Resource Quiz Assessment | Senior Resource Connect

Resource Assessment Quiz - 2022 Version

Need Support Now? Call 911 if you're in immediate danger. The Senior Resource Connect interactive quiz will help you find resources for yourself or someone in your community. Our 8 question quiz will walk you through common issues older adults face. Once completed, the quiz will recommend relevant resources for you or a friend.

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I’m interested in local senior services resources for:*

Myself

My family member, close friend, or loved one

Someone in my community

Are you a caregiver?*

Yes

I'm not sure

Within the past 12 months, have you worried that your food would run out before you got money to buy more?*

Yes

In the last month, did you ever eat less than you felt you should because there wasn’t enough money to buy food?*

Yes

In the past 12 months has the electric, gas, oil or water company threatened to shut off services in your home?*

Yes

Do you find that you often don’t have enough money to pay your bills?*

Yes

How often does anyone, including family, physically hurt you?*

Not at all

Several days

More than half the days in a week

Every day

How often does anyone, including family, insult or talk down to you?*

Not at all

Several days

More than half the days in a week

Every day

How often does anyone, including family, threaten you with harm?*

Not at all

Several days

More than half the days in a week

Every day

What is your current living situation?*

I have a place to live today but am worried about the future

I do not have a steady place to live, and am temporarily living with others

I have a steady place to live

Are you worried that in the next month you may not have stable housing?*

No I do not rent

Yes, I rent but don't have issues

Yes I rent, and need help with my payments/tenet relationship.

Do you rent your home, and if so, do you have issues with payments/ or landlords?*

Yes - I rent and am having issues with payments or landlord

No - I rent, and do not have problems with payments or landlords

In the last month, you have needed to see a doctor but don’t not because of cost?*

Yes

Do you currently have health insurance?*

Yes

Insured, but interested in learning more about other health insurance options that may be available.

Do you have someone to take you to a clinic or doctor's offices if you need a ride?*

Yes

In the past month has a lack of transportation kept you from medical appointments, meetings, work, or getting things needed for daily living?*

Yes

Do you need assistance coordinating your care?*

Yes

Think about the place you live, do you have a problem with any of the following:

Pests such as bugs, ants, and mice

Lack of heat/ water or other utilities

Smoke detectors/ CO detectors need replacing

Minor repairs needed

Safety devices needed to easily move around (grab bars, bathroom chairs, etc.)

None

How often do you feel lonely or isolated?*

Not at all

Several days

More than half the days in a week

Every day

Have you experienced any of the following in the past 2 weeks?

Grief or loss of a loved one

Change in living situation or level of independence

Recently retired

Caregiver has recently passed away

Often, over the last two weeks, I have felt little interest or pleasure in doing things.*

Yes

Often, over the last two weeks, I have felt down, depressed or hopeless.*

Yes

I sometimes drink more than I feel I should.*

Yes

I have good friends who provide me with the emotional support I need*

Yes

Have you recently felt lonely or rarely leave your home?*

Yes

Are you looking for education opportunities?*

Yes

Would you like to learn more about local social activities and events?*

Yes

Are you interested in joining local fitness or recreational programs?*

Yes

I’m interested in learning ways to improve my physical wellness.*

Yes

I’m interested in increasing my overall wellness and fitness to prevent falls*

Yes

Generally, I feel confident, rather than stressed and worried, about my role as a caregiver.*

Yes

I want to connect with other caregivers in my area.*

Yes

I’m worried about the legal challenges of being a caregiver.*

Yes

I need a break from my caregiver duties.*

Yes

I’m an older adult caring for a younger family member.*

Yes

I would like additional training in caregiving.*

Yes

Have you noticed any of the following changes related to this person’s household and home life?

Home is not as tidy or clean as it usually is

Appliances or home needs fixing or maintenance.

Piles of neglected mail, bills, or newspapers

Potential safety issues or trip hazards in walking paths

Unusual things purchased, like subscriptions or items from TV ads

Does not leave the house as regularly or seems lonely.

Changing eating habits, weight loss, or missed meals

Increased or concerning use of alcohol or drugs.

Has this person experienced any of the following recently:

Grief or loss of a loved one

Change in living situation or level of independence

Recently retired

Their caregiver has recently passed away

Have you noticed any of the following changes when you interact with this person?

Missing medical or other appointments and/or social engagements more than usual.

Personal hygiene (clothing, oral hygiene, body odor, etc.) seems neglected.

An ailment seems to be worsening their day-to-day life.

Behavior changes, like confusion, aggression, seeming louder or quieter, or becoming paranoid.

Someone new has become involved, and you’re not sure if the relationship is appropriate

Recent fall(s) at home or away from home.

Has this person mentioned any of the following issues?

Risk of eviction or losing housing.

Depression or suicidal thoughts.

Recent car accidents or fender benders

Mistreatment by a caregiver, or sudden appearance of a new caregiver.

Trouble paying bills or unable to afford medication, food, etc.

Have you noticed any of the following changes related to this person’s household and home life?

Home is not as tidy or clean as it usually is.

Appliances or home needs fixing or maintenance.

Piles of neglected mail, bills, or newspapers.

Potential safety issues or trip hazards in walking paths.

Unusual things purchased, like subscriptions or items from TV ads.

Does not leave the house as regularly or seems lonely.

Changing eating habits, weight loss, or missed meals.

Increased or concerning use of alcohol or drugs.

Has this person experienced any of the following recently:

Grief or loss of a loved one

Change in living situation or level of independence

Recently retired

Their caregiver has recently passed away

Have you noticed any of the following changes when you interact with this person?

Missing medical or other appointments and/or social engagements more than usual.

Personal hygiene (clothing, oral hygiene, body odor, etc.) seems neglected

An ailment seems to be worsening their day-to-day life

Behavior changes, like confusion aggression, seeming louder or quieter, or becoming paranoid.

Someone new has become involved, and you’re not sure if the relationship is appropriate

Recent fall(s) at home or away from home.

Has this person mentioned any of the following issues?

Risk of eviction or losing housing

Depression or suicidal thoughts

Recent car accidents or fender benders

Mistreatment by a caregiver, or sudden appearance of a new caregiver.

Trouble paying bills or unable to afford medication, food, etc.

Would you like to speak with someone about referrals or resources?

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