Caregiving - past 12 months
The next questions ask about help or care you may have given to family, friends or neighbours for a long-term illness, disability or aging.
1. During the past 12 months, have you helped or cared for someone who had one of the following?
This help may include driving them, shopping with or for them, helping with housework, personal care or anything else.
Exclude: paid help to clients or patients, or help provided on behalf of an organization.
(a) a long-term health condition or a physical or mental disability
Yes
No
(b) problems related to aging
Yes
No
Type of help – past 12 months
The next questions ask about the types of help you have given to family, friends, or neighbours.
2. During the past 12 months, have you helped someone with any of the following?
Refers to help given during the past 12 months for a long-term health condition; physical or mental disability and problems related to aging; help to family, friends and neighbours.
(a) transportation to do shopping or errands, or to get to medical appointments, or social events
Yes
No
(b) meal preparation, meal clean-up, house cleaning, laundry or sewing
Yes
No
(c) house maintenance or outdoor work
Yes
No
(d) personal care, such as bathing, dressing, toileting, hair care, or care of nails
Yes
No
(e) medical treatments such as changing bandages, taking medications, measuring insulin levels, or other medical procedures
Yes
No
(f) scheduling or coordinating care-related tasks, such as making appointments or hiring professional help
Yes
No
(g) banking, bill paying or managing their finances
Yes
No
(h) other activity
Yes
No
Other type of activity – specify:
Hours of assistance on average by week
3. In an average week, how many hours of care or help did you provide with these activities?
Number of people assisted - past 12 months
4. During the past 12 months, how many family members, friends or neighbours have you helped with any of the previous activities?
Relationship of respondent to people receiving assistance
How many of these people are:
5. Relationship
(a) your immediate family (spouse or partner, children, parents and siblings)
(b) your extended family (e.g. cousins, grandparents, aunts, uncles, in-laws)
(c) your friends or neighbours
Total
6. Sex
(a) Women
(b) Men
Total
Demographics of people receiving assistance from respondent
At the time you were helping them, how many of these people were:
Number
7. Employment
(a) Employed
(b) Retired
(c) Unemployed
Total
8. Education
Students
9. Age
(a) below the age of 19
(b) between 19 and 44 years old
(c) between 45 and 64 years old
(d) between 65 and 79 years old
(e) 80 years of age or older
Total
Emotional support provided
10. During the past 12 months, have you provided emotional support?
Emotional support includes spending time with the person, talking with and listening to them, cheering them up, being there for them
Yes
No
Primary care receiver - past 12 months
The next section will ask some questions about the person to whom, over the past 12 months, you have dedicated the most time and resources because of a long-term health condition, a physical or mental disability, or problems related to aging.
Include: care or help given to family, friends and neighbours.
Exclude: paid help to clients or patients and help provided on behalf of an organization.
11. What is the first name of the person to whom you have dedicated the most time and resources over the past 12 months?
12. What is the sex of this person?
Male
Female
13. How old is this person?
Select this box if this person is deceased.
14. How old was this person at the time of his/her death?
15. Where did this person die?
a hospital
a long-term care facility
their home
your home
some other place
Primary care receiver – gender and relationship
16. What is/was the relationship of this person to you? He/She is/was your:
Spouse/partner
Same-sex partner
Ex-spouse/ex-partner
Son
Daughter
Father
Mother
Brother
Sister
Grandson
Granddaughter
Grandfather
Grandmother
Son-in-law
Daughter-in-law
Father-in-law
Mother-in-law
Brother-in-law
Sister-in-law
Nephew
Niece
Uncle
Aunt
Cousin
Close friend
Neighbour
Co-worker
Other
Other type of relationship – specify:
Care receiver – health problems which require assistance
17. What is/was the main health condition or problem for which this person received help?
Enter the main health condition or problem of this person.
18. Would you say that this condition is mild, moderate or severe?
Mild
Moderate
Severe
Work information of primary care receiver
19. At the time you were providing help, did this person work at a paid job or business?
Yes, worked 30 hours or more in an average week
Yes, worked less than 30 hours in an average week
No
Year when respondent started to provide assistance
20. In what year did you start to help this person?
Enter year when you first started to help this person for a long term health condition, physical or mental disability or problem related to aging.
21. How old were you when you started to help this person?
Still providing assistance to primary care receiver
22. Are you still helping this person?
Yes
No
23. Why are you no longer helping this person?
Specify reasons why you are no longer helping this person.
Month and year when providing help ended
24a. In what month did you stop helping this person?
<<< Select >>>
January
February
March
April
May
June
July
August
September
October
November
December
24b. In what year did you stop helping this person?
Dwelling of care receiver
25. At the time you were providing help, how close did this person live to you ? / How close does this person live to you?
in the same household
in the same building
less than 10 minutes by car
10 minutes to less than 30 minutes by car
30 minutes to less than 1 hour by car
1 hour to less than 3 hours by car
more than 3 hours by car
Usual dwelling of care receiver
26. During the time you were providing help, where did this person live ? / Where does this person live?
in a private household or apartment
in supportive housing
in an institution or care facility
in some other type of housing
Other type of housing – specify:
27. During the time you were providing help, did you move residences, in order to live closer to this person?/ Did you move residences, in order to live closer to this person?
