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Private Caregiver or Attendant Interview Questions

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This form structures your interview with each caregiver, giving you examples of the most important information to obtain. This form also gives you a place to take notes from each interview so you can easily review the content of each interview, avoiding any confusion later. 1. What is the level of staff training? _____ nurse’s aide/support worker/home health aide _____ Registered nurse’s assistant _____ Registered nurse

2. Do you have a license or certification? _____ yes _____ no __________________ regulating agency

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3. What has been your training? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 4. What caregiving services have you given in the past?

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_____ housekeeping _____ bathing _____ shopping _____ companionship _____ palliative/hospice care _____ toileting

_____ medication management _____ meal preparation _____ escort to appointments _____ post-operative care _____ driving _____ grooming

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Other: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

5. What were the medical problems of your previous clients? Alzheimer’s _____ Dementia ______ Parkinson’s _____ Cancer _________ Heart problems _____ COPD ______ End of life care _______ Other: _____________________________________________________

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


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6. What is the minimum number of hours for a shift? ________________________________________________________ 7. How much notice will I get if you are going on vacation? Do you have a person that you can recommend if you are sick or going on vacation? ___________________________________________________________ ___________________________________________________________ 8. Hourly rate? Weekly rate? ________________________________________________________

9. What types of emergencies have you dealt with in the past? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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10. If my loved one becomes verbally aggressive (yelling, arguing), what would you do: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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11. If my loved one becomes physically aggressive (throwing an object, hitting), what would you do? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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12. Describe the most challenging situation you have been in when providing care? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 13. Are there any types of patients that you are uncomfortable caring for? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 14. How do you feel about caring for someone in my loved one’s condition? ___________________________________________________________ ___________________________________________________________

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


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15. Are you comfortable providing end of life care? (if applicable) ___________________________________________________________ ___________________________________________________________ 16. Do you provide a receipt for tax purposes? ___________________________________________________________ 17. Reference names and phone numbers: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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18. Share your expectations with the caregiver or attendant you are interviewing: a. Vacation notice: ________________________________________ b. Resignation notice: _____________________________________ c. What you expect regarding the care and employment (arrive on time, document patient’s activities, personal care, etc.) d. Other: _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________

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19. Share the following information with the caregiver regarding your loved one’s needs: a. Health status and medical diagnoses b. Medication type and dosing c. Behavioral problems or concerns, mood problems or concerns, personality characteristics (social, quiet, private, etc.), d. Interests (cards, reading, television) e. Personality type of caregiver you’re requesting (talkative, patient, firm, etc.) f. Family support g. Services required h. Other: _____________________________________________________ _____________________________________________________ _____________________________________________________

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


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