Lutheran Senior Services: Red Flag Checklist

Welcome to
Outreach Programs

723 S. Laclede Station Rd.
St. Louis, MO 63119
(314) 961-3468
(314) 446-2520 FAX

Lutheran Senior Services Outreach Services

Red Flag Checklist

Here is a tool that can help you determine if the older adult in your life needs more assistance.

Read through the list. Mark all that apply. If more than one item is checked in a category, consult a healthcare professional or social service agency.

COGNITIVE/BEHAVIORAL
___	Forgets to keep appointments or engagements.
___	Makes repeated calls about same condition, concern or complaint.
___	Makes calls at odd times of day.
___	Is confused or disoriented about time of day, month or year.
___	Repeats same story within same visit.
___	Exhibits change in personality or behavior.
___	Appears overly suspicious, paranoid, withdrawn, or anxious (hands in motion most of the time).
___	Doesn't participate in previous activities of interest.
___	Has difficulty with language (can't find right words) and medial history does not explain cause.
___	Forgets to take medications as ordered or is unaware of reason for taking medications.
___	Forgets to turn stove off (odor of burnt food or pans with burnt food are present).
___	When driving he/she gets lost, has frequent accidents or car shows damage.
___	Frequently locks self out of house/car.
___	Unable to report what he/she would do in case of an emergency (fire, stranger at the door, etc.)

NUTRITION
___	Clothes don't fit because of weight loss.
___	Appears too frail to do meal preparation and doesn't receive assistance.
___	Uneaten food in Meals on Wheels containers.
___	Stacks of old dirty dishes in sink.
___	Spoiled food on counters or in refrigerator.
___	Absence of food.
___	Does not have transportation to grocery store, doctor's office, or church.

PHYSICAL
___	Appears unsteady getting up, down or when walking (uses walker, cane or other helpful devices).
___	Forgets or refuses to use cane or walker.
___	Has a history of falling (sign of bruising on arms, legs or facial area).
___	Takes several medications.
___	Difficulty with dressing or toileting.
___	Significant loss of vision or hearing and not using adaptive devices.
___	Neglects personal appearance.
___	Has frequent visits to the Emergency Room.

TRANSITIONS
___	Recent death of:
___	Recent move from: to:
___	Increase in health problems.
___	Increase in vision impairment.
___	Increase in confusion/forgetfulness.
___	Increase in loss of physical ability.

FINANCIAL
___	Utilities have been disconnected.
___	Bills unpaid or large amount of credit card debt.
___	Bank account overdrawn.
___	Can't reconcile bank account.
___	Stacks or piles of mail.
___	Participates in mail order sweepstakes that involve a purchase or contribution.
___	Gives large amounts of money to charities but appears not able to afford the contributions.
___	Lack of basic necessities (food, medications, etc).
___	Reluctant to go to doctor or shopping because of cost of transportation.

ENVIRONMENTAL
___	Household in disarray.
___	Difficult to make a pathway through the house.
___	Throw rugs present or carpet wrinkled.
___	Strong odor of garbage, urine or gas is present.
___	No handrails or banisters (inside house or outside entrances).
___	Poor lighting.
___	Home is not secure (door is unlocked when you arrive, no deadbolts).
___	Smoke alarms or carbon monoxide detectors are not installed or are not working.
___	Thermostat is not set appropriately.
___	Yard is unkempt (grass uncut, collection of newspapers/mail, etc).
___	Sidewalk is cracked or cluttered with high weeds.
___	Unattended or poorly attended pets.

FAMILY AND SUPPORT SYSTEM
___	Does not have family or friends.
___	Family cannot visit frequently because of other commitments.
___	Family does not live in immediate area.
___	Family or friends do not seem to provide emotional support.
___	Family or friends do not seem to provide hands-on support.
___	Family is not able to provide financial support when needed.
___	Family member appears to be cause of concern or stress.
___	Family member or friend seems abusive (physically, verbally or financially).
___	Neighbors are not part of the support system.
___	Does not know neighbors' names.

RESPONSIBILITIES
___	Lives alone.
	___	Responsible for self.
	___	Receives help from:	Name: Phone Number:	Relationship:
___	Responsible for others in household.
		Name:		Relationship:

Lutheran Senior Services Outreach Social Services would welcome the opportunity to provide you and your family resource and referral information. This service is FREE of charge. Please call 314-961-3468, ext. 4, 5 or 6 for more information.

Older Adults Living Life to the Fullest
Lutheran Senior Services
709 South Laclede Station Road • St. Louis, MO 63119
Call our toll-free LSS Help Line (877) 363-1211