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  5. Caregiver Questionnaire
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Exit Survey
 
 
Hello Caregivers,

Welcome to the CareMatch questionnaire #1!

This questionnaire is designed to allow you to input information regarding your caregiving experience and expectations in order to more effectively match you with someone seeking a caregiver in this area. Please answer all questions completely and honestly, keeping in mind that these answers will be viewed by potential clients.

Thank you for your time,
CareMatch
 
 
 
 
* For how many hours per week are you seeking employment?
 
5-10 hours
 
10-20 hours
 
20-30 hours
 
30-40 hours
 
 
 
* What is your hourly pay rate?
 
$10.00-$15.00
 
$15.00-$20.00
 
$20.00-$25.00
 
$25.00-$30.00
 
Other
 
 
 
 
* What is your level of education or certification?
 
Elder Pal
 
Personal Care Assistant
 
Home Care Assistant
 
Dementia and Alzheimer's Disease Training
 
Geriatric Home Caregiver
 
Other
 
 
 
 
* For how many weeks/months are you seeking employment?
 
4-8 weeks
 
8-12 weeks
 
3-6 months
 
PRN
 
As long as needed
 
Other
 
 
 
 
* How long have you worked in the caregiving field?
 
0-5 weeks
 
1-3 months
 
6-12 months
 
1-5 years
 
5+ years
 
 
How comfortable are you with:
Very Uncomfortable Uncomfortable Neutral Comfortable Very Comfortable
* helping the client get out of bed
* assisting the client in getting dressed
* assisting the client in using the restroom
* assisting the client in taking a bath/shower
* assisting the client in eating a meal
* preparing meals for the client
* shopping for the client
* doing light cleaning at the client’s place of residence
* driving the client to appointments
* helping care for the client’s hygiene
* taking the client to his/her place of worship
* being around a client’s family members
* going to a client’s home
* doing range of motion exercises with the client
* dispensing a client’s medications
 
 
 
* What job duties have you performed in the past:
   
 
 
 
* What job duties are you not able to perform/comfortable with performing:
   
 
 
 
* How do you react to constructive criticism?
   
 
 
 
* How do you feel about having to make choices that are consistent with the list of special diets, likes, dislikes, mobility problems, heath issues, danger signs to monitor, possilbe behavior problems, medication schedules, thereapeutic exercises, eye glasses /dentures/prosthetics care regimens, etc. that are provided? Please elaborate.