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What is your date of birth?
(MIN: 1) (MAX: 31)
DK, RF
What is your date of birth?
What is your date of birth?
(MIN: 1881) (MAX: 2017)
DK, RF
So, your age is ^BDR_D120. Is that correct?
What is your age?
(MIN: 1) (MAX: 130)
DK, RF
This survey is for persons aged 15 and older. So, for this household, the survey is now completed. Thank you for your co-operation.
I'd like to confirm your marital status. Are you ^piSelRespMarS?
What is your marital status? Are you:
How many children do you have? Please include all birth, step and adopted children.
(MIN: 0) (MAX: 20)
DK, RF
During the past 12 months, was your main activity working at a paid job or business, looking for paid work, going to school, caring for children, household work, retired or something else?
(During the past 12 months, was your main activity working at a paid job or business, looking for paid work, going to school, caring for children, household work, retired or something else?)
(80 spaces)
DK, RF
Were you employed or self-employed at any time last week?
In the last four weeks, did you look for a job?
Were you employed or self-employed at any time during the past 12 months?
Have you ever been employed or self-employed?
In what year did you last do any paid work?
(MIN: 1900) (MAX: 2017)
DK, RF
How old were you when you last did any paid work?
(MIN: 10) (MAX: 130)
DK, RF
The next questions ask about help or care you may have received for a long-term illness, disability or aging. This help may come from family, friends, neighbours, paid workers or organizations. It may include help with driving, shopping, housework, personal care or anything else.
During the past 12 months, have you received help or care for a long-term health condition or a physical or mental disability?
During the past 12 months, have you received help for problems related to aging?
What is the main health condition or problem for which you have received help?
(What is the main health condition or problem for which you have received help?)
(80 spaces)
(DK, RF not allowed)
Would you say that this condition is mild, moderate or severe?
The next questions ask about the types of help you received for the health condition or problem you just mentioned. Here we are talking about help only from family, friends, or neighbours. Exclude help from paid workers or organizations.
During the past 12 months, have you received help with:
… transportation to do shopping or errands, or to get to medical appointments, or social events?
During the past 12 months, have you received help with:
… meal preparation, meal clean-up, house cleaning, laundry or sewing?
During the past 12 months, have you received help with:
… house maintenance or outdoor work?
During the past 12 months, have you received help with:
… personal care, such as bathing, dressing, toileting, hair care, or care of nails?
During the past 12 months, have you received help with:
… medical treatments, such as changing bandages, taking medications, or other medical procedures?
During the past 12 months, have you received help with:
… scheduling or coordinating care-related tasks, such as making appointments or hiring professional help?
During the past 12 months, have you received help with:
… banking, bill paying or managing your finances?
During the past 12 months, have you received help with anything else?
(During the past 12 months, have you received help with anything else?)
(80 spaces)
DK, RF
In an average week, how many hours of care or help did you receive with these activities?
(MIN: 0) (MAX: 168)
DK, RF
During the past 12 months, how many family members, friends or neighbours have helped you with any of the previous activities?
(MIN: 1) (MAX: 60)
DK, RF
How many of these people are your:
… immediate family (spouse or partner, children, parents and siblings)?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people are your:
… extended family (e.g. cousins, grandparents, aunts, uncles, in-laws)?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people are your:
… friends and neighbours?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were women?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were helping you, how many of these people were:
… employed?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were helping you, how many of these people were:
… retired?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were helping you, how many of these people were:
… unemployed?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were helping you, how many of these people were:
… students?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… below the age of 19?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… 19 to 44?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… 45 to 64
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… 65 to 79
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… 80 years of age or older?
(MIN: 0) (MAX: 20)
DK, RF
During the past 12 months, have you received emotional support?
Now some questions about help from professionals. By professionals, we mean paid workers or organizations.
Have you received any types of help or care from professionals for a long-term health condition, disability or problems related to aging?
During the past 12 months, have you received professional help with:
… transportation to do shopping or errands, or to get to medical appointments, or social events?
During the past 12 months, have you received professional help with:
… meal preparation, meal clean-up, house cleaning, laundry or sewing?
During the past 12 months, have you received professional help with:
… house maintenance or outdoor work?
During the past 12 months, have you received professional help with:
… personal care, such as bathing, dressing, toileting, hair care, or care of nails?
During the past 12 months, have you received professional help with:
… medical treatments, such as changing bandages, taking medications or other medical procedures?
During the past 12 months, have you received professional help with:
… scheduling or coordinating care-related tasks such as making appointments or hiring professional help?
During the past 12 months, have you received professional help with:
… banking, bill paying or managing your finances?
During the past 12 months, did a professional provide you with emotional support?
During the past 12 months, did a professional provide you with any other type of help?
During the past 12 months, did a professional provide you with any other type of help?
(80 spaces)
DK, RF
In an average week, how many hours of professional help did you receive with these activities?
(MIN: 0) (MAX: 168)
DK, RF
In general, did you receive the care or help you needed during the past 12 months? Please think of both professional care, and care from family and friends.
Why not?
(80 spaces)
DK, RF
For the types of help we have just talked about, would you rather have had professional help than help from family and friends?
For the types of help we have just talked about, would you rather have had help from family and friends than help from professionals?
For all the types of help we have just talked about, are you satisfied with the balance of help from family and friends, and from professionals?
Would you have preferred to receive more professional help or more help from family and friends?
During the past 12 months, did you need help or care for a long-term health condition, physical or mental disability, or problems related to aging?
Did you ask for help?
If you had needed help, would you have been able to get it?
