{"id":441,"date":"2025-03-27T10:04:00","date_gmt":"2025-03-27T10:04:00","guid":{"rendered":"https:\/\/new.mcareagency.com\/?page_id=441"},"modified":"2025-03-27T14:05:50","modified_gmt":"2025-03-27T14:05:50","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/mcareagency.com\/index.php\/questionnaire\/","title":{"rendered":"Questionnaire"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"273\" src=\"https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/caregiver1-1024x273.png\" alt=\"\" class=\"wp-image-376\" style=\"width:1100px;height:auto\" srcset=\"https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/caregiver1-1024x273.png 1024w, https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/caregiver1-300x80.png 300w, https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/caregiver1-768x205.png 768w, https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/caregiver1-600x160.png 600w, https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/caregiver1.png 1500w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p>Should Your Relative Live Alone?<\/p>\n\n\n\n<p>It&#8217;s often difficult to know what service needs your relative may have when returning home from the hospital. This checklist may serve as a guide to evaluate if your older adult relative can safely continue to live alone.<\/p>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-674a6de6-adf9-4c56-a23b-e7f5fc60b2dc wpforms-render-modern\" id=\"wpforms-446\"><form id=\"wpforms-form-446\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"446\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/441\" data-token=\"132450aa91dc94cfe6396f603ab3e482\" data-token-time=\"1777213304\"><noscript class=\"wpforms-error-noscript\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-446-field_7-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Safety needs<\/legend><ul id=\"wpforms-446-field_7\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_7_1\" name=\"wpforms[fields][7][]\" value=\"Has you relative had accidents because of weakness,dizziness, or inability to get around\" aria-errormessage=\"wpforms-446-field_7_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_7_1\">Has you relative had accidents because of weakness,dizziness, or inability to get around<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_7_2\" name=\"wpforms[fields][7][]\" value=\"Has use of a stove, oven or appliances become a safety problem of forgetfulness\" aria-errormessage=\"wpforms-446-field_7_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_7_2\">Has use of a stove, oven or appliances become a safety problem of forgetfulness<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_7_3\" name=\"wpforms[fields][7][]\" value=\"Are there hazardous conditions in his\/her home,such as the bathroom and bedrom being on separate floors?\" aria-errormessage=\"wpforms-446-field_7_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_7_3\">Are there hazardous conditions in his\/her home,such as the bathroom and bedrom being on separate floors?<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_7_5\" name=\"wpforms[fields][7][]\" value=\"Does your relative refuse to use wheelchair, walker or other assistive devices necessary for safety?\" aria-errormessage=\"wpforms-446-field_7_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_7_5\">Does your relative refuse to use wheelchair, walker or other assistive devices necessary for safety?<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_7_4\" name=\"wpforms[fields][7][]\" value=\"Does your relative expressa desire to die, or seem to be depressed, apathetic, or without an interest in living?\" aria-errormessage=\"wpforms-446-field_7_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_7_4\">Does your relative expressa desire to die, or seem to be depressed, apathetic, or without an interest in living?<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-446-field_8-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">Nutritional Needs<\/legend><ul id=\"wpforms-446-field_8\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_8_1\" name=\"wpforms[fields][8][]\" value=\"Is There a demonstrated nutritional problem (weight loss,ilness, anemia, etc.)?\" aria-errormessage=\"wpforms-446-field_8_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_8_1\">Is There a demonstrated nutritional problem (weight loss,ilness, anemia, etc.)?<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_8_2\" name=\"wpforms[fields][8][]\" value=\"Does your relative eat only inappropriate foods that will not supply nutritional needs?\" aria-errormessage=\"wpforms-446-field_8_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_8_2\">Does your relative eat only inappropriate foods that will not supply nutritional needs?<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-446-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-446-field_1\" >address Medical Needs<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-446-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-446-field_9-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Personal Needs<\/legend><ul id=\"wpforms-446-field_9\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_9_1\" name=\"wpforms[fields][9][]\" value=\"Is your relative unwilling or unable to get to the toilet when necessary?\" aria-errormessage=\"wpforms-446-field_9_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_9_1\">Is your relative unwilling or unable to get to the toilet when necessary?<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_9_2\" name=\"wpforms[fields][9][]\" value=\"Is your relative unable to change clothing or bed linens as necessary to remain clean and dry?