Observe: Objects on floor or Hazards pathways in main areas used by (care II) p. recipient) 64-65 Do you have a grab bar in the bathroom () primarily used by (care recipient)? (continued) Evaluation Instrument Details (continued) Instrument How and citation many Domain links items Sample item(s) Instructions, scoring Permissions Interviewer selects 2-3 appropriate scenarios out of 7 possibilities Making & Executing Example: The door to your home is locked Decisions for 12-18 Administration and and you do not have a key Risk Safe and scoring instructions No special (6 per What would you do if the door to your assessment/ Independent are included on the permissions required. home was locked and you didn’t have a Safety Living instrument. key? What you do if [this response] didn’t () work? What could you do to prevent yourself from getting locked out of your home? Fortinsky How certain are you right now that you can: Instrument questions Caregiver No instructions are in the (available Handle any problems your relative has, Self-Efficacy provided. Consult with for a nominal fee). like memory loss, wandering, or Self-efficacy 10 an evaluator for Notify of use. No (Fortinsky, behavior problems? appropriate use. other permissions are Kercher & Do something to keep your relative as required. Burant) independent as possible? (continued)
Hazards II) p. 64-65 () Observe: Objects on floor or pathways in main areas used by (care recipient) Do you have a grab bar in the bathroom primarily used by (care recipient)? (continued) Evaluation Instrument Details (continued) Domain Instrument and citation links How many items Sample item(s) Instructions, scoring Permissions Risk assessment/ Safety Making & Executing Decisions for Safe and Independent Living () 12-18 (6 per Interviewer selects 2-3 appropriate scenarios out of 7 possibilities Example: The door to your home is locked and you do not have a key What would you do if the door to your home was locked and you didn’t have a key? What you do if [this response] didn’t work? What could you do to prevent yourself from getting locked out of your home? Administration and scoring instructions are included on the instrument. No special permissions required. Self-efficacy Fortinsky Caregiver Self-Efficacy (Fortinsky, Kercher & Burant) 10 How certain are you right now that you can: Handle any problems your relative has, like memory loss, wandering, or behavior problems? Do something to keep your relative as independent as possible? No instructions provided. Consult with an evaluator for appropriate use. Instrument questions are in the (available for a nominal fee). Notify of use. No other permissions are required. (continued)