If you had asked for help, do you think that you would have been able to get it?
Who would have provided this help to you?
Now some questions about the person who, over the past 12 months, has spent the most time and resources helping you because of a long-term health condition, a physical or mental disability, or problems related to aging. Exclude assistance from professionals.
What is the first name of this person?
(30 spaces)
DK, RF
How old is ^DT_PGN_Q10_R_E?
(MIN: 10) (MAX: 995)
DK, RF
How old was ^DT_PGN_Q10_R_E at the time of his/her death?
(MIN: 10) (MAX: 130)
DK, RF
What ^DT_ISWAS the relationship of ^piPGN_Q10 to you?
(What ^DT_ISWAS the relationship of ^piPGN_Q10 to you?)
(80 spaces)
(DK, RF not allowed)
What ^DT_ISWAS ^piPGN_Q10's sex?
At the time you were receiving help:
… was ^piPGN_Q10 employed or self-employed?
At the time you were receiving help:
… did ^piPGN_Q10 work 30 hours or more in an average week?
In what year did you start to receive help from ^piPGN_Q10?
(MIN: 1910) (MAX: 2017)
DK, RF
How old were you when you started to receive help from ^piPGN_Q10?
(MIN: 0) (MAX: 130)
DK, RF
Are you still receiving help from ^piPGN_Q10?
Why are you no longer receiving help from ^piPGN_Q10?
(Why are you no longer receiving help from ^piPGN_Q10?)
(80 spaces)
DK, RF
In what month and year did you stop receiving help from ^piPGN_Q10?
In what month and year did you stop receiving help from ^piPGN_Q10?
(MIN: 1911) (MAX: 2017)
DK, RF
If ^piPGN_Q10 had not helped you, would you have had difficulty finding help from someone else?
How close does ^piPGN_Q10 live to you:
Do you live:
(What type of housing?)
(80 spaces)
DK, RF
Did you move residences, in order to live closer to ^piPGN_Q10?
During the past 12 months, on average, how often did ^piPGN_Q10 see you? Was it:
During the past 12 months, on average, how often did ^piPGN_Q10 have contact with you by letter, email or phone? Was it:
During the past 12 months, has ^piPGN_Q10 helped you with transportation to do shopping or errands, or to get to medical appointments, or social events?
How often has ^DT_AGGEND_E helped you with these tasks? Was it:
In an average ^DT_AGTIME_E, how much time has ^piPGN_Q10 spent helping you with these tasks? Was it:
Would that be:
Was there anyone else who could have provided this help to you?
During the past 12 months, has ^piPGN_Q10 helped you with meal preparation, meal clean-up, house cleaning, laundry or sewing?
How often has ^DT_AGGEND_E helped you with these tasks? Was it:
In an average ^DT_AGTIME_E, how much time has ^piPGN_Q10 spent helping you with these tasks? Was it:
Would that be:
Was there anyone else who could have provided this help to you?
During the past 12 months, has ^piPGN_Q10 helped you with house maintenance or outdoor work?
How often has ^DT_AGGEND_E helped you with these tasks? Was it:
In an average ^DT_AGTIME_E, how much time has ^piPGN_Q10 spent helping you with these tasks? Was it:
Would that be:
Was there anyone else who could have provided this help to you?
During the past 12 months, has ^piPGN_Q10 helped you with personal care?
How often has ^DT_AGGEND_E helped you with these tasks? Was it:
In an average ^DT_AGTIME_E, how much time has ^piPGN_Q10 spent helping you with these tasks? Was it:
Would that be:
Was there anyone else who could have provided this help to you?
During the past 12 months, has ^piPGN_Q10 helped you with medical treatments or procedures?
How often has ^DT_AGGEND_E helped you with these tasks? Was it:
In an average ^DT_AGTIME_E, how much time has ^piPGN_Q10 spent helping you with these tasks? Was it:
Would that be:
Was there anyone else who could have provided this help to you?
During the past 12 months, has ^piPGN_Q10 helped you with scheduling or coordinating care-related tasks, such as making appointments or hiring professional help?
How often has ^DT_AGGEND_E helped you with these tasks? Was it:
In an average ^DT_AGTIME_E, how much time has ^piPGN_Q10 spent helping you with these tasks? Was it:
Would that be:
Was there anyone else who could have provided this help to you?
During the past 12 months, has ^piPGN_Q10 helped you with banking, bill paying or managing your finances?
How often has ^DT_AGGEND_E helped you with these tasks? Was it:
In an average ^DT_AGTIME_E, how much time has ^piPGN_Q10 spent helping you with these tasks? Was it:
Would that be:
Was there anyone else who could have provided this help to you?
During the past 12 months, has ^piPGN_Q10 checked up on you by visiting or calling to make sure you were okay?
Was there anyone else who could have provided this help to you?
During the past 12 months, has ^piPGN_Q10 provided you with emotional support?
Was there anyone else who could have provided this help to you?
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. This help may include driving them, shopping with or for them, helping with housework, personal care or anything else.
During the past 12 months, have you helped or cared for someone who had a long-term health condition or a physical or mental disability?
During the past 12 months, have you helped or cared for someone who had problems related to aging?
The next questions ask about the types of help you have given to family, friends, or neighbours.
During the past 12 months, have you helped someone with:
… transportation to do shopping or errands, or to get to medical appointments, or social events?
During the past 12 months, have you helped someone with:
… meal preparation, meal clean-up, house cleaning, laundry or sewing?
During the past 12 months, have you helped someone with:
… house maintenance or outdoor work?
