Spokane Area Dementia Friendly Community Needs Assessment Survey

A dementia friendly community is a town, city, or county that is respectful toward and informed about individuals with the disease, their families, and their caregivers. These communities offer support, services, and environment features that foster quality of life.

Alzheimer’s disease and other related dementias are characterized by progressive memory loss, which can be difficult for people living with dementia (PLWD) and those that care for them. It has been shown that PLWD can age in place longer with supportive communities. This survey is designed to help the Spokane Area Dementia Friendly Community initiative assess the Spokane area’s strengths, gaps, and priorities, as we work to become a more dementia friendly community.

Your responses will be reported only as a percentage of total responses. Thank you for your time and input during this process.

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* 1. Tell us a little about yourself: Which statement(s) describe you? (Choose all that apply)

I have memory loss / dementia

I have a family member or friend with memory loss / dementia

I have high levels of direct connection with people who have memory loss / dementia (due to work, volunteering, neighbors, etc.)

I have moderate levels of direct connection with people who have memory loss / dementia (due to work, volunteering, neighbors, etc.)

I have no direct connection to someone with memory loss / dementia, but I care about dementia-friendly communities

I have no direct connection to someone with memory loss / dementia

Other (please describe)

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* 2. What is your level of knowledge of the 10 warning signs of dementia?

The 10 warning signs are:
1. Memory loss that disrupts daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality.
(Please MARK ONLY ONE.)

Very High

High

Moderate

Low

Very Low

Don't Know

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* 3. Tell us a little about your community connection: Which community sector best describes you (e.g. where you primarily spend your time, work, or volunteer)? (Please mark ONLY ONE)

Community-Based Services and Supports

Communities of Faith

Community Member Living with Dementia

Family Care Partners

Hospitals / Acute Care Settings

Local Government / Agencies

Residential Care

Other (please describe)

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* 4. Tell us a little about your priorities:
How strongly do you agree / disagree that each of the following focus areas should be a priority in becoming a dementia friendly community? Please rate each question independently, making sure to mark only one response per question.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Don't Know
Increase community awareness of the resources and organizations that can help support people living with dementia and their families.	Increase community awareness of the resources and organizations that can help support people living with dementia and their families. Strongly Agree	Increase community awareness of the resources and organizations that can help support people living with dementia and their families. Agree	Increase community awareness of the resources and organizations that can help support people living with dementia and their families. Neutral	Increase community awareness of the resources and organizations that can help support people living with dementia and their families. Disagree	Increase community awareness of the resources and organizations that can help support people living with dementia and their families. Strongly Disagree	Increase community awareness of the resources and organizations that can help support people living with dementia and their families. Don't Know
Increasing community members' knowledge about the warning signs of dementia should be a priority in making our community dementia friendly.	Increasing community members' knowledge about the warning signs of dementia should be a priority in making our community dementia friendly. Strongly Agree	Increasing community members' knowledge about the warning signs of dementia should be a priority in making our community dementia friendly. Agree	Increasing community members' knowledge about the warning signs of dementia should be a priority in making our community dementia friendly. Neutral	Increasing community members' knowledge about the warning signs of dementia should be a priority in making our community dementia friendly. Disagree	Increasing community members' knowledge about the warning signs of dementia should be a priority in making our community dementia friendly. Strongly Disagree	Increasing community members' knowledge about the warning signs of dementia should be a priority in making our community dementia friendly. Don't Know
Increasing community members’ skills for interacting with people living with dementia should be a priority in making our community dementia friendly.	Increasing community members’ skills for interacting with people living with dementia should be a priority in making our community dementia friendly. Strongly Agree	Increasing community members’ skills for interacting with people living with dementia should be a priority in making our community dementia friendly. Agree	Increasing community members’ skills for interacting with people living with dementia should be a priority in making our community dementia friendly. Neutral	Increasing community members’ skills for interacting with people living with dementia should be a priority in making our community dementia friendly. Disagree	Increasing community members’ skills for interacting with people living with dementia should be a priority in making our community dementia friendly. Strongly Disagree	Increasing community members’ skills for interacting with people living with dementia should be a priority in making our community dementia friendly. Don't Know
Increasing dementia-related resources tailored to our diverse and under-served populations should be a priority in making our community dementia friendly.	Increasing dementia-related resources tailored to our diverse and under-served populations should be a priority in making our community dementia friendly. Strongly Agree	Increasing dementia-related resources tailored to our diverse and under-served populations should be a priority in making our community dementia friendly. Agree	Increasing dementia-related resources tailored to our diverse and under-served populations should be a priority in making our community dementia friendly. Neutral	Increasing dementia-related resources tailored to our diverse and under-served populations should be a priority in making our community dementia friendly. Disagree	Increasing dementia-related resources tailored to our diverse and under-served populations should be a priority in making our community dementia friendly. Strongly Disagree	Increasing dementia-related resources tailored to our diverse and under-served populations should be a priority in making our community dementia friendly. Don't Know
Increasing staff/volunteer education training on dementia and effective dementia friendly communication skills should be a priority in making our community dementia friendly.	Increasing staff/volunteer education training on dementia and effective dementia friendly communication skills should be a priority in making our community dementia friendly. Strongly Agree	Increasing staff/volunteer education training on dementia and effective dementia friendly communication skills should be a priority in making our community dementia friendly. Agree	Increasing staff/volunteer education training on dementia and effective dementia friendly communication skills should be a priority in making our community dementia friendly. Neutral	Increasing staff/volunteer education training on dementia and effective dementia friendly communication skills should be a priority in making our community dementia friendly. Disagree	Increasing staff/volunteer education training on dementia and effective dementia friendly communication skills should be a priority in making our community dementia friendly. Strongly Disagree	Increasing staff/volunteer education training on dementia and effective dementia friendly communication skills should be a priority in making our community dementia friendly. Don't Know

