Grandparents Raising Children

Survey of Needs -- 2009
Family Caregiver Support Program
1. What percentage of time do you have responsibility for caring for your grandchildren?
0-25% 25-50% 50-75% 75-100%

 2. If so, please indicate the number of grandchildren and their ages.
# of Children
Age Range Under 2 Years Old Ages 3-5 Ages 5-10 Ages 10-15 Ages 15-20
3. How long do you expect to have sole responsibility for your grandchildren?
4. Do other family members help you either financially or with their time? Please check the ways in which family members assist you (check all that apply)
Help with household chores Watch the children so I can get a break Provide transportation
Spend time with the kids (e.g., playing with the kids, taking them to sporting events or the park, etc)
Help the kids with their homework Attend school events or other child focused activities
Make meals Help buy clothes, school supplies and/or other needed items
Provide financial support Provide housing Other (please describe)
5. Do you receive help from any government agencies or community organizations? Yes No
5a. If yes, please list.
6. Do you need child care? Yes No
7. Do you need assistance finding quality child care? Yes No
8. Do you need more information about qualifying for financial assistance for child care? Yes No
9. Do you and your grand children have adequate healthcare? Yes No
9a. If the answer is no, please explain:
10. Do you need more information on health care for your grandchildren? Yes No
11. Has your grandchildren's school assisted you sufficiently? Yes No
12. Do you need more information on working with your grandchildren's school? Yes No
13. Are you living on Social Security or retirement funds? Yes No
14. Do you need financial assistance to help house, feed, and clothe your grandchildren? Yes No
15. Are you caring for children who are drug affected? Yes No
16. Are you caring for children who have special medical needs? Yes No
17. Are you caring for children who have special emotional and/or behavioral needs? Yes No
18. What are the greatest challenges you face in caring for your grandchildren (Please list)
19. Under what circumstances did you come to be the caregiver for your grandchildren?
The parents are deceased.
Child(ren) were removed from their parents by Child Welfare System and placed with me.
Their parents are incarcerated.
I was given guardianship of the child(ren) due to the fact that their parents were unable or unwilling to care for the children.
Parents are on active military duty.
Other (please describe):
20. Does raising your grandchildren put additional stress on you and your family? Yes No
21. Would you be interested in meeting with other grandparents raising their grandchildren to share your experience and learn new information? Yes No
22. Do you provide care for anyone in addition to your grandchildren? Yes No
23. If so, please indicate your relationship to care receiver and their age.
24. If you have other unmet needs, please indicate what they are.
25. What are the barriers to accessing services?

Please indicate your age: Under 45 45-49 50-54 55-59 60-64
  65-69 70-74 75-79 80-84 85+

Please indicate where you reside: Benicia Dixon Fairfield Rio Vista Suisun City
  Vacaville Vallejo American Canyon Calistoga Napa
  St. Helena Yountville Other

Please indicate your Ethnicity: Decline to state African American/Black
American Indian/Alaskan Native Asian Caucasian/White Hispanic/Latino
Native Hawaiian/other Pacific Islander Other Multi-racial


Please indicate your household's annual income level: Decline to state
 
1-Individual 2-Person Household 3-Person Household 4-Person Household
up to $10,830 up to $14,750 up to $18,310 up to $22,050
$10,831 - $13,357 $14,571 - $18,212 $18,311 - $22,887 $22,051 - $27,562
$13,358 - $16,245 $18,213 - $21,855 $22,887 - $27,465 $27,562 - $33,075
$16,246 - $21,660 $21,856 - $29,140 $27,466 - $36,620 $33,076 - $44,100
$21,661 - $32,490 $29,141 - $43,710 $36,620 - $54,930 $44,101 - $66,150
$32,491 - $43,320 $43,711 - $58,280 $54,931 - $73,240 $66,150 - $88,200
$43,321 or more $58,281 or more $73,241 or more $88,201 or more


Optional: Name:   Phone:
  Address:
  City:   State:   Zip:

Thank you for helping us gather information about Grandparents Raising Grandchildren.
Please return this survey to the Area Agency on Aging Serving Napa and Solano
P.O. Box 3069, Vallejo, CA 94590.

If you would like more information about the Family Caregiver Support Program, and services for Grandparents Raising Children, please call Roger at 707-644-6612.

For Senior Information and Assistance, call 1-800-510-2020

Programs at the Area Agency on Aging Serving Napa and Solano, including the Family Caregiver Support Program are supported with funding from the Older Americans Act, contributions from private foundations and individual donations.

This Grandparents Raising Grandchildren Project is a collaborative project with support of many community organizations, and is made possible by an award from the Brookdale Foundation Group.