Share The Care™ - How to Organize A Group to Care for Someone Who Is Seriously Ill
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Share The Care™ Group Questionnaire

The ShareTheCaregiving™ organization, is collecting data about Share The Care™ groups around the country. This information can lend courage, support and proof that this system really works, to those who are contemplating starting a group yet hesitant to begin. It will also help us discover and document ways in which groups have adapted the Share The Care™ model for the needs of their care recipients and team members.

We would like to invite you to participate in our research by sharing some basic information with us. Take a moment to answer the following questions. If you require more space than provided, you may submit additional information to the E-mail address at the end of the questionnaire. We appreciate your completing the questions even if your group is no longer active.

In addition we ask that you submit a short story about your group's experience - one that you think would be helpful to other groups. (Please limit to 500 words). If you have photos you would like to share, please feel free to send those along as well in a jpeg format.

Thank you in advance for your loving contribution to help others.

Our commitment to your privacy ensures that your information will only be used to help other Share The Care™ groups  or as part of research studies intended to improve the quality of life for patients and caregivers.
Fields marked with an * are required
Share The Care™ group:
City
State
Does/Did your group have a special name (such as “The Funny Family”)?
If so, what is the name?
Name of care recipient?
Age of care recipient
How many people are/were in the group?
Men
Women
Aged 65+
Children
Teens
How many are/were core members?
Free Floaters?
What type of illness/condition does the care recipient have?
Did/Does the care recipient have family members participating?
Yes
No
If so, please state their relationship(s) to the person receiving care.
Please list other group members’ relationship to the care recipient (friends,
co-workers, neighbors, church members, etc.).
How long has/was the group been in existence (year started)?
What is/was the biggest challenge?
What is/was the most satisfying (unusual or original) thing your group has done for the care recipient?
How did you learn about Share The Care™ ?
What would you suggest to make the Share The Care™ experience a better one?
Are there any other specific comments about your group that you would like to share?
Please provide your contact information:
Fields marked with an '*' are required.
Name*
Address*
Telephone (area code + number)*
E-mail address*

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Thank you for sharing your experiences with us.

If you have questions, or additional information please click here to email Sheila

Copyright 2008 ShareTheCaregivingTM, Inc. All Rights Reserved. This written content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. The content may not be altered in any manner without permission from ShareTheCaregivingTM, Inc. If any other use is desired, permission in writing from ShareTheCaregivingTM, Inc., is required. ShareTheCaregivingTM, Inc. is not responsible for any claims of any nature arising out of any individual's participation in a Share The CareTM group.
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