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HomeMy WebLinkAbout2 Handout - CG Survey June 1 20221 NEED ASSESSMENT SURVEY: HAWAII’S CAREGIVERS Version 1.0 The Department of Health, Executive Office on Aging is requesting your assistance and participation in completing this survey. This survey will look at issues faced by you as a caregiver. The results of this survey will help with the development of programs, services, and the direction of the 2023-2027 Hawaii State Plan on Aging. Answers are strictly voluntary and anonymous. Note: A “Caregiver” is someone who regularly provides unpaid assistance to a person who would otherwise have difficulty on their own. 1. How many people have you helped or provided care to in the past 12 months? (Check all that apply) 1 Person 2 People 3 or More People Older Adult - Age 60 to 84 Older Adult - Age 85 and Older Persons with Disabilities – Age 18 to 59 Your Own Children – Under Age 18 Your Grandchildren – Under Age 18 Other people I provided care to in the last 12 months, please specify. CAREGIVER DEMOGRAPHICS 2. Where do you live? ____ City and County of Honolulu ____ Maui County ____ Hawaii County ____ Kauai County ____ Another State or Country. Please specify: _________________ 3. What City do you live in? __________________________ 4. What is your 5-digit Residence Zip code? ___________________ (If you use a P.O. Box, please indicate the zip code of the P.O. box.) 5. What is your Age? __________ 2 6. What is your Race/Ethnicity? (Check all that apply) ____ American Indian or Alaska Native ____ Hawaiian ____ Samoan ____ Black or African American ____ Hispanic or Latin ____ Tongan ____ Caucasian or White ____ Japanese ____ Vietnamese ____ Chinese ____ Korean ____ Prefer not to answer ____ Filipino ____ Marshallese Other Race, please specify ___________________________________________ 7. Is English your primary language? ____ Yes ____ No - Please specify your preferred language and dialect. For example: Filipino and Tagalog. _____________________________________ 8. What gender identity status do you identify with? ____ Male ____ Female ____ Transgender ____ Non-binary/gender nonconforming ____ Not listed above, please specify: ____________________________________ ____ Prefer not to answer 9. How many people live in your household (include yourself): ______ 10. Which of the following statements best describes your living situation? (Check all that apply): ____ I live alone ____ I live with my spouse ____ I live with other family members ____ I live with friends, roommates, etc. ____ I have pets in the home ____ I am currently homeless/houseless ____ Other, please specify: _____________________________________________ ____ Prefer not to answer 3 11. What is the highest level of formal education you have completed so far? ____ Elementary/Middle School ____ Some high school ____ High school graduate ____ Some college or technical training ____ College degree ____ Graduate school ____ Prefer not to answer YOUR ROLE AS A CAREGIVER 12. Does the person(s) you care for receive additional help from other people or an organization? ____ No ____ Yes. Please identify who else helps this person ____________________________ ____ Prefer not to answer 13. What help do you provide to the person(s) that you are caring for? (Check all that apply) Other, please specify _______________________________________________________________ 14. What are your greatest needs as a caregiver? (Check all that apply) ____ Additional in-home support, help providing care ____ Juggling work and caregiving ____ Caregiver support groups ____ Managing my own finances ____ Caregiver Training/Education ____ Transportation Assistance ____ Information and Assistance ____ Prefer not to answer Other, please specify ________________________________________________ ____ Help with household tasks ____ Help with accessing the internet ____ Manage their medical care ____ Help with bathing ____ Help with meal/food preparation ____ Provide financial support ____ Help with toileting ____ Help with yardwork ____ Provide transportation ____ Help with using the phone ____ Manage their medications ____ None of the above 4 15. In the last month, have you felt financially burdened by your caregiver responsibilities? ____ Always ____ Usually ____ Sometimes ____ Rarely ____ Never ____ Prefer not to answer 16. In the last month, have you felt stressed, overwhelmed, or tired by your caregiver responsibilities? ____ Always ____ Usually ____ Sometimes ____ Rarely ____ Never ____ Prefer not to answer 17. As a caregiver, which best describes your employment status? ____ Employed 20 or more hours a week ____ Employed less than 20 hours a week ____ Self employed ____ Unemployed ____ Retired ____ No longer working because of caregiving responsibilities ____ No longer working because of my health problems ____ Prefer not to answer INFORMATION AND SERVICES 18. How difficult is it to find information you need about available services and programs? ____ Very difficult ____ Somewhat difficult ____ Not difficult at all ____ Haven’t tried ____ Prefer not to answer 