Long-term care home residents

Thank you for answering this survey. It should take about 15 minutes to complete.

Patient Ombudsman is interested in hearing about your experiences as a resident of a long-term care home during the COVID-19 pandemic even if there was no outbreak in the home where you lived.

We want to know about your experience since the beginning of the pandemic, March 2020 until now. If you lived in more than one long-term care home during this period, please choose one home and answer the survey questions based on that home. Please answer the questions to the best of your knowledge or recollection.

If you need help, consider asking a family member or friend to assist you. If you require any help filling out this survey please call 1-888-321-0339 x 1960 or email us at ltch_investigation@patientombudsman.ca

All personal and other information collected for this survey will be handled confidentially and only for the purpose of Patient Ombudsman’s investigation.

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* 1. What long-term care home were you living in between March and now? (Optional)

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* 2. What city/town is your long-term care home located in (Optional)?

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* 3. Did your long-term care home experience one or more COVID-19 outbreaks?

Yes

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* 4. If there were one or more COVID-19 outbreaks, to the best of your recollection, when did they begin? Please check as many as apply.

March 2020

April 2020

May 2020

June 2020

July 2020

August 2020

September 2020

October 2020

November 2020

December 2020

January 2021

February 2021

March 2021

April 2021

No COVID outbreak

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* 5. If there was a COVID-19 outbreak, who became ill?

One or more residents

One or more staff members

Both residents and staff

There hasn’t been a COVID-19 outbreak in my home

I don't know

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* 6. If you know, please check the type of long-term care home you live in:

Municipal (owned by the city)

Not-for-profit

For-profit and part of a chain of homes (for example, Chartwell, Extendicare, Revera, Sierra)

Independent for-profit (not part of a chain)

I don't know

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* 7. What type of room did you live in the spring of 2020?

One bed room

Two bed room (shared with one roommate)

Three or more bed room (shared with two or more roommates)

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* 8. If there was an outbreak in the home where you lived, were you moved to a different room to help prevent the spread of COVID-19?

Yes

I don't know

There was no outbreak

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* 9. Please indicate if there were changes in the level of support or quality of care you received between March 2020 and now related to the COVID-19 pandemic. Please check all the changes you experienced.

