Respite
is meant to prevent a crisis or any negative physical or emotional effects for the family caregiver and care recipient and is designed to ensure the well-being of not only the family caregiver, but also the family as a whole
Respite care
is short-term care option that provides temporary relief for caregivers of a child or adult with disabilities. Short term can be as short as a few hours or as long as overnight.
Are you a caregiver of a individual with a disability ?
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Yes
No
What is your relationship with the individual with a disability?
*
Please describe the disability.
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Does the individual with a disability currently receive Medicaid?
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Yes
No
In process
How many hours per week are you the primary caregiver for the individual ?
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Where do you live in central Louisiana?
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On a sale of 1-10. When 1 is no support and 10 is completely supported. How well supported are your emotional and personal needs as a caregiver of a person with a disability ?
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No support
1
2
3
4
5
6
7
8
9
Completely supported
10
1 is No support, 10 is Completely supported
On a sale of 1-10. When 1 is no support and 10 is completely supported. How well supportive are you of the use of respite care to increase caregiver overall wellbeing?
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No support
1
2
3
4
5
6
7
8
9
Completely supported
10
1 is No support, 10 is Completely supported
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Name
First Name
Last Name
Email
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No
Phone Number
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