During the past 12 months, have you helped someone with:
… personal care, such as bathing, dressing, toileting, hair care, or care of nails?
During the past 12 months, have you helped someone with:
… medical treatments, such as changing bandages, taking medications or other medical procedures?
During the past 12 months, have you helped someone with:
… scheduling or coordinating care-related tasks, such as making appointments or hiring professional help?
During the past 12 months, have you helped someone with:
… banking, bill paying or managing their finances?
During the past 12 months, have you helped someone with:
… anything else?
(Anything else? )
(80 spaces)
DK, RF
In an average week, how many hours of care or help did you provide with these activities?
(MIN: 0) (MAX: 168)
DK, RF
During the past 12 months, how many family members, friends or neighbours have you helped with any of the previous activities?
(MIN: 1) (MAX: 60)
DK, RF
How many of these people are your:
… immediate family (spouse or partner, children, parents and siblings)?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people are your:
… extended family (e.g. cousins, grandparents, aunts, uncles, in-laws)?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people are your:
… friends or neighbours?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people are women?
(MIN: 0) (MAX: 20)
DK, RF
At the time you were helping them, how many were:
… employed?
(MIN: 0) (MAX: 20)
DK, RF
At the time ^YOU1 ^WERE helping them, how many were:
… retired?
(MIN: 0) (MAX: 20)
DK, RF
At the time ^YOU1 ^WERE helping them, how many were:
… unemployed?
(MIN: 0) (MAX: 20)
DK, RF
At the time ^YOU1 ^WERE helping them, how many were:
… students?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… below the age of 19?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… 19 to 44
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… 45 to 64
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… 65 to 79
(MIN: 0) (MAX: 20)
DK, RF
How many of these people were:
… 80 years of age or older?
(MIN: 0) (MAX: 20)
DK, RF
During the past 12 months, have you provided emotional support?
Now some questions about the person you have helped during the past 12 months.
Now 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.
What is the first name of this person?
(30 spaces)
DK, RF
How old is ^DT_PRN_Q10_R_E?
(MIN: 0) (MAX: 995)
DK, RF
How old was ^DT_PRN_Q10_R_E at the time of his/her death?
(MIN: 0) (MAX: 130)
DK, RF
Did ^DT_PRN_Q10_R_E die in:
What ^DT_ISWAS the relationship of ^piPRN_Q10 to you?
(What ^DT_ISWAS the relationship of ^piPRN_Q10 to you?)
(80 spaces)
DK, RF
What ^DT_ISWAS ^piPRN_Q10's sex?
What ^DT_ISWAS the main health condition or problem for which ^piPRN_Q10 received help?
(What ^DT_ISWAS the main health condition or problem for which ^piPRN_Q10 received help?)
(80 spaces)
(DK, RF not allowed)
Would you say that this condition is mild, moderate or severe?
At the time you were providing help:
… was ^piPGN_Q10 employed or self-employed?
At the time you were providing help:
… did ^piPRN_Q10 work 30 hours or more in an average week?
In what year did you start to help ^piPRN_Q10?
(MIN: 1910) (MAX: 2017)
DK, RF
How old were you when you started to help ^piPRN_Q10?
(MIN: 0) (MAX: 130)
DK, RF
Are you still helping ^piPRN_Q10?
Why are you no longer helping ^piPRN_Q10?
(Why are you no longer helping ^piPRN_Q10?)
(80 spaces)
DK, RF
In what month and year did you stop helping ^piPRN_Q10?
In what month and year did you stop helping ^piPRN_Q10?
(MIN: 1911) (MAX: 2017)
DK, RF
How close does ^piPRN_Q10 live to you:
Does ^piPRN_Q10 live:
What type of housing?
(80 spaces)
DK, RF
Did you move residences, in order to live closer to ^piPRN_Q10?
During the past 12 months, on average, how often did you see ^piPRN_Q10? Was it:
During the past 12 months, on average, how often did you have contact with ^piPRN_Q10 by phone, email or letter? Was it:
During the past 12 months, have you helped ^piPRN_Q10 with transportation to do shopping or errands, or to get to medical appointments, or social events?
How often have you helped ^DT_ARGEND_E with these tasks? Was it:
In an average ^DT_ARTIME_E, how much time have you spent helping with these tasks? Was it:
Would that be:
Was there anyone else, other than a paid caregiver, who could have provided this help to ^DT_ARGEND_E?
During the past 12 months, have you helped ^piPRN_Q10 with meal preparation, meal clean-up, house cleaning, laundry or sewing?
How often have you helped ^DT_ARGEND_E with these tasks? Was it:
In an average ^DT_ARTIME_E, how much time have you spent helping with these tasks? Was it:
Would that be:
Was there anyone else, other than a paid caregiver, who could have provided this help to ^DT_ARGEND_E?
During the past 12 months, have you helped ^piPRN_Q10 with house maintenance or outdoor work?
How often have you helped ^DT_ARGEND_E with these tasks? Was it:
In an average ^DT_ARTIME_E, how much time have you spent helping with these tasks? Was it:
Would that be:
Was there anyone else, other than a paid caregiver, who could have provided this assistance to ^DT_ARGEND_E?
During the past 12 months, have you helped ^piPRN_Q10 with personal care?
How often have you helped ^DT_ARGEND_E with these tasks? Was it:
In an average ^DT_ARTIME_E, how much time have you spent helping with these tasks? Was it:
Would that be:
Was there anyone else, other than a paid caregiver, who could have provided this assistance to ^DT_ARGEND_E?
