Rensselaer County Caregiver Survey
To better understand the needs of those who care for older adults, the Rensselaer County Department for the Aging is seeking your participation in the attached survey. The information shared with us will help guide our efforts to developing more programs and services specifically designed to better support you with the complex and daily challenges of caring for older parents, a spouse, relatives and others.

Your responses will be anonymous and confidential.

Thank you for your time and participation with this important survey!

If you have any questions, please contact Darcie Casey at 518-270-2786.
For whom do you provide care for? *
How often do you provide care? *
Do you live with the person you are taking care of? *
How long have you been a caregiver? *
How do you help the person in need? *
Required
Does your care recipient receive other services to assist with your caregiving? *
Required
Do you feel prepared to take on the role of caregiving? *
Please rate each statement: *
Concerned
Somewhat Concerned
Not Concerned
Finding trained and reliable home care providers:
Having enough money to pay for care
Balancing other family responsibilities
Ensuring the care recipient’s safety
Finding transportation
Talking with the care recipient’s Doctor
Planning for end of life care
Meeting my daily personal needs
Has caregiving caused you: *
Yes
No
Physical/Health changes
Financial strain
Emotional strain and/or stress
What community and/or in home services would you find helpful in assisting your role as a caregiver? *
Required
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