Greensburg

Call 724-838-8300   TTY: 711

123 Triangle Drive
Greensburg, PA 15601

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Life Program Eligibility*

Progress:

Does your loved one need assistance with or have difficulty with any of the following?

Dressing
  • Never
  • Sometimes
  • Always
Walking
  • Never
  • Sometimes
  • Always
Hygiene
(toileting, bathing)
  • Never
  • Sometimes
  • Always
Meal Preparation
  • Never
  • Sometimes
  • Always

Medications:

Does your loved one need assistance with or have difficulty managing their medications?

 
  • Never
  • Sometimes
  • Always

How many prescriptions does your loved one take?

 
  • 4 or Less
  • 8
  • 12 Or More

Is your loved one’s health affected by memory loss, dementia, or Alzheimer’s?

 
  • Not At All
  • Sometimes
  • Yes

Could your loved one benefit from increased socialization?

 
  • No
  • Maybe
  • Yes

Does your loved one or caregiver have difficulty arranging for transportation to and from medical appointments?

 
  • Never
  • Sometimes
  • Always

Does your loved one have difficulty with balance and/or experience falls?

 
  • Never
  • Sometimes
  • Always

Does your loved one have difficulty affording medical premiums, co-pays and deductibles, including the cost of medications?

 
  • Never
  • Sometimes
  • Always

Would your loved one benefit from having their medical care centralized through one healthcare team?

 
  • No
  • Maybe
  • Yes

Do you have difficulty balancing the care and needs of your loved one with your own?

 
  • Never
  • Sometimes
  • Always

Does your loved one desire to receive the health care and personal support to allow him or her to remain in their home?

 
  • No
  • Maybe
  • Yes

Congratulations!

You’ve finished the Assessment!

Your loved one is an excellent candidate for the LIFE Program.
Your loved one could benefit from the LIFE Program
Your loved one may qualify for the LIFE Program
Low
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High

Yes, please e-mail me more information and show me the results of my assessment.

* This assessment is for informational purposes only and should not replace an in-person evaluation with Senior LIFE. To be eligible for services at no cost, participants must be 55 years of age or older; live in an area served by a LIFE Provider and meet certain medical and financial eligibility guidelines. For more information, call 724-838-8300.

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