What type of accommodations are you interested in?

Alzheimer's Community
Independent Living
Assisted Living Home / Center
Skilled Nursing Care

Does the senior primarily use a:

Cane
Wheelchair
Walker

Do they require assistance with any of the following?

Bathing
Dressing
Eating
Taking medications
Getting in or out of bed
Walking
Toileting

Does the senior suffer from any of the following?

Impaired vision
Hearing deficit
Incontinence (lacks bladder / bowel control)

Do they suffer from memory impairment?

No, senior is alert and oriented
Some short-term memory loss
Moderate short-term memory loss with some
long-term memory loss
Severe memory loss (diagnosed with Alzheimer's
disease / dementia)

Does the senior have any of the following dietary needs?:

Diabetic
Low sodium
Low fat / cholesterol
Vegetarian
Soft Foods

What type of activities/interests are important to the senior?

Piano
Bingo
Exercise Class
Gardening
Cooking
Cultural Events
Arts and Crafts
Recreational Outings
Bridge / Playing cards
Billiards / Pool
Daily Walks
Musical Programs
Lectures / Seminars
Religious Activities

What type of amenities and services would they like access to?

Swimming Pool
Transportation Services
Beautician Services
Spa/Whirlpool
Library
Computer and Internet
Cable TV
Physical Therapy
Walking Paths
Massage Therapy

What language other than English does the senior require
their caregiver to speak?

Chinese
Italian
Russian
Romanian
Tagalog
French
German
Japanese
Korean
Spanish

Would they like to attend church or synagogue services?

Yes
No

Does the senior prefer a room that is: (required)

Private
Semi-private

Does the senior desire a facility that:(optional)

Allows pets
Does not allow pets

What is your monthly price range?

$1,500 to $1,899
$2,700 to $3,099
$1,900 to $2,299
$3,100 to $3,499
$2,300 to $2,699
$3,500+

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