During the past 12 months, have you helped ^piPRN_Q10 with medical treatments or procedures?
How often have you helped ^DT_ARGEND_E with these tasks? Was it:
In an average ^DT_ARTIME_E, how much time have you spent helping with these tasks? Was it:
Would that be:
Was there anyone else, other than a medically trained professional, who could have provided this help to ^DT_ARGEND_E?
During the past 12 months, have you helped ^piPRN_Q10 with scheduling or coordinating care-related tasks, such as making appointments or hiring professional help?
How often have you helped ^DT_ARGEND_E with these tasks? Was it:
In an average ^DT_ARTIME_E, how much time have you spent helping with these tasks? Was it:
Would that be:
Was there anyone else, other than a paid caregiver, who could have provided this assistance to ^DT_ARGEND_E?
During the past 12 months, have you helped ^piPRN_Q10 with banking, bill paying or managing finances?
How often have you helped ^DT_ARGEND_E with these tasks? Was it:
In an average ^DT_ARTIME_E, how much time have you spent helping with these tasks? Was it:
Would that be:
Was there anyone else who could have provided this help to ^DT_ARGEND_E?
During the past 12 months, have you checked up on ^piPRN_Q10 by visiting or calling to make sure ^DT_GEND1_E was okay?
Was there anyone else who could have provided this help to ^DT_ARGEND_E?
During the past 12 months, have you provided ^piPRN_Q10 with emotional support?
Was there anyone else who could have provided this help to ^DT_ARGEND_E?
Would you say that ^piPRN_Q10 consider^DT_CCP10_E you to be ^DT_GEND_E primary caregiver?
Do you believe you ^DT_CCP20_E the main contact or coordinator for ^piPRN_Q10's care arrangements?
Now we would like to know about people other than you who provided help to ^piPRN_Q10.
How many other friends and family members have helped ^piPRN_Q10 during the past 12 months?
(MIN: 0) (MAX: 60)
DK, RF
How many of these people are your:
… immediate family (spouse or partner, children, parents and siblings)?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people are your:
… extended family (e.g. cousins, grandparents, aunts, uncles, in-laws)?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people are your:
… friends or neighbours?
(MIN: 0) (MAX: 20)
DK, RF
How many of these people are women?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were providing help to ^piPRN_Q10:
… how many of these people were employed?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were providing help to ^piPRN_Q10:
… how many of these people were below the age of 19?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were providing help to ^piPRN_Q10:
… how many of these people were between 19 and 44?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were providing help to ^piPRN_Q10:
… how many of these people were between 45 and 64?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were providing help to ^piPRN_Q10:
… how many of these people were between 65 and 79?
(MIN: 0) (MAX: 20)
DK, RF
At the time they were providing help to ^piPRN_Q10:
… how many of these people were 80 years of age or older?
(MIN: 0) (MAX: 20)
DK, RF
What is the relationship between ^piPRN_Q10 and this person who provided help?
(What is the relationship between ^piPRN_Q10 and this person who provided help?)
(80 spaces)
(DK, RF not allowed)
What is the sex of this person?
While providing help to ^piPRN_Q10, was this person employed?
How old is this person?
(MIN: 10) (MAX: 130)
DK, RF
During the past 12 months, has piPRN_Q10 received help from professionals that is paid workers or organizations?
In an average week, how many hours of help has ^DT_HESHE received from professionals?
The next questions are about support you may have received from others to help you with your caregiving responsibilities.
To accommodate your caregiving duties:
… has your spouse or partner modified their life and work arrangements?
To accommodate your caregiving duties:
… have your children provided you with help (such as helping with household chores)?
To accommodate your caregiving duties:
… have your extended family members provided you with help?
To accommodate your caregiving duties:
… have your close friends or neighbours provided you with help?
To accommodate your caregiving duties:
… have your community, spiritual community, or cultural or ethnic groups provided you with help?
To accommodate your caregiving duties:
… have you had occasional relief or respite care?
To accommodate your caregiving duties:
… have your family or friends provided you with financial support?
To accommodate your caregiving duties:
… have you received money from government programs?
Have you received any Federal tax credits for which caregivers may be eligible (e.g., caregiver tax credit, infirm dependant tax credit, medical expense tax credit)?
Is there any other type of support that you would like to have to help with your caregiving duties?
What kinds of support would you like to have?
(What kinds of support would you like to have?)
(80 spaces)
DK, RF
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 and volunteering on behalf of an organization.
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 paid assistance to clients or patients and volunteering on behalf of an organization.
How many people have you provided care to?
(MIN: 1) (MAX: 10)
DK, RF
We have a few questions about some of those people.
In what year did you begin to provide care to ^DT_PERSON?
(MIN: 1911) (MAX: 2017)
DK, RF
At what age did you begin to provide care to this person?
(MIN: 0) (MAX: 130)
DK, RF
In what year did you stop providing care to this person?
(MIN: 1911) (MAX: 2017)
DK, RF
At what age did you stop providing help to this person?
(MIN: 15) (MAX: 130)
DK, RF
What was the relationship of this person to you?
(What was the relationship of this person to you?)
(80 spaces)
DK, RF
Would you say that, other than professional care, this person considered you to be his or her primary caregiver (the person from whom he or she received the most time and resources)?
Did this person also receive professional care?
Now I would like to ask about any end-of-life care you may have provided to family, friends or neighbours. Exclude paid assistance to clients or patients and volunteering on behalf of an organization.
Have you ever provided end-of-life care?