Yes
No
Frequency of contact – past 12 months
28. During the past 12 months, on average, how often did you see this person?
daily
at least once a week
at least once a month
less than once a month
29. During the past 12 months, on average, how often did you have contact with this person by phone, e-mail or letter?
daily
at least once a week
at least once a month
less than once a month
Activity type provided to primary care receiver
30. During the past 12 months, have you helped this person with any of the following?
(a) transportation to do shopping or errands, or to get to medical appointments, or social events
Yes
No
(b) meal preparation, meal clean-up, house cleaning, laundry or sewing
Yes
No
(c) house maintenance or outdoor work
Yes
No
(d) personal care, such as bathing, dressing, toileting, hair care, or care of nails
Yes
No
(e) medical treatments such as changing bandages, taking medications, measuring insulin levels, or other medical procedures
Yes
No
(f) scheduling or coordinating care-related tasks, such as making appointments or hiring professional help
Yes
No
(g) banking, bill paying or managing finances
Yes
No
31. How often have you helped this person with these tasks?
(a) transportation to do shopping or errands, or to get to medical appointments, or social events
daily
at least once a week
at least once a month
less than once a month
(b) meal preparation, meal clean-up, house cleaning, laundry or sewing
daily
at least once a week
at least once a month
less than once a month
(c) house maintenance or outdoor work
daily
at least once a week
at least once a month
less than once a month
(d) personal care, such as bathing, dressing, toileting, hair care, or care of nails
daily
at least once a week
at least once a month
less than once a month
(e) medical treatments such as changing bandages, taking medications, measuring insulin levels, or other medical procedures
daily
at least once a week
at least once a month
less than once a month
(f) scheduling or coordinating care-related tasks, such as making appointments or hiring professional help
daily
at least once a week
at least once a month
less than once a month
(g) banking, bill paying or managing finances
daily
at least once a week
at least once a month
less than once a month
32. On average, how much time have you spent helping with these tasks?
(a) transportation to do shopping or errands, or to get to medical appointments, or social events
less than 1 hour per occasion
1 hour to less than 3 hours per occasion
3 hours to less than 5 hours per occasion
5 hours to less than 10 hours per occasion
10 hours to less than 15 hours per occasion
15 hours to less than 20 hours per occasion
20 hours or more per occasion
(b) meal preparation, meal clean-up, house cleaning, laundry or sewing
less than 1 hour per occasion
1 hour to less than 3 hours per occasion
3 hours to less than 5 hours per occasion
5 hours to less than 10 hours per occasion
10 hours to less than 15 hours per occasion
15 hours to less than 20 hours per occasion
20 hours or more per occasion
(c) house maintenance or outdoor work
less than 1 hour per occasion
1 hour to less than 3 hours per occasion
3 hours to less than 5 hours per occasion
5 hours to less than 10 hours per occasion
10 hours to less than 15 hours per occasion
15 hours to less than 20 hours per occasion
20 hours or more per occasion
(d) personal care, such as bathing, dressing, toileting, hair care, or care of nails
less than 1 hour per occasion
1 hour to less than 3 hours per occasion
3 hours to less than 5 hours per occasion
5 hours to less than 10 hours per occasion
10 hours to less than 15 hours per occasion
15 hours to less than 20 hours per occasion
20 hours or more per occasion
(e) medical treatments such as changing bandages, taking medications, measuring insulin levels, or other medical procedures
less than 1 hour per occasion
1 hour to less than 3 hours per occasion
3 hours to less than 5 hours per occasion
5 hours to less than 10 hours per occasion
10 hours to less than 15 hours per occasion
15 hours to less than 20 hours per occasion
20 hours or more per occasion
(f) scheduling or coordinating care-related tasks, such as making appointments or hiring professional help
less than 1 hour per occasion
1 hour to less than 3 hours per occasion
3 hours to less than 5 hours per occasion
5 hours to less than 10 hours per occasion
10 hours to less than 15 hours per occasion
15 hours to less than 20 hours per occasion
20 hours or more per occasion
(g) banking, bill paying or managing finances
less than 1 hour per occasion
1 hour to less than 3 hours per occasion
3 hours to less than 5 hours per occasion
5 hours to less than 10 hours per occasion
10 hours to less than 15 hours per occasion
15 hours to less than 20 hours per occasion
20 hours or more per occasion
33. Was there anyone else, other than a paid caregiver, who could have provided this help to this person?
(a) transportation to do shopping or errands, or to get to medical appointments, or social events
Yes
No
(b) meal preparation, meal clean-up, house cleaning, laundry or sewing
Yes
No
(c) house maintenance or outdoor work
Yes
No
(d) personal care, such as bathing, dressing, toileting, hair care, or care of nails
Yes
No
(e) medical treatments such as changing bandages, taking medications, measuring insulin levels, or other medical procedures
Yes
No
(f) scheduling or coordinating care-related tasks, such as making appointments or hiring professional help
Yes
No
(g) banking, bill paying or managing finances
Yes
No
Visiting – past 12 months
34. During the past 12 months, have you checked up on this person by visiting or calling to make sure he/she was okay?
Yes
No
35. Was there anyone else who could have provided this help to this person?
Yes
No
Emotional help to primary care receiver
36. During the past 12 months, have you provided this person with emotional support?
Emotional support includes spending time with the person, talking and listening to the person, cheering the person up, being there for the person.
Yes
No
37. Was there anyone else who could have provided this help to this person?
Yes
No
Care receiver considers respondent their primary caregiver
38. Would you say that this person considers you to be his/her primary caregiver?
Yes
No
39. Do you believe you are the main contact or coordinator for this person’s care arrangement?
Yes
No
Care giving network for primary care recipient – past 12 months
Now we would like to know about people other than you who provided help to this person.
40. How many other friends and family members have helped this person during the past 12 months?
Relationships of network to person who receives care
41. How many of these people are this person’s:
Number
(a) immediate family (spouse or partner, children, parents and siblings)
(b) extended family (e.g. cousins, grandparents, aunts, uncles, in-laws)
(c) friends or neighbours
Total
Demographics of network to primary care receiver
42. How many of these people are:
Number
(a) women
(b) men
Total
43. At the time they were providing help to this person, how many of these people were employed?
Include both part time and full time workers. Full time students should be excluded even if they are working part time.
