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50+: Live Better, Longer

Caregiving Support Assessment

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Things to Consider

Select the numbered statement that best describes your situation for each item or issue. You can total your scores by adding the numbers of the items you choose to get a big picture of the situation. Lower scores indicate less manageable situations -- that is situations that require more support than the primary caregiver can provide. Higher scores indicate situations that may be more readily managed.

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For the care recipient and caregiver:

_____ (1) There are no community support services available

_____ (2) There are some community support services available such as transportation and meals

_____ (3) There is support ready and available to help with long-term care

For the care recipient and caregiver:

_____ (1) There are no informal support groups available

_____ (2) There are inadequate informal support groups

_____ (3) There are networks of informal support available through neighbors, family and

friends, or religious groups

The primary caregiver:

_____ (1) Does not "believe in" accepting help of any kind from anyone

_____ (2) Does not "believe in" accepting help from anyone outside the family

_____ (3) Is open to accepting help from others

The primary caregiver:

_____ (1) Is essentially cut off from participating in social or recreational activities

_____ (2) Is significantly restricted in participating in social or recreational activities

_____ (3) Is able to continue to participate in at least one important social or

recreational activity

The primary caregiver:

_____ (1) Will be isolated from previous activities and relationships with significant others

_____ (2) Will find relationships outside the home significantly restricted

_____ (3) Will find relationships with significant others can continue on a regular, if somewhat reduced, basis

The primary caregiver:

_____ (1) Will be essentially cut off from participation in valued religious activities

_____ (2) Will be significantly restricted from participation in valued religious activities

_____ (3) Will be able to maintain participation in valued religious activities

Scoring

Lower scores indicate less manageable situations -- situations requiring additional support beyond that given by the primary caregiver. Higher scores indicate situations that may be more readily managed.

Lowest possible rating score for this section: 6 **

** indicates a need for significant caregiver support

Highest possible rating score for this section: 18

Your total rating score for this section:

WebMD Medical Reference

Reviewed by Jennifer Robinson, MD on December 15, 2014

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