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Which of these statements most aligns with the person you care for’s attitude toward health care decisions?
I want to make my health care decisions and choices.
I want my doctor(s) to make my health care decisions and choices.
How comfortable is the person you care for speaking up for themselves at doctor appointments?
Very confident
Confident
Somewhat confident
Neutral
Somewhat unconfident
Unconfident
Very unconfident
Have you heard of the phrase “age-friendly” as it relates to health care experiences?
Yes
No
Not sure
Age-friendly health care describes care that prioritizes what a person wants. This kind of care also includes regular conversations about the individual’s medication list, mental/cognitive health and the importance of staying active and mobile. Do the doctors of the person you care for practice health care like this?
Their doctor(s) practice all of this
Their doctor(s) practice some of this
Their doctor(s) don’t practice this
Not sure
Do you think the person you care for would benefit from this kind of care?
Yes
No
Not sure
How often do doctors and nurses ask about the person you care for’s daily routine to inform care plans? (For example, a doctor could ask questions to find out which physical activities are important to someone to avoid prescribing medications that make it harder to participate in activities.)
Always
Sometimes
Occasionally
Never
Not sure
How often do doctors and nurses discuss mental health and cognition with the person you care for?
Always
Sometimes
Occasionally
Never
Not sure
How often do doctors and nurses discuss staying mobile and active with the person you care for?
Always
Sometimes
Occasionally
Never
Not sure
Does it seem like doctors are cautious about the number of medications the person you care for is prescribed?
Always
Sometimes
Occasionally
Never
Not sure
If the person you care for is 65 or older, do they see a geriatrician?
Yes
No
They are younger than 65
I don’t know
If they don’t see a geriatrician, why is that?
We didn’t know that was an option
We don't know how to find one
We like the doctor we have
There aren’t any in our area
It’s hard to get an appointment with one
It doesn’t seem necessary
They are under 65
They do see a geriatrician
Other reason (please specify)
Culturally-competent care is care that is tailored to a person’s identities including race, ethnicity, gender, sexual orientation, ability, socioeconomic status.
How often does the person you care for receive culturally-competent care?
Always
Sometimes
Occasionally
Never
Not sure
How would you describe where you (and the person you care for) live?
Urban
Rural
Suburban
Prefer not to say
What is your gender?
Female
Male
Non-binary
Prefer not to say
Prefer to self-describe
What is the gender of the person you care for?
Female
Male
Non-binary
Prefer not to say
Prefer to self-describe
What is your age?
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85-94
95 years or older
Prefer not to say
What is the age of the person you care for?
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85-94
95 years or older
Prefer not to say
What is your annual income?
Less than $20,000 per year
$20,000-$49,999 per year
$50,000-$74,999 per year
$75,000-$100,000 per year
More than $100,000 per year
Prefer not to say
Is there anything else you’d like to tell us about this topic?
May a Next Avenue reporter follow up with you via email about your responses to this survey?
Name
Email Address
Phone Number
Current Progress,
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