44. At the time they were providing help to this person, how many of these people were the following ages?
Number
(a) below the age of 19 years
(b) between 19 and 44 years old
(c) between 45 and 64 years old
(d) between 65 and 79 years old
(e) 80 years of age or older
Total
Relationship of other person providing assistance to primary care receiver
45. What is the sex of this person providing assistance?
Male
Female
46. What is the relationship of the person receiving cares to this person providing assistance? The person providing assistance is his/her:
Spouse/partner
Same-sex partner
Son
Daughter
Father
Mother
Brother
Sister
Grandson
Granddaughter
Son-in-law
Daughter-in-law
Nephew
Niece
Close friend
Neighbour
Other
Other relationship - specify:
Demographics of other person providing assistance to primary care receiver
47. While providing help to the person receiving care was this person employed?
Yes
No
48. How old is this person providing assistance?
Select this box if this person is deceased.
Help provided to primary care receiver of respondent from paid workers, government agencies or voluntary organizations – past 12 months
49. During the past 12 months, has this person received help from professionals, that is, paid workers or organizations?
Include: help from all federal, provincial and municipal levels of government, such as hospitals, health centres, clinics and visiting nurses, etc.
Include: non-profit and volunteer organizations that offer help with household chores, transportation, personal care, companionship and other activities.
Help from professionals includes: visiting nurses, physiotherapists, home care providers, transportation services, Meals on Wheels, doctors, community care centres, support from organizations for specific conditions or any services that were paid for because of the care receiver’s condition.
Yes
No
Hours of assistance from paid workers or government or non-government organizations received by primary care receiver
51. In an average week, how many hours of professional help did this person receive?
Less than 1 hour
1 hour to less than 3 hours
3 hours to less than 5 hours
5 hours to less than 10 hours
10 hours or more
Accommodate caregiving duties
The next questions are about support you may have received from others to help you with your caregiving responsibilities.
52. To accommodate your caregiving duties:
Respite care is defined as temporary care of a few hours or weeks for a sick or disabled person to provide a break or relief to the regular caregiver.
(a) has your spouse or partner modified their life and work arrangements?
Yes
No
(b) have your children provided you with help (such as helping with household chores)?
Yes
No
(c) have your extended family members provided you with help?
Yes
No
(d) have your close friends or neighbours provided you with help?
Yes
No
(e) have your community, spiritual community, or cultural or ethnic groups provided you with help?
Yes
No
(f) have you had access to occasional relief or respite care?
Yes
No
(g) have your family or friends provided you with financial support?
Yes
No
(h) have you received money from government programs?
Yes
No
53. Have you received any federal tax credits for which caregivers may be eligible (e.g. caregiver, infirm dependant or medical expense tax credit)?
Yes
No
Other type of support to accommodate caregiving duties
54. Is there any other type of support that you would like to have to accommodate your caregiving duties?
Yes
No
55. What kinds of support would you like to have?
Caregiving history (lifetime)
56. Have you ever provided care to someone with a long-term health condition, disability or problems related to aging?
Exclude: Paid assistance to clients or patients or volunteering on behalf of an organization.
A long-term health condition is one that lasted or was expected to last 6 months or longer.
Yes
No
Now we would like to know about all your lifetime major caregiving experiences.
57. Not including the people you have helped during the past 12 months, have you ever provided care to anyone else with a long-term health condition, a physical or mental disability or problems related to aging?
Exclude: People you assisted in the past 12 months even if you helped them for another reason. Paid assistance to clients or patients; volunteering on behalf of an organization.
Yes
No
58. How many people have you provided care to?
Exclude: People you assisted in the past 12 months even if you helped them for another reason.
Caregiving incident detail
The following few questions will ask about details of your caregiving experiences for the persons you mentioned in the previous question.
59. At what age did you begin to provide care to these persons:
Person #{__counter}
Age
60. At what age did you stop providing care to these persons:
Person #{__counter}
Age
61. What was the relationship of these persons to you?
Person #{__counter}
Spouse/partner
Same-sex partner
Ex-spouse / ex-partner
Son / Daughter
Father / Mother
Brother / Sister
Grandson / Dranddaughter
Grandfather / Grandmother
Son-in-law / Daughter-in-law
Father-in-law / Mother-in-law
Brother-in-law / Sister-in-law
Nephew / Niece
Uncle / Aunt
Cousin
Close friend
Neighbour
Co-worker
Other
Specify the other type of relationship between Person #{__counter} and you.
62. Would you say that, other than professional care, these persons considered you to be their primary caregiver?
The primary caregiver is the person from whom he or she received the most time and resources.
Person #{__counter}
Yes
No
63. Did this/these person(s) also receive professional care?
Person #{__counter}
Yes
No
Caregiving – End-of-life care
Now we would like to ask about any end-of-life care you may have provided to family, friends or neighbours.
64a. Have you ever provided end-of-life care?
End-of-life care means taking care of someone who is dying.
Exclude: paid assistance to clients or patients and volunteering on behalf of an organization.
Yes
No
64b. Have you provided end-of-life care during the past 12 months?
Yes
No
Currently providing end-of-life care
65. Are you currently providing end-of-life care?
If you provided end-of-life care to more than one person, provide information on the most recent one.
Yes
No
66. Do/Did you provide this care in your home?
“Home” could also include the home of the person receiving the end-of-life care.
