Select an individual topic for your table:
Caregiver
Screening questions about help given to care recipient
Need Help With Dress/Eat/Bathe (CGACTI01)
Need Help With Taking Medicine/Bandages (CGACTI02)
Need Help Keeping Track Of Bills/Checks (CGACTI03)
Need Help Preparing Meals/Laundry (CGACTI04)
Need Help By Taking Shopping/Doctor (CGACTI05)
Need Help To Coordinate Care/Services (CGACTI06)
What Is Your Relationship To Participant (CGREL)
NFCSP - Respite care
Number Hrs/Wk Respite Care Usually Received (CGHRWK)
In-Home Respite Care (CGRSP01)
Adult Daycare Services (CGRSP02)
Overnight Respite Care (CGRSP03)
Has Recipient Received Respite Care (CGRSPT)
NFCSP - Help or information given
Someone Help Caregiver Get Info On Services/Resources (CGINFO)
NFCSP - Training and education
Caregiver Education/Training (CGEDKD01)
Counseling To Assist W/Caregiver Situations (CGEDKD02)
Caregiver Support Groups (CGEDKD03)
Caregiver Get Training To Help Make Decisions (CGEDU)
NFCSP Provide - Home Modifications (CGSUPA)
NFCSP Provide - Nutritional Supplements (CGSUPB)
NFCSP Provide - Assistive Devices (CGSUPC)
NFCSP Provide - Emergency Response System (CGSUPD)
NFCSP Provide - Specialized Equipment (CGSUPE)
NFCSP Provide - Money Or Stipend (CGSUPF)
Result of Services Received
Because Of Caregiver Services-More Time-Personal Activities (CGAFECA)
Because Of Caregiver Services-Feel Less Stress (CGAFECB)
Because Of Caregiver Services-Easier To Care For (CGAFECC)
Because Of Caregiver Services-Know How Get Services (CGAFECD)
Because Of Caregiver Services-Know More About Condition (CGAFECE)
Because Of Caregiver Services-Care Recipient Benefits (CGAFECF)
Received Services Provide Care For Long Time (CGCARLG)
Difficult to Get Services From Agency (CGDIFF)
Where Hear Of National Family Caregiver Support (CGHEAR)
Have Caregiver Services Help Be Better Caregiver (CGHELP)
Which Service Was The Most Helpful (CGMSTHLP)
Rate Caregiver Support Services (CGRATE)
Rating of Caregiver Services Good to Excellent (CGRATE2)
Do you have any recommendations to improve the caregiver support service? (CGRECMND)
Would you recommend the caregiving support services to a friend? (CGREMND)
Overall, do you feel like you have enough support? (CGSUPP)
Questions about the caregiver employment
Did the caregiver support services help you deal with these work difficulties? (CAREHLP)
Are you currently employed? (CAREMP)
As a result of caregiving-related changes in your employment or expenses, have you had to dip into your savings? (CGFINCLA)
As a result of caregiving-related changes in your employment or expenses, have you had to take out a loan or increase your level of credit card debt? (CGFINCLB)
As a result of caregiving-related changes in your employment or expenses, have you had to cut back on your own spending for vacations or travel? (CGFINCLC)
As a result of caregiving-related changes in your employment or expenses, have you had to cut back on your own spending for hobbies, going out to eat, movies, or other leisure activities? (CGFINCLD)
As a result of caregiving-related changes in your employment or expenses, have you had to cut down on your own spending for groceries? (CGFINCLE)
As a result of caregiving-related changes in your employment or expenses, have you had to cut back on your own spending on health care or dental care? (CGFINCLF)
As a result of caregiving-related changes in your employment or expenses, have you had to cut back on your own spending for basic home maintenance? (CGFINCLG)
As a result of caregiving-related changes in your employment or expenses, have you had to cut back on your own spending for necessities you have not already mentioned, such as clothing, transportation, or home utilities? (CGFINCLH)
As a result of caregiving-related changes in your employment or expenses, have you had to quit your job? (CGFINCLI)
As a result of caregiving-related changes in your employment or expenses, have you had to make any other changes? (CGFINCLJ)
Has providing care for the care recipient interfered with your job? (CGINTER)
How Often Care Interfered With Job (CGINTJB)
Providing Care Interfered With Job (CGINTRFR)
Caregiver Responsibilities Cause - Quit/Retire (CGQUIT)
Caregiver Support Services Helped Deal W/Work Difficulty (CGSRVHLP)
Current Employment Status (CGWORK)
Because of providing care for the care recipient, did you take a less demanding job? (CRPROBA)
Because of providing care for the care recipient, did you change from full time to part-time/reduced official working hours? (CRPROBB)
