Cona Elder Law

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Cona Elder Law’s Elder Care Employee Benefit Working Caregiver survey

Name(Required)
1. Do you anticipate needing to provide care or assistance to an aging loved one in the next five years?(Required)
2. Are you currently caring for an aging loved one?(Required)
Please enter a number from 0 to 100.
0 of 20 max characters
hours per week
7. Please check the tasks you assist with: (Check all that apply)
per month
9. Which of the following best describes your role as an elder caregiver:(Required)
10. Have you taken time off from work to care for your aging loved one?(Required)
11. Please check the response that best describes your situation when you need to take time off work to assist an aging loved one. (You may select more than one)(Required)
12. How comfortable are you talking with your HR person at work about your responsibilities for your aging loved one? (select one)(Required)
I can contact EAP
13. Because of your care giving responsibilities, in the past month how many times have you had to, or chosen to:(Required)
a. Miss a day’s work
b. Arrive late at work
c. Leave work early
d. Spend time at work on the phone
 
14. How often have you worked less effectively in the past month because you were concerned or preoccupied?
15. Because of your responsibilities, in the past year have you
a. Worked reduced hours
b. Worked a different shift from spouse/partner so that one adult is available
c. Quit a job
d. Chosen a job that gives you more flexibility
e. Refused to relocate
f. Refused or decided not to work towards a promotion
g. Refused or limited your travel
h. Had an aging loved one live with you to make it easier for you to help them
i. Participated in a support group

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