It is important for family caregivers to know how to create a needs assessment so that they have a grasp on all the information and details that need to be attended to for a loved one who needs home care. Following is a needs assessment outline and checklist that will help you put one together. By putting this information into a simple and accessible place where the family caregivers can access and use it, you will save yourself a load of time, hassle and frustration.

How to Create a Needs Assessment for a Loved One

Personal Information

• Social Security Number
• Birth Certificate
• Driver’s License/Organ Donor Card
• Passport/Citizenship Papers
• Marriage or Divorce Certificate
• Death Certificate of Deceased Spouse if applicable
• Life Insurance Policy
• Health Insurance Policy
• Disability Insurance Policy
• Long Term Insurance Policy
• Homeowners Insurance Policy
• Personal Property Insurance Policy
• Property Taxes
• Military Records if applicable, including:

Branch of Service
VA ID#
Veterans Military Service Record (DD – 214)
Dates of Service

• Will
• Trusts
• Safety Deposit Box Location, Numbers and Keys
• Contact Info for Friends and Colleagues
• Cemetery Plot/Funeral/Burial Instructions

Health Information

• Family Doctor
• Specialists
• Pharmacy Contact
• Prescriptions and Dosages
• Health Insurance Coverage
• Medicare Number and ID Card
• Medicaid Number and ID Card
• Medicare Prescription Drug Coverage
• Living Will
• Durable Power of Attorney for Health Care
• DNR (Do Not Resuscitate) Order
• Advance Directives

Car Information

• Car Make and Model
• Auto Loan Info or Title
• Car Insurance Policy
• Parking if applicable

Financial Information

• Bank Accounts and Records
• List of Assets and Debts
• Past Federal and State Tax Returns
• Retirement Plans
• Financial Planner Contact
• Rental Agreements
• Business Contracts

Personal Care Needs Assessment

Family members – What family members will be available to help with personal care tasks like bathing, grooming, dressing, eating, medication management, etc?

Home Care Aids – Where do you want to fill in the gaps of what family members can and can’t do by hiring a home care aid to assist your loved one with personal care tasks.

Home Maintenance Needs Assessment

Lawn Care – What ongoing lawn maintenance needs to be done and who will do it?

Household Chores – Who will handle this? Does help need to be hired? Keep in mind that home care aids can often do household chores in conjunction with caring for your loved one.

Pet Care – Who will handle caring for your loved one’s pet(s)?

Necessary Home Repairs or Alterations – Note any safety concerns and get estimates on what will need to be done to make the home safer.

Financial Needs Assessment

Public Benefits – Who will handle applying for public benefits like Medicare and Medicaid?

Insurance and Medical Documents – Who will handle submitting the necessary forms and medical documents for insurance?

Paying the Bills – Who will handle paying the bills, such as:

• Mortgage or Rent
• Utilities
• Telephone
• Lawn Care
• Home Repairs
• Garbage Service
• Home Care
• Hair Stylist
• Doctors Appointments and Prescriptions
• Grocery

Transportation Needs Assessment

Accompaniment Transportation – Home care companies often provide accompaniment transportation services, which includes a home care aid driving your loved one to their destination, accompanying them inside and being there for any care that needs to take place.

Family Drivers – Are there any family members who will commit to driving your loved one to appointments or to run errands?

We hope this outline helped you understand how to create a needs assessment for your loved one. To help you get the conversation started with your loved one, read our article called 5 Tips for Talking With a Loved One About a Care Plan.

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