What this is
Five short questions you can ask the spouse, adult child, or partner who is doing the unpaid full-time work of caring for your patient. None of them require a clipboard or a special tone. All of them are designed to be slipped into a normal conversation during a visit. The goal isn't a score — it's to surface the suffering that almost never makes it into a chart and to act on what you hear.
The 5 questions
- "How are you sleeping?"
Caregivers under stress sleep poorly. A real answer about waking up four times a night to reposition or to listen for falls tells you the load is unsustainable.
- "When was the last time you got out of the house — not for an errand or an appointment, just for yourself?"
If the answer is "I can't remember" or "not since this started," they have no respite. That's a referral.
- "Who's helping you with this besides yourself?"
The lonely caregivers are the ones most at risk. A list of zero names is a flag. A list of family who "say they'll help but don't" is also a flag.
- "Is there anything you're worried about that you haven't been able to bring up?"
This question, asked once and then quiet, lets people raise the thing they've been carrying alone. Sometimes it's a fall they didn't report. Sometimes it's that they can't keep doing this. Either matters.
- "How are you, honestly?"
Not "how is your husband." Not "how is the patient." You. Asked plainly, with eye contact, and then a real pause. Caregivers will sometimes break down at this question because nobody has asked them in months.
What to do with the answers
- One or two concerning answers — name what you heard, reflect it back ("That sounds like a lot — you've been carrying it without much help"), document in your visit note under caregiver status, and mention to the primary RN or case manager.
- Three or more concerning answers, or any answer that signals depression / hopelessness — refer to your agency's social worker the same day. If you suspect clinical depression in the caregiver, notify the patient's primary physician; the caregiver may need their own evaluation.
- Any answer that signals risk to the patient (e.g., "I yelled at her and I scared myself") — escalate to your clinical manager that day. This is a safety situation, not just a wellness one. See staying safe on home visits.
- Any answer that signals risk to the caregiver themselves (e.g., self-harm thoughts) — stay, listen, do not leave them alone with that, and connect them to crisis resources before you leave. The 988 Suicide & Crisis Lifeline is the right number.
What to offer, every time
- Social work consult — they know the local respite, support groups, transportation, food assistance, and benefits the family hasn't applied for.
- Home health aide if the patient qualifies — practical hands-on help.
- Caregiver support groups — disease-specific ones (Alzheimer's, stroke, cancer) often have local and online options. The Family Caregiver Alliance and AARP both maintain directories.
- Hospice or palliative care — not only for end-of-life. Palliative consultation can dramatically lower the load if it's appropriate.
What to put in the chart
The caregiver work disappears from the chart unless you put it there. A line on every relevant visit is enough:
"Primary caregiver (daughter) present. Reports sleeping ~4 hrs/night, no respite in 6 wks, denies any help from other family. Caregiver coping fair, declined to discuss further. Recommend SW consult; will discuss with case manager."
Adapted from Working with Caregivers and Families. Not a validated screening instrument — a clinician-friendly conversation tool.