Our House Care Level Estimator


The Care Level Estimator is intended to provide an estimated monthly cost based on the information you provide. It is not a clinical assessment or a guarantee of pricing. Each resident’s care needs are unique and require a personalized evaluation. To receive an accurate care level and exact pricing, we encourage you to schedule a complimentary assessment with one of our Directors. Please select the option that best describes the person being assessed for each question.

When you submit this form, we will email the results to the address provided.

Our House Care Level Estimator_260619

Section 1: Mobility & Transfers

1. How does your loved one move around?
2. Does your loved one need help transferring (bed, chair, toilet)?
3. Has your loved one fallen in the last 12 months?

Section 2: Personal Care 

4. Dressing
5. Bathing/Showering
6. Grooming (hair, teeth, shaving, etc.)
7. Toileting (Urinary catheter management)

Section 3: Continence

8. Bladder Incontinence
9. Bowel Incontinence

Section 4: Medication & Medical Needs

10. How are medications managed?
11. Number of medications
12. Diabetic management required?
13. Other skilled medical treatments required? (Oxygen, nebulizers, injections)

Section 5: Memory & Cognition

14. Memory
15. Orientation
16. Wandering risk
17. Requires frequent redirection throughout the day

Section 6: Behavior & Supervision

18. Anxiety, agitation, or behaviors requiring intervention
19. Requires supervision for safety
20. Participation in meals and activities
Name
Name
First Name
Last Name

Our House Care Level Estimator