Part I: physical burden |
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1 |
Personal care of the dependent (bathing, dressing, etc.) |
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- I don’t have to look after the personal care of my dependent. |
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- I only supervise the personal care of my dependent. |
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- I must lend a hand to help with the personal care of my dependent. |
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- I must assist in less than 50% of my dependent’s personal care. |
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- I must assist in more than 50% of my dependent’s personal care. |
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- I must do all my dependent’s personal care. |
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2 |
Household work of the dependent (housekeeping, helping oneself, etc.) |
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- I don’t have to do anything except my own household work. |
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- I only supervise when my dependent is doing some household work. |
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- I must lend a hand when my dependent is doing some household work. |
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- I must do less than 50% of my dependent’s household work. |
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- I must do more than 50% of my dependent’s household work. |
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- I must do all my dependent’s household work in addition to mine. |
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3 |
My personal health |
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- My health is by no means affected because of caregiving. |
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- I am worried about my health because of caregiving. |
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- I’m ok, but I feel physically exhausted because of caregiving. |
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- I feel I will soon become ill because of caregiving. |
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- I am ill, and I feel like I need support. |
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- I am ill, and I cannot continue caregiving. |
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Overall score for physical burden |
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Part II: psychological burden |
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4 |
Overall satisfaction of the care I provide |
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- I am extremely satisfied with the care I provide for my dependent. |
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- I think I am able to provide the basic care for my dependent. |
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- I think I need to improve with my caregiving. |
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- I feel that there is something wrong with the care I provide. |
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- I am not satisfied with the care I provide. |
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- I am fed up with this caregiving situation. |
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5 |
Concern about my dependent’s future |
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- My concern about my dependent’s future is not worrisome. |
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- I worry to a small degree about my dependent’s future. |
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- I am worried, but I believe everything will be alright soon. |
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- I am worried, and I believe this is going to take time. |
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- I am worried as there is only minimal improvement. |
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- I am extremely worried as there is no improvement. |
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6 |
Concern about my own future |
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- This caregiving situation will not affect my future in any way. |
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- I am slightly worried that the present situation may have some impact on my future. |
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- I am worried about the present situation, but I believe it will be alright soon. |
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- I am worried about the present situation and I believe this is going to take time. |
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- My future is getting spoiled as I am stuck with this caregiving situation. |
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- I have no future because of this caregiving situation. |
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Overall score for psychological burden |
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Part III: social burden |
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7 |
Relationships with other family members and friends |
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- My relationships are in no way affected. |
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- I think my relationships might get affected. |
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- My relationships have started to get affected. |
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- My relationships are affected to a small degree. |
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- My relationships are affected to a great degree. |
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- My relationships are suffering. |
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8 |
Social and leisure activities |
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- I can participate in all social and leisure activities. |
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- I must adjust, but can participate in all social and leisure activities. |
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- I can participate in most of the social and leisure activities. |
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- I can participate in a few of the social and leisure activities. |
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- I can rarely participate in social and leisure activities. |
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- I cannot participate in any social and leisure activities. |
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Overall score for social burden |
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Part IV: financial burden |
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7 |
Financial resources other than periodical income (savings, property, etc.) |
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- This caregiving situation will not affect my financial resources. |
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- I have started to spend wisely to protect my financial resources. |
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- My financial resources have started to deplete. |
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- Less than 50% of my financial resources have depleted. |
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- More than 50% of my financial resources have depleted. |
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- I am financially broken down. |
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8 |
Periodical income |
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- This caregiving situation will not affect my periodical income. |
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- I might have to avail of a leave of absence without pay. |
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- Sometimes I take a leave of absence without pay for a day or 2. |
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- I am frequently taking a leave of absence without pay for a day or 2. |
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- I have been on a leave of absence without pay for quite a long time now. |
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- I lost/quit my job because of the caregiving situation. |
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Overall score for financial burden |
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Overall care giver burden score |
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