1)      Since you began giving care has your work situation:

a.       Gotten better

b.      Stayed the same

c.       Gotten worse

d.      No  Response

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2)      Due to your eldercare commitments have you had to change your work situation?

a.       Quit work

b.      Cut  back hours

c.       Unpaid leave

d.      Use vacation days

e.      Increase hours or added another job to pay for things

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3)      Would you say that being a caregiver

a.       Has had no effect on your working worries

b.      Has increased your level of working worries

c.       Has lessened your worries

d.      No response

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4)      Do you feel that since you have been a care giver your boss has

a.       Noticed a decrease in your work’s productive

b.      Noticed an increase in your productive

c.       Stayed the same

d.      No reply

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5)      Do you feel that since you have been a care giver your coworkers have

a.       Been very supportive and helpful

b.      Given you the “cold shoulder”

c.       No difference in their behavior

d.      No reply

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6)      What do you guess your out of pocket expenses to be for a typical month.

a.       Nothing

b.      $1-$20

c.       $21-$50

d.      $51-$75

e.      $75-$100

f.        More than $100

 

7)      Once at work do you have the ability to “forget about” the care giving and concentrate only on your work?

a.       Yes

b.      No

c.       Most of the time I can concentrate on work but sometimes I think about what will need to get done at home.

d.      No reply

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