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Dependency Test

Welcome to the Dependency Assessment screener. This brief questionnaire is designed to assist people who are concerned about their own dependency level or that of a relative. The questions are intended to gather information and to identify appropriate next steps.

The dependency classification shown by the thermometer, and the accompanying guidance, should not substitute for a more formal assessment by a professional. In general, however, older people with higher dependency scores should obtain assistance sooner.

#	Category	Question?	No	Need Help	Yes	Independent
1.	Bathing	Are you or your relative able to get in and out of the bath / shower, and wash?
2.	Grooming	Are you or your relative able to wash themselves, comb hair, shave and clean teeth?
3.	Dressing	Are you or your relative able to put on all your/their clothes including fastening zips and buttons (clothes may be adapted)
4.	Feeding	If food is placed within easy reach are you or your relative able to cut up food/spread butter/ feed themselves?
5.	Mobility	Are you or your relative able to get around indoors(perhaps using a stick or frame?
		Can you get around with someone to help you?
		Are you or you relative indpendent in a wheelchair and able to negotiate doors and corners unaided?
		Do you or your relative need more help than this?
6.	Transfer	Do you or your relative need help in getting in and out of bed or a chair?
		Can you manage with the help of one person?
		Do you need the help of at least two people but can still sit up without help?
		You or your relatice can't do any of the above?
7.	Stairs	Can you or your relative go up and down stairs on your own and carry any necessary walking aids?
8.	Toilet	Can you or your relative get on and off your toilet or commode, undress and dress and keep clean without help?
9.	Bladder	In the last 7 days have you or your relative been dry or have been able to manage with the help of any device (e.g. catheter)?
		Had the occassional accident (once a day or less)?
		Had more than one accident each day?
10.	Bowels	In the last 7 days have you or your relative been contient?
		Had the occassional accident?
		Needed an enema or had unpredictable accidents?