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

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1. Do you anticipate needing to provide care or assistance to an aging loved one in the next five years?(Required)

Yes

2. Are you currently caring for an aging loved one?(Required)

Yes

3. How old is your loved one(s)?(Required)

Please enter a number from 0 to 100.

4. What is his/her relationship to you?(Required)

5. About how many miles away from you does your loved one live?(Required)

6. On average, about how many hours do you spend each week caring for your aging loved one?(Required)

hours per week

7. Please check the tasks you assist with: (Check all that apply)

Shopping

Home maintenance

Transportation to appointments

Providing emotional support

Overseeing finances

Medication management

Making arrangements for care

Meal preparation

Bathing

Providing other hands on care

8. On average, about how much of your own funds do you spend per month on care-related expenses? (such as hiring outside help, transportation expenses, financial support, etc.) $(Required)

per month

9. Which of the following best describes your role as an elder caregiver:(Required)

I have been the only or the main person helping

I have shared the care equally with others

Others have been the main ones, with some help from me

10. Have you taken time off from work to care for your aging loved one?(Required)

Yes

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)

I use my vacation time

I am able to take paid time off work

I take unpaid time off

I can work from home

I am able to rearrange my schedule and make up time

I haven taken a leave of absence

I have taken time off under FMLA

12. How comfortable are you talking with your HR person at work about your responsibilities for your aging loved one? (select one)(Required)

Very comfortable

Somewhat comfortable

Uncomfortable

Very Uncomfortable

Other

EAP(Required)

I can contact EAP

Other

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?

Never

Seldom

Sometimes

Frequently

Most of the time

15. Because of your responsibilities, in the past year have you

a. Worked reduced hours

Yes

b. Worked a different shift from spouse/partner so that one adult is available

Yes

c. Quit a job

Yes

d. Chosen a job that gives you more flexibility

Yes

e. Refused to relocate

Yes

f. Refused or decided not to work towards a promotion

Yes

g. Refused or limited your travel

Yes

h. Had an aging loved one live with you to make it easier for you to help them

Yes

i. Participated in a support group

Yes

k. Other

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

15. Because of your responsibilities, in the past year have you

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

15. Because of your responsibilities, in the past year have you

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