Answer the following questions as honestly as possible in order to receive the most accurate assessment of your caregiver burden
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| | OPTIONS |
| 1. Do you feel that your loved one asks for more help than they need? |
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| 2. Do you feel that, because of the time you spend with your loved one, you don’t have enough time for yourself? |
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| 3. Do you feel stressed between caring for your loved one and trying to meet other responsibilities for your family or work? |
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| 4. Do you feel embarrassed about your loved one’s behavior? |
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| 5. Do you feel angry when you are around your loved one? |
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| 6. Do you feel that your loved one affects your relationships with other family members or friends in a negative way? |
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| 7. Are you afraid of what the future holds for your loved one? |
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| 8. Do you feel your loved one is dependent on you? |
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| 9. Do you feel strained when you are around your loved one? |
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| 10. Do you feel your health has suffered because of your involvement with your loved one? |
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| 11. Do you feel that you don’t have as much privacy as you would like because of your loved one? |
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| 12. Do you feel that your social life has suffered because you are caring for your loved one? |
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| 13. Do you feel uncomfortable about having friends to your home because of your loved one? |
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| 14. Do you feel that your loved one seems to expect you to take care of them as if you were the only one they could depend on? |
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| 15. Do you feel that you do not have enough money to take care of your loved one in addition to your other expenses? |
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| 16. Do you feel that you will be unable to take care of your relative much longer? |
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| 17. Do you feel you have lost control of your life since your relative became ill? |
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| 18. Do you wish you could leave the care of your loved one to someone else? |
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| 19. Do you feel uncertain about what to do about your loved one? |
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| 20. Do you feel you should be doing more for your loved one? |
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| 21. Do you feel that you could do a better job of caring for your loved one? |
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| 22. Overall, how burdened do you feel in caring for your loved one? |
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