Because of providing care for the care recipient, did you lose some of your employment fringe benefits? (CRPROBC)
Because of providing care for the care recipient, did you have time conflicts between working and caregiving? (CRPROBD)
Because of providing care for the care recipient, did you use your vacation time to provide care? (CRPROBE)
Because of providing care for the care recipient, did you take a leave of absence to provide care? (CRPROBF)
Because of providing care for the care recipient, did you lose a promotion? (CRPROBG)
Because of providing care for the care recipient, did you work less than your normal number of hours last month? (CRPROBH)
Has providing care for the care recipient interfered with your job in any other way? (CRPROBI)
Questions about experiences as a caregiver
Have you attended counseling to assist with your specific caregiving situation? (ATTNDCON)
Have you attended caregiver support groups? (ATTNDSUP)
Have you attended caregiver education or training such as classroom or on-line courses? (ATTNDTRN)
How often does being a caregiver provide you with a sense of accomplishment? (CGACOMP)
Regarding your present social activities, do you feel that you are doing about enough, too much, or would like to be doing more? (CGACT)
What prompted you to contact [AGENCY NAME]? (CGAGNAME)
How true is the statement for you: it is easy for you to stick to your aims and accomplish your goals. (CGAIMS)
Did Caregiver Support Services Help Deal W/Difficulty From Caregiving (CGALLEV)
How true is the statement for you: when you are confronted with a problem you can usually find several solutions. (CGCONFRNT)
Please think about all of the health care professionals or service providers who give care or treatment to the care recipient. How easy or difficult is it for you to coordinate care between those providers? (CGCOORD)
Biggest difficulty faced in caring? (CGDIF)
Have Physical Condition Or Problem (CGDISAB)
In the past 12 months, have you been to see a doctor? Do not include going to the hospital emergency department. (CGDOCTOR)
As a caregiver, how often do you feel you are fulfilling your duty by caring for the care recipient? (CGDUTY)
How true is the statement for you: you are confident that you could deal efficiently with unexpected events. (CGEFF)
How Emotionally Stressful Is Caring? (CGEMSTRS)
In the past 12 months, have you been to a hospital emergency department? (CGER)
In the past 12 months, how many times did you go to a hospital emergency department? (CGERNUMB)
How often does caregiving prevent you from having enough time for your family? (CGFAMILY)
How much of the time during the past four weeks have you felt calm and peaceful? (CGFEELA)
How much of the time during the past four weeks have you had a lot of energy? (CGFEELB)
How much of the time during the past four weeks have you felt downhearted and depressed? (CGFEELC)
How true is the statement for you: you can usually handle whatever comes your way. (CGHANDL)
How Much Overall Hardship is Caring? (CGHDSHP)
Caregiver's Health (CGHEALTH)
Caregiving Created Health Problems (CGHLTH)
In the past 12 months did you have to stay overnight in a hospital? (CGHOSP)
How many times were you hospitalized for one night or longer? (CGHOSPN)
How many total nights did you spend in the hospital? (CGHOSPNN)
How long have you been receiving caregiver support services? (CGHOWLNG)
How often does being a caregiver for the person you care for give you the joy of spending time with someone you care about? (CGJOY)
If the care recipient needed a greater amount of care, would you be able to increase your caregiving responsibilities? (CGMORE)
Have your social opportunities increased since you became involved with [PROVIDER AGENCY NAME] services? (CGOPPINC)
In the last year, have you paid for care recipient's medications or medical care? (CGPAIDA)
In the last year, have you paid for care recipient's insurance premiums or copayments? (CGPAIDB)
In the last year, have you paid for care recipient's mobility devices, such as walkers, canes, or wheelchairs? (CGPAIDC)
In the last year, have you paid for features that have made the care recipient's home safer? (CGPAIDD)
In the last year, have you paid for any other assistive devices that make it easier or safer for the care recipient to do activities or do them on his/her own? (CGPAIDE)
In the last year, have you paid for anything else for the care recipient? (CGPAIDF)
