- Currently providing
- Not currently providing —-> (Go to
Q{number} <how-worried>)
[For respondents who answered "1. Currently providing" in Q1]
Who is the person (or who are the people) for whom you provide nursing care? If you provide nursing care to multiple people, please answer for those who are closest to you (up to three people).
Relationship (Choose code from the table below) |
Residence (Choose code from the table below) |
Are you the main care giver? |
|
|---|---|---|---|
| Person 1 | 1.Yes 2.No |
||
| Person 2 | 1.Yes 2.No |
||
| Person3 | 1.Yes 2.No |
| Relationship | Residence |
|---|---|
01 Father 02 Mother 03 Grandfather/grandmother 04 Spouse 05 Sibling 06 Child 07 Spouse's father 08 Spouse's mother 09 Spouse's sibling 10 Spouse's grandfather/grandmother 11 Other (please specify: _______________ ) |
21 Lives with me 22 Lives alone elsewhere 23 Lives elsewhere with his/her spouse 24 Lives elsewhere with family member(s) or relative(s) 25 Lives at a care facility or hospital 26 Other |
[For respondents who answered "1. Currently providing" in Q1]
__ __ __ hours per week
[For respondents who answered "1. Currently providing" in Q1]
- No burden at all
- Some burden
- A level of burden that others would normally feel
- Considerable burden
- Very substantial burden
[For all respondents]
How worried are you about care that you will provide to your family member(s) and/or relative(s) in the future?
- Very worried
- Worried
- A little worried
- Not worried
- Don't know