Please take time to share how the caregiver crisis is impacting you and your family.

This survey hopes to show the daily impact of Wisconsin's direct care crisis on natural supports and family caregivers. 
It will gather information about number of hours of care provided or not provided by the caregiver, predictability of support, caregiver experience, impacts on caregiver employment, retirement and future, as well as, information about the caregivers thoughts of the future, and possible improvements. 

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* 1. Tells us the age of the family member(s) for whom you provide care or support?

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* 2. What best describes your role to the person receiving support? 

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* 3. How long have you been providing care to this person receiving support?

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* 4. How many more years to you expect to be in this role?

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* 5. How are in-home care supports for your person paid for? 

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* 6. What time of day do you typically provide care or support? 

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* 7. On average how many hours of care do you provide in a 24-hour period?

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* 8. In your experience, How many hours do you provide care per week (including weekends and overnights)?

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* 9. What are the total hours per week of paid care authorized for your person through state funded programs? (IRIS, Family Care or CLTS, Veterans Benefits, etc.)

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* 10. What are the total hours per week of paid support or care authorized for your person through Medical Assistance Personal Care (MAPC)?

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* 11. How many hours of your person's authorized paid care  are typically provided by a direct support professional?  

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* 12. On a scale of 1-5, with 5 being most likely,  please tell us how likely you think it is that you will cover paid caregiving hours because a worker isn't available in the next 7 days?

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i We adjusted the number you entered based on the slider’s scale.

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* 13. Typically, how many times per week do you fill in for unavailable paid care worker or agency?

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* 14. Rank from the choices below who provides support to your family member if no worker is available.

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* 15. How long have you been providing the level of care you are currently providing?

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* 16. How has family caregiving impacted your ability to work in another job?

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* 17. How do family caregiver responsibilities impact the kind of job you can take? (Please check all that apply)

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* 18. When you think of the financial future, and the employment choices you have made to accommodate caregiving, what are you most concerned about?

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* 19. If you are no longer able to care for you family member or support their care, what is the most likely outcome for them? 

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* 20. When you think about the future, what most worries you?

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* 21. What county do you live in?

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* 22. If you are interested in providing more information, please include your contact information below. 

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