In the past month, have you been bothered by pain? (CGPAIN)
How Much Physical Strain Is Caring? (CGPSTRN)
In the past 12 months, did you have to stay overnight in a nursing home or rehabilitation center? (CGREHAB)
In the past 12 month, how many times have you stayed in a nursing home or lived in a rehabilitation center? (CGREHABN)
How true is the statement for you: you can remain calm when facing difficulties because you can rely on your coping abilities. (CGRELY)
How true is the statement for you: thanks to your resourcefulness, you know how to handle unforeseen situations. (CGRESORC)
How much satisfaction do you gain from performing your care tasks? (CGSATISA)
How often does caregiving conflict with your social life? (CGSOCIAL)
How true is the statement for you: you can always manage to solve difficult problems if you try hard enough. (CGSOLV)
How true is the statement for you: you can solve most problems if you invest the necessary effort. (CGSOLVE)
How true is the statement for you: if you are in trouble, you can usually think of a solution. (CGTRBL)
In the past 12 months, have you been to an urgent care center? Do not include going to the hospital or to the hospital emergency department. (CGURGNT)
How true is the statement for you: if someone opposes you, you can find the means and ways to get what you want. (CGWANT)
How often do you feel that the person you care for appreciates the care that you are providing to him/her? (CRAPREC)
In the last year, have you found financial help for the care recipient including helping him/her apply for Medicaid? (HELPFIN)
Do you know where to go to ask for respite care, which allows you a brief period of rest or relief while temporary care is provided to the care recipient either in your home or his/her home or someplace else? (KNOWRSPT)
Do you have a need for counseling to assist with your specific caregiving situation? (NEEDCON)
Do you have a need for caregiver education or training, such as classroom or on-line courses? (NEEDEDU)
Do you have a need for attending caregiver support groups? (NEEDSUP)
In the last month, have you fallen down? (NHATSHC14)
In the last month, did you worry about falling down? (NHATSHC15)
In the last month, did this worry ever limit your activities? (NHATSHC16)
In the last 12 months, have you fallen down? (NHATSHC17)
In the last 12 months, have you fallen down more than one time? (NHATSHC18)
How often do you feel alone? Is it hardly ever, some of the time, or often? (SIHRS1)
First, how often do you feel that you lack companionship? Hardly ever, some of the time, or often? (SIUCLA1)
How often do you feel left out: Hardly ever, some of the time, or often? (SIUCLA2)
How often do you feel isolated from others? Hardly ever, some of the time, or often? (SIUCLA3)
Questions about the care recipient
Does Recipient Live Alone (CGALONE)
Are you responsible for providing help or supervision to the care recipient on a 24-hour basis? (CGBASIS)
How Long Have You Been Caring (CGHLONG)
Number Hours Help Each Day Care Recipient Needs (CGHRS)
Number Hours Help Each Week care Recipient Need (CGHRS7)
Number Hours You Care on the Weekend (CGHRSWD2)
Number Hours You Care per Week (CGHRSWK5)
Hours Help Caregiver Provides per Week (CGHRSWK7)
On a scale from 1 to 5 where 1 is not very intense and 5 is very intense, how intense is the care you provide? (CGINSTY)
Can Recipient Be Left Alone For A Day (CGLFTLN)
How Far Away Live From Care Recipient (CGMINUT)
In the past six months, have you ever considered a nursing home, boarding home, or assisted living for the care recipient? (CGNH)
In the past six months, have you felt that the care recipient would be better off in a nursing home, boarding home, or assisted living facility? (CGNHBTR)
In the past six months, have you taken any steps toward placement? (CGNHSTPS)
Thinking about all the family members or friends who provide help, care, or supervision for the care recipient, what proportion of the care do you provide during a typical week? (CGPORT)
In the past six months, have you discussed the possibility of a nursing home, boarding home, or assisted living with family members or others excluding the care recipient? (NHCRDIS)
In the past six months have you discussed that possibility with the care recipient? (NHDISCR)
How Often Does Caregiver Visit Care Recipient? (VISTIMES)
Does care recipient receive help from other places?
Who Provides Most Of The Care (CGCARE)
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