Yes
No
Preferred to provide end-of-life care at home
67. Would you prefer/have preferred to provide end-of-life care in your home?
“Home” could also include the home of the person receiving the end-of-life care.
Yes
No
Conditions needed to provide end-of-life care at home
68. What conditions would enable/have enabled you to provide end-of-life care to this person in your home?
(a) physical modifications to your home
Yes
No
(b) financial assistance to cover additional costs
Yes
No
(c) time off work without loss of pay
Yes
No
(d) better physical health or stamina
Yes
No
(e) health-related training
Yes
No
(f) home care support
Yes
No
(g) some other condition
Yes
No
If indicated “some other condition” – specify:
Compassionate care leave – lifetime
69. Have you ever taken compassionate care leave to care for a terminally ill family member or friend?
This type of leave may be taken, for up to eight weeks, by a person who has to be absent from work to provide care or support to a gravely ill family member or friend at risk of dying within 26 weeks. Some employees may be entitled to cash benefits under the Employment Insurance Act.
Yes, within the last 12 months
Yes, over 12 months ago
No
Impact of caregiving – past 12 months
Now we would like to know how all your caregiving responsibilities may have affected your life during the past 12 months.
70. In general, how are you coping with your caregiving responsibilities?
very well
generally well
not very well
not well at al
71. In the past 12 months, have your caregiving responsibilities caused you to do the following?
(a) spend less time with your spouse or partner
Yes
No
(b) spend less time with your children
Yes
No
(c) spend less time with (other) family members
Yes
No
(d) spend less time with friends
Yes
No
(e) spend less time on social activities or hobbies
Yes
No
(f) spend less time on relaxing or taking care of yourself
Yes
No
(g) spend less time volunteering for an organization
Yes
No
(h) spend less time participating in political, social or cultural groups
Yes
No
(i) make holiday plans and change or cancel them
Yes
No
(j) not make holiday plans at all
Yes
No
(k) move residences
Yes
No
72. In the past 12 months, have your caregiving responsibilities caused strain in your relationship with family members or friends?
Yes
No
73. In the past 12 months, have your caregiving responsibilities affected the amount of exercise that you usually get?
Include all types of exercise such as walking, jogging, sports, working out in a gym, etc.
Yes
No
Don’t exercise
74. Did the amount of exercise increase or decrease?
Increased
Decreased
75. In the past 12 months, have your eating habits changed as a result of your caregiving responsibilities?
Yes
No
76. Have your eating habits become more healthy or less healthy?
Healthy eating includes a variety of foods such as vegetables and fruit, grains, milk and alternatives, and meat and alternatives, while limiting fat, sugar or salt intake.
More healthy
Less healthy
77. During the past 12 months, have your caregiving responsibilities affected the amount of alcohol you consume?
Yes
No
Don’t drink alcohol
78. Did you do any of the following?
Increase your drinking
decrease your drinking
stop drinking
start drinking
79. In the past 12 months, have your smoking habits changed because of your caregiving responsibilities?
Yes
No
Don’t smoke
80. Did you do any of the following?
Increase the number of cigarettes you smoke
decrease the number of cigarettes you smoke
stop smoking
start smoking
81. During the past 12 months, has your overall health suffered because of your caregiving responsibilities?
Overall health refers to both physical and emotional health.
Yes
No
82. During the past 12 months, how physically strenuous were your caregiving responsibilities?
Strenuous is defined as demanding, tiring, taxing, tough or difficult.
Very strenuous
strenuous
somewhat strenuous
not at all strenuous
83. During the past 12 months, how often did you see a medical professional for your own health problems which resulted from your caregiving responsibilities?
Medical professionals may include physicians, nurses, psychologists, physiotherapists, sports medicine specialists, chiropractors, naturopaths, and other specialists whose work involves healing.
Never
Once
2 to 3 times
4 or more times
84. Have your caregiving responsibilities prevented you from seeing a medical professional for health problems of your own?
Yes
No
85. During the past 12 months, have you suffered any injuries while performing your caregiving responsibilities?
Yes
No
86. Did you suffer one injury or more than one injury?
One injury
More than one injury
87. Did your most serious injury caused any of the following?
(a) limit your daily activities for at least one day
Yes
No
(b) seek treatment from a medical professional
Yes
No
(c) take time off from caregiving duties
Yes
No
(d) take time off from your job or business
Yes
No
88. Do you feel you had a choice in taking on your caregiving responsibilities during the past 12 months?
Yes
No
89. Has your relationship with the person or persons you are caring for strengthened during this time?
Yes
No
Stayed the same
90. How rewarding were your caregiving experiences during the past 12 months?
very rewarding
rewarding
somewhat rewarding
not at all rewarding
91. How stressful were your caregiving responsibilities during the past 12 months?
very stressful
stressful
somewhat stressful
not at all stressful
Find it stressful – related to caregiving
92. Specify what you found stressful about caregiving responsibilities.
Caregiving responsibilities and your health – past 12 months
93. During the past 12 months, have your caregiving responsibilities caused you any of the following?
(a) to feel tired
Yes
No
(b) to feel worried or anxious
Yes
No
(c) to feel overwhelmed
Yes
No
(d) to feel lonely or isolated
Yes
No
(e) to feel short-tempered or irritable
Yes
No
(f) to feel resentful
Yes
No
(g) to feel depressed
Yes
No
(h) to experience loss of appetite
Yes
No
(i) to experience disturbed sleep
Yes
No
(j) to experience any other symptoms
Yes
No
Specify what were the other symptoms
Coping methods to help deal with caregiving responsibilities
94. There are many ways of handling difficult situations. In the past 12 months, have you used any specific coping methods to help you deal with your caregiving responsibilities?
