Companionship Needs Assessment
A brief multiple-choice assessment to gauge the level of companionship and supervision support that may be helpful. Choose one option per question; your total score maps to a suggested support level.
/10
How often does the person feel lonely or socially isolated?
Rarely or never
Occasionally (1–2 days/week)
Often (3–5 days/week)
Most days or daily
/10
How comfortable is the person being alone at home for a few hours?
Very comfortable and safe
Mostly comfortable; minor concerns
Uncomfortable; safety concerns sometimes
Not safe/appropriate to be alone
/10
How often are there safety risks that benefit from someone being present (e.g., falls risk, leaving stove on, wandering)?
Never
Rarely
Sometimes
Often
/10
How often does the person need reminders or prompts for routine tasks (meals, hydration, medications reminders, appointments)?
Not needed
Occasionally
Daily for one or two routines
Multiple times per day
/10
How much does the person benefit from help with meaningful activities (conversation, games, reading, hobbies, light outings)?
Prefers to do activities independently
Enjoys company occasionally
Benefits from planned activities weekly
Benefits from structured engagement most days
/10
How often does the person experience confusion, disorientation, or memory-related issues that affect daily life?
Never or minimal
Occasionally
Frequently
Most of the time
/10
How challenging is it for family/caregivers to provide consistent check-ins or supervision?
Not challenging; support is readily available
Somewhat challenging due to schedules
Very challenging; coverage gaps occur
Not sustainable without outside support
/10
How often does the person need accompaniment for outings (walks, appointments, errands) for confidence or safety?
Never
Occasionally
Often
Almost always
/10
How stable is the person’s mood and anxiety levels day to day?
Stable; minimal anxiety
Occasional worry or low mood
Frequent anxiety or mood changes
Significant distress that interferes with daily life
/10
How urgent is the need for companionship or supervision support right now?
Not urgent; planning for the future
Within the next month
Within the next 1–2 weeks
Immediate need (this week)
Low Need (Light Check-ins / Social Boost)
The responses suggest the person is generally safe and comfortable but may benefit from occasional companionship, friendly visits, or periodic check-ins to support wellbeing and connection.
Moderate Need (Regular Companionship & Some Supervision)
The responses suggest consistent support would be helpful. Regular visits, activity engagement, reminders, and accompaniment for outings may improve safety, routine, and quality of life.
High Need (Frequent Supervision / Structured Support)
The responses suggest a higher level of supervision and consistent presence may be appropriate. Frequent visits or extended shifts can help reduce safety risks, provide routine prompts, and offer strong social and emotional support.