Caregiver Survey Invitation

If you are currently providing care or support to a family member, friend, or loved one who needs assistance due to illness, disability, or aging, we invite you to participate in our Caregiver Survey.

This survey aims to better understand the experiences, challenges, and needs of caregivers like you. Your valuable input will remain confidential, and will help improve resources, support programs, and services designed to assist caregivers.

This survey will ask about respite care. Respite care is short-term relief for primary caregivers, giving them a break while someone else cares for their loved one.

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* 1. What is your zip code (this will help us identify areas within Placer County that could benefit from additional services).

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* 2. Do you live with the person you care for?

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* 3. What is your age?

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* 4. Do you care for someone over the age of 60?

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* 5. What is the relationship to the person you are caring for?

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* 6. How long have you been providing care to this person?

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* 7. Are you the primary caregiver?

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* 8. On average, how many hours per week do you provide care?

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* 9. On a normal day, who assists you in caring for your loved one?

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* 10. What types of care do you provide?

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* 11. On a scale of 0-10, how would you rate your caregiver-related stress on average?

0-Low 5 10-High
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i We adjusted the number you entered based on the slider’s scale.

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* 12. Where did you first learn about respite care?

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* 13. Do you know what types of respite care are available in your area?

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* 14. Have you ever used respite care services?

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