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Let's Connect: Zarit Caregiver Burden Scale (Post)
1.
Please enter your initials:
2.
Please enter the initials of the person you provide care for:
3.
Please select your loved one's service provider (e.g. day program, community-based network, etc.):
OSCC Faith Place
OSCC Northview
OSCC Conant
OSCC John St.
CCD Pickering
CCD Whitby
CCD Clarington
Hillsdale Estates Adult Day Program
Alzheimer Society of Durham Region
Oshawa Public Library (McLaughlin)
Oshawa Public Library (Legends)
4.
Do you feel that because of the time you spend with your relative that you don’t have enough time for yourself?
Never
Rarely
Sometimes
Quite frequently
Nearly always
5.
Do you feel stressed between caring for your relative and trying to meet other responsibilities (work/family)?
Never
Rarely
Sometimes
Quite frequently
Nearly always
6.
Do you feel angry when you are around your relative?
Never
Rarely
Sometimes
Quite frequently
Nearly always
7.
Do you feel that your relative currently affects your relationship with family members or friends in a negative way?
Never
Rarely
Sometimes
Quite frequently
Nearly always
8.
Do you feel strained when you are around your relative?
Never
Rarely
Sometimes
Quite frequently
Nearly always
9.
Do you feel that your health has suffered because of your involvement with your relative?
Never
Rarely
Sometimes
Quite frequently
Nearly always
10.
Do you feel that you don’t have as much privacy as you would like because of your relative?
Never
Rarely
Sometimes
Quite frequently
Nearly always
11.
Do you feel that your social life has suffered because you are caring for your relative?
Never
Rarely
Sometimes
Quite frequently
Nearly always
12.
Do you feel that you have lost control of your life since your relative’s illness?
Never
Rarely
Sometimes
Quite frequently
Nearly always
13.
Do you feel uncertain about what to do about your relative?
Never
Rarely
Sometimes
Quite frequently
Nearly always
14.
Do you feel you should be doing more for your relative?
Never
Rarely
Sometimes
Quite frequently
Nearly always
15.
Do you feel you could do a better job in caring for your relative?
Never
Rarely
Sometimes
Quite frequently
Nearly always