Post- Caregiver Respite Funding Survey

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* 2. Have you felt a reduction in caregiving stress because of having Caregiver-GAP funds?

Yes

Please explain.

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* 3. Regarding the use of Caregiver Respite funds, do you feel …? (Check all that apply)

More comfortable accepting help from others

More comfortable having respite workers provide support at home

More comfortable with respite support outside of home

That respite workers have provided competent care

That I should have used respite support earlier

Other (Please Describe)

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* 4. How much do you agree with the following statement: I used my respite plan to do something I enjoyed and felt that the respite was “time well spent”?

Completely Disagree

Somewhat Disagree

Somewhat Agree

Completely Agree

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* 5. Has respite allowed you to spend time on the various activities that you enjoy (e.g., going to religious services, socializing with others, going out for a meal) or spending time on hobbies or activities you like to enjoy alone (e.g., reading or gardening)?

Yes

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* 6. Has the use of respite made a positive difference to you and your family?

Yes

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* 7. If given the opportunity, would you use respite services again?

Yes

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* 8. I feel …. (Check all that apply)

A sense of relief that someone else is available to provide care

More confident about asking for help or assistance with care

More balance in my life in giving care and also trying to take care of myself

I have regained some enjoyable activities I had lost in caregiving

I am taking better care of my own health (physically and emotionally) through respite

Getting respite breaks was worth my time and effort in arranging them

The quality of the care during respite was competent and adequate for our needs

I am able to continue in my caregiving role for the foreseeable future

That the care recipient has benefited from the interaction with the respite worker/provider

More confident about finding/identifying/selecting a respite provider

More confident about preparing/training a respite provider to give care

More confident about how to use respite breaks effectively

More convinced of the benefits received from respite

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* 9. BEFORE receiving respite, how “stressed” were you as a result of caring for your family member?

Low Stress

Moderate Stress

Very Stressed

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* 10. 1. NOW that you have received respite services, how “stressed” are you as a result of caring for your family member?

Low Stress

Moderate Stress

Very Stressed

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* 11. Do you have someone now you can call on in an emergency to fill in for you as a caregiver?

Yes

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* 12. Please indicate your overall level of satisfaction with the respite services you recently received

Completely Dissatisfied

Somewhat Dissatisfied

Somewhat Satisfied

Completely Satisfied

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* 13. Is there anything else that would help you in your caregiver role?

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* 14. What is your 5-digit zip code?

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* 15. Age Category

under 60

60 - 64

65 - 74

74 - 84

85+

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* 16. Gender

Female

Male

Female to Male / Transgender Male

Male to Female / Transgender Female

Decline to Answer

Other (please specify)

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* 17. Ethnicity

Not Hispanic or Latino

Hispanic or Latino

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* 18. Your Race

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Another race

Post- Caregiver Respite Funding Survey

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* 1. Who provided the service you requested?

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* 2. Have you felt a reduction in caregiving stress because of having Caregiver-GAP funds?

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* 3. Regarding the use of Caregiver Respite funds, do you feel …? (Check all that apply)

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* 4. How much do you agree with the following statement: I used my respite plan to do something I enjoyed and felt that the respite was “time well spent”?

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* 5. Has respite allowed you to spend time on the various activities that you enjoy (e.g., going to religious services, socializing with others, going out for a meal) or spending time on hobbies or activities you like to enjoy alone (e.g., reading or gardening)?

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* 6. Has the use of respite made a positive difference to you and your family?

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* 7. If given the opportunity, would you use respite services again?

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* 8. I feel …. (Check all that apply)

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* 9. BEFORE receiving respite, how “stressed” were you as a result of caring for your family member?

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* 10. 1. NOW that you have received respite services, how “stressed” are you as a result of caring for your family member?

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* 11. Do you have someone now you can call on in an emergency to fill in for you as a caregiver?

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* 12. Please indicate your overall level of satisfaction with the respite services you recently received

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* 13. Is there anything else that would help you in your caregiver role?

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* 14. What is your 5-digit zip code?

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* 15. Age Category

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* 16. Gender

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* 17. Ethnicity

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* 18. Your Race

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* 19. What is your relationship with the person receiving care?