\" aria-errormessage=\"wpforms-446-field_9_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_9_2\">Is your relative unable to change clothing or bed linens as necessary to remain clean and dry?<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-446-field_10-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Medical Needs<\/legend><ul id=\"wpforms-446-field_10\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_10_1\" name=\"wpforms[fields][10][]\" value=\"Does your relative forget to take necessary medications?\" aria-errormessage=\"wpforms-446-field_10_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_10_1\">Does your relative forget to take necessary medications?<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_10_2\" name=\"wpforms[fields][10][]\" value=\"Is it likely that your relative would take an inappropriate dose of medicine, purposely or accidentally?\" aria-errormessage=\"wpforms-446-field_10_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_10_2\">Is it likely that your relative would take an inappropriate dose of medicine, purposely or accidentally?<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_10_3\" name=\"wpforms[fields][10][]\" value=\"Is your relative unable to obtain help in case of need?\" aria-errormessage=\"wpforms-446-field_10_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_10_3\">Is your relative unable to obtain help in case of need?<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-446-field_11-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Social Needs<\/legend><ul id=\"wpforms-446-field_11\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_11_1\" name=\"wpforms[fields][11][]\" value=\"Is your relative unable to handle money\" aria-errormessage=\"wpforms-446-field_11_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_11_1\">Is your relative unable to handle money<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_11_2\" name=\"wpforms[fields][11][]\" value=\"Does your relative get lost in familiar situations?\" aria-errormessage=\"wpforms-446-field_11_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_11_2\">Does your relative get lost in familiar situations?<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_11_3\" name=\"wpforms[fields][11][]\" value=\"Has your relative left home without destination?\" aria-errormessage=\"wpforms-446-field_11_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_11_3\">Has your relative left home without destination?<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_11_5\" name=\"wpforms[fields][11][]\" value=\"Does your relative often behave inappropriately?\" aria-errormessage=\"wpforms-446-field_11_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_11_5\">Does your relative often behave inappropriately?<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-446-field_11_4\" name=\"wpforms[fields][11][]\" value=\"Does your relative have mental or emotional problems which might be a threat to self or others?\" aria-errormessage=\"wpforms-446-field_11_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-446-field_11_4\">Does your relative have mental or emotional problems which might be a threat to self or others?<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-446-field_6-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-446-field_6\">Your e-mail address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-446-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" spellcheck=\"false\" aria-errormessage=\"wpforms-446-field_6-error\" required><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-446-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-446-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-446-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-invisible\" ><div class=\"g-recaptcha\" data-sitekey=\"6Lc8mAErAAAAAM7yjnjH9EKNqcncX2WUMLzMwoJD\" data-size=\"invisible\"><\/div><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"446\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/pages\/441\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-446\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Send\" aria-live=\"assertive\" value=\"wpforms-submit\">Send<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/mcareagency.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Wczytywanie\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"509\" src=\"https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/map.png\" alt=\"\" class=\"wp-image-361\" srcset=\"https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/map.png 400w, https:\/\/mcareagency.com\/wp-content\/uploads\/2025\/03\/map-236x300.png 236w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/figure>\n\n\n\n<p>INDIANA<br>Munster, IN<br>Phone: (219) 865 4775<\/p>\n<\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Should Your Relative Live Alone? It&#8217;s often difficult to know what service needs your relative may have when returning home from the hospital. This checklist may serve as a guide to evaluate if your older adult relative can safely continue<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-441","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/pages\/441","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/comments?post=441"}],"version-history":[{"count":3,"href":"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/pages\/441\/revisions"}],"predecessor-version":[{"id":515,"href":"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/pages\/441\/revisions\/515"}],"wp:attachment":[{"href":"https:\/\/mcareagency.com\/index.php\/wp-json\/wp\/v2\/media?parent=441"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}