Who needs care?
  • Myself
  • A parent or relative
  • A spouse/partner
  • Someone else
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What type of care is needed?
  • Personal care (bathing, dressing, hygiene)
  • Companionship
  • Meal preparation
  • Medication reminders
  • Transportation
  • Other (please specify)
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How often is care needed?
  • Full-time (daily or 24/7)
  • Part-time (a few days a week)
  • Occasional/as-needed
  • Not sure yet
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When do you need care to start?
  • Immediately
  • Within 1–2 weeks
  • Within a month
  • Just exploring options
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