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Caregiver Self-Assessment

Self-scoring quiz designed to help caregivers identify how well they are managing the stress of caring for a loved one. Make sure to count the number of "Yes" responses.

Do you provide care to a loved one more than 10 hours per week?
- Yes
- No
Are you finding it increasingly difficult to provide care due to other demands on your time?
- Yes
- No
Have you had to make significant changes in your life to provide care (i.e., reduce the number of hours working, moving to live with your loved one or vice versa)?
- Yes
- No
Do you have any health symptoms such as chronic conditions, difficulty sleeping, or anxiety or depression?
- Yes
- No
Do you feel uncertain about your caregiving role?
- Yes
- No
Do you find yourself angry or inpatient with your loved one more often than usual?
- Yes
- No
Do you often feel caregiving is too much of a burden?
- Yes
- No
Have you had to give up leisure activities as a result of your caregiving role?
- Yes
- No
Do you have other people who help in providing care to your loved one (i.e., spouse, sibling, friend, etc.)?
- Yes
- No
Besides caregiving, you probably have other responsibilities (i.e., housework, shopping, yard work). Do you have adequate support from other family members to meet all these demands?
- Yes
- No
Would you like a Resource & Service Navigator to contact you?
- Yes
- No
Name*
First Last
Email*
Phone*
Zip Code*

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Make sure to count the number of “Yes” responses on this page!

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1550 E. College Parkway

Carson City, NV 89706

nvcc@adsd.nv.gov

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