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* 5. What do you see as our community’s main strengths for addressing the needs of people with dementia and their families? (Choose all that apply)

Support Groups

Community-Based Services

Transportation Services

Clinical Services

Other (please describe)

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* 6. What resources and organizations would you suggest to individuals who may show signs of dementia? (Choose all that apply)

Support Groups

Community-Based Services

Transportation Services

Clinical Services

Other (please describe)

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* 7. What do you see as our community’s main gaps for addressing the needs of people living with dementia and their families? (Choose all that apply)

Support Groups

Community-Based Services

Transportation Services

Clinical Services

Other (please describe)

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* 8. Is there anything else you would like us to know?

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* 9. Would you be interested in helping create a dementia friendly community?

Yes

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* 10. Would you like to be periodically updated on how the project is progressing?

Yes

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* 11. If you marked “Yes” to either question above, please enter your contact information below.

Name

Email Address

Spokane Area Dementia Friendly Community Needs Assessment Survey

Question Title

* 1. Tell us a little about yourself: Which statement(s) describe you? (Choose all that apply)﻿

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* 3. Tell us a little about your community connection: Which community sector best describes you (e.g. where you primarily spend your time, work, or volunteer)? (Please mark ONLY ONE)

Question Title

* 4. Tell us a little about your priorities:How strongly do you agree / disagree that each of the following focus areas should be a priority in becoming a dementia friendly community? Please rate each question independently, making sure to mark only one response per question.

Question Title

* 5. What do you see as our community’s main strengths for addressing the needs of people with dementia and their families? (Choose all that apply)

Question Title

* 6. What resources and organizations would you suggest to individuals who may show signs of dementia? (Choose all that apply)

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* 7. What do you see as our community’s main gaps for addressing the needs of people living with dementia and their families? (Choose all that apply)

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* 8. Is there anything else you would like us to know?

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* 9. Would you be interested in helping create a dementia friendly community?

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* 10. Would you like to be periodically updated on how the project is progressing?

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* 11. If you marked “Yes” to either question above, please enter your contact information below.

* 1. Tell us a little about yourself: Which statement(s) describe you? (Choose all that apply)

* 4. Tell us a little about your priorities:
How strongly do you agree / disagree that each of the following focus areas should be a priority in becoming a dementia friendly community? Please rate each question independently, making sure to mark only one response per question.