Yes
No
Specify what were the methods you used to cope with difficult situations
95. In the past 12 months, have you used prescription drugs to help you cope with your caregiving responsibilities?
Yes
No
Impact of caregiving – past 12 months
The next questions ask about expenses you may have incurred in the past 12 months as a result of all your caregiving responsibilities. This section applies to all carereceivers you have helped in the last 12 months.
96. In the past 12 months, have you had the following expenses?
We are talking about out-of-pocket expenses that are not reimbursed
(a) home modifications to accommodate your care receiver'(s) needs
That includes expenses for your home or the care receiver's home.
Yes
No
(b) professional services for your care receiver'(s) healthcare or rehabilitation
Professional services may include nurses, doctors, dentists, medical specialists, physiotherapists, chiropractors, dieticians, psychologists, occupational therapist, social workers, etc.
Yes
No
(c) hiring people to help with your care receiver'(s) daily activities
Activities may include meal preparation, routine housework or heavy household chores, paying bills, banking or other finances, shopping, personal care such as bathing or grooming, supervising, help with communicating, learning, socializing, etc.
Yes
No
(d) transportation, travel or accommodation because of your caregiving responsibilities
Includes cost of gas, parking, hotel stays and meals, accessible community transportation, a specialized vehicle, specialized features in your vehicle, cost of traveling to medical appointments and to other places related to caregiving.
Yes
No
(e) specialized aids or devices for your care receiver’(s) use
Includes wheelchairs, lift devices, voice amplifier, hearing aid, computer or voice recognition program, ostomy supplies, breathing apparatus or any other device needed because of the disability or health condition.
Yes
No
(f) for prescription or non-prescription drugs for your care receiver’(s) use
Yes
No
(g) any other costs
Could include costs for legal or accounting expenses, counselling, respite care for caregiver or anything else.
Yes
No
Specify what were these expenses.
Best Estimate of Expenses
97. Which of the following categories did these expenses fall into?
(a) home modifications to accommodate your care receivers’ needs
less than $200
$200 to less than $500
$500 to less than $1,000
$1,000 to less than $2,000
$2,000 to less than $5,000
$5,000 or more
(b) professional services for your care receivers’ healthcare or rehabilitation
less than $200
$200 to less than $500
$500 to less than $1,000
$1,000 to less than $2,000
$2,000 to less than $5,000
$5,000 or more
(c) hiring people to help with your care receivers’ daily activities
less than $200
$200 to less than $500
$500 to less than $1,000
$1,000 to less than $2,000
$2,000 to less than $5,000
$5,000 or more
(d) transportation, travel or accommodation because of your caregiving responsibilities
less than $200
$200 to less than $500
$500 to less than $1,000
$1,000 to less than $2,000
$2,000 to less than $5,000
$5,000 or more
(e) specialized aids or devices for your care receivers’ use
less than $200
$200 to less than $500
$500 to less than $1,000
$1,000 to less than $2,000
$2,000 to less than $5,000
$5,000 or more
(f) prescription or non-prescription drugs for your care receivers’ use
less than $200
$200 to less than $500
$500 to less than $1,000
$1,000 to less than $2,000
$2,000 to less than $5,000
$5,000 or more
(g) any other costs incurred because of your caregiving responsibilities
less than $200
$200 to less than $500
$500 to less than $1,000
$1,000 to less than $2,000
$2,000 to less than $5,000
$5,000 or more
98. During the past 12 months, have you experienced financial hardship because of your caregiving responsibilities?
Yes
No
99. During the past 12 months, have you had to take any of the following measures because of your caregiving responsibilities?
(a) borrow money from family or friends
Yes
No
(b) take loans from a bank or financial institution
Yes
No
(c) use or defer savings
Yes
No
(d) modify your spending
Yes
No
(e) sell off assets
Yes
No
(f) file for bankruptcy
Yes
No
(g) anything else
Yes
No
Specify what else you did.
Impact of caregiving on education – past 12 months
100. Are you currently attending school?
Yes
No
101. In the past 12 months, have you postponed enrolling in an education or training program because of your caregiving responsibilities?
Yes
No
102. Did you postpone plans?
Indefinitely
To the next available starting date
To some other date
103. In the past 12 months, have your studies been affected because of your caregiving responsibilities?
Yes
No
Impact of caregiving on employment – past 12 months
The next questions ask about the impact that caregiving may have had on your employment during the past 12 months.
105. How many times during the past 12 months did you go to work late, leave early or take time off during the day because of your caregiving responsibilities?
106. Were you paid for this time off?
Yes
No
Some paid, some unpaid
107. Did you reduce your regular weekly hours of work because of your caregiving responsibilities?
Yes
No
108. How many fewer hours per week did you work because of your help/care responsibilities?
109. Did you lose some or all of your employment benefits because of this reduction in hours?
Yes – Some
Yes – All
No
110. Which benefits have you lost?
(a) extended health benefits
Yes
No
(b) dental benefits
Yes
No
(c) employer-provided pension
Yes
No
(d) life insurance
Yes
No
(e) prescription medication coverage
Yes
No
(f) any other type of benefit
Yes
No
Specify the other benefit you lost.
111. How many times during the past 12 months did you take one or more days off from your job because of your caregiving responsibilities?
112. How long was your longest time off? Provide answer in day(s), week(s) or month(s)
<<< Select >>>
Day(s)
Week(s)
Month(s)
113. Was this time paid or unpaid?
Paid
Unpaid
Partly paid
114. What were your annual earnings before taxes from this job?
115. During the past 12 months, did you quit a job or close a business because of your caregiving responsibilities?
Yes
No
116. For how long were you unemployed after you quit your job? Provide answer in week(s) or month(s)
<<< Select >>>
Week(s)
Month(s)
117. What circumstances would have enabled you to keep working while providing care at the same time?
118. What were your annual earnings before taxes from this job?
119. During the past 12 months, were you ever fired, laid off, or asked to resign from a job because of your caregiving responsibilities?
