MODERNIZATION GRANT: CAREGIVER SURVEY QUESTIONS
 FOR TRANSITIONAL PLANNING GUIDE PROJECT

Introduction
 
Reena and Mary Centre of the Archdiocese of Toronto (Mary Centre), received funding from the Ministry of Community & Social Services (MCSS) to revise and update the 2006 Transitional Guidefor persons aging with a developmental disability (DD). The purpose of the Transitional Guide is to assist caregivers and health and social service organizations in early planning for transitions in care needs for persons living with a DD.
 
As part of this project, we value your input. We have created an anonymous survey , which should take you about 20 minutes to complete  Please complete this survey by June 8, 2018.    Thank you in advance for your assistance and participation.  If you have any questions or wish to speak further with the project leads, please contact Mindy Ginsler at ginslerm@yahoo.ca or Christel Galea at qualityhmc@gmail.com.  

CAREGIVER DEMOGRAPHICS:   Please check the age range of the caregiver(s) responding to this survey.

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* 1. CAREGIVER DEMOGRAPHICS:   Please check the age range of the caregiver(s) responding to this survey.

CAREGIVER DEMOGRAPHICS: Please choose the box that best describes your relationship to the person that  you are supporting.

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* 2. CAREGIVER DEMOGRAPHICS: Please choose the box that best describes your relationship to the person that  you are supporting.

CAREGIVER DEMOGRAPHICS:   In what region/municipality are you providing care for the person with DD?

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* 3. CAREGIVER DEMOGRAPHICS:   In what region/municipality are you providing care for the person with DD?

CAREGIVER DEMOGRAPHICS: What is the primary language spoken at home?

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* 4. CAREGIVER DEMOGRAPHICS: What is the primary language spoken at home?

CAREGIVER DEMOGRAPHICS: I have been caring for the person with a Developmental Disability for?

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* 5. CAREGIVER DEMOGRAPHICS: I have been caring for the person with a Developmental Disability for?

CAREGIVER DEMOGRAPHICS:  Do you have access to a primary care physician/family doctor to support the person?

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* 6. CAREGIVER DEMOGRAPHICS:  Do you have access to a primary care physician/family doctor to support the person?

CAREGIVER DEMOGRAPHICS:  Do you have access to tools and resources to help you plan and/or access care for the person?

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* 7. CAREGIVER DEMOGRAPHICS:  Do you have access to tools and resources to help you plan and/or access care for the person?

CAREGIVER DEMOGRAPHICS: If you have tools and resources to help plan and access care for the person, which resources/tools are the most useful?

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* 8. CAREGIVER DEMOGRAPHICS: If you have tools and resources to help plan and access care for the person, which resources/tools are the most useful?

CAREGIVER DEMOGRAPHICS: Personally, I am experiencing....(Check all that apply)

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* 9. CAREGIVER DEMOGRAPHICS: Personally, I am experiencing....(Check all that apply)

CAREGIVER DEMOGRAPHICS: The person I am caring for currently receives/has received the following types of services/care provided by health, community and/or social services organizations (Select ALL that apply)

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* 10. CAREGIVER DEMOGRAPHICS: The person I am caring for currently receives/has received the following types of services/care provided by health, community and/or social services organizations (Select ALL that apply)

CAREGIVER DEMOGRAPHICS: As a Caregiver, the biggest barriers I have encountered is/are (Select ALL that apply):

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* 11. CAREGIVER DEMOGRAPHICS: As a Caregiver, the biggest barriers I have encountered is/are (Select ALL that apply):

CAREGIVER DEMOGRAPHICS: The most positive experience that I have had as a caregiver caring for an aging person with DD is /was …

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* 12. CAREGIVER DEMOGRAPHICS: The most positive experience that I have had as a caregiver caring for an aging person with DD is /was …

CAREGIVER DEMOGRAPHICS: If I could change one thing to improve my experience as a caregiver caring for an aging person with DD, it would be…

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* 13. CAREGIVER DEMOGRAPHICS: If I could change one thing to improve my experience as a caregiver caring for an aging person with DD, it would be…

PERSON LIVING WITH A DEVELOPMENTAL DISABILITY (DD) DEMOGRAPHICS: What age range is the person living with DD, that you are caring for?

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* 14. PERSON LIVING WITH A DEVELOPMENTAL DISABILITY (DD) DEMOGRAPHICS: What age range is the person living with DD, that you are caring for?

PERSON LIVING WITH A DD DEMOGRAPHICS:In what region/municipality is care being provided? Check where care is being provided

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* 15. PERSON LIVING WITH A DD DEMOGRAPHICS:In what region/municipality is care being provided? Check where care is being provided

PERSON LIVING WITH A DD DEMOGRAPHICS:   Diagnosis/ Relevant Medical History

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* 16. PERSON LIVING WITH A DD DEMOGRAPHICS:   Diagnosis/ Relevant Medical History

QUESTIONS REGARDING PLANNING AND SUPPORT: What is your single most important priority/goal as a caregiver providing care for the person living with a DD?

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* 17. QUESTIONS REGARDING PLANNING AND SUPPORT: What is your single most important priority/goal as a caregiver providing care for the person living with a DD?

