Functional Assessment

In-Person Care Evaluation

Silver Home Care

Assessment Guidelines

  • Follow the exact task code script — ask one question at a time
  • Use a warm, respectful, conversational tone
  • Go off-script only when clarification is needed for care, preferences, or safety
  • For each task, always ask: What happens without help? Days/times needed? Level of care?

Level of Care Options:

0 - No Help – Independent and safe
1 - Reminders / Confirmation
2 - Supervision – Nearby for safety
3 - Standby Assistance
4 - Hands-On Assistance

Initial Questions

"Before we go through each area, I have a few general questions..."

Selected days: 0 - none

Important: Please notify Silver Home Care of any hospitalization, even if it occurred outside of our scheduled shift. This helps us monitor your health and make necessary adjustments to your care plan.

Important: Please notify Silver Home Care of any fall, even if it happened when we weren't there. Falls can indicate health changes and help us identify risks and interventions to keep you safe.

Select Tasks to Assess

Check the care areas you want to assess. Click "Apply" when ready to begin the assessment.

115 🍽️ Meal Preparation

"Do you need help planning meals, cooking, or preparing food?"

  • What parts are hardest? (e.g., lifting, standing, safety, memory)
  • Do you prepare anything yourself? (describe what you can do)
  • Do you skip meals? (if yes, why)

No days selected in initial questions

Assessor Notes

Export for AI Analysis

Generate a de-identified summary ready for AI analysis. No names, DOB, or contact info will be included.

Client Care Plan Summary

Generate a client-friendly summary of care needs that can be shared with the client or family members.

Silver Home Care • Functional Assessment Tool • Confidential