Ind Living Self Assessment – Collat Jewish Family Services

This short self-check is designed to help you think about how you—or a loved one—are managing day-to-day life. It is not a medical diagnosis. Many people use tools like this to spot small changes early and explore support that can help them stay independent longer.

Name

Email

Phone Number

Managing Everyday Tasks

How easy is it to manage everyday household tasks (cleaning, laundry, basic home upkeep)?

I manage these easily and independently

I can manage, but it takes more effort than it used to

I need help with some tasks

I rely on help for most tasks

Getting Around Safely

How confident do you feel moving around safely—inside and outside the home?

Very confident, no concerns

Mostly confident, but more cautious than before

I worry about falls or balance at times

I’ve had a fall or avoid certain activities due to safety concerns

Managing Medications

How well are medications managed (taking the right ones at the right time)?

No issues; medications are managed well

Occasional reminders are helpful

I sometimes miss doses or feel unsure

Medications are often missed or confusing

Transportation & Appointments

How easy is it to get to appointments, errands, or social activities?

I drive or arrange transportation easily

I can get around, but it requires planning or help at times

Transportation is becoming difficult

I often miss appointments or stay home due to transportation challenges

Memory & Organization

How often do memory or organization issues affect daily life?

Rarely or not at all

Occasionally (forgetting small things)

More frequently than before

Often enough to interfere with daily routines

Nutrition & Meals

How well are meals and nutrition being handled?

Meals are prepared regularly and balanced

Meals are simple or repetitive, but adequate

Meals are skipped or rely heavily on convenience foods

Eating regularly or well is a challenge

Social Connection

How connected do you feel to friends, family, or community?

I feel well connected and supported

Somewhat connected, but less than I’d like

I often feel isolated or lonely

I’m rarely socially engaged

Managing Finances & Paperwork

How comfortable are you managing bills, paperwork, and important decisions?

Very comfortable and independent

Mostly comfortable, with occasional help

I find it stressful or confusing

I rely on others to manage these for me

CJFS enhances quality of life and strengthens independence for individuals and families, with a primary focus on older adults, by providing exceptional support services. Guided by Jewish values, we serve people of every faith, age, and background with programs that strengthen lives and build community.