The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Required format:

2bId2kIoE3aV7TDDmaPhTbpiAhfCy3mJra49NVtMRDhbvWZEGHGDyPTcQ9W329mYihLxBoqMiI8DmLvN3QwTw3fwcDaHnHge5GT4ebm9

Caregiver Questionnaire Survey

Returning?

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Thank you for volunteering to participate in this short interview about your important experiences with caregiving. The Department of Gerontology at Virginia Commonwealth University in partnership with Gerontecture, LLC, the Riverside Center for Excellence in Aging and Lifelong Health, and Lift Caregiving, is conducting a study about the aging experience of caregiving.

Caregiving means that in the past 12 months, you have provided unpaid care to a relative or friend 18 years of age or older to help them support and take care of themselves. This care may include help with personal needs, household chores, or transportation. It might also be managing a person's finances, arranging for services, or visiting regularly to see how they are doing. This person need not live with you.

There are no known risks if you decide to participate in this research study. There are no costs to you for participating in this study. The interview will take about 20 minutes to complete. No one will be able to identify you or your answers, and no one will know whether or not you participated in the study. Should the data be published, no individual information will be disclosed.

You may choose to end this interview at any time, and may refuse to answer any question during the interview.

I fully understand the purpose of this study and I verbally consent to participate. I understand that my participation is voluntary.

What is your age?

What is your gender?

In the last 12 months, have you provided unpaid help to a relative or friend who is 18 years or older or are doing so currently?

* must provide value

How many years ago did you begin providing unpaid care to help a relative or friend who is 18 years or older?

What is the person's relationship to you?

If other, please describe:

How old is the person you provide care for?

Does the person you provide care for live...

If not living in your home, how often do you visit the person you provide care for?

How many hours per day do you spend with the person you care for including time when running errands for this person such as trips to the doctor, grocery store, picking up perscriptions, or any other related time?

Have you provided unpaid help to more than one relative or friend over the last 12 months?

Regarding yourself, are you currently (check the one that is MOST applicable):

If other, please describe:

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In your experience as both an employee and a caregiver, did you ever:

Have to go in late, leave early or take time off during the day to provide care?

Have to take leave of absence?

Have to go from working full time to part time?

Have to take a less demanding job?

Have to turn down a promotion?

Lose any of your job benefits?

Have to give up work entirely?

Choose early retirement?

How much of your money would you estimate you spend in a typical month for groceries, medicines, or other kinds of financial support for the person you care for? RECORD IN NEAREST DOLLAR VALUE.

Do you find that you have less time for friends or other family members than before you began caregiving?

Do you find you have to give up or take fewer vacations, hobbies or your own social activities than before you began caregiving?

Do you find you get less excercise than before caregiving?

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Physical Strain (e.g., lifting, transferring, etc.)

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Stress (emotional)

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Financial Hardship

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Do you feel you had a choice in being the care provider for this individual? In other words, did you make a conscious decision to provide this care?

Do you recall how you became involved as this individual's caregiver? In other words, was there a particular situation that led to your involvement or did it happen gradually over time?

Yes, there was a situation. Please describe:

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Yes, this happened over time. Please describe:

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Before you began caregiving, would you describe your health as...

How would you say taking care of this individual has affected your health?

In terms of caregiving experience, do you consider yourself to be a...

What was most important to you in the first year of caregiving? Please describe as much detail as you are able.

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Please describe how things are different for you now as a caregiver from when you first started caregiving (e.g., family life, work life, decision making, etc.).

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As an experienced caregiver, what do you find most helpful?

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Imagine that your best friend just discovered one of their family members will require around the clock care at home. What would you share as the three most important things that your friend should do as a new care provider?

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Have you ever attended a caregiver support group?

If yes, for how long?

Was the support group helpful?

If yes, please explain in what way it helped.

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Have you used other resources (e.g., website, particular agency, books, professionals, family or friends) to help you with caregiving?

If yes, please explain and identify.

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If your employer provided an onsite monthly support group for anyone interested in caregiving as a resource for information and venue to know that you're not alone as a caregiver, would you attend?

If yes, please share any additional thoughts.

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Thank you for taking the time to complete this information.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.