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New Haven
Memory Care
New Haven
Assisted Living
August 18, 2023
Memory Care Quiz
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What's your name, partner?
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Phone
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Next
Does your loved one sometimes fail to recognize or name people, places, or things that should be familiar to them?
Yes
No
Does it seem like technology or appliances they previously could use without a problem are now a challenge?
Yes
No
Do they often forget whether or not they have taken their medicine, or struggle with keeping a medication schedule?
Yes
No
Do they ask the same questions over and over, or do you find yourself having to repeat stories or instructions because they forgot or became confused?
Yes
No
Do you find personal possessions in strange places, such as keys put away in the refrigerator, or a wallet in the bath?
Yes
No
Have you noticed they sometimes don’t seem to be sure what month or year it is, or where they are?
Yes
No
Have you noticed forgetfulness about things that are a regular part of their schedule, such as a weekly family dinner?
Yes
No
Do you ever get the feeling they are having a hard time keeping up with a conversation or following the points in a story?
Yes
No
Do they seem to have trouble with tasks or ideas that require them to follow a number of steps in order?
Yes
No
Do you feel like they are acting scared, confused, withdrawn, or suspicious without a clear reason?
Yes
No
Does it seem like they have a hard time making decisions or choices that should be simple?
Yes
No
Are they confused by numbers or symbols, or having trouble with simple math, like making change?
Yes
No
Are they losing interest in spending time with friends and family, or doing activities they used to love?
Yes
No
Have you noticed them doing something dangerous without seeming to recognize the risk?
Yes
No
Thank you for completing our survey. Do you have any additional questions or concerns about your loved one?
Submit
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