Caregiver Survival Questionnaire

DIRECTIONS:    Read the statements & place a check for each “yes” .    Add the total of your YES answers.  Your total could be as small as 0, or as large as 20.

1. As a caregiver, do you ever wake up in the morning & wish you had not?                  _____  
2. Are you afraid to admit you are beginning to dislike the person you care for?            _____  
3. Sometimes do you get the urge to run away & never come back?                                 _____  
4. Do you think about getting sick (injured) so you would be hospitalized for rest?      _____  
5. Do you often have trouble going to sleep at night?                                                         _____  
6. Do you sometimes drink too much alcohol  out of sheer frustration?                            _____
7. Do you sometimes yell at the person you are caring for?                                                 _____
8. Do you think the person you care for may be taking advantage of you?                      _____  
9. Do you think the person you care for has become indifferent to  your comfort?         _____  
10. Have your friends disappeared since you have become a caregiver?                          _____  
11. Is the care recipient occassionally jealous when you do something recreational?     _____  
12. Have you realized you no longer have much to talk about with the your charge?     _____  
13. Have your children &/or other relatives stopped visiting your home?                        _____

14. Are you eating too much, or too little?                                                                              _____

15.  Do you have a lot more headaches or other physical discomforts?                            _____  
16.  Do you have fantasies about finding someone else to spend time with?                   _____  
17.  Do you find yourself depressed or in a bad mood these days?                                   _____  
18.  Have you begun to neglect your your personal hygiene lately?                                 _____  
19.  Do you find yourself driving more carelessly than before you

       became a full-time caregiver?                                                                                             _____

20.  Has caregiving diminsihed your sexual realtionship?                                                   _____

21.  Do you feel stuck because of a promise or wedding vow?                                          _____

22.  When you feel burned out, you feel guilty?                                                                  _