General Issues: Are you the primary caregiver? Yes No Don't Know Do you have any siblings? Yes No Names Ages & Locations What involvement will they have in the process? Do they live in the same state as your parents? Yes No Do all family members share the same feelings about caregiving? Yes No What differences are there? Have you heard your parents say "I do not want to be a burden to my children"? Yes No   Financial What is your parents financial situation? Great Fair Bad Don't Know What Makes You Say That? Is there a list of assets (including value and location)? Yes No Do they have mortgages car payments credit card payments? Do you have a list of income sources from Social Security and pensions monthly and yearly income and expenses? Yes No Do they have a statement of networth? Yes No Do you know the estimated costs for your parents current and future needs? I think so I don't know What do you think they are? Are either of your parents Veterans? Yes No Are you aware of the following VA Programs that they might qualify for? Aid and Attendance Pension Compensation   Legal: Do you know who would manage your parents financial/legal matters should one parent die or have a debilitating illness? Yes No Do you understand the legal documents required to assure that your parent receive the care they want and that their finances are taken care of? Yes No Do your parents have an updated Will? Yes No Do they have a Living Will? Yes No Have you viewed them and know where they are kept? Yes No Where Kept / When Viewed Do your parents have a signed Durable Power of Attorney for business and legal matters? Yes No Do your parents have health care Power of Attorney for medical decision making? Yes No   Home: Is your parents home paid for or do they currently have a mortgage? Paid for Mortgage Do you know the value of the property? If so what Is It? Is the house safe for your parents to live in now or in the future? Yes No Do your parents want to stay in their current home with home modifications for safety? Yes No Do you know the difference in independent living assisted living shared housing and nursing home care? Yes No   Contact Information Name Phone # Email   Security code:   * Do not enter anything in this field: