Caregiver Self-Assessment Questionnaire
How are YOU?
Caregivers are often so concerned with caring for their relative’s needs that they lose sight of their own well-being. Please take just a moment to answer the following questions.
During the past week or so, I have. . .
Interpretation of your score.
Chances are you are experiencing a HIGH degree of distress:
- If you answered “Yes” to either or both questions 4 and 11; or
- If your total “Yes” score = 10 or more;
- If your score on questions 17 and 18 – is 6 or higher.
Your stress level is in the moderate category:
- If you answered “Yes to either question 4 or 11; or
- If your total “Yes” score is between 5 and 10;
- If you answered “Yes” to either questions 17 or 18.
Next Steps:
Ø Consider a medical checkup.
Ø Seek respite care from community resources.
Ø Ask a family member to give you a break.
Ø Call your local faith community for possible assistance.
Ø Contact Butler Counseling & Consulting and The Guardians Gift for help to reduce your stress level. You don’t have to do this alone.