Have
you or any member of your family used long-term care
services within the last 5 years? Yes
No
Do
you believe your or a family member may need long-term
services in the next 5 years? Yes
No
Do
you currently have a family member who cannot remain
home alone because of concerns for their safety and
well being? Yes
No
Are
you this family member's primary caregiver? Yes
No
If
you are not this family member's primary caregiver,
do you assist the caregiver or give them "a break"? Yes
No
Have
you or the caregiver ever lost time on a job to handle
a crisis with your family member? Yes
No
Have
you or the caregiver ever passed up a promotion because
of your family member? Yes
No
Have
you or the caregiver ever had to change jobs because
of your family member? Yes
No
Would
the availability of Adult Day Care in Muskogee, OK,
be of benefit to you, your family member, or their caregiver? Yes
No
Please
tell us a little about the health care coverage your
family member has... Medicare, Medicaid, private insurance,
etc.
Is
there anything else you'd like to tell or ask us?
