Pastoral and Family Caregiver Survey

1. Pastoral and Family Caregiver Needs Assessment

The Elizabeth McGown Training Institute and the Georgie Briscoe Senior Resource Center are committed to offering training and education to support older adults. We ask that you take a few moments and assist us to identify those classes and programs that will be of most assistance in providing care for older adults and those that serve them as caregivers.

1. My Zip Code is

My Zip Code is

2. Making Difficult and Important Choices ( check all that interest you)

Making Difficult and Important Choices ( check all that interest you) How to Select a Nursing Home or Assisted Living

Understanding Hospice- what it does and does not offer

What are realistic expectations for care in a nursing home

What is Respite Care

Adult Day Care- What I need to know and ask

3. Legal Issues(please check all topics of interest to you)

Legal Issues(please check all topics of interest to you) Common Fraud and Scams that seniors are faced with

How to find, screen and hire a personal caregiver

Files for life-Documents and information we all should have.

A clear explanation of Durable Power of Attorney for Healthcare and Living Wills/Advanced Directives

Understanding "Do Not Resuscitate Orders".

What is considered elder abuse?

Understanding Medicare and Medicaid

4. Mental Health Issues ( please check all topics of interest to you)

Mental Health Issues ( please check all topics of interest to you) Depression and Aging

Caregiver Stress

Anxiety and Fears of Living Alone

Geriatric Psychiatric Issues

Grief and Bereavement

Living with Loss

Addicitons in the elderly

5. Aging Well Staying Healthy

Aging Well Staying Healthy Exercise at home exercise alone

Nutrition, Healthy, inexpensive easy meals to prepare

Brain games for brain gain

Home Safety for Seniors

Good Dental Care for the aging senior

Safe Driving-Learing to drive better and longer and what do do when driving is no longer an option

What's in your Medicine Cabinet? Drugs might hurt you more than help you.

6. Physical/ Health Issues

Physical/ Health Issues Diabetes-What you don't know can hurt you

High Blood Pressure-How to prevent it and how to treat it

Glaucoma, Macular Degeneration other eyesight issues

Stroke Prevention-Know the signs and know what to do

CPR

Vaccinations for elders- New Vaccines Better Health

Cancer- Diagnosis and Treatment Options

7. Pastoral Care

Pastoral Care Ageism in the church

Church Worship Services for Older Adults

Confidentiality and Pastoral Care

Making the most of nursing home visit

The Aging Congregation

End of Life issues

Meeting the spiritual needs of patients with dementia

8. Special Needs

Special Needs Preventing Skin breakdown or Bed Sores

How to transfer someone who cannot move from bed to chair

Bathing and Showering Techniques

Feeding someone who has difficulty swallowing

Medication assistance-How to help a loved one remember to take their medication

Preventing Falls

9. Alzheimer's Disease

Alzheimer's Disease Diagnosis - it may not be Alzheimer's

What to expect as the disease progresses

Activities for family members with Alzheimer's

Managing Difficult Behaviors

Alzheimer Safety Tool Box - Keeping your loved one safe

Sexuality and Alzheimer's

10. I was born in the year

I was born in the year

11. My gender is

My gender is male

female

12. My ethic group is:

My ethic group is: Hispanic/Latino

White/Caucasian

Black/African American

Asian/Pacific Islander/ Native American/ Alaskan American

Other

13. Please answer all that apply to you

Please answer all that apply to you I am currently raising grandchild/grandchildren

I currently provide unpaid care for a family member

I currently provide paid care for an individual in their home

14. My income is

My income is less than $10,000 per year

$10,000-35,000 per year

$35,000-55,000 per year

More than $55,000 per year

15. I would like information on the following topics not listed in previous question

I would like information on the following topics not listed in previous question 1.
2.
3.
4.
5.

16. If you would like to receive information about classes offered please provide the following information

If you would like to receive information about classes offered please provide the following information Name
Street address
City
State
Zip Code
Telephone
E-mail