Yes
No
120. How long were you unemployed after you lost your job? Provide answer in week(s) or month(s)
<<< Select >>>
Week(s)
Month(s)
121. What were your annual earnings before taxes from this job?
122. During the past 12 months, did you turn down a job offer or promotion, or decide not to apply for a job, because of your caregiving responsibilities?
Yes
No
123. Did you take a less demanding job because of your caregiving responsibilities?
Yes
No
124. Did this less demanding job pay less or more than your previous job?
Paid less
Paid more
Paid the same
125. Did this less demanding job provide fewer or more benefits than your previous job?
Fewer benefits
More benefits
Same benefits
Interest in employment
126. Are your caregiving responsibilities preventing you from working at a paid job?
Yes
No
127. Are you interested in finding paid employment?
Yes
No
128. Would you like a full or part-time job?
Full-time
Part-time
129. What would enable you to work at a paid job?
Impact of caregiving on employment prior to the past 12 months
The next questions ask about the impact that caregiving may have had on your employment over the years prior to the past 12 months.
130a. Excluding the past 12 months, have you ever worked at a paid job or business while providing care?
Yes
No
130b. Excluding the past 12 months, did you ever reduce your regular weekly hours of employment because of your caregiving responsibilities?
Yes
No
132. Did you lose some or all of your employment benefits because you reduced your weekly hours?
Yes – Some
Yes – All
No
133. Excluding the past 12 months, did you ever have to take a leave from a job because of your caregiving responsibilities?
Includes any type of paid or unpaid leave.
Yes
No
134. How long was your longest leave? Provide answer in day(s), week(s), month(s) or year(s)
<<< Select >>>
Day(s)
Week(s)
Month(s)
Year(s)
135. Was this leave paid or unpaid?
Paid
Unpaid
Partly paid
136. What were your annual earnings before taxes from this job?
137. Not including the past 12 months, how many times did you have to quit a job or close a business because of your caregiving responsibilities?
138. What circumstances would have enabled you to keep working while providing care at the same time?
139. Not including the past 12 months, how many times were you ever fired, asked to resign or laid off from a job, because of your caregiving responsibilities?
140. Not including the past 12 months, how many times did you turn down a job offer or promotion, or take a less demanding job because of your caregiving responsibilities?
Impact of caregiving on employment – plans for retirement
141. Have you ever retired from a job or business?
Yes
No
143. Was/Will the timing of your retirement (be) affected because of your caregiving responsibilities?
Yes
No
144. Did you retire earlier or later than you would have preferred to? / Will you retire earlier or later than you would like to?
Earlier
Later
Neither earlier nor later
145. How much earlier/later? Provide answer in month(s) or year(s)
<<< Select >>>
Month(s)
Year(s)
146. What were your annual earnings before taxes from the last job you held before retiring?
Employment – past 12 months
147. For how many weeks during the past 12 months were you employed? Include vacation, illness, strikes, lock-outs or maternity/paternity or parental leave.
148. Were you mainly:
a paid worker
self-employed
an unpaid family worker
146. For whom did you work the longest time during the past 12 months?
150. What kind of business, industry or service is/was this?
151. What kind of work are/were you doing?
152. What are/were your most important activities or duties?
153. Are you still working for this employer/at this business?
Yes
No
154. Which of the following best describes your terms of employment in this job?
A regular employee (no contractual or anticipated termination date)
A seasonal employee (employment on this job is intermittent according to the seasons of the year)
A term employee (term of employment has a set termination date)
A casual or on-call employee
155. Are/Were you a union member or covered by a union contract or collective agreement in this job?
Yes
No
156. Did you have more than one paid job last week?
Yes
No
157. How many hours a week do/did you usually work at your job?
158. How many hours a week do/did you usually work at these jobs?
(a) main job
(b) other job(s)
Total
159. Why do/did you usually work less than 30 hours a week? Select as many responses as applicable
Own illness or disability
Child care responsibilities
Care responsibilities for an adult
Other personal or family responsibilities
Going to school
I could only find part-time work
I did not want full-time work
Requirement of the work
Full-time work is defined under 30 hours per week
Other reason for working less than 30 hours – Specify:
Specify the other reason for working less than 30 hours a week.
160. How many days a week do/did you usually work (including all jobs)?
161. Which of the following best describes your usual work schedule at your job/main job?
A regular daytime schedule or shift
A regular evening shift
A regular night shift
A rotating shift (one that changes periodically from days to evenings or to nights)
A split shift (one consisting of two or more distinct periods each day)
A compressed work week
On call or casual
An irregular schedule
Other
Specify your usual work schedule:
162. Excluding overtime, do/did you usually work any of your scheduled hours at home?
Yes
No
Not applicable
163. How many paid hours per week do/did you usually work at home?
164. What is the main reason you do/did some of your work at home?
Care for children
Care for other family members
Other personal or family responsibilities
Requirements of the job, no choice
Home is usual place of work
Better conditions of work
Saves time, money
Live too far from work to commute
Other
Specify the other reason for working at home:
165. Do you have a flexible schedule that allows you to choose the time you begin and end your work day?
Yes
No
166. Does your employer provide you with the following options?
(a) work part-time
Yes
No
(b) take leave, paid or unpaid, to take care of your child(ren)
Yes
No
(c) take leave, paid or unpaid, to take care of your spouse, partner or other family members
Yes
No
(d) take extended leave without pay for personal reasons
Yes
No
(e) telework
Yes
No
167. Do you think you could use these flexible work arrangements without a negative impact on your career?
Yes
No
Work-life balance – past 12 months
168. In the past 12 months, how often has it been difficult to do the following?
(a) fulfill family responsibilities because of the amount of time you spent on your job
All of the time
Most of the time
Sometimes
Never
(b) concentrate or fulfill your work responsibilities because of your family responsibilities
All of the time
Most of the time
Sometimes
Never
169. How satisfied are you with the current balance between your job and home life?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
170. Why are you dissatisfied?
Housing
The following questions are about your housing characteristics.
