About 5 — Kathelene’s Compassionate Adult Day Care

My Caregiver Journey

Kathelene’s Adult Day Care

Caregiver's Name

First Name

Last Name

Phone

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Caregiver's Age

Relation To Your Loved One

Caregiver's Occupation

Your Loved One's Name

First Name

Last Name

Your Loved One's Age

Your Loved One's Former Occupation

Your City & State

Your loved one’s Diagnosis

Did you have your Estate Planning ( i.e. Living Will, Trust, Funeral Arrangements, Power of Attorney) in place prior to your love one’s diagnosis? If so, what did you put in place?

What years were/are you a caregiver from __ to __.:

Is Your Loved One A Veteran?

Yes

If so, What Branch Of Service?

Did you or your loved one save for their long term care (Long Term Care Insurance, Disability Insurance, any other savings to cover aides, adult day care etc)? If so, list:

Was your monthly social security enough to help you manage your love one’s care? If no, explain:

Did they attend Kathelene’s Adult Day Care:?

Yes

Did Medicare, Medicaid or your health insurance help with respite care? If no, explain:

15. Were you expecting to be a caregiver?

Yes

Were you trained to be a caregiver?

Yes

If you were trained to be a caregiver, who trained you?

What are/were 3 of your biggest problems as a caregiver?

Out of the 3 biggest challenges how did you manage or solve those problems (explain)

Who is/was your support system? Explain

Did you use any services to help you manage your care giving role (home care/private duty, respite care, adult day care

Share with us 2 funny stories about your love one who was diagnosed with some type of dementia or memory loss. What did they do and how did you manage them?

Tell us about your love ones behavior issues and how did you adjust:

If you had to take the keys to the car how did you do it?

If you had to take over the finances how did you do it? Explain

What was your outlet? How did you take a break?

Please be detailed as possible. What advice would you give to another caregiver?

If your love one made their transition what helped you with the grieving process? What advice would you share with a grieving caregiver?

Permission

I ____________ give permission for Teberah Alexander (Nurse T) and Kathelene’s Adult Day Care to use my information above and my photo to educate, support and inspire other caregivers. This information can be published, used for research, on social media and in marketing material. I understand I am not receiving any compensation for this and I voluntarily shared my caregiver journey, I was not paid. I answered these questions as honest as possible.

Today's Date

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Located in Farmington Hills, Michigan, Kathelene’s Adult Day Care provides a one-stop shop for activities and services to adults in their Golden Years. With a motto of No Veteran Left Behind, No Senior Left Inside, staff helps seniors foster self-esteem by keeping them physically, socially and emotionally active.

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