Have you provided end-of-life care during the past 12 months?
^DT_CPE01_E you currently providing end-of-life care?
^DT_CPE01_E you provide this care in your home?
Would you ^DT_PEH01_E to provide end-of-life care in your home?
What conditions would ^DT_CEH01_E you to provide end-of-life care to this person in your home? Would it be:
… physical modifications to your home?
What conditions would ^DT_CEH01_E you to provide end-of-life care to this person in your home? Would it be:
… financial assistance to cover additional costs?
What conditions would ^DT_CEH01_E you to provide end-of-life care to this person in your home? Would it be:
… time off work without loss of pay?
What conditions would ^DT_CEH01_E you to provide end-of-life care to this person in your home? Would it be:
… better physical health or stamina?
What conditions would ^DT_CEH01_E you to provide end-of-life care to this person in your home? Would it be:
… health-related training?
What conditions would ^DT_CEH01_E you to provide end-of-life care to this person in your home? Would it be:
… home care support?
What conditions would ^DT_CEH01_E you to provide end-of-life care to this person in your home? Would it be:
… some other condition?
What conditions would ^DT_CEH01_E you to provide end-of-life care to this person in your home? Would it be:
… some other condition?
(80 spaces)
DK, RF
Have you ever taken "Compassionate Care Leave" to care for a terminally ill family member or friend?
Did you take this leave during the past 12 months?
Now some questions about how all your caregiving responsabilities during the past 12 months may have affected your life?
Some questions may not apply to you but we have to ask the same questions of everyone.
In general, how have you been coping with your caregiving responsibilities? Would you say:
In the past 12 months, have your caregiving responsibilities caused you to:
… spend less time with your spouse or partner?
In the past 12 months, have your caregiving responsibilities caused you to:
… spend less time with your children?
In the past 12 months, have your caregiving responsibilities caused you to:
… spend less time with ^DT_OTHER family members?
In the past 12 months, have your caregiving responsibilities caused you to:
… spend less time with friends?
In the past 12 months, have your caregiving responsibilities caused you to:
… spend less time on social activities or hobbies?
In the past 12 months, have your caregiving responsibilities caused you to:
… spend less time on relaxing or taking care of yourself?
In the past 12 months, have your caregiving responsibilities caused you to:
… spend less time volunteering for an organization?
In the past 12 months, have your caregiving responsibilities caused you to:
… spend less time participating in political, social or cultural groups?
In the past 12 months, have your caregiving responsibilities caused you to:
… make holiday plans and change or cancel them?
In the past 12 months, have your caregiving responsibilities caused you to:
… not make holiday plans at all?
In the past 12 months, have your caregiving responsibilities caused you to:
… move residences?
In the past 12 months, have your caregiving responsibilities caused strain in your relationship with family members or friends?
In the past 12 months, have your caregiving responsibilities affected the amount of exercise that you usually get?
Did the amount of exercise increase or decrease?
In the past 12 months, have your eating habits changed as a result of your caregiving responsibilities?
Have your eating habits become more healthy or less healthy?
During the past 12 months, have your caregiving responsibilities affected the amount of alcohol you consume?
Did you:
In the past 12 months, have your smoking habits changed because of your caregiving responsibilities?
Did you:
During the past 12 months, has your overall health suffered because of your caregiving responsibilities?
During the past 12 months, how physically strenuous were your caregiving responsibilities? Were they:
During the past 12 months, how often did you see a medical professional for your own health problems which resulted from your caregiving responsibilities?
Have your caregiving responsibilities prevented you from seeing a medical professional for health problems of your own?
During the past 12 months, have you suffered any injuries while peRForming your caregiving responsibilities?
Did you suffer one injury or more than one injury?
Did your most serious injury cause you to:
… limit your daily activities for at least one day?
Did your most serious injury cause you to:
… seek treatment from a medical professional?
Did your most serious injury cause you to:
… take time off from caregiving duties?
Did your most serious injury cause you to:
… take time off from your job or business?
Do you feel you had a choice in taking on your caregiving responsibilities during the past 12 months?
Has your relationship with the person or persons you have been caring for strengthened during this time?
How rewarding have your caregiving experiences been during the past 12 months? Were they:
How stressful have your caregiving responsibilities been during the past 12 months? Were they:
What specifically did you find stressful about caregiving?
(What specifically did you find stressful about caregiving?)
(80 spaces)
DK, RF
During the past 12 months, have your caregiving responsibilities caused you to feel:
… tired?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… worried or anxious?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… overwhelmed?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… lonely or isolated?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… short-tempered or irritable?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… resentful?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… depressed?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… experience loss of appetite?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… experience disturbed sleep?
During the past 12 months, have your caregiving responsibilities caused you to feel:
… experience any other symptoms?
What were these symptoms?
(80 spaces)
DK, RF
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?
What were these coping methods?
(What were these coping methods?)
(80 spaces)
DK, RF
In the past 12 months, have you used prescription drugs to help you cope with your caregiving responsibilities?
The next questions ask about expenses you may have incurred in the past 12 months as a result of all your caregiving responsibilities. We are talking about out-of-pocket expenses that are not reimbursed.
In the past 12 months, have you had any out-of-pocket expenses for home modifications to accommodate your ^DT_CARERECEIVER needs?
In the past 12 months, have you had any out-of-pocket expenses for professional services for your ^DT_CARERECEIVER healthcare or rehabilitation?
In the past 12 months, have you had any out-of-pocket expenses for hiring people to help with your ^DT_CARERECEIVER daily activities?
