Memory & Movement Charlotte - Take Charge! Caregiver Survey
A generous grant from the Philip Van Every Foundation has provided us an exciting opportunity to expand Take Charge - an individualized and comprehensive education and support program to empower family and friends who walk alongside our Memory & Movement Charlotte patients. As we build this program, we are asking you, the family and friends of the care recipient, for critical insights by completing this short 5 minute survey.
*The term "care recipient" refers to the person who is a patient at MMC.
*"Care partner" is interchangeable with "caregiver", the support system for the care recipient.
*Answers will be anonymous.
*All program team members have signed a confidentiality agreement in compliance with HIPAA.
Thank you in advance for completing this survey and sharing your care partner experience with us!
What is your role with the care recipient?
I am the person primarily responsible for providing care and/or support to the care recipient.
I am not primarily responsible for the care and/or support but I am involved with the care recipient.
I am a supporting family member or friend but do not provide any care
What is your relationship to the care recipient?
How far does the care recipient live from you?
Resides in the same home
Are you set up with MMC to use the patient portal, the electronic messaging system?
Yes and I use it for communication with the office
Yes but I do not use it for communication with the office
No, but I would use it if I was instructed
I do not prefer to use the patient portal
From the following list, select ALL the diagnoses that have been given to the care recipient:
Age related memory loss
Mild Cognitive Impairment
Lewy body dementia
Other movement disorder
Other mood disorder
From the list below, select ALL answers that accurately complete this sentence: "I have a good understanding of..."
The care recipient's diagnosis
The current needs of the care recipient and how to meet those caregiving needs
What to expect in the future regarding the care recipient's needs
If and when to share the diagnosis with the care recipient
The medications the care recipient takes and why
How to obtain Powers of Attorney and a Living Will
Who can manage the needs of the care recipient if the primary care partner cannot do so for any reason, short or long term
How to manage the stress of being a care partner
None of the above
From the list below, select ALL the resources you have used:
Advice from a non-medical family member
Advice from a non-medical, non-family member
Adult day care
Staff at assisted living or memory care
In home unpaid caregiver other than the primary care partner
In-home professional caregiver
Caregiver support group
Memory & Movement Charlotte (MMC) website
Alzheimer's Association website or Parkinson's Association website
On-line internet search other than Alzheimer's Assoc., Parkinson's Assoc., or MMC
MMC's Caregiver Connection classes in person
MMC's Caregiver Connection classes by video
MMC Happy Hour
Books on caregiving
Magazine articles on caregiving
Professional counseling for the primary care partner
I have not used any of the above resources
From the list below, select ALL offerings of interest:
Support group for the care partner
Engagement program for the care partner and care recipient (art class, book review, music, walks, etc)
Engagement program for the care recipient (art class, book review, music, walks, etc)
Exercise classes for the care recipient
Social gatherings with the care partner and care recipient
Social gathering with other care partners
Social gatherings with other care partners and care recipients
Buddy program for the care partner with someone who is walking the same path currently
Mentoring program for the care partner with someone who has walked the same path
Volunteer activities as a group or available in the community
From the list below, select ALL format(s) for receiving care partner education that you prefer:
Verbal instructions from the clinical staff
Written materials provided at the conclusion of the appointment
Written materials sent to your email
Written materials sent through the portal
Videos accessed on the MMC website
Previously recorded videos sent to your email
Live video conferencing classes such as Zoom
In-person classes held during the day
In-person classes held during the evening
A hard cover binder for organizing medical information, caregiving responsibilities and educational materials
A personalized web page or computer app for organizing medical information and caregiving responsibilities
From the list below, select ALL preferred methods for MMC to relay information about caregiver education opportunities or activities in the community:
Mailing delivered to my home
Email from MMC
Social media posting such as Facebook and Twitter
Please share any thoughts you have about what would make you feel more empowered as a caregiver:
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