Nebraska BI Needs Assessment - Family Members & Unpaid Caregivers Survey

This survey is for family members and unpaid caregivers/support persons of individuals living with a brain injury in Nebraska. We would appreciate hearing about your experiences and opinions.

NOTE: This survey is meant to capture the experiences of family members and/or those who are serving as an unpaid caregiver for someone living with a brain injury. This does not include personal care attendants or other paid caregiving roles. Those individuals are encouraged to complete the service provider survey.

Question Title

* 1. Is the individual with a brain injury your:

Spouse/Partner

Parent

Sibling

Friend

Child (16 or older)

Child (under the age of 16)

Other (please specify):

Question Title

* 2. Where do you live in relation to the individual with the brain injury?

In the same residence

Less than 1 hour away

1+ hours away

Question Title

* 3. What caregiving role(s) do you serve for that individual? Select all that apply.

Unpaid caregiver

Legal guardian

Payee or conservator

Active Durable Power of Attorney

None – I do not provide formal care

Other (please specify):

6% of survey complete.