TX HHS Form 1027. Caregiver Status Questionnaire

The TX HHS Form 1027, Caregiver Status Questionnaire, is a practical tool designed to help identify caregivers who assist individuals in need of care. This form is typically used in situations where unpaid caregivers are providing support with daily activities such as shopping, household tasks, meal preparation, doctor's visits, or personal care.

The questionnaire is initiated by asking if there is an unpaid neighbor, relative, or friend helping the care recipient with various activities. If the answer is yes, the form guides the interviewer to gather information about the caregiver, including their presence and willingness to discuss available resources. The form also includes procedures for following up with the caregiver to offer assistance and support.

Key features of this form include the identification of caregivers who may not be aware of available resources to assist them in their caregiving roles. By completing this questionnaire, HHSC staff can provide targeted support and services to both the care recipient and the caregiver. Some key points to note are:

• The form is used to identify unpaid caregivers providing assistance with daily activities.
• The interviewer should substitute the name of the individual or relationship (e.g., "her," "you," "Mrs. Jones") in place of "Care recipient's name."
• The form includes procedures for following up with the caregiver to offer available resources and support.