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Request for Services

Find out if home health is right for you. Once this request is received it will be given to one of our Registered Nurses to contact you for further details and to arrange for an initial home visit.

How do I know if I or my loved one would benefit from home care services?

  1. Do you currently see a doctor on a regular basis to help manage your health?
  2. Have you recently been to an emergency room or admitted to a hospital?
  3. Have you had a recent knee, hip or shoulder replacement or other surgery?
  4. Do you have health issues such as stroke, lung or heart disease, or diabetes?
  5. Do your feet regularly swell?
  6. Do you have trouble leaving home or walking more than a short distance?
  7. Are you short of breath with limited activity?
  8. Do you have trouble with getting in and out of your bathtub/taking a bath or getting around?
  9. Have you had any recent changes to your medications?
  10. Do you take multiple medications daily?
  11. Do you have questions or are confused about how to take your medications?
  12. Have you fallen within the past year?
  13. Have you had a fall that resulted in a skin injury, broken bone or head injury?
  14. Have you gained or lost weight in a short period of time?
  15. Have you been diagnosed with depression, anxiety or psychosis?
  16. Are you living with dementia or Alzheimer’s disease?
  17. Do you/your family member experience mood swings, rage or hostility?
  18. Do you/your family member experience forgetfulness or wonder off?
  19. Do you feel sad or lonely?
  20. Are you not interested in doing your regular hobbies?
  21. Is your personal hygiene not a priority anymore?
  22. Are you having difficulty with staying on top of taking care of your finances, cleaning or laundry?
  23. Do you have difficulty leaving your home to buy groceries or run errands?

If you answered "yes" to any of the above questions, home care could be an option for you.
 

Request for Services

  1. Skilled Nursing
    Physical Therapy
    Occupational Therapy
    Speech Therapy
    Home Health Aide
    Homemaker
    Respite Services

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