QUESTIONS REGARDING PLANNING AND SUPPORT:  Are you ready to plan for the care needs of the person with DD when you can no longer fulfill your caregiving role due to the changing care needs of the person who is aging (e.g. wandering, decreased mobility, confusion)?

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* 18. QUESTIONS REGARDING PLANNING AND SUPPORT:  Are you ready to plan for the care needs of the person with DD when you can no longer fulfill your caregiving role due to the changing care needs of the person who is aging (e.g. wandering, decreased mobility, confusion)?

QUESTIONS REGARDING PLANNING AND SUPPORT: If you have completed a plan, did you have help/support to develop the plan?

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* 19. QUESTIONS REGARDING PLANNING AND SUPPORT: If you have completed a plan, did you have help/support to develop the plan?

QUESTIONS REGARDING PLANNING AND SUPPORT: If you have completed a plan, do all the relevant caregivers/service providers have access to these plans?

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* 20. QUESTIONS REGARDING PLANNING AND SUPPORT: If you have completed a plan, do all the relevant caregivers/service providers have access to these plans?

QUESTIONS REGARDING PLANNING AND SUPPORT: If you have completed a plan, how often do you and the person with DD update the plan?

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* 21. QUESTIONS REGARDING PLANNING AND SUPPORT: If you have completed a plan, how often do you and the person with DD update the plan?

QUESTIONS REGARDING PLANNING AND SUPPORT:     Do you understand the wishes, beliefs, and preferences of the person with the DD?

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* 22. QUESTIONS REGARDING PLANNING AND SUPPORT:     Do you understand the wishes, beliefs, and preferences of the person with the DD?

QUESTIONS REGARDING PLANNING AND SUPPORT:    Are you aware of the signs and symptoms of early aging and the need for early recognition and detection of health issues?

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* 23. QUESTIONS REGARDING PLANNING AND SUPPORT:    Are you aware of the signs and symptoms of early aging and the need for early recognition and detection of health issues?

QUESTIONS REGARDING PLANNING AND SUPPORT:  How are you monitoring changes in physical (e.g. walking, eating, managing personal care needs) and cognitive (e.g. behavior, memory) capabilities?  (Check all that apply).

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* 24. QUESTIONS REGARDING PLANNING AND SUPPORT:  How are you monitoring changes in physical (e.g. walking, eating, managing personal care needs) and cognitive (e.g. behavior, memory) capabilities?  (Check all that apply).

QUESTIONS ABOUT PLANNING AND SUPPORT:Would you be interested in using early recognition, detection and screening tools to identify changes in care needs that could be reliable and easy to use for the person aging with DD?

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* 25. QUESTIONS ABOUT PLANNING AND SUPPORT:Would you be interested in using early recognition, detection and screening tools to identify changes in care needs that could be reliable and easy to use for the person aging with DD?

QUESTIONS REGARDING PLANNING AND SUPPORT: Delivery of community based supports and services to aging adults with DD is essential for success in order to remain in the community for as long as safely possible.  What community – based programs/services have you accessed (Check all that apply)

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* 26. QUESTIONS REGARDING PLANNING AND SUPPORT: Delivery of community based supports and services to aging adults with DD is essential for success in order to remain in the community for as long as safely possible.  What community – based programs/services have you accessed (Check all that apply)

QUESTIONS REGARDING PLANNING AND SUPPORTS: Would you like support to access the resources listed above (Q26) or other supports/resources?

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* 27. QUESTIONS REGARDING PLANNING AND SUPPORTS: Would you like support to access the resources listed above (Q26) or other supports/resources?

QUESTIONS REGARDING PLANNING AND SUPPORT: What community - based resources do you feel are a priority for your wellness as a caregiver/ provider caring for persons aging and living with DD to know and/or be linked to? (Check all that apply)

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* 28. QUESTIONS REGARDING PLANNING AND SUPPORT: What community - based resources do you feel are a priority for your wellness as a caregiver/ provider caring for persons aging and living with DD to know and/or be linked to? (Check all that apply)

QUESTIONS REGARDING PLANNING AND SUPPORT:    Of the following list, check areas where you require more information to support your planning? (Check ALL that apply)

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* 29. QUESTIONS REGARDING PLANNING AND SUPPORT:    Of the following list, check areas where you require more information to support your planning? (Check ALL that apply)

QUESTIONS REGARDING PLANNING AND SUPPORT:  In what format would you prefer the  guide “Aging with a Developmental Disability: Planning for Success ” be available for your use?

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* 30. QUESTIONS REGARDING PLANNING AND SUPPORT:  In what format would you prefer the  guide “Aging with a Developmental Disability: Planning for Success ” be available for your use?

QUESTIONS REGARDING PLANNING AND SUPPORT:   Any additional comments or suggestions that can assist us in planning the new guide called Aging with a Developmental Disability: Planning for Success?

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* 31. QUESTIONS REGARDING PLANNING AND SUPPORT:   Any additional comments or suggestions that can assist us in planning the new guide called Aging with a Developmental Disability: Planning for Success?

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