Indicate your level of agreement with this Indicate your level of agreement with this statement: Our community provides an statement: Increasing the level of caregiving adequate level of caregiving coaching/care coaching/care consultation services for caregivers consultation services for caregivers of people of people with dementia should be a priority for with dementia. action in our community. 1. Strongly disagree 1. Strongly disagree 2. Disagree 2. Disagree 3. Neither agree or disagree 3. Neither agree or disagree 4. Agree 4. Agree 5. Strongly agree 5. Strongly 0. Do not know 0. Do not know Question 13 Do you currently offer any of the following respite programs or services? Are the respite options social in nature only or do they include medical care as well? Are they tailored to people with dementia? (Q14 in full assessment) Respite options for Currently Social or medical Tailored to dementia? caregivers available Describe how. ___ Yes ___ day programs ___ Yes No Emergency or crisis ___ Yes ___ ___ Yes respite No ___ Yes ___ Extended respite ___ Yes No ___ Yes ___ In home ___ Yes No Overnight, weekend ___ Yes ___ ___ Yes respite No ___ Yes ___ Other (please specify) ___ Yes No of Current Activity Priority for Action Indicate your level of agreement with this Indicate your level of agreement with this statement: Our community has an adequate statement: Increasing the level of respite programs level of respite programs or services for or services for caregivers of people with dementia caregivers of people with dementia. should be a priority for action in our community.
Indicate your level of agreement with this statement: Our community provides an adequate level of caregiving coaching/care consultation services for caregivers of people with dementia. Indicate your level of agreement with this statement: Increasing the level of caregiving coaching/care consultation services for caregivers of people with dementia should be a priority for action in our community. 1. Strongly disagree 2. Disagree 3. Neither agree or disagree 4. Agree 5. Strongly agree 0. Do not know 1. Strongly disagree 2. Disagree 3. Neither agree or disagree 4. Agree 5. Strongly 0. Do not know Question 13 Do you currently offer any of the following respite programs or services? Are the respite options social in nature only or do they include medical care as well? Are they tailored to people with dementia? (Q14 in full assessment) Respite options for caregivers Currently available Social or medical Tailored to dementia? Describe how. day programs ___ Yes ___ No ___ Yes Emergency or crisis respite ___ Yes ___ No ___ Yes Extended respite ___ Yes ___ No ___ Yes In home ___ Yes ___ No ___ Yes Overnight, weekend respite ___ Yes ___ No ___ Yes Other (please specify) ___ Yes ___ No ___ Yes of Current Activity Priority for Action Indicate your level of agreement with this statement: Our community has an adequate level of respite programs or services for caregivers of people with dementia. Indicate your level of agreement with this statement: Increasing the level of respite programs or services for caregivers of people with dementia should be a priority for action in our community.
P2%20R3%20questionnaire%20caregiver.docx