In the past 12 months, have you had any out-of-pocket expenses for transportation, travel or accommodation because of your caregiving responsibilities?
During the past 12 months, have you had any out-of-pocket expenses for specialized aids or devices for your ^DT_CARERECEIVER use?
In the past 12 months, have you had any out-of-pocket expenses for prescription or non-prescription drugs for your ^DT_CARERECEIVER use?
During the past 12 months, have you had any other out-of-pocket expenses because of your caregiving responsibilities that we haven't covered so far?
What were these expenses for?
(200 spaces)
DK, RF
During the past 12 months, have you experienced financial hardship because of your caregiving responsibilities?
Have you had to:
… borrow money from family or friends?
Have you had to:
… take loans from a bank or financial institution?
Have you had to:
… use or defer savings?
Have you had to:
… modify your spending?
Have you had to:
… sell off assets?
Have you had to:
… file for bankruptcy?
Have you had to do anything else?
Have you had to do anything else?
(80 spaces)
DK, RF
What is your best estimate of these expenses ^PHRASE_E?
(MIN: 1) (MAX: 50000)
DK, RF
Which of the following categories did these expenses ^PHRASE_E fall into? Was it:
Now some questions about your education and employment.
Are you currently attending school, college, CEGEP or university?
What type of educational institution ^DT_EOR02_E you attend?
^DT_EOR03_E you:
What is the highest level of education that you have completed?
In the past 12 months, have you postponed enrolling in an education or training program because of your caregiving responsibilities?
Did you postpone plans:
In the past 12 months, have your studies been affected because of your caregiving responsibilities?
For how many weeks during the past 12 months were you employed?
(MIN: 1) (MAX: 52)
DK, RF
Were you mainly:
What is the name of your business?
(80 spaces)
DK, RF
What kind of business, industry or service ^DT_WLY120_E this?
(80 spaces)
DK, RF
What kind of work ^DT_WLY130_E you doing?
(80 spaces)
DK, RF
What ^DT_WLY140_E your most important activities or duties?
(80 spaces)
DK, RF
Are you still working ^DT_WLY145_E?
Which of the following best describes your terms of employment in this job? ^DT_WLY150_E you a:
^DT_WLY150_E you a union member or covered by a union contract or collective agreement in this job?
Did you have more than one paid job last week?
How many hours a week ^DT_WHW120_E you usually work at your job?
(MIN: 0.1) (MAX: 168.0)
DK, RF
How many hours a week do you usually work at your main job?
(MIN: 0.1) (MAX: 168.0)
DK, RF
How many hours a week do you usually work at your main job(s)?
(MIN: 0.1) (MAX: 168.0)
DK, RF
Why ^DT_WHW160_E you usually work less than 30 hours a week?
(Why ^DT_WHW160_E you usually work less than 30 hours a week?)
(80 spaces)
DK, RF
How many days a week ^DT_WHW210_E you usually work (including all jobs)?
(MIN: 1) (MAX: 7)
DK, RF
Which of the following best describes your usual work schedule at your ^DT_WHW230_E1? ^DT_WHW230_E2 it:
(Which of the following best describes your usual work schedule at your ^DT_WHW230_E1? ^DT_WHW230_E2 it:)
(80 spaces)
DK, RF
Excluding overtime, ^DT_WTI110_E you usually work any of your scheduled hours at home?
How many paid hours per week ^DT_WTI120_E you usually work at home?
(MIN: 1) (MAX: 168)
DK, RF
What is the main reason you ^DT_WTI130_E some of your work at home?
(What is the main reason you ^DT_WTI130_E some of your work at home?)
(80 spaces)
(DK, RF not allowed)
^DT_FWA120_E you have a flexible schedule that ^DT_ALLOW_E you to choose the time begin and end your work day?
^DT_FWA130_E your employer:
… provide you with the option to work part-time?
^DT_FWA130_E your employer:
… provide you with the ability to take leave, paid or unpaid, to take care of your child(ren)?
^DT_FWA130_E your employer:
… provide you with the ability to take leave, paid or unpaid, to take care of your spouse, partner or other family members?
^DT_FWA130_E your employer:
… provide you with the ability to take extended leave without pay for personal reasons?
^DT_FWA130_E your employer:
… provide you with the option to telework?
Do you think you could ^DT_FWA150_E these flexible work arrangements without a negative impact on your career?
In the past 12 months, how often has it been difficult to fulfill family responsibilities because of the amount of time you spent on your job? Was it:
In the past 12 months, how often has it been difficult to concentrate or fulfill your work responsibilities because of your family responsibilities? Was it:
How satisfied are you with the current balance between your job and home life? Are you:
Why are you dissatisfied?
(Why are you dissatisfied?)
(80 spaces)
DK, RF
The next questions ask about the impact that caregiving may have had on your employment during the past 12 months.
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?
(MIN: 0) (MAX: 95)
DK, RF
Were you paid for this time off?
Did you reduce your regular weekly hours of work because of your caregiving responsibilities?
How many fewer hours per week did you work because of your caregiving responsibilities?
(MIN: 0.5) (MAX: 60.0)
DK, RF
Did you lose some or all of your employment benefits because of this reduction in hours?
Did you lose your:
… extended health benefits?
Did you lose your:
… dental benefits?
Did you lose your:
… employer-provided pension?
Did you lose your:
… life insurance?
Did you lose your:
… prescription medication coverage?
Did you lose your:
… any other type of benefit?
(Did you lose your:
… any other type of benefit?))
