Instrument How and citation many Domain items Sample questions Instructions, scoring Permissions Risk/ Making & 12-18 (6 [Select 2-3 scenarios that are Administration and No special permissions Safety Executing per appropriate out of 7 possibilities] scoring instructions are required. Decisions for scenario) Example: The door to your home is included on the Safe and locked and you do not have a key instrument. Independent What would you do if the door to Living your home was locked and you didn’t have a key? What would you do if [this () response] didn’t work? What could you do to prevent yourself from getting locked out of your home? Fortinsky 10 certain are you right now No instructions Notify of use. No other “How Caregiver that you can…” provided. Consult with permissions are required. Handle any problems your relative an evaluator for has, like memory loss, wandering, appropriate use. () or behavior problems? Do something to keep your relative as independent as possible? Preparedness 8 How well prepared do you you Scoring instructions are Credit the developers by for Caregiving are to take care of your family included on the using the complete Scale member’s physical needs? instrument. citation. No other How well prepared do you think permissions are required. () you are to find out about and set up services for him or her? (continued) Evaluation Instrument Details (continued) Instruments indicated with an asterisk (*) are available upon request from the National Alzheimer’s and Dementia Resource Center
Domain Instrument and citation How many items Sample questions Instructions, scoring Permissions Risk/ Safety Making & Executing Decisions for Safe and Independent Living () 12-18 (6 per scenario) [Select 2-3 scenarios that are appropriate 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 would 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. Fortinsky Caregiver () 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. Notify of use. No other permissions are required. Preparedness for Caregiving Scale () 8 How well prepared do you you are to take care of your family member’s physical needs? How well prepared do you think you are to find out about and set up services for him or her? Scoring instructions are included on the instrument. Credit the developers by using the complete citation. No other permissions are required. (continued) Evaluation Instrument Details (continued) Instruments indicated with an asterisk (*) are available upon request from the National Alzheimer’s and Dementia Resource Center
2018EvalMeasuresResourceList%20508_0.docx