Maui County Office on Aging - 2022 Caregiver Survey

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* 4. What is your marital status?

Never married

Married

Widow/Widower

Separated or divorced

Partnered with Significant other

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* 5. What is your employment status?

Full Time

Part Time

Not employed

Retired

Quit employment due to caregiving

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* 6. What is your annual personal (not household) income?

Less than $5,000

$5000-$10,000

$10,001-$50,000

$50,001-$100,000

More than $100,000

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* 7. What is your race/ethnicity? (select all that apply)

American Indian or Alaska Native

Hawaiian

Samoan

Black or African American

Hispanic or Latin

Tongan

Caucasian or White

Japanese

Vietnamese

Chinese

Korean

Filipino

Marshallese

Prefer Not to answer

Other (please specify)

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* 8. Is English our primary language?

Yes

Other (please specify)

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* 9. Who do you assist? Check all that apply.

Spouse

Parents

Other relative

Friend

Adult child under 60 yrs of age

Grandchild under 18 yrs of age

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* 10. How many (#) individuals do you provide for?

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* 11. If you are caring for more than one person, answer the next following questions about the person you provide the most care to. How old is the person that you assist?

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* 12. Are you the primary or secondary caregiver?

Primary caregiver (person that provides the most care)

Secondary caregiver (provides some support)

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* 13. Do you live with the person you provide care for?

Yes

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* 14. How long have you been providing care?

Less than 1 year

1 yr - 5 yrs

6 yrs - 10 yrs

11 or more yrs

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* 15. Who helps you provide care? Check all that apply.

Other Family members

Friends

No one

Paid Helper(s)

Other (please specify)

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* 16. How often do you provide care during the week?

Once a week

2-3 times a week

4-5 times a week

6 times a week

Every day

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* 17. How would you describe your stress level related to your caregiving responsibilities?

None

A little

Moderate

A lot

None

A little

Moderate

A lot

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* 18. What types of help do you provide? Check all that apply.

Shopping

Transportation

Help with Medications

Personal care- bathing, dressing, grooming, toileting, feeding

Financial Management- help with paying bills, managing money

Financial Assistance- giving money to help pay for rent, groceries, etc.

Housekeeping- light chores, including sweeping, laundry, and preparing meals

Other (please specify)

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* 19. Which services does this person currently receive from agencies? Which services do you need more of? Check all that apply.

	Yes, Receiving	I pay out of pocket	Need more of
Home delivered meals	Home delivered meals Yes, Receiving	Home delivered meals I pay out of pocket	Home delivered meals Need more of
Light Housekeeping	Light Housekeeping Yes, Receiving	Light Housekeeping I pay out of pocket	Light Housekeeping Need more of
Heaving Cleaning, yardwork, etc.	Heaving Cleaning, yardwork, etc. Yes, Receiving	Heaving Cleaning, yardwork, etc. I pay out of pocket	Heaving Cleaning, yardwork, etc. Need more of
Personal care (help with bathing, dressing, etc.)	Personal care (help with bathing, dressing, etc.) Yes, Receiving	Personal care (help with bathing, dressing, etc.) I pay out of pocket	Personal care (help with bathing, dressing, etc.) Need more of
Transportation	Transportation Yes, Receiving	Transportation I pay out of pocket	Transportation Need more of
Respite (temporary break for caregivers)	Respite (temporary break for caregivers) Yes, Receiving	Respite (temporary break for caregivers) I pay out of pocket	Respite (temporary break for caregivers) Need more of
Adult Day Care/Day Health	Adult Day Care/Day Health Yes, Receiving	Adult Day Care/Day Health I pay out of pocket	Adult Day Care/Day Health Need more of
Caregiver support (indiv and grp support, training and education)	Caregiver support (indiv and grp support, training and education) Yes, Receiving	Caregiver support (indiv and grp support, training and education) I pay out of pocket	Caregiver support (indiv and grp support, training and education) Need more of
Friendly visitor (visits/help from volunteer/friend)	Friendly visitor (visits/help from volunteer/friend) Yes, Receiving	Friendly visitor (visits/help from volunteer/friend) I pay out of pocket	Friendly visitor (visits/help from volunteer/friend) Need more of
Case management (social worker/case manager helping with coordination)	Case management (social worker/case manager helping with coordination) Yes, Receiving	Case management (social worker/case manager helping with coordination) I pay out of pocket	Case management (social worker/case manager helping with coordination) Need more of
Nursing Services	Nursing Services Yes, Receiving	Nursing Services I pay out of pocket	Nursing Services Need more of
Legal Services (Wills, guardianship, power of attorney)	Legal Services (Wills, guardianship, power of attorney) Yes, Receiving	Legal Services (Wills, guardianship, power of attorney) I pay out of pocket	Legal Services (Wills, guardianship, power of attorney) Need more of
Public Assistance (Medicaid, Food Stamps/SNAP, Housing Assistance, etc.)	Public Assistance (Medicaid, Food Stamps/SNAP, Housing Assistance, etc.) Yes, Receiving	Public Assistance (Medicaid, Food Stamps/SNAP, Housing Assistance, etc.) I pay out of pocket	Public Assistance (Medicaid, Food Stamps/SNAP, Housing Assistance, etc.) Need more of

