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Caregivers
Profile questionnaire « Caregivers »
You have stated in the general profile questionnaire that you are a "caregiver" for a sick, disabled, dependent, or elderly person.
To better understand your role, we have a few questions to ask you.
Please consider every person you take care of within your household.
Do you provide care for anyone suffering from any of the following health and medical conditions?
Eye, ear, nose, and throat conditions
Painful conditions or diseases of the bones/joints/muscles
Allergies
Physical appearance issues (hair loss, aesthetics, etc.)
Cancer
Diabetes
Skin diseases
Heart/blood diseases
Digestive diseases
Immunological diseases
Neurological/brain diseases
Respiratory diseases
Weight problems
Women's health
Men's health
Mental and behavioural health
Sexual health
Learning and cognitive disorders (ADHD, ADD, etc.)
Sleep disorders
Post-traumatic disorder (loss of a limb, accident, war, surgery, etc.)
None of the above
I do not wish to answer
As a caregiver, do you know that there is an employee status available?
Yes, and I have obtained it
Yes, but I have not obtained it
No
Do you currently receive, or have you ever received any assistance related to your caregiver status?
Respite solutions (temporary housing during your vacations, home relief, etc.)
Caregiver leave (temporary leave from your professional activity)
Carer’s Allowance
Credit (Carer’s, Pension or Universal)
Legal protection for the cared-for person (guardianship, conservatorship…)
Training
Other assistance, specify
I do not receive (have not received) any assistance
What activities do you regularly perform as a caregiver for the person you assist?
Personal care (bathing, dressing…)
Helping the person move around within the home
Helping the person move outside the home
Managing administrative procedures
Managing the budget
Accompanying the person to a medical appointment
Doing grocery shopping
Preparing/helping with meals
Purchasing medication
Doing household chores
Providing companionship
Assisting with access to medical care
Managing vacations and leisure activities (bookings…)
Other, specify
Does the person you assist have an assistance tool that alerts you in case of a problem?
Alert bracelet/beeper
Surveillance cameras
GPS tracker
Other, specify
None of these tools
Do you have a professional occupation alongside your caregiving activities?
Yes
No
Do you think being a caregiver impacts your professional life?
Yes, significantly
Yes, somewhat
No, not really
No, not at all
Do you work:
Part-time
Full-time
Is your employer aware of your caregiver status?
Yes
No, because I haven’t thought about it
No, because I do not wish to share it
Which of the following best describes your situation?
The person I assist lives in their own home, and I travel to help them
The person I assist lives in a specialised facility, and I travel to help them
The person I assist lives in my home
Do you know other people who are also caregivers?
Yes, several
Yes, one person
No
Do you continue the leisure activities you had before becoming a caregiver?
Yes, all of them
Yes, some of them
No, I have stopped
I did not have any leisure activities
