OrgStory Survey 2 - Residents in Long-Term Care At the core of our mission is speaking up for quality long-term care. VOYCE is asking you to speak out on this subject and complete this confidential questionnaire about your perceptions, attitudes and experiences related to long-term care. Your insights will help enable VOYCE to provide an annual "Report to the Region" and enable VOYCE to continue to be the leading advocate for quality long-term care. All answers are completely anonymous and confidential. Thank you for taking the time to complete this survey. Question Title * 1. What is your zip code? Question Title * 2. On a scale of 1 to 5 (1 meaning NOT concerned, 5 meaning VERY concerned), how concerned are you about the following issues around your own aging? 1 2 3 4 5 Losing independence and being reliant on others Losing independence and being reliant on others 1 Losing independence and being reliant on others 2 Losing independence and being reliant on others 3 Losing independence and being reliant on others 4 Losing independence and being reliant on others 5 Losing your memory or other mental abilities Losing your memory or other mental abilities 1 Losing your memory or other mental abilities 2 Losing your memory or other mental abilities 3 Losing your memory or other mental abilities 4 Losing your memory or other mental abilities 5 Paying for long-term care Paying for long-term care 1 Paying for long-term care 2 Paying for long-term care 3 Paying for long-term care 4 Paying for long-term care 5 Having to move into a nursing home facility of some type Having to move into a nursing home facility of some type 1 Having to move into a nursing home facility of some type 2 Having to move into a nursing home facility of some type 3 Having to move into a nursing home facility of some type 4 Having to move into a nursing home facility of some type 5 Being a burden on your family Being a burden on your family 1 Being a burden on your family 2 Being a burden on your family 3 Being a burden on your family 4 Being a burden on your family 5 Being alone Being alone 1 Being alone 2 Being alone 3 Being alone 4 Being alone 5 Question Title * 3. On a scale of 1 to 5 (1 meaning NOT concerned, 5 meaning VERY concerned), how concerned are you about the following issues around the aging of a loved one, such as a spouse or parent? 1 2 3 4 5 The loss of independence and becoming reliant on others The loss of independence and becoming reliant on others 1 The loss of independence and becoming reliant on others 2 The loss of independence and becoming reliant on others 3 The loss of independence and becoming reliant on others 4 The loss of independence and becoming reliant on others 5 The loss of memory and other mental abilities The loss of memory and other mental abilities 1 The loss of memory and other mental abilities 2 The loss of memory and other mental abilities 3 The loss of memory and other mental abilities 4 The loss of memory and other mental abilities 5 Paying for long-term care Paying for long-term care 1 Paying for long-term care 2 Paying for long-term care 3 Paying for long-term care 4 Paying for long-term care 5 Having to move into a nursing home facility of some type Having to move into a nursing home facility of some type 1 Having to move into a nursing home facility of some type 2 Having to move into a nursing home facility of some type 3 Having to move into a nursing home facility of some type 4 Having to move into a nursing home facility of some type 5 Being a burden on your family Being a burden on your family 1 Being a burden on your family 2 Being a burden on your family 3 Being a burden on your family 4 Being a burden on your family 5 Feeling alone Feeling alone 1 Feeling alone 2 Feeling alone 3 Feeling alone 4 Feeling alone 5 Question Title * 4. Based on living at a long-term care facility, which of the following statements most accurately reflects your experience thus far? (Please select one) I'm completely satisfied with the care and attention I receive I'm somewhat satisfied with the care and attention I receive I'm completely dissatisfied with the care and attention I receive Question Title * 5. When it comes to getting questions answered or issues resolved with your long-term care facility, which of the following most accurately describes your situation? (Check only one) I handle on my own A family member takes care of getting my questions answered or issues resolved A member of the facility speaks on my behalf to get my questions answered or issues resolved I have a third party advocate that is not a member of my family, healthcare team or facility that helps get questions answered and issues resolved Question Title * 6. When you have questions and/or concerns about your care or other matters related to your nursing home or assisted living community, how long does it generally take to get them addressed? (Check only one) Same day 1 - 2 days 3 - 5 days More than 5 days Question Title * 7. Please check the boxes that best represent you (Optional) Male Female Under 50 years old 51 - 60 years old 61 - 70 years old 71 - 80 years old Over 80 years old Done