(80 spaces)
DK, RF
How many times during the past 12 months did you take one or more days off from your job because of your caregiving responsibilities?
(MIN: 0) (MAX: 95)
DK, RF
How long was your longest time off?
How long was your longest time off?
(MIN: 1) (MAX: 365)
DK, RF
How long was your longest time off?
(MIN: 1) (MAX: 52)
DK, RF
How long was your longest time off?
(MIN: 1) (MAX: 12)
DK, RF
Was this time off paid or unpaid?
What were your annual earnings before taxes from this job?
(MIN: -9000000) (MAX: 90000000)
DK, RF
During the past 12 months, did you quit a job because of your caregiving responsibilities?
For how long were you unemployed after you quit your job?
For how long were you unemployed after you quit your job?
(MIN: 1) (MAX: 52)
DK, RF
For how long were you unemployed after you quit your job?
(MIN: 1) (MAX: 12)
DK, RF
What circumstances would have enabled you to keep working while providing care at the same time?
(What circumstances would have enabled you to keep working while providing care at the same time?)
(80 spaces)
DK, RF
What were your annual earnings before taxes from this job?
(MIN: -9000000) (MAX: 90000000)
DK, RF
During the past 12 months, were you fired, laid off, or asked to resign from a job because of your caregiving responsibilities?
How long were you unemployed after you lost your job?
How long were you unemployed after you lost your job?
(MIN: 1) (MAX: 52)
DK, RF
How long were you unemployed after you lost your job?
(MIN: 1) (MAX: 12)
DK, RF
What were your annual earnings before taxes from this job?
(MIN: -9000000) (MAX: 9000000)
DK, RF
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?
Did you take a less demanding job because of your caregiving responsibilities?
Did this less demanding job pay less or more than your previous job?
Did this less demanding job provide fewer or more benefits than your previous job?
Have your caregiving responsibilities prevented you from working at a paid job?
Are you interested in finding paid employment?
Would you like a full or part-time job?
What would enable you to work at a paid job?
(What would enable you to work at a paid job?)
(80 spaces)
DK, RF
The next questions ask about the impact that caregiving may have had on your employment over the years prior to the past 12 months.
Excluding the past 12 months, have you ever worked at a paid job while providing care?
Excluding the past 12 months, did you ever reduce your regular weekly hours of employment because of your caregiving responsibilities?
Did you lose some or all of your employment benefits because you reduced your weekly hours?
Excluding the past 12 months, did you ever have to take a leave from a job because of your caregiving responsibilities?
How long was your longest leave?
How long was your longest leave?
(MIN: 1) (MAX: 365)
DK, RF
How long was your longest leave?
(MIN: 1) (MAX: 52)
DK, RF
How long was your longest leave?
(MIN: 1) (MAX: 12)
DK, RF
How long was your longest leave?
(MIN: 1.0) (MAX: 25.0)
DK, RF
Was this leave paid or unpaid?
What were your annual earnings before taxes from this job?
(MIN: -9000000) (MAX: 90000000)
DK, RF
Excluding the past 12 months, how many times did you have to quit a job because of your caregiving responsibilities?
(MIN: 0) (MAX: 995)
DK, RF
What circumstances would have enabled you to keep working while providing care at the same time?
(What circumstances would have enabled you to keep working while providing care at the same time?)
(80 spaces)
DK, RF
Excluding 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?
(MIN: 0) (MAX: 995)
DK, RF
Excluding 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?
(MIN: 0) (MAX: 995)
DK, RF
Have you ever retired from a job or business?
^DT_TIMING_E affected because of your caregiving responsibilities?
Did you retire earlier or later than you would have preferred to?
How much ^DT_TIME_E?
How much ^DT_TIME_E?
(MIN: 1) (MAX: 12)
DK, RF
How much ^DT_TIME_E?
(MIN: 1) (MAX: 20)
DK, RF
What were your annual earnings before taxes from the last job you held before retiring?
(MIN: -9000000) (MAX: 90000000)
DK, RF
The following questions are about your housing characteristics.
In what type of dwelling are you now living? Is it a:
(In what type of dwelling are you now living? Is it a:)
(80 spaces)
DK, RF
Is this dwelling:
Is there a mortgage on this dwelling?
How long have you lived in this dwelling?
How long have you lived in this neighbourhood?
How long have you lived in this city or local community?
Would you say that you know:
Would you say this neighbourhood is a place where neighbours help each other?
In the past month, have you done a favour for a neighbour?
In the past month, have any of your neighbours done a favour for you?
In your neighbourhood, is public transportation available (for example, bus, rapid transit or subway)?
The next questions ask about how accessible your home may be to someone using a wheelchair.
Does your home have:
… a street level entrance with no steps?
Does your home have:
… a ramp at the entrance?
Does your home have:
… doorways that are wide enough for a wheelchair?
Does your home have:
… lowered counters in the kitchen or bathroom?
Does your home have:
… grab bars in the bathroom?
Does your home have:
… easy to open doors, including lever handles?
Does your home have:
… an elevator or lift device?
Are you aware of any government grants to make homes more accessible to persons with disabilities?
The following questions ask about your day-to-day health.
In general, would you say your health is:
In general, would you say your mental health is:
In general, would you say that your eating habits are:
In the past week, how many times did you participate in moderate or vigorous physical activity for leisure, work, housework or transportation?
(MIN: 0) (MAX: 50)
DK, RF
About how much time did you spend on each occasion?
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?
Thinking of the amount of stress in your life, would you say that most days are:
Do you regularly have trouble going to sleep or staying asleep?
