Is It Time for Memory Care?
Patient Checklist For Primary Care Providers:
Assess When Home Care May No Longer Be Safe*
SAFETY RISKS
COGNITIVE DECLINE
BEHAVIORAL CHANGES
CAREGIVER STRESS
DAILY LIVING CHALLENGES
SCORING GUIDANCE
NEXT STEPS
WHY CHOOSE OUR MEMORY CARE?
DOWNLOAD THIS CHECKLIST
and share with families:
CONTACT OUR MEMORY CARE TEAM:
-I think that formatting this as a 1-page PDF makes for easy printing and sharing.
- Red flags (⚠️) will highlight high-risk items (e.g., wandering, aggression).
- Include our logo and tagline: “From Home to Haven: Your Partner in Dementia Care."
This checklist helps PCP's objectively identify when a patient’s cognitive decline requires specialized care, positioning your services as a trusted solution.
480-331-3604
Always consult with a neurologist or geriatrician for clinical guidance
- Smooth transition from home care with familiar staff.
- Specialized programs for agitation, wandering, and cognitive stimulation.
- Family support groups and monthly care plan reviews.
1. Discuss with family: Share this checklist to validate concerns.
2. Order a safety assessment: Contact us for a free in-home evaluation.
3. Explore options:
- In-home memory care (ideal for early-stage decline).
- Residential memory care (secure environment for advanced needs).
- 1–5 "Yes" Responses: In-home memory care may suffice with increased support.
- 6–10 "Yes" Responses: Strongly consider transitioning to a secure memory care residence.
- 11+ "Yes" Responses: Urgent need for 24/7 supervised memory care.
☐ Wandering/getting lost (even in familiar places).
☐ Frequent falls or unexplained injuries.
☐ Leaving appliances on (stove, oven, water running).
☐ Medication mismanagement (overdosing, skipping doses).
☐ Driving accidents or near-misses.
☐ Repeating questions or stories multiple times daily.
☐ Difficulty recognizing family/friends.
☐ Inability to follow simple instructions (e.g., dressing).
☐ Getting lost in familiar neighborhoods.
☐ Forgetting recent events (e.g., meals, visits).
☐ Aggression, paranoia, or hallucinations.
☐ Sundowning (increased agitation in evenings).
☐ Social withdrawal or loss of interest in hobbies.
☐ Hoarding or hiding objects.
☐ Incontinence without awareness.
☐ Family caregiver exhaustion (physical/emotional).
☐ Safety fears when leaving the patient alone.
☐ Sleep disruption (patient wandering at night).
☐ Resistance to care (refusing baths, meals).
☐ Poor hygiene (not bathing, wearing dirty clothes).
☐ Weight loss/malnutrition (forgetting to eat).
☐ Unpaid bills or financial mismanagement.
☐ Home clutter/unsanitary conditions
MEDICAL FACTORS
☐ Frequent hospitalizations (UTIs, dehydration, falls).
☐ Diagnosis of Alzheimer’s/dementia (moderate-severe).
☐ Comorbid conditions (diabetes, heart disease) worsening due to cognitive decline.