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Harbour Landing Village
Retirement Living Assessment
Let's get started with your
first name
(don’t worry this is just to personalize our conversation)
Your First Name
Nice to meet you. Tell us, what's changed?
I am ready for a lifestyle change
My health has changed
I'm forgetting things
1 out of 7
How much help do you need?
Little to no help
I need some help with my daily activities
I need help with everything
2 out of 7
Now can you tell us a little bit more? Which applies to you?
I do most things myself.
I need some help with my daily activities such as getting dressed and bathing.
3 out of 7
Almost done. Which applies to you?
I'd like to cook for myself.
I don’t want to worry about cooking anymore.
4 out of 7
Are you able to manage your medications okay?
Yes
My medications are easy to manage and I seldom forget to take them
I have doubts
My medications are confusing and I could use some help and reminders
No
I need someone to manage my medications
5 out of 7
How comfortable are you getting around on your own?
Quite comfortable
I feel safe getting around on my own
I need help sometimes
I no longer feel safe getting around on my own
Not comfortable
I need assistance at all times
6 out of 7
How's your memory?
My memory is good
But I’m human – I forget something now and then
I need reminders
I often feel like I’ve forgotten something
I am living with dementia
I have been diagnosed with Alzheimer’s and/or dementia and need a lot of support
7 out of 7
Time's up
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info@hlvillage.ca
306.559.5545