Lifespan Respite
Technical Assistance Center

Sample Performance Measurement Tools
for Lifespan Respite Programs

To Measure Lifespan Respite Systems Change Outcomes 

State Lifespan Respite Grantee Sample Tools:

  MA Tools for evaluating state level strategic alliance:

Levels of Organizational Integration Rubric

LOIR Template

Utilizing Collaboration Theory

Evaluating Organizational Collaborations

Measuring Collaboration in Lifespan Respite: Massachusetts Levels of Organizational Integration, Presentation of Leanne Winchester, MA Lifespan Respite Coalition, PPT Slides


ARCH Sample Measurement Tools:
Systems Change Outcome #1 Tracking Form
Increase in Caregiver Access to Respite (1)
Increase in Caregiver Access to Respite (2)
MOU Fulfillment of Agreement Matrix
Coordination_Collaboration Tracking Form


To Measure Caregiver/Care Recipient/Family Outcomes

State Lifespan Respite Grantee Sample Tools:
AL HEARTS Pre and Post Respite Evaluation
DE Lifespan Respite Network Financial Assistance Evaluation Form
DE Lifespan Respite Network Respite Care Information and Referral Service Evaluation Form
NC Post-Respite Survey
NC Pre-Respite Survey
NC Setting Goals to Maximize Your Respite Time
2017 NE Lifespan Respite Family Caregiver Survey with supplemental questions
NE Family Caregiver Depression Screen
NV Rx Pre-Respite Survey

NV Rx Post-Respite Survey

OK Lifespan Respite Grant Pre Voucher Survey

OK Lifespan Respite Grant Post Voucher Survey

TN Respite Coalition Caregiver Survey

VA Lifespan Respite Voucher Program Satisfaction Survey

Nationally Recognized Tools:

See also FRIENDS National Resource Center for Community-based Child Abuse Prevention. Compendium of Annotated Tools.

Measures for Assessing Caregiving Coping (APA):

Care Receiver Assessment Tools (APA):

Parent Caregiver Tools (APA):

ARCH Sample Measurement Tools:


American Psychological Association, Public Interest Directorate. Caregiver Assessment Tools.  

Family Caregiver Alliance and Benjamin Rose Institute on Aging (2012; 2nd Edition). Selected Caregiver Assessment Measures: A Resource Inventory for Practitioners  

Lund, D; Wright, SD; Caserta, M; Utz, R; Lindfelt, C; Montoro-Rodriguez, J; and Shon, H (2014). Time for Living and Caring, Making Respite Services Work for You.  

US Administration on Aging. Performance Measurement Outcome Project (POMP).

Lifespan Respite

Technical Assistance and Resource Center

ARCH National Respite Network and Resource Center

(703) 256-2084 |

This project is supported, in part by grant number 90LT0001, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.


The ARCH National Respite Network and Resource Center is a program of Families and Communities Rising |4220 NC Hwy 55, Suite 330, Durham, NC 27713 |



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