	Much better	Better	No change	Worse	Much worse
Help with meals and snacks	Help with meals and snacks Much better	Help with meals and snacks Better	Help with meals and snacks No change	Help with meals and snacks Worse	Help with meals and snacks Much worse
Help walking or moving around	Help walking or moving around Much better	Help walking or moving around Better	Help walking or moving around No change	Help walking or moving around Worse	Help walking or moving around Much worse
Help to get out of bed	Help to get out of bed Much better	Help to get out of bed Better	Help to get out of bed No change	Help to get out of bed Worse	Help to get out of bed Much worse
Help putting on and taking off clothes	Help putting on and taking off clothes Much better	Help putting on and taking off clothes Better	Help putting on and taking off clothes No change	Help putting on and taking off clothes Worse	Help putting on and taking off clothes Much worse
Washing/bathing	Washing/bathing Much better	Washing/bathing Better	Washing/bathing No change	Washing/bathing Worse	Washing/bathing Much worse
Daily oral care (mouth care, brushing teeth, denture care)	Daily oral care (mouth care, brushing teeth, denture care) Much better	Daily oral care (mouth care, brushing teeth, denture care) Better	Daily oral care (mouth care, brushing teeth, denture care) No change	Daily oral care (mouth care, brushing teeth, denture care) Worse	Daily oral care (mouth care, brushing teeth, denture care) Much worse
Foot and nail care	Foot and nail care Much better	Foot and nail care Better	Foot and nail care No change	Foot and nail care Worse	Foot and nail care Much worse
Nursing care	Nursing care Much better	Nursing care Better	Nursing care No change	Nursing care Worse	Nursing care Much worse
Medical care	Medical care Much better	Medical care Better	Medical care No change	Medical care Worse	Medical care Much worse
Emotional support	Emotional support Much better	Emotional support Better	Emotional support No change	Emotional support Worse	Emotional support Much worse
Rehabilitation/therapy	Rehabilitation/therapy Much better	Rehabilitation/therapy Better	Rehabilitation/therapy No change	Rehabilitation/therapy Worse	Rehabilitation/therapy Much worse
Dental/denturist care	Dental/denturist care Much better	Dental/denturist care Better	Dental/denturist care No change	Dental/denturist care Worse	Dental/denturist care Much worse
Activities and recreation	Activities and recreation Much better	Activities and recreation Better	Activities and recreation No change	Activities and recreation Worse	Activities and recreation Much worse
Maintenance/repairs for assistive medical devices (for example, walker, wheelchair, hearing aid)	Maintenance/repairs for assistive medical devices (for example, walker, wheelchair, hearing aid) Much better	Maintenance/repairs for assistive medical devices (for example, walker, wheelchair, hearing aid) Better	Maintenance/repairs for assistive medical devices (for example, walker, wheelchair, hearing aid) No change	Maintenance/repairs for assistive medical devices (for example, walker, wheelchair, hearing aid) Worse	Maintenance/repairs for assistive medical devices (for example, walker, wheelchair, hearing aid) Much worse
Help with medications and drugs	Help with medications and drugs Much better	Help with medications and drugs Better	Help with medications and drugs No change	Help with medications and drugs Worse	Help with medications and drugs Much worse
Meal choice	Meal choice Much better	Meal choice Better	Meal choice No change	Meal choice Worse	Meal choice Much worse
Support for special diets	Support for special diets Much better	Support for special diets Better	Support for special diets No change	Support for special diets Worse	Support for special diets Much worse
Quality or amount of food	Quality or amount of food Much better	Quality or amount of food Better	Quality or amount of food No change	Quality or amount of food Worse	Quality or amount of food Much worse
Spiritual/religious support	Spiritual/religious support Much better	Spiritual/religious support Better	Spiritual/religious support No change	Spiritual/religious support Worse	Spiritual/religious support Much worse
Cleaning of your room and common areas	Cleaning of your room and common areas Much better	Cleaning of your room and common areas Better	Cleaning of your room and common areas No change	Cleaning of your room and common areas Worse	Cleaning of your room and common areas Much worse

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* 10. Did you have concerns about the level or quality of care you received in the long-term care home before the COVID-19 pandemic?

Yes

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* 11. Has the COVID-19 pandemic affected your health or well-being?

Yes

I don't know

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* 12. What kind of change in your health or well-being did you experience? Please check all of the changes you experienced.

General decline in physical health

General decline in ability to do day-to-day activities

General decline in emotional well-being

Loss of skin integrity/bed sores

Increased pain/poor pain management

Weight loss

Difficulty walking

Difficulty with eating

Difficulty moving from bed to chair

Increased sadness or depression

Increased anxiety

Loneliness

Memory decline

Increased confusion

Decreased ability to communicate

Other (please specify)

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* 13. Were you confined to your room to prevent the spread of COVID-19 or because staff were not available to help you??

Yes

I don't know

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* 14. Were you left in bed all day because staff were not available to help you?

Yes

I don't know

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* 15. Were you denied the ability to go outside to prevent the spread of COVID-19 or because staff were not available to help you?

Yes

I don't know

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* 16. What is your mother tongue?

English

French

Other (please specify)

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* 17. Do you normally receive services in your mother tongue in your long-term care home?

Yes

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* 18. If you answered yes to question 17, did the COVID-19 pandemic affect your access to services in your mother tongue between March 2020 and now?

Yes

Does not apply

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* 19. Did you raise concerns with anyone about the level of support or quality of care you received in the long-term care home between March 2020 and now?

Yes

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* 20. Who did you share your concerns with? Please check all of the people or organizations you shared your concerns with.

