Client Homebound Assessment

Dwelling Well being Care Go to Guidelines 1. Environmental Evaluation a. Neighborhood: b. Exterior of Dwelling: Dwelling Well being Care Go to Guidelines Web page 1 of 11 c. Inside of Dwelling: (Verify all that apply) Crowding Pets Good housekeeping Books Hominess Tv Privateness Memorabilia Web Data and Communication Know-how d. Security: (Verify all that apply) Entry to Emergency Companies Different energy supply if wanted Variations to residence wanted Phone availability Toilet Kitchen Carpets Lighting Electrical cords Fireplace/smoke detectors Stairs Fireplace extinguishers Tables, chairs and different furnishings Emergency plans Scorching water heater Evacuation routes Gasoline or electrical vary Heating/air con Water supply 2. Medical/Surgical Historical past a. Medical Historical past b. Surgical Historical past three. Cognitive Standing: four. Sensory Evaluation: a. Listening to b. Imaginative and prescient c. Odor d. Style e. Tactile f. Falls *Seek the advice of this Useful resource: Fall Danger Evaluation for Older Adults 5. ADL's: *Seek the advice of this Useful resource: KATZ ADL Evaluation a. Ambulation b. Toileting c. Transferring d. Bathing e. Feeding f. Continence g. Dressing 6. IADL's: *Seek the advice of this Useful resource: Lawton Instrumental Actions of Each day Residing Scale a. Employment/ Volunteering b. Studying c. Music d. Socialization e. Funds f. Hobbies g. Cooking/ meals buying h. Housekeeping i. Different 7. Diet: * Seek the advice of this Useful resource: Assessing Diet in Older Adults a. Consuming Habits b. Selection and high quality of meals c. Pantry d. Fridge e. Freezer f. Dietary standing: i. Fluid Consumption ii. Alcohol use iii. Swallowing Problem iv. Oral well being v. Weight reduction vi. Weight problems Dwelling Well being Care Go to Guidelines Web page 6 of 11 eight. Caregiver 9. Medicines: a. Prescription b. Non-prescription c. Dietary and Natural Dietary supplements d. Treatment compliance e. Treatment discrepancy Dwelling Well being Care Go to Guidelines Web page 7 of 11 f. A number of prescribers g. Allergic reactions h. Written Directions 10. Very important Indicators a. Temperature b. Pulse: Apical and radial c. Respirations d. BP sitting and standing e. Weight f. Ache 11. Mini-Psychological State *Seek the advice of this Useful resource: Psychological State Evaluation of Older Adults: The Mini-Cog 12. Normal Bodily Situation: 13. Centered Examination: 14. Non secular Evaluation: (Cultural and ethnic affect) Dwelling Well being Care Go to Guidelines Web page 10 of 11 15. Neighborhood Companies Wanted: (Verify all that apply) Police Dwelling well being Fireplace Social providers Emergency MOW Medical providers Hospice Transportation Authorized Gear Different: 16. Enter the Identify of the Further Useful resource Software Used a. Enter outcomes or evaluation information from the software 16. Narrative Observe: Identify: Date: -research paper writing service
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