Survey of Family Caregivers

The Vermont Department of Disabilities, Aging, and Independent Living (DAIL) wants to learn about the needs of family caregivers of Vermonters 60 and older, and how best to support them.
This survey can be completed by anyone who lives in Vermont and provides care to a family member age 60 or older. All answers are confidential and anonymous.

Please complete by September 27, 2024.

For questions about the survey, contact your Area Agency on Aging.
For questions about how the survey results will be used, contact Jason Pelopida, DAIL State Unit on Aging Director, at jason.pelopida@vermont.gov

1.What is your relationship to the person age 60 or older for whom you primarily provide care?

 Spouse/Life partner)

 Parent/parent-in-law

 Grandparent

 Other relative

2.What is the age of the person you care for?

 60-64

 65-74

 75-84

 85+

3.What are the health conditions of your family member that require your care? (Check all that apply)

 Alzheimer’s or another form of dementia

 Brain injury (i.e. from a stroke, fall, accident, etc.)

 Physical disability

 Chronic physical health condition or illness

 No diagnosis

 I prefer not to say.

Other (please describe)

4.How long have you been a caregiver for your age 60+ family member?

 Less than 1 year

 1-3 years

 4-6 years

 More than 6 years

5.In a typical week, approximately how many hours do you spend caregiving?

6.Respite care is an opportunity for you to have a break from providing care while someone else helps the person you care for. That “someone else” can be a family member, friend, volunteer, or a paid worker. Respite can be for a few hours a month to several days or nights each week. Do you get respite services?

 Yes

 No, but would like to

 No, not interested

7.If you do not use respite care, why? (Check all that apply.)

 I do not need or want respite services

 I do not like to ask for help

 The person I care for will not accept care from anyone else

 I cannot afford respite services

 Respite service does not fit with our culture

 Respite is not available when I need it

 It does not feel safe

 I have had negative experiences with respite

 I do not know where to find respite services

9.Which of the following best describes your experience?

Tried it, was helpful

Tried it, not helpful

Have not tried, expect it would help

Have not tried, expect it would NOT help

Individual Counseling

Tried it, was helpful

Tried it, not helpful

Have not tried, expect it would help

Have not tried, expect it would NOT help

Caregiver Support Groups

Tried it, was helpful

Tried it, not helpful

Have not tried, expect it would help

Have not tried, expect it would NOT help

10.Which of the following do you use to find support, resources, and/or information that you need as a family caregiver? (Check all that apply.)

11.What year were you born?

12.What is your zip code?

13.What types of insurance cover the family member for whom you provide care? (Check all that apply)