Net Worth Assessment Form for Family Caregivers

This 11-page Net Worth Assessment Form helps family caregivers organize an aging family member’s assets and liabilities before calculating a net-worth total. The member-only PDF includes sections for cash and bank accounts, investments and retirement accounts, property and other assets, short- and long-term debts, and contingent liabilities.

Before you begin

Gather current statements for the accounts, loans, credit cards, mortgages, and other items you plan to include. The worksheet asks for account and policy numbers, so store the completed file securely and share it only with people authorized to help with the family member’s finances.

How to use this worksheet

Enter the amounts you can verify, total the assets and liabilities, then subtract liabilities from assets. Treat the result as an organizational snapshot—not a promise of affordability or financial security. The form does not determine tax consequences, public-benefit eligibility, or which care or housing choice is appropriate.

Download access requires a Caregiver Relief membership. The PDF is 11 pages and about 214 KB.

If the worksheet raises questions about a family member’s finances, taxes, benefits, or legal authority, consult a qualified professional who can review the person’s circumstances. If you are considering whether someone should help manage a family member’s money, see the Consumer Financial Protection Bureau’s financial-caregiving guides. You can also explore Caregiver Relief’s financial caregiving resources and planning guide for aging in familiar surroundings.