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Caregiver Self Assessment

 

Self Help Tools

 

Caregivers often do not consider their own needs when taking care of someone ill, which can have consequences for you, the caregiver, and may increase risk to your well-being. This is perfectly normal. The questions below are designed to help you identify your level of risk. Considering your current situation, look at the following statements and indicate whether you agree or disagree.

There are no good or bad responses. Answering as honestly as you can will help in understanding how caregiving may be affecting you. After completing the questions, total your score to find your category of risk. This is not meant to be a diagnostic tool.

Your local Office on Aging is available to discuss services or supports that may be available in your community to assist you. It can be reached by calling NJ EASE toll free at 1-877-222-3737.

    Totally disagree Somewhat disagree Somewhat agree Totally agree
1. Caring for my relative has negative effects on my physical health.
2. I am not coping well with my present situation.
3. I am more cut off from my regular activities than before.
4. Taking care of my relative has put a strain on my family relationships.
5. I will not be able to continue caring for my relative much longer.
6. Taking care of my relative has put a strain on my relationship with him/her.
7. I feel that meeting the needs of my relative is no longer worth the effort.
8. I don’t have a minute’s break from caregiving.
9. I do more than my share of caring compared to family members or my other supports.
10. I feel depressed.
11. I feel I am losing control over my life because of my present situation.
12. In the past few months, I have increased my intake of alcohol, drugs or cigarettes.

Adapted with permission by Guberman, Keefe, Fancey, Nahmiash & Barylak.
Further use or copying of this tool is only available through the written permission from the authors.


Department of Health and Senior Services

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Phone: (609) 292-7837
Toll-free in NJ: 1-800-367-6543
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