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.

During the past week or so, I have...

Had trouble keeping my mind on what I was doing

Yes
No

Felt that I couldn't leave my relative alone

Yes
No

Had difficulty making decisions

Yes
No

Felt completely overwhelmed

Yes
No

Felt useful and needed

Yes
No

Felt lonely

Yes
No

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

Yes
No

Felt a loss of privacy and/or personal time

Yes
No

Been edgy or irritable

Yes
No

Had sleep disturbed because of caring for my relative

Yes
No

Had a crying spell(s)

Yes
No

Felt strained between work and family responsibilities

Yes
No

Had back pain

Yes
No

Felt ill (headaches, stomach problems or common cold)

Yes
No

Been satisfied with the support my family has given me

Yes
No

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

Yes
No

On a scale of 1 to 10, please rate your current level of stress

On a scale of 1 to 10, please rate your current health compared to what it was this time last year