Caregiver Self Assessment

Directions: Caregivers are often so busy caring for a loved one that they tend to neglect their own well-being. This checklist is intended to identify how well you are managing the stress in caring for a loved one. For each question below, mark the circle that most appropriately reflects how you are feeling. Add up the points to come up with a total score.

How often have you lately… Please Rate
1 = Never 3 = Sometimes 5 = Always
Had trouble staying focused on what I was doing?
Had difficulty making decisions?
Felt that I can't leave my relative alone?
Felt overwhelmed with managing multiple demands
(family, work, caregiving)?
Felt resentful?
Felt helpless?
Felt useless?
Felt lonely?
Felt weary or tired?
Felt numb or drained of any feeling?
Felt anxious?
Had a crying spell?
Been physically exhausted?
Been edgy or irritable?
Felt ill (headaches, stomach problems, back pain, or common cold)?
Lost or had poor sleep?
Either overeaten or had a poor appetite?
Been upset that my relative has changed so much from his/her former self.

Additional Questions

On a scale of 1 to 5, with 1 being "not stressful" to 5 being "extremely stressful," please rate your current level of stress.
On a scale of 1 to 5, with 1 being "very healthy" to 5 being "very ill," please rate your current health compared to what it was last year.

Total Score:

If your score is under 20, you are likely managing the multiple of caregiver demands well. If your score is 21 to 60, you may want to think about some of the suggestions listed below. If your score is over 60 or above, the stress of caregiving is starting to affect you. If your score is 80 or above, you are likely feeling burned out. Having a prolonged level of high stress can cause physical and emotional problems. But you are not alone. This is common and there are many things you can do to better manage your stress and improve your well-being and health.

Consider the following suggestions to improve how you cope with stress and improve your well-being:

  • Take care of your health. See your physician for a check-up. Try to improve your diet. Get enough sleep. Exercise.
  • Get some relief from your caregiving duties either from your family or community resources. Spouse, children, sibling, aunts, uncles and other family members, friends and neighbors all could help with household tasks, driving, managing the finances, and finding services you need. A geriatric care manager, home health aide, homemaker or other community volunteer could also help. Respite care allows you to take a break for a few hours, a day or even a weekend.
  • Seek support. Join a support group or talk with friends, family, or a therapist about how you feel.
  • Take time out for yourself. This includes socializing with friends, reading, meditating, listening to music, or walking - anything that helps you feel calm or more relaxed.
  • Give yourself a break. Prioritize what needs to get done but also set limits and learn to say "no" when asked to take on new tasks. Recognize and deal with negative feelings such as anger and guilt which may include confronting and resolving issues with relatives. Focus on all the good you do for yourself and your family.


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