171. In what type of dwelling are you now living?
Single detached house
Semi-detached or double (side by side)
Garden home, town-house or row house
Duplex (one above the other)
Low-rise apartment (less than 5 stories)
High-rise apartment (5 or more stories)
Mobile home or trailer
Other
Specify the other type of dwelling:
172. Is this dwelling owned (even if it is still being paid for) or rented (even if no cash rent is paid)?
Owned
Rented
173. Is there a mortgage on this dwelling?
Yes
No
174. How long have you lived in this:
(a) dwelling?
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years to less than 10 years
10 years and over
(b) neighbourhood?
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years to less than 10 years
10 years and over
(c) city or local community?
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years to less than 10 years
10 years and over
175. Would you say that you know:
Most of the people in your neighbourhood
Many of the people in your neighbourhood
A few of the people in your neighbourhood
None of the people in your neighbourhood
176. Would you say this neighbourhood is a place where neighbours help each other?
Yes
No
177. In the past month, have you done a favour for a neighbour?
Yes
No
Just moved into the area
178. In the past month, have any of your neighbours done a favour for you?
Yes
No
Just moved into the area
179. In your neighbourhood, is public transportation (e.g. bus, rapid transit or subway) available?
Yes
No
The next questions ask about how accessible your home may be to someone using a wheelchair.
180. Does your home have:
(a) a street level entrance with no steps
Yes
No
(b) a ramp at the entrance
Yes
No
(c) doorways that are wide enough for a wheelchair
Yes
No
(d) lowered counters in the kitchen or bathroom
Yes
No
(e) grab bars in the bathroom
Yes
No
(f) easy to open doors (including lever handles)
Yes
No
(g) an elevator or lift device
Yes
No
181. Are you aware of any government programs that provide grants to home owners and landlords for modifications to make their property more accessible to persons with disabilities?
Yes
No
Overall health and well being
The following questions ask about your day-to-day health.
182. In general, would you say your health is:
Excellent
Very good
Good
Fair
Poor
183. In general, would you say your mental health is:
Excellent
Very good
Good
Fair
Poor
184. In general, would you say your eating habits are:
Excellent
Very good
Good
Fair
Poor
185. In the past 7 days, how many times did you participate in moderate or vigorous physical activity for leisure, work, housework or transportation?
186. About how much time did you spend on each occasion?
Less than 15 minutes
16 to 30 minutes
31 to 60 minutes
More than 1 hour
187. Using a scale of 0 to 10, where 0 means “Very dissatisfied” and 10 means “Very satisfied”, how do you feel about your life as a whole right now?
<<< Select >>>
0 – Very dissatisfied
1
2
3
4
5
6
7
8
9
10 – Very satisfied
188. Thinking of the amount of stress in your life, would you say that most days are:
not at all stressful
not very stressful
a bit stressful
quite a bit stressful
extremely stressful
189. Do you regularly have trouble going to sleep or staying asleep?
Yes
No
190. Do you take any medication to help you sleep?
Yes
No
191. For each of the following six questions, please indicate whether the statement describes your feelings, using the categories: yes, more or less, or no.
(a) I experience a general sense of emptiness.
Yes
More or less
No
(b) There are plenty of people I can rely on when I have problems.
Yes
More or less
No
(c) There are many people I can trust completely.
Yes
More or less
No
(d) There are enough people I feel close to.
Yes
More or less
No
(e) I miss having people around.
Yes
More or less
No
(f) I often feel rejected.
Yes
More or less
No
The next set of questions ask about your day-to-day abilities.
192. Are you usually able to:
(a) see well enough to read ordinary newsprint without glasses or contact lenses?
Yes
No
(b) hear what is said in a group conversation with at least three other people without a hearing aid?
Yes
No
(c) be understood completely when speaking with strangers in your own language?
Yes
No
(d) walk around the neighbourhood without difficulty and without mechanical support such as braces, a cane or crutches?
Yes
No
(e) grasp and handle small objects such as a pencil or scissors?
Yes
No
Vision
The following questions are asked because you indicated you were not able to see well enough to read ordinary newsprint without glasses or contact lenses.
193. Are you usually able to see well enough to read ordinary newsprint with glasses or contact lenses?
Yes
No
194. Are you able to see at all?
Yes
No
195. Are you able to see well enough to recognize a friend on the other side of the street without glasses or contact lenses?
Yes
No
196. Are you usually able to see well enough to recognize a friend on the other side of the street with glasses or contact lenses?
Yes
No
Hearing
The following questions are asked because you indicated you were not able to hear what is said in a group conversation with at least three other people without a hearing aid.
197. Are you usually able to hear what is said in a group conversation with at least three other people with a hearing aid?
Yes
No
198. Are you able to hear at all?
Yes
No
199. Are you usually able to hear what is said in a conversation with one other person in a quiet room without a hearing aid?
Yes
No
200. Are you usually able to hear what is said in a conversation with one other person in a quiet room with a hearing aid?
Yes
No
Speech
The following questions are asked because you indicated you were not able to be understood completely when speaking with strangers in your own language.
