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Forward Free National Survey

Caregiver Survey Concerning Respite Care for Mobility-Impaired Veterans

Thank you for participating in our survey! It only takes 5 minutes.

As a caregiver, your input is vital and greatly appreciated. Information you provide will be used by Forward Free for respite care planning. No personal information will be retained, used, or shared.
Are you under age 60?
Do you live in an urban area?
Do you currently use respite care programs offered by private, commercial, or government agencies including the VA?
If yes, what agency and services do you use?
If VA, which facility does your care recipient use?
How often have you previously used such programs?
Have there been recent situations where you wanted respite care, but didn't get it?
If so, what was the main cause for wanting respite care?
What prevented you from getting it?
In your own words, describe the ideal respite care program if you could get it.
What skills or training would be helpful for you to have (or to have had earlier) to support you as a caregiver?
How does caregiving affect your own health and well-being, and what kind of support would you want?
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