
  Shopping
  Telephone calls
  Money management
  Transportation
  Light cleaning
  Heavy cleaning
  None of the above


5. I would describe my mobility level as follows:
   

  I walk without help
  I use a cane or walker
  I use a wheelchair or scooter
  I am not able to get out of bed


6. I have experienced symptoms such as:
   

  Confusion about where I am
  Forgetting the names of close family members or friends
  I have not experienced the above symptoms


7. In my current care situation, I have:
   

  Periods of more than 24 hours when I am left alone
  Care needs that are often unmet
  Not enough chances to socialize with others
  Family and friends who do not live close enough to visit regularly
  Generally sufficient care for my needs


8. I am able to pay for services out of pocket:
   

  Entirely
  Somewhat
  Not at all
  I don't know


9. My health insurance is issued by:
   

  The Veterans Administration
  Medicaid
  Medicare
  Long-term care insurance
  Other
  I am not insured


10. I have the following medical conditions:
    

  Alzheimer's or dementia
  Brain injury
  Cancer
  Stroke
  Pulmonary (lung) disease
  Heart problems
  Recovering from surgery or an infection or injuries
  Diabetes
  Parkinson's disease
  Multiple sclerosis
  Developmental disability
  HIV/AIDS
  Arthritis
  Depression, psychiatric illness
  None of the above


11. My two or three most pressing needs are:
    

  Food
  Housing
  Daily living help
  Rehabilitation (from surgery, an accident,stroke, etc.)
  Social and recreational activities
  Help to develop a care plan
  Transportation
  Companionship
  End-of-life planning
  Management of overall service needs
  Care in case of emergency


12. Other services I might find useful are:
    

  Legal advice or estate planning
  Support for my caregivers
  Professional care management
  Medication and appointment reminders

If you'd like to find services near you, specify your county:

Select a county Baker Benton Clackamas Clark Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Out of State Polk Sherman Tillamook Umatilla Union Unknown Wallowa Wasco Washington Wheeler Yamhill State-Wide Nation-Wide