Hello, to get started, can you tell us who you are concerned about?

Okay, let's get a handle on where things are today. Where do you live?

How Old Are You?

Can you tell us about your current living situation?

Do You Drive?

Do you get help and care when needed?

Alright, now let's talk about why you think it might be time to consider making some changes. You can choose more than one.

It might be time to consider downsizing.
I am curious about home care and senior living community options.
I am thinking about current and/or future care needs.
I am concerned that the current environment is not safe.
I am concerned about loneliness or isolation.
I am feeling a little overwhelmed and could use some help.

What kinds of daily activities do you enjoy? You can choose more than one.

A walk or other physical activity
Connecting with friends and family
Being with pets
Being outdoors
Spiritual or faith-based activities
TV, movies or music
Quiet time on my own
Other interests or hobbies

Do you think you need help with things like meal preparation, housekeeping, and running errands?

Okay, now let's talk about some changes you might have noticed. Do you think that you have lost interest in daily activities?

Do you think you need help with personal activities, such as getting dressed, bathing and using the bathroom?

How about staying hydrated? Do you forget to drink water or other beverages?

Are you likely to forget the names of friends and family, or how to do things like use the phone, TV, or thermostat?

Is it likely you could wander and get lost in familiar places?

Are you showing signs of poor judgment?

Have you had a recent fall?

Do you need help managing and taking medications?

Do you need around-the-clock medical or nursing care?

Finally, let's talk about how ready you might be for a change. Would you be open-minded about discussing changes at home, or moving somewhere where more help is available?

How concerned are you about the financial impact of paying for care?

Do you currently make a monthly housing payment?

Do you have access to any programs that can help cover housing and care costs? You can choose more than one.

I am a veteran or the spouse of a veteran
I have long-term care (LTC) insurance
I have or qualify for Medicaid
Something else
None of these
I'm not sure

When you think about this decision, what would make it easier? You can choose more than one.

Having a clearer picture of what life at a senior living community is like
Feeling confident that getting help is the right choice
Feeling confident that it’s the right time to make a change
Feeling confident about my financial situation
Getting everyone in my family on the same page
Something else
I'm not sure

Are you interested in talking with an expert at Courtyard Luxury Senior Living about options that might be a good fit for you?

First Name

Last Name

Email

Phone

When is the best time to contact you?

Finally, are you interested in more information about any of the items below? You can choose more than one:

Pricing & availability
Floor Plans
Calendar of activities & events
Pets
Meals & dining
Transportation
Something else
No, thank you

Additional Questions or Comments?

Is It Time Survey

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