Started August 15, 2019 0 0 Adults 60 and Over: Do You Want to Stay in Your Home? Take This Simple Test and See if Staying at Home is Right for You! Are you worried about how you will continue to remain at home? Wilf at Home is an exciting new program that provides services to help older adults live in their homes safely and independently. Take a few minutes to complete our survey. Fill in your score in the box on the right of each question. When you are finished, add up your score. This can help you determine whether Wilf at Home may be right for you or your loved one. Name Email Phone Number Have you fallen down more than once during the past year? Yes No Did you need to be hospitalized for the fall(s)? Yes No Do you have trouble going up and down the stairs? Yes No Do you drive? Yes No Do you feel comfortable driving at night? Yes No Are your family or your friends asking you to give up your car? Yes No Are you skipping meals or too tired to make a meal for yourself and spouse? Yes No Do you feel like your home is becoming hard to manage? (laundry, housekeeping, raking leaves, shoveling, paying bills on time, piles of papers are building up, changing lightbulbs, moving deck furniture, etc.) Yes No Do you have a chronic illness, such as heart disease, Chronic Obstructive Pulmonary Disease (COPD), Parkinson’s Disease, and/or Diabetes? Yes No Does a family or friend currently help you in your home? Daily 3 Days a week 1 day a week Never Time's up
