This free survey is powered by
  1. Surveys
  2. 2013
  3. April
  4. C
  5. CaringEyes
0%
Exit Survey
 
 
1. Hello:
You are invited to participate in our survey. In this survey, approximately 2000 people will be asked to complete a survey that asks questions about senior care services. It will take approximately 5 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Rhonda Handke at the [email protected].

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
2. Are you or do you have seniors that currently
 
Live alone and are still independent
 
Live with a spouse and live independent
 
Live with family/other caretakers at home
 
Live in an assisted living facility
 
Live in a Board and Care or other nursing facility
 
Not applicable
 
 
 
3. Do you have seniors that you share in responsibility that live near you or your family so you can check in on them frequently
 
Less than an hour drive
 
1- 4 hours drive
 
More than 4 hours or a flight away
 
Not Applicable
 
 
 
4. What desired services/assistance would you like for your senior (Select all that apply)?
 
Verify medication is taken daily
 
Ensure eating healthy/prepare meals
 
Help with bathing
 
Help with laundry
 
Running errands (grocery shopping etc.)
 
Social interaction/companionship
 
Activities (movies, park, shopping)
 
Light housekeeping
 
Spend the night to help with bathroom visits
 
Daily phone calls/friend for company and conversation
 
Diners Club
 
Other
 

 
 
 
5. How many days a week would you want services identified above for your senior?
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
 
 
6. How many hours per visit would you want services provided?
 
2 hours
 
4 hours
 
8 hours
 
12 hours
 
24 hours
 
 
 
7. Please rank (1-5) the following in order of importance when selecting a caregiver/service for your senior:
Bonded
Customized Daily Report emailed to you after each visit
Unscheduled routine visits by supervisors to augment care and oversight, accompanied by an email report to designated family members
RN or LVN visit to take vitals periodically
Home check to verify no maintenance issues or potential hazards exist to seniors
Chauffeurs License to take my senior out and about time to time
 
 
 
8. My seniors presently or will require help with daily needs and/or companionship
 
Needs some help now
 
Within the next 6 months
 
Within the next 6-12 months
 
Within the next 1-2 years
 
Within the next 5-10 years
 
10 Years+
 
Annually
 
 
 
9. What financial resources (not including Medical Insurance or Home Rentals) are available for the additional help/services identified above
 
Less than $200 a month
 
$200-$500/month
 
$500-$800/month
 
$800-$1200/month
 
$1200-$2000/month
 
$2000-$4000/month
 
$4000+/month
 
 
 
10. Other Comments/Suggestions for Senior Care Services: