Exit Caregiver Respite Experience Survey Question Title * 1. First and Last Name: Question Title * 2. Overall, how satisfied or dissatisfied are you with the application process of RCAW's Caregiver Respite Grant Program? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 3. Did you find the processes involved in applying for assistance via the Caregiver Respite Grant program user friendly? Extremely friendly Very friendly Somewhat friendly Not so friendly Not at all friendly Question Title * 4. Were you happy with the respite you received as a result of RCAW's Caregiver Respite Grant Program? A great deal A lot A moderate amount A little Not at all Question Title * 5. What did you do during your respite time? Spent time with spouse/partner/other friends and family Participated in social/recreational activities? i.e. church, visit with friends, go to a concert, etc. Run errands Completed household tasks Had private time to relax, rest, read, pursue hobbies/interests? Participate in physical activities or exercise Go to medical appointments/Tended to own health care needs Other (please specify) Question Title * 6. How likely are you going to apply to the Caregiver Respite Grant Program again? Very likely Likely Neither likely nor unlikely Unlikely Very unlikely Question Title * 7. What are the top three (3) challenges that you have as a family caregiver? Select up to three answers. Financial Feeling overwhelmed, anxious, depressed Physical or other personal health challenges Lack of sleep Feeling isolated and lack of socialization Strain on relationships with other family members No challenges - all is good! Question Title * 8. Did the Caregiver Respite Grant Program help or relieve any of the challenges you identified above? Yes No If no, what could we do better to help you address any challenges you identified? Question Title * 9. Tell us about your respite experience Question Title * 10. Any suggestions on what we can do to improve our Caregiver Respite Grant Program? Yes, please see below. No, not at this time. If yes, please specify Done
