Caregivers are often so concerned with caring for their relative's needs that they lose sight of their own well-being. Please take just a moment to answer the following questions. Once you have answered the questions, turn the page to do a self-evaluation.
During the past week or so, I have ...
1. Had trouble keeping my mind on what I was doing...................□Yes □No
2. Felt that I couldn't leave my relative alone............................□Yes □No
3. Had difficulty making decisions..................................□Yes □No
4. Felt completely overwhelmed......□Yes □No
5. Felt useful and needed...............□Yes □No
6. Felt lonely.................................□Yes □No
7. Been upset that my relative has changed so much from his/her former self.....................□Yes □No
8. Felt a loss of privacy and/or personal time............................□Yes □No
9. Been edgy or irritable.................□Yes □No
10. Had sleep disturbed because of caring for my relative...........□Yes □No
11. Had a crying spell(s)................□Yes □No
12. Felt strained between work and family responsibilities………
13. Had back pain.........................□Yes □No
14. Felt ill (headaches, stomach problems or common cold)............□Yes □No
15. Been satisfied with the support my family has given me............□Yes □No
16. Found my relative's living situation to be inconvenient or a barrier to care..,......□Yes □No
17. On a scale of 1 to 10, with 1 being "not stressful" to 10 being "extremely stressful," please rate your current level of stress.
18. On a scale of 1 to 10, with 1 being "very healthy" to 10 being "very ill," please rate your current health compared to what it was this time last year. _____
Self-evaluation
To determine the score:
1. Reverse score questions 5 and 15. (For example, a "No" response should be counted as "Yes" and a "Yes" response should be counted as "No.")
2. Total the number of "yes" responses.
To interpret the score
Chances are that you are experiencing a high degree of distress:
• If you answered "Yes" to either or both questions 4 and 11; or
• If your total "Yes" score = 10 or more; or
• If your score on question 17 is 6 or higher;
• If your score on question 18 is 6 or higher
Next steps
• Consider seeing a doctor for a check-up for yourself
• Consider having some relief from caregiving (Discuss with the doctor or a social worker the resources available in your community.)
• Consider joining a support group
Eldercare Locator (a national directory of community services)
(800)677 1116
www.eldercare.gov
Family Caregiver Alliance
(415) 434-3388
www. caregiver.org
Medicare Hotline
(800) 633-4227
www. medicare.gov
National Alliance for Caregiving
(301) 718-8444
www. caregiving. org
National Family Caregivers Association
(800) 896-3650
www. nfcacares.org
National Information Center for Children
Youth with Disabilities
(800) 695-0285
www. nichcy.org