5 19. What are the best ways for you to get information about available services in your community? (Check all that apply) ____ TV ____ County Office on Aging/ADRC ____ Radio ____ State Executive Office on Aging ____ Newspaper ____ Doctor/healthcare provider ____ Internet ____ Newsletters or flyers in the mail ____ Friends/Family (word of mouth) ____ Senior or community center ____ Church/Social groups ____ None of the above ____ Communications with a State or local agency Other, please specify ________________________________________________________________ 20. How do you access the internet for information? (Check all that apply) ____I do not access the internet ____ I do not know how to access the internet ____I access the internet from my home computer, laptop, or tablet ____ I access the internet from my cell phone ____ I use a friend/family’s computer, laptop, tablet, and/or cell phone ____ I have other ways I access the internet, please specify ____________________ ______________________________________________________________ ____ None of the above YOUR COMMUNITY 21. How would you rate your community as a place to live for people as they age? ____ Excellent ____ Very good ____ Good ____ Fair ____ Poor ____ Prefer not to answer 6 22. Do you have ideas on how to make aging in your home or community better or easier? ___ No ___ Yes. Please share your ideas. __________________________________________ _______________________________________________________________ _______________________________________________________________ 23. Do you do volunteer work in your community? ___ No ___ Yes, describe the volunteer work that you do_________________________________ _________________________________________________________________ _________________________________________________________________ COVID-19 PANDEMIC & EMERGENCY PREPAREDNESS 24. What kinds of information do you need relating to COVID-19? (Check all that apply) ____ Prevention measures to avoid being infected with COVID-19 ____ The signs and symptoms of COVID-19 ____ What to do if I get infected ____ Where to test for COVID-19 ____ Where to go for vaccinations and boosters ____ Coping with long-term COVID-19 symptoms ____ Coping and living with COVID-19 within your community ____ Other COVID-19 information needed, please specify_________________________ ________________________________________________________________ ____ None of the above 25. Do you know where to go for COVID-19 information? ____ Yes ____ No ____ Prefer not to answer 7 26. Over the last two years, the COVID-19 pandemic has impacted your life and your daily activities. ____ Strongly disagree ____ Somewhat disagree ____ Neither agree nor disagree ____ Somewhat agree ____ Strongly agree ____ Prefer not to answer 27. During the COVID-19 pandemic (last two years), you felt isolated from family and friends. ____ Strongly disagree ____ Somewhat disagree ____ Neither agree nor disagree ____ Somewhat agree ____ Strongly agree ____ Prefer not to answer 28. In case of an emergency (earthquakes, flooding, no electricity, etc.), do you have a disaster plan in place for the people you care for? ____ No ____ Yes, please describe your plan: __________________________________________________________________________ __________________________________________________________________________ YOUR QUALITY OF LIFE 29. How do you rate your quality of life right now? ____ Excellent ____ Good ____ Fair ____ Poor ____ Other, please specify ________________________________________________ ____ Prefer not to answer 8 30. As a caregiver, what are your Top 3 life challenges. (Select a maximum of 3 life challenges) ____ Stress ____ My health conditions ___ Commuting to work ____ Keeping a positive attitude ____ Paying my bills ___ Caregiving responsibilities ____ Feeling lonely ____ Job security ___ Balancing work and caregiving ____ Lack of sleep ____ Affordable housing ___ Getting respite services ____ Lack of time for myself ____ Reliable transportation ___ Finding childcare Other life challenges, please specify _____________________________________________ ___________________________________________________________________________ 31. As a caregiver, what are the Top 3 things that make you happy in life. (Select a maximum of 3 things) ___ Socializing with friends/family ___ Surfing/Beach activities ___ Praying/Religious activities ___ Time for myself ___ Golfing ___ Cooking and/or baking ___ Playing with my pet(s) ___ Shopping ___ Sleeping as long as I want ___ Exercising ___ Listening to music ___ Having stable finances ___ Volunteering ___ Taking a vacation ___ Living in Hawaii Other things that make you happy, please specify _________________________________ _________________________________________________________________________ 32. Do you have any thoughts on aging and caregiving programs in the State of Hawaii (current programs or suggestions for development of new programs? ___ No ___ Yes, please share your thoughts _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Thank you for taking the time to complete this survey.