If you answer yes to 3 or more questions it is likely time to consider additional support for your loved one.

 

1. Does a family visit involve an abundance of chores rather than meaningful family time?

Yes No

 

2. Are you worrying about your loved ones during work?

Yes No

 

3. Are you missing work to care for a loved one?

Yes No

 

4. Do you feel your family relationships are suffering due to the amount of caregiving you are providing?

Yes No

 

5. Have you taken a loved one to the Hospital Emergency Department within the past month?

Yes No

 

6. Are you worried about your loved one falling?

Yes No

 

7. Are you worried about your loved one being alone during the night?

Yes No

 

8. Are you receiving calls throughout the night from your loved one?

Yes No

 

9. Are you concerned that your loved one is not maintaining proper hygiene?

Yes No

 

10. Are you concerned that your loved one is not eating properly?

Yes No

 

11. Is your loved one having difficulty performing activities of daily living?

Yes No

 

12. Is your loved one unable to do shopping and errands on their own?

Yes No