Chatham-Kent Hospice Strategic Plan - General Public Survey

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* 1. What’s your connection with the CK Hospice? (Select all that apply)

I've used the services

Friends or family have used the services

Never used services myself

Expect to use services in the future

Donor

Other

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* 2. What are your hopes and dreams for the CK Hospice over the next 3 years? Think big!

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* 3. What is the Hospice known for? What's our reputation?

	Low	Medium	High
Knowledge of Hospice	Knowledge of Hospice Low	Knowledge of Hospice Medium	Knowledge of Hospice High
Helpfulness	Helpfulness Low	Helpfulness Medium	Helpfulness High
Quality of Care	Quality of Care Low	Quality of Care Medium	Quality of Care High
Access to Services	Access to Services Low	Access to Services Medium	Access to Services High
Welcoming and Inclusive	Welcoming and Inclusive Low	Welcoming and Inclusive Medium	Welcoming and Inclusive High
Safe	Safe Low	Safe Medium	Safe High

Other (please specify)

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* 4. What additional programs or services could the Hospice offer? (list your top 3)

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* 5. What trends/issues/opportunities are there in Chatham-Kent that could impact the CK Hospice over the next 3-5 years? (list your top 3)

	No this isn't a gap	Yes this is a gap	I don't know
Awareness of available services	Awareness of available services No this isn't a gap	Awareness of available services Yes this is a gap	Awareness of available services I don't know
Other (please specify)
Type of programs and services offered	Type of programs and services offered No this isn't a gap	Type of programs and services offered Yes this is a gap	Type of programs and services offered I don't know
Other (please specify)
Wait times	Wait times No this isn't a gap	Wait times Yes this is a gap	Wait times I don't know
Other (please specify)
Where services are offered	Where services are offered No this isn't a gap	Where services are offered Yes this is a gap	Where services are offered I don't know
Other (please specify)
Services for indigenous people	Services for indigenous people No this isn't a gap	Services for indigenous people Yes this is a gap	Services for indigenous people I don't know
Other (please specify)
Services for people with lower incomes	Services for people with lower incomes No this isn't a gap	Services for people with lower incomes Yes this is a gap	Services for people with lower incomes I don't know
Other (please specify)
Services for people from diverse backgrounds	Services for people from diverse backgrounds No this isn't a gap	Services for people from diverse backgrounds Yes this is a gap	Services for people from diverse backgrounds I don't know
Other (please specify)

No this isn't a gap

Yes this is a gap

I don't know

Awareness of available services

Awareness of available services No this isn't a gap

Awareness of available services Yes this is a gap

Awareness of available services I don't know

Other (please specify)

Type of programs and services offered

Type of programs and services offered No this isn't a gap

Type of programs and services offered Yes this is a gap

Type of programs and services offered I don't know

Other (please specify)

Wait times

Wait times No this isn't a gap

Wait times Yes this is a gap

Wait times I don't know

Other (please specify)

Where services are offered

Where services are offered No this isn't a gap

Where services are offered Yes this is a gap

Where services are offered I don't know

Other (please specify)

Services for indigenous people

Services for indigenous people No this isn't a gap

Services for indigenous people Yes this is a gap

Services for indigenous people I don't know

Other (please specify)

Services for people with lower incomes

Services for people with lower incomes No this isn't a gap

Services for people with lower incomes Yes this is a gap

Services for people with lower incomes I don't know

Other (please specify)

Services for people from diverse backgrounds

Services for people from diverse backgrounds No this isn't a gap

Services for people from diverse backgrounds Yes this is a gap

Services for people from diverse backgrounds I don't know

Other (please specify)

Chatham-Kent Hospice Strategic Plan - General Public

Question Title

* 1. What’s your connection with the CK Hospice? (Select all that apply)

Question Title

* 2. What are your hopes and dreams for the CK Hospice over the next 3 years? Think big!

Question Title

* 3. What is the Hospice known for? What's our reputation?

Question Title

* 4. What additional programs or services could the Hospice offer? (list your top 3)

Question Title

* 5. What trends/issues/opportunities are there in Chatham-Kent that could impact the CK Hospice over the next 3-5 years? (list your top 3)

Question Title

* 6. What gaps in services are you aware of when it comes to hospice and palliative care in Chatham-Kent?

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* 7. Additional comments