Other: Please describe.

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* 20. Do you have access to and use the Internet either at home, work, or another place?

Yes

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* 21. What types of respite care do you think are available in your area? You may select more than one answer if it applies.

In-home respite care

Day activity programs

Residential respite care

I don't know what respite care is available.

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* 22. If you have not used community agency services to help you with your caregiving, what is/are the main reason(s) for not using them? Check all that apply.

I can't afford to pay out of pocket.

The person I care for applied but was denied.

I don't know what is available.

I can manage on my own for now.

I don't know how to get information.

Services are not available during the times I need them.

I don't want outsiders coming into my home/elder's home.

Other (please specify)

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* 23. What issues concern you as a caregiver? Check all that apply.

Nursing home placement for loved one

Reluctance of client to accept services

Family conflict- other family members not helping out

Having your own children and/or family to care for

Accepting the disability/declining health of the person being care for

Legal matters

My health/own future

Financial challenges

Future care of your loved one

End of Life Issues- loss and grief, death and dying

Other (please specify)

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* 24. What kinds of support would help you and other caregivers in the community? Check all that apply.

Respite services in the home to give caregivers a break

Counseling

Support groups

Legal assistance

Addressing end-of-life issues- loss and grief, death and dying

Understanding family dynamics- family roles, how to manage conflict among family members

Hands-on care techniques- how to help with bathing, transferring, using medical equipment, handling behavioral problems

Financial planning for the future

Any help (info, money or resources) to help me renovate the home to become more age-friendly (e.g. install railings, shower bars, ramps, etc.)

Education Workshops/trainings

Other (please specify)

Maui County Office on Aging - 2022 Caregiver Survey

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* 1. What is your Post Office zip code?

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* 2. What is your age?

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* 3. What is your gender identity?

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* 4. What is your marital status?

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* 5. What is your employment status?

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* 6. What is your annual personal (not household) income?

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* 7. What is your race/ethnicity? (select all that apply)

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* 8. Is English our primary language?

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* 9. Who do you assist? Check all that apply.

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* 10. How many (#) individuals do you provide for?

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* 11. If you are caring for more than one person, answer the next following questions about the person you provide the most care to. How old is the person that you assist?

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* 12. Are you the primary or secondary caregiver?

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* 13. Do you live with the person you provide care for?

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* 14. How long have you been providing care?

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* 15. Who helps you provide care? Check all that apply.

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* 16. How often do you provide care during the week?

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* 17. How would you describe your stress level related to your caregiving responsibilities?

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* 18. What types of help do you provide? Check all that apply.

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* 19. Which services does this person currently receive from agencies? Which services do you need more of? Check all that apply.

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* 20. Do you have access to and use the Internet either at home, work, or another place?

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* 21. What types of respite care do you think are available in your area? You may select more than one answer if it applies.

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* 22. If you have not used community agency services to help you with your caregiving, what is/are the main reason(s) for not using them? Check all that apply.

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* 23. What issues concern you as a caregiver? Check all that apply.

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* 24. What kinds of support would help you and other caregivers in the community? Check all that apply.

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* 25. Do you have any general comments or have any ideas on how we can better serve caregivers in our county?