CARE GIVER SUPPLIERS

QUESTIONNAIRE
1. Name of the Company/Managers : ________________________________________
2. Address
: _______________________________________________________
_______________________________________________________
_______________________________________________________
3. Phone Number : _______________________________________________________
4. Email ID
: _______________________________________________________
5.

6. What is the profile of the senior citizens they cater to ?

Age
Sex
Marital Status
What is the profile of the senior citizens they cater to age, sex, marital status,
healthy/physically afflicted/ mentally afflicted (incl. type of affliction)
Are they trained? If yes, what kind of training?
What is the fee structure ? What are the terms of agreement with the client and with
their employer?
How do the employers get to know of them?
Why did they choose this profession?
Are there any legal issues that they face?
What are the other servces (apart from health related services) that they provide for
the eldery?
Are there other services (maybe health related/not health related) that they wish they
could provide to senior citizens ? what stops them?
What makes them glad/ sad/ frustrated about this profession?
How long do they see themselves in this profession?
What are other stated/ unstated challenges that we can pick up?
Care Takers
What is the profile of the senior citizens they cater to age, sex, marital status,
healthy/physically afflicted/ mentally afflicted (incl. type of affliction)
Do the employ service providers? If so the profile of service providers they employ
What challenges do they face in getting care givers? How do they locate care givers?
Are the care givers trained? If yes, what kind of training?
What is the fee structure? What are the terms of agreement?
Are there any safety or legal issues that they face?

What are the other servces (apart from health related services) that they provide for
the eldery?
Are there other services (maybe health related/not health related) that they wish they
could
Obtain?
What are other stated/ unstated challenges that we can pick up?

CARE GIVERS
QUESTIONNAIRE
1. Care Giver Name : ____________________________________________________

2. Address

: __________________________________________________________
__________________________________________________________
_______________________________________________________

3. Phone Number : _______________________________________________________

4. Email ID : __________________________________________________________
5. Age
o Below 25 years
o 25 to 35 years
o 35 to 50 years
o 50 to 60 years
o Above 60 years
6. Marital Status
o Male
o Female

Working Side:
6. How long you are doing this service ?
o Less than 1 year
o 1 year to 2 years
o 2 years to 5 years
o More than 5 years
7. Whether you get regular payment from your management ?
o Yes
o No
Service Side

OLDER AGE HOME MANAGERS

QUESTIONNAIRE
1. Name of the Company/Managers : ________________________________________
2. Address
: _______________________________________________________
_______________________________________________________
_______________________________________________________
3. Phone Number : _______________________________________________________
4. Email ID
: _______________________________________________________

CARE TAKERS
QUESTIONNAIRE
1. Name of the Company/Managers : ________________________________________
2. Address
: _______________________________________________________
_______________________________________________________
_______________________________________________________
3. Phone Number : _______________________________________________________
4. Email ID
: _______________________________________________________