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A Global Response to Elder Abuse - page 74 / 149

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Activity

Degree

For each item

Who performs

Does the subject

of Assistance

indicate if the

the activity?

live with

(1-4)

situation is

(see A-D, above)

the caregiver?

A GLOBAL RESPONSE TO ELDER ABUSE AND NEGLECT

Temporary or Permanent

Bathing

Dressing

Toileting

Medication Administration

Housekeeping

Meal preparation

Eating

Shopping

Transportation

Mobility

Other

21. Ask questions directly to the subject about the type of care that he/she receives and about the relationship with the person who helps him/her:

  • Have there ever been any problems with the type of care you received in the last 12

months?

Yes p

No p

N/A p

R/A p

Describe:

PAGE 59

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