Returning to Day Hab Survey

Returning to Day Hab Survey (Disability Law Center).

This survey is for individuals or family members of individuals who are having difficulty returning to day hab, community based day supports or both. Please answer for yourself, or for your family member who was or is enrolled in day habilitation, or wishes to be.

Question Title

* 1. What type of problem(s) do you have returning to your day program? (Choose one)

I cannot return to my day habilitation program, or am not being given enough days there.

I cannot return to my community based day supports (CBDS) program or am not being given enough days there.

I am having trouble being allowed to return to both programs.

I am having a problem returning to a day hab or community based day support program, but I am not sure about what type of program this is.

I have never received day habilitation services, and my attempt to participate for the first time has been denied.

Other (please specify)

Question Title

* 2. Did you or your family member receive day habilitation services before the Covid pandemic started in 2020? (Choose Yes or No)

Yes

Question Title

* 3. Before the COVID pandemic, how many days a week did you attend a day hab program? (Choose one)

No days

One day

Two days

Three days

Four days

Five days

Other (please specify)

Question Title

* 4. How many days do you currently attend day hab per week? (Choose one)

No days

One day

Two days

Three days

Four days

Five days

Other (please specify)

Question Title

* 5. How many ADDITIONAL days would you attend day hab (beyond the days you attend now) if you were permitted to do so? (Choose one)

No days

One day

Two days

Three days

Four days

Five days

Other (please specify)

Question Title

* 6. Before the COVID pandemic, for about how many years did you attend a day hab program? (Choose one)

I did not attend day hab before COVID.

One year

Two years

Three years

Four years

Five or more years

Other (please specify)

Question Title

* 7. What reasons have you been given for why you cannot attend day hab as much as you might like? (Choose all that apply):

There are not enough staff at the day hab.

My support needs are too high.

My disabilities are too complex.

I have been offered a place in the program but no transportation, and my family and/or my residential program cannot supply transportation.

There are not enough staff for all day hab participants, regardless of my support needs or disabilities. Everyone is being treated equally.

I was not given any reasons for why I could not attend more often.

My day hab program closed during the pandemic and I have not been assigned to another.

Not applicable - I do not wish to attend day hab more than I am being offered right now.

Other (please specify)

Question Title

* 8. How do you spend your days now? (Choose all that apply):

virtual (Zoom) classes, instruction or videos;

with family, with no increase in family support funds;

with family, with some increase in family support funds;

with residential staff from my residential program

I have meaningful planned activities during the day.

I do not have meaningful planned activities during the day.

Other (please specify)

Question Title

* 9. As a result of not being able to attend day hab as much as I would like or as much as I attended in the past, I am currently experiencing the following: (Choose all that apply):

Boredom

Anxiety

Depression

Behavioral challenges

A loss of skills in managing my activities of daily living

Financial and personal costs to family members who are providing care during the day.

I have found other day activities and am satisfied with how I spend my days.

Other (please specify)

Question Title

* 10. What is the name the day hab provider and the town in which the program was located (Optional).

Question Title

* 11. If it would be helpful in our work, may we contact you to discuss your situation confidentially in more detail? If so, please provide your name and contact information (telephone and/or email). (Optional)