201. Are you able to be understood partially when speaking with strangers?
Yes
No
202. Are you able to be understood completely when speaking with those who know you well?
Yes
No
203. Are you able to be understood partially when speaking with those who know you well?
Yes
No
Mobility
The following questions are asked because you indicated you were not able to walk around the neighbourhood without difficulty and without mechanical support such as braces, a cane or crutches.
204. Are you able to walk at all?
Yes
No
205. Do you require mechanical support such as braces, a cane or crutches to be able to walk around the neighbourhood?
Yes
No
206. Do you require the help of another person to be able to walk?
Yes
No
207. Do you require a wheelchair to get around?
Yes
No
208. How often do you use a wheelchair?
Always
Often
Sometimes
Never
209. Do you need the help of another person to get around in a wheelchair?
Yes
No
Dexterity
The following questions are asked because you indicated you were not able to grasp and handle small objects such as a pencil or scissors.
210. Do you require the help of another person because of limitations in the use of hands or fingers?
Yes
No
1. Do you require the help of another person with:
some tasks
most tasks
almost all tasks
all tasks
212. Do you require special equipment, for example, devices to assist in dressing, because of limitations in the use of hands or fingers?
Yes
No
Overall health and well being
213. Would you describe yourself as being usually:
happy and interested in life
somewhat happy
somewhat unhappy
unhappy with little interest in life
so unhappy that life is not worthwhile
214. How would you describe your usual ability to remember things?
Able to remember most things
somewhat forgetful
very forgetful
unable to remember anything at all
215. How would you describe your usual ability to think and solve day-to-day problems?
Able to think clearly and solve problems
having a little difficulty
having some difficulty
having a great deal of difficulty
unable to think or solve problems
216. Are you usually free of pain or discomfort?
Yes
No
217. How would you describe the usual intensity of your pain or discomfort?
Mild
Moderate
Severe
218. How many activities does your pain or discomfort prevent?
None
A few
Some
Most
219. Do you have any long-term health conditions, or physical or mental disabilities?
No
Yes – specify:
General information
Now we would like to ask you a few general questions.
220. In what country were you born?
‹‹‹ Select ›››
Canada
Other
Other country – specify:
221. In which province or territory?
‹‹‹ Select ›››
Newfoundland and Labrador
Prince Edward Island
Nova Scotia
New Brunswick
Quebec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia
Yukon
Northwest Territories
Nunavut
222. In what year did you first come to Canada to live?
223. Are you now, or have you ever been, a landed immigrant in Canada?
Yes
No
224. In what year did you first become a landed immigrant in Canada?
225. What were the ethnic or cultural origins of your ancestors?
Canadian
English
French
Scottish
Irish
German
Italian
Aboriginal (North American Indian, Métis or Inuit)
Ukrainian
Chinese
Dutch (Netherlands)
Polish
South Asian (East Indian, Sri Lankan, Pakistani, Punjabi, etc.)
Jewish
Portuguese
Other
Specify the other ethnic or cultural origin.
226. What is your religion?
227. Not counting events such as weddings or funerals, during the past 12 months, how often did you participate in religious activities or attend religious services or meetings?
At least once a week
At least once a month
At least 3 times a year
Once or twice a year
Not at all
228. How important are your religious or spiritual beliefs to the way you live your life?
Very important
Somewhat important
Not very important
Not at all important
229. In the past 12 months, how often did you engage in religious or spiritual activities on your own? This may include prayer, meditation and other forms of worship taking place at home or in any other location.
At least once a day
At least once a week
At least once a month
At least 3 times a year
Once or twice a year
Not at all
230. What language did you first speak in childhood?
English
French
Italian
Chinese
German
Portuguese
Polish
Ukrainian
Spanish
Vietnamese
Greek
Punjabi
Arabic
Tagalog (Filipino)
Hungarian
Other first language spoken in childhood – Specify:
Specify other first language spoken in childhood
231. Do you still understand?
(a) English
Yes
No
(b) French
Yes
No
(c) Italian
Yes
No
(d) Chinese
Yes
No
(e) German
Yes
No
(f) Portuguese
Yes
No
(g) Polish
Yes
No
(h) Ukrainian
Yes
No
(i) Spanish
Yes
No
(j) Vietnamese
Yes
No
(k) Greek
Yes
No
(l) Punjabi
Yes
No
(m) Arabic
Yes
No
(n) Tagalog (Filipino)
Yes
No
(o) Hungarian
Yes
No
(p) Other first language spoken in childhood
Yes
No
232a. What language do you speak most often at home?
English
French
Italian
Chinese
German
Portuguese
Polish
Ukrainian
Spanish
Vietnamese
Greek
Punjabi
Arabic
Tagalog (Filipino)
Hungarian
Other language spoken most often at home – Specify:
Specify other language spoken most often at home.
232b. Can you speak English well enough to conduct a conversation?
Yes
No
232c. Can you speak French well enough to conduct a conversation?
Yes
No
Now we would like to ask some questions about income.
233. What is your best estimate of your total personal income, before taxes and deductions, from all sources, during the year ending December 31, 2011?
234. Can you estimate in which of the following groups your total personal income falls for the year ending December 31, 2011? Was it:
less than $5,000
$5,000 to less than $10,000
$10,000 to less than $15,000
$15,000 to less than $20,000
$20,000 to less than $30,000
$30,000 to less than $40,000
$40,000 to less than $50,000
$50,000 to less than $60,000
$60,000 to less than $70,000
$70,000 to less than $80,000
$80,000 to less than $90,000
$90,000 to less than $100,000
$100,000 to less than $150,000
$150,000 or more
