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You may not know where to start when it comes to caring for your elderly or disabled loved one. Our two-Minute Caregiver Assessment will help you determine your stress and capacity level as a caring individual. Once submitted, you will be provided with immediate feedback and a suggested strategy as to where you might start to decrease your stress and improve your capacity as a caregiver. Please answer each of the 14 questions honestly keeping in mind that there are no right or wrong answers. Your answers are completely confidential and your information will not be shared. Thank You!
Two-Minute Caregiver Assessment Senior Care Giver logo
  • Please answer all questions below.
  • After completion, your results will be calculated and displayed for you.
  • Your information is confidential and will not be sold or shared with anyone.

* all survey fields are required

Caregiver Information
E-mail Address:* 
State:* 
Working and Caregiving
1. Are you currently working full or part time in addition to caregiving?

Full time
Part time
Not applicable
2. Caregiving takes time out of my workday?

Yes
Somewhat
Not at all
Medication Management
1. I assist my loved one with managing his/her medications.

Yes
Sometimes
Not at all
2. I understand what my loved one's medications are for, their possible side effects, and how they may interact with one another.

Yes
Somewhat
Not at all
Depression
1. I have feelings of loneliness?

Yes
Sometimes
Not at all
2. I wake up worrying about caregiving in the middle of the night.

Yes
Sometimes
Not at all
Smaller Tasks
1. I feel disorganized and could use assistance in organizing the care of my loved one.

Yes
Sometimes
Not at all
2. When I ask for help from family and/or friends I generally receive the help.

Yes
Sometimes
Not at all
Stress
1. I have emotional or physical health problems?

Yes
Sometimes
Not at all
2. Do you have frequent nights where you are not able to sleep through the night?

Yes
Sometimes
Not at all
Outsourcing
1. I am familiar with programs and/or services that may help me with caregiving?

Yes
Somewhat
Not at all
2. I have a plan in place for the future care of my loved one.

Yes
Somewhat
Not at all
Preplanning
1. I have a plan in place in case there is a sudden loss of my loved one.

Yes
Somewhat
Not at all
2. I know where to locate the necessary emergency paperwork in the case of an emergency.

Yes
Somewhat
Not at all

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