Do you take any medication to help you sleep?
For each of the following six questions, please indicate whether the statement describes your feelings, using the categories: yes, more or less, or no.
I experience a general sense of emptiness.
There are plenty of people I can rely on when I have problems.
There are many people I can trust completely.
There are enough people I feel close to.
I miss having people around.
I often feel rejected.
The next set of questions ask about your day-to-day abilities.
Are you usually able to see well enough to read ordinary newsprint without glasses or contact lenses?
Are you usually able to see well enough to read ordinary newsprint with glasses or contact lenses?
Are you able to see at all?
Are you able to see well enough to recognize a friend on the other side of the street without glasses or contact lenses?
Are you usually able to see well enough to recognize a friend on the other side of the street with glasses or contact lenses?
Are you usually able to hear what is said in a group conversation with at least three other people without a hearing aid?
Are you usually able to hear what is said in a group conversation with at least three other people with a hearing aid?
Are you able to hear at all?
Are you usually able to hear what is said in a conversation with one other person in a quiet room without a hearing aid?
Are you usually able to hear what is said in a conversation with one other person in a quiet room with a hearing aid?
Are you usually able to be understood completely when speaking with strangers in your own language?
Are you able to be understood partially when speaking with strangers?
Are you able to be understood completely when speaking with those who know you well?
Are you able to be understood partially when speaking with those who know you well?
Are you usually able to walk around the neighbourhood without difficulty and without mechanical support such as braces, a cane or crutches?
Are you able to walk at all?
Do you require mechanical support such as braces, a cane or crutches to be able to walk around the neighbourhood?
Do you require the help of another person to be able to walk?
Do you require a wheelchair to get around?
How often do you use a wheelchair?
Do you need the help of another person to get around in a wheelchair?
Are you usually able to grasp and handle small objects such as a pencil or scissors?
Do you require the help of another person because of limitations in the use of hands or fingers?
Do you require the help of another person with:
Do you require special equipment, for example, devices to assist in dressing, because of limitations in the use of hands or fingers?
Would you describe yourself as being usually:
How would you describe your usual ability to remember things? Are you:
How would you describe your usual ability to think and solve day-to-day problems? Are you:
Are you usually free of pain or discomfort?
How would you describe the usual intensity of your pain or discomfort?
How many activities does your pain or discomfort prevent?
Do you have any long-term health conditions, or physical or mental disabilities ^DT_CONDITION_E?
What is this condition?
(What is this condition?)
(80 spaces)
DK, RF
Now, I'd like to ask a few general questions.
In what country were you born?
(50 spaces)
DK, RF
(In what country were you born?)
(80 spaces)
DK, RF
In which province or territory?
In what year did you first come to Canada to live?
(MIN: 1900) (MAX: 9995)
DK, RF
Are you now, or have you ever been, a landed immigrant in Canada?
In what year did you first become a landed immigrant in Canada?
(MIN: 1900) (MAX: 2011)
DK, RF
What were the ethnic or cultural origins of your ancestors?
(What were the ethnic or cultural origins of your ancestors?)
(80 spaces)
DK, RF
What is your religion?
(50 spaces)
DK, RF
(What is your religion?)
(80 spaces)
DK, RF
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?
How important are your religious or spiritual beliefs to the way you live your life? Would you say they are:
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.
What language did you first speak in childhood?
(What language did you first speak in childhood?)
(80 spaces)
(DK, RF not allowed)
Do you still understand English?
Do you still understand French?
Do you still understand Italian?
Do you still understand Chinese?
Do you still understand German?
Do you still understand Portuguese?
Do you still understand Polish?
Do you still understand Ukrainian?
Do you still understand Spanish?
Do you still understand Vietnamese?
Do you still understand Greek?
Do you still understand Punjabi?
Do you still understand Arabic?
Do you still understand Tagalog?
Do you still understand Hungarian?
Do you still understand ^LNR_S100?
What language do you speak most often at home?
(What language do you speak most often at home?)
(80 spaces)
(DK, RF not allowed)
Can you speak English well enough to conduct a conversation?
Can you speak French well enough to conduct a conversation?
Now, the last set of questions.
What was your main source of income during the year ending December 31, ^DV_PASTYEAR?
(What was your main source of income during the year ending December 31, ^DV_PASTYEAR?)
(80 spaces)
DK, RF
What is your best estimate of your total personal income, before taxes and deductions, from all sources during the year ending December 31, ^DV_PASTYEAR?
(MIN: -9000000) (MAX: 90000000)
DK, RF
Can you estimate in which of the following groups your total personal income falls for the year ending December 31, ^DV_PASTYEAR? Was it:
Please stop me when I have read the category which applies to you. Was it:
Please stop me when I have read the category which applies to you. Was it:
Not including you, how many other household members received income from any source during that period (the year ending December 31, ^DV_PASTYEAR)?
(MIN: 0) (MAX: 19)
DK, RF
What is your best estimate of your total household income, received by all household members, from all sources, before taxes and deductions, during the year ending December 31, ^DV_PASTYEAR?
(MIN: -9000000) (MAX: 90000000)
DK, RF
Can you estimate in which of the following groups your total household income falls for the year ending December 31, ^DV_PASTYEAR? Was it:
Can you estimate in which of the following groups your total household income falls for the year ending December 31, ^DV_PASTYEAR?
Please stop me when I have read the category which applies to your household. Was it:
Can you estimate in which of the following groups your total household income falls for the year ending December 31, ^DV_PASTYEAR?
Please stop me when I have read the category which applies to your household. Was it: