Caregiver Self Assessment

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. Once you have answered the questions, click the Submit button to see your results.

  1. During the past week or so, I have…
  2. Had trouble keeping my mind on what I was doing

  3. Felt that I couldn't leave my relative alone

  4. Had difficulty making decisions

  5. Felt completely overwhelmed

  6. Felt useful and needed

  7. Felt lonely

  8. Been upset that my relative has changed so much from his/her former self

  9. Felt a loss of privacy and/or personal time

  10. Been edgy or irritable

  11. Had sleep disturbed because of caring for my relative

  12. Had a crying spell(s)

  13. Felt strained between work and family responsibilities

  14. Had back pain

  15. Felt ill (headaches, stomach problems or common cold)

  16. Been satisfied with the support my family has given me

  17. Found my relative's living situation to be inconvenient or a barrier to care

  18. (required)
  19. (required)

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