"Making Moments Matter"

This survey is about the experiences of care and the services received by you and your family member/friend while in Hospice.  The information you give will help us improve care for people who are dying, and for their family and friends.  Your views are important to us and we appreciate your time to provide feedback.

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1. I am....

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2. If you answered "Other", what is your relationship to the resident?

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3. Are you or your loved one currently receiving care at the hospice?

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4. If you selected "no" from the question above.  How long ago did your loved one die?

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5. Was Hospice the preferred place to receive End of Life Care

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6. If no, Where was the preferred place to receive End of Life Care?

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7. Did Health care providers in Hospice involve resident and family in care planning?

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8. Were any changes to care and/or medication changes explained to your satisfaction?

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9. If No, please share your comments with us so we may continue to meet the needs of the individuals we serve.

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10. Were you provided enough help and support through your experience in Hospice?

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11. If No, What could we have done differently to support you?

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12. Were you made to feel welcome at the hospice?

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13. If you answered "no" to the above question, please share your concerns with us.

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14. Thinking about the care received in Hospice please indicate the overall level of support provided in the following areas:

  Excellent Very Good Good  Fair Poor Not Sure
Relief of physical pain
Relief of other symptoms
Emotional support
Spiritual Support
Respect and Dignity

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15. Overall, how do you feel about the care provided by:

  Excellent Very Good Good Fair Poor Not Sure
Nurses
Personal Support Workers
Physicians

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16. Lisaard and Innisfree has a number of available services.  Please select the ones you were aware of  while at hospice.

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17. Please indicate the services you had the opportunity to access while at Hospice

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18. Did you find the information in the Welcome Book helpful

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19. Has your experience with our hospice been what you had hoped for?

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20. Thank-you for taking the time to answer this survey. We feel privileged that you allowed us to provide care and support during this difficult and personal time.  Please share any other thoughts you have about the care provided.

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