Step 1 of 16 6% Care ServicesIf potential care charges are something you’d like to learn more about…let us help you plan with this estimate tool. With this online basic healthcare assessment, we aim to give you a general idea of what you can expect to pay for care upon moving into Cooperwood Senior Living. This is fairly brief, but it will provide a personalized estimate for you or your loved one in a matter of minutes.Initials(Required)Type Initials in boxAcknowledgment(Required) By completing this online care calculator, I understand this is strictly reflective of estimated care needs, and not a comprehensive assessment performed by a medical professional. These are approximations and therefore not binding as care fees may vary and are subject to change without prior notice. Other costs including the base rental rates for various apartment types are not included in the price herein; they will be provided separately. Is this for yourself? Or is it for a loved one?(Required) Myself My loved one There are many healthcare services we can provide; we call them Activities of Daily Living (ADLs). Which of the following meet your current needs? Choose as many as are applicable.(Required) Bathing Hygiene Dressing Mobility Continence Eating Telephone Shopping Transportation Medications Mental Status Health Status I Don't Need Any Assistance Select all that applyHmm, maybe assisted living isn’t the right fit right now. Bathing(Required) Independent - no assistance required. Set up for shower and/or bathing articles; reminders as necessary. Requires moderate assistance - requires significant amounts of assistance. In addition to set up, requires stand by assistance into/out of shower for safety reasons (unsteadiness, etc.). Full assistance needed with bathing; helping individual in and out of shower, complete washing and drying of body Please select which of the following best describes your current health care needs as it relates to bathing (or showering).How many times per week?(Required)Please enter a number greater than or equal to 1. Hygiene(Required) Independent - no assistance required Set up needed, including reminders to bathe, shave, comb hair, clip nails, brush teeth, insert dentures In addition to set up, needs stand by assistance, usually involving reminders or preparation of grooming activities Requires moderate assistance such as steadying of hands when shaving or combing hair, clipping nails Full assistance required in all aspects of hygiene Please select which of the following best describes your current health care needs as it relates to hygiene. Dressing(Required) Independent - no assistance needed Assist with clothing, zippers, buttons, or shoes Set up clothing daily, assist with clothing, zippers, buttons or shoes. Assist with braces, compression hose or splints In addition to set up, needs moderate assistance with putting on/taking off clothing and shoes or hose Full assistance required with dressing Please select which of the following best describes your current health care needs as it relates to dressing. Mobility(Required) Independent- No assistance needed Not always reliable - needs occasional in-room supervision and/or escort to/from dining room In addition to set up, requires stand by assistance into/out of shower for safety reasons (unsteadiness, etc.) Requires single-person transfer from chair, bed or toilet to wheelchair. Not likely to maneuver wheelchair. Requires two-person transfer from chair, bed or toilet to wheelchair due to weight or for safety Please select which of the following best describes your current health care needs as it relates to incontinence mobility. Continence(Required) Independent - no assistance required Requires moderate assistance to manage continence. Includes assistance to/from bathroom, toileting checks at night Requires full assistance to manage continence. Includes schedule for toileting, supervision while on toilet and assistance in cleaning Please select which of the following best describes your current health care needs as it relates to continence. Eating(Required) Total independent-needs no special assistance or special diets OR requires minor assistance opening jars Requires moderate assistance - requires special cup or utensils OR requires significant amounts of assistance Requires special diet including soft mechanical, special liquids or foods or sodium restrictions Please select which of the following best describes your current health care needs as it relates to eating. Telephone(Required) Independent - no assistance required Individual is able to answer telephone, but needs staff to initiate calls Individual unable to use telephone, depends on staff to receive all incoming message and make all calls Please select which of the following best describes your current health care needs as it relates to telephone. Shopping(Required) Individual or individual's family take care of all needs Family does some shopping Full assistance required- facility does all shopping Please select which of the following best describes your current health care needs as it relates to shopping. Transportation(Required) Uses facility vehicles, family provides transportation or resident drives own car Requires handicapped or medical transport vehicle for transportation, facility make arrangements Please select which of the following best describes your current health care needs as it relates to transportation. Medications(Required) Individual has routine or PRN orders for 0 to 2 treatments (eye drops, duragesic patches, creams and salves) per day Individual has routine or PRN orders for 3 to 4 treatments per day Individual has routine or PRN orders for 5 to 6 treatments per day Individual has routine or PRN orders for 1 to 6 prescribed and/or over the counter medications per day Individual has routine or PRN orders for 7 to 10 prescribed and/or over the counter medications per day Individual has routine or PRN orders for 10 to 13 prescribed and/or over the counter medications per day Individual has routine or PRN orders for 14 or more prescribed and/or over the counter medications per day Individual uses oxygen; either full-time or part-time Individual requires more than monthly blood pressure checks Individual requires AccuChecks or other diabetes-related treatments Please select any of the following that best describe your current health care needs as it relates to medications.We are happy to discuss any more complex medication services you may need, including nebulizers, sprays, etc. Please contact the Community for more information on these services and pricing. Mental Status(Required) Appropriately oriented in person, place and time. Mild impairment - some confusion, difficulty in remembering details in conversations, forgetfulness Moderate impairment - memory loss, especially of current events - may be anxious and/or agitated about this Severe impairment affecting all areas of judgement - requires constant orientation program Abnormal impairment affecting all areas of judgement - may display paranoid or schizophrenic behavior Please select which of the following best describes your current health care needs as it relates to transferring. Health Status(Required) In good general overall health with no serious difficulties preventing independent living Stable chronic conditions - occasional flare ups but generally conditions are not life threatening Unstable chronic conditions where flare-ups occur frequently; including, but not limited to, diabetes Acute or life threatening conditions temporarily resulting in bed rest with good hope for recovery Terminal illness, a state of dying with comfort care only. Generally a hospice situation Please select which of the following best describes your current health care needs as it relates to transferring. Almost done! Please fill out some basic information about yourself or your loved one, before your customized basic assessment is provided. Thank you for taking the time to fill this out, we appreciate your interest in our Community. Please call with any questions, we are glad to be of service. Name(Required) First Last Email(Required) Phone(Required)CommentsEstimates are intended to give you a basic idea of what care services cost at our community. Your actual rate may vary depending on the results of your comprehensive, in-person assessment. These assessments help us tailor services to individual needs and are among the factors we consider in determining and monitoring staff levels.Total
