Above And Beyond healthcare
I am an Arizona Resident * Select…YesNo
Who Needs Care at Home? * Select…My SelfParentGrandParentOther RelativeFriendOther
How Old is the Person Who Needs Care? * Select Age…45-5455-6465-7475-8485 or older
Male or Female? * Select Gender…MaleFemale
What is their current living situation? * Select…Living Alone at HomeLiving at Home with FamilyIn the Hospital Needs a SitterIn the Hospital Discharging to HomeAssisted LivingIndependent Senior Living
Estimate How Much Care They Might Need * Select Gender…A few hours per weekMore than 20 hours per week40 or more hours per weekAround-the-Clock CareLive-in Care
How will care be paid for? * Select…Private FundsLong-Term Care InsuranceMedicaidOther - (VA Aid and Attendace, Reverse Morgage, etc)
What type of Care is Needed? (Check all that apply) *
Light Meal PreparationLight LaundryLight HousekeepingCompanionshipTransportation to AppointmentsGrocery Shopping
ErrandsBathingToiletingMedication RemindersRespite CareHospice
Zip Code Where Care is Needed *