A family member or friend

Staff in my long-term care home

Public Health

Ministry of Long-Term Care or Ministry of Health

Patient Ombudsman

Media

Does not apply

Other (please specify)

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* 21. Were you satisfied with the response to your concerns

Yes

Does not apply

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* 22. At the times when visitors were not allowed, were you able to communicate with your family and friends?

Yes

Does not apply to me

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* 23. If you answered ‘Yes’ to question 22, how were you able to communicate with your family and friends? (Please check all options available to you).

Face to face visit in the home

Telephone

Video or "Zoom" visit on a tablet/phone or computer

Window visit

Outdoor visit

Other (please specify)

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* 24. Were you able to communicate with your family and friends often enough?

Yes, often enough

No, not often enough

Does not apply

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* 25. If communication with your family and friends wasn’t possible, do you know why? Please check all options related to your experience.

I was able to communicate with family/friends

No phone, tablet or computer was available

The staff were unavailable or did not have time to help me

I have trouble communicating with a phone, tablet or computer

My health did not allow communication

I don't know

Other (please specify)

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* 26. How did your inability to visit and/or communicate with friends and family affect you? Please check all options related to your experience.

I didn’t have any significant problems

I was lonely or sad

I was scared or anxious

I was bored

I was worried about my family and friends

Does not apply

Other (please specify)

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* 27. Between March 2020 and now, did you get the information you needed about what was happening in the home where you lived?

Yes, I was kept well-informed

No, I wanted or needed more information

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* 28. Were you able to get answers to your questions?

Yes

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* 29. If you didn’t get all of the information you needed, what would you have liked to receive? Please check all that apply.

The steps the home was taking to keep residents and staff safe

The expected date that the outbreak would be over

How other residents were doing

How staff members were doing

When my family or friends could visit again

Other (please specify)

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* 30. Are you currently able to have visits with one or more family members or friends?

Yes

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* 31. Have you received the COVID-19 vaccine?

First dose only

Fully vaccinated

I haven’t had access to the vaccine

I chose not to get the vaccine

I don't know

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* 32. If you chose to not get the vaccine, why not?

I have a health condition that made it too risky (e.g., serious allergies)

I was concerned that it wouldn’t be safe

Does not apply to me

Other (please specify)

Long-term care home residents

Thank you for answering this survey. It should take about 15 minutes to complete.

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* 1. What long-term care home were you living in between March and now? (Optional)

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* 2. What city/town is your long-term care home located in (Optional)?

Question Title

* 3. Did your long-term care home experience one or more COVID-19 outbreaks?

Question Title

* 4. If there were one or more COVID-19 outbreaks, to the best of your recollection, when did they begin? Please check as many as apply.

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* 5. If there was a COVID-19 outbreak, who became ill?

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* 6. If you know, please check the type of long-term care home you live in:

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* 7. What type of room did you live in the spring of 2020?

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* 8. If there was an outbreak in the home where you lived, were you moved to a different room to help prevent the spread of COVID-19?

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* 9. Please indicate if there were changes in the level of support or quality of care you received between March 2020 and now related to the COVID-19 pandemic. Please check all the changes you experienced.

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* 10. Did you have concerns about the level or quality of care you received in the long-term care home before the COVID-19 pandemic?

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* 11. Has the COVID-19 pandemic affected your health or well-being?

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* 12. What kind of change in your health or well-being did you experience? Please check all of the changes you experienced.

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* 13. Were you confined to your room to prevent the spread of COVID-19 or because staff were not available to help you??

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* 14. Were you left in bed all day because staff were not available to help you?

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* 15. Were you denied the ability to go outside to prevent the spread of COVID-19 or because staff were not available to help you?

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* 16. What is your mother tongue?

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* 17. Do you normally receive services in your mother tongue in your long-term care home?

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* 18. If you answered yes to question 17, did the COVID-19 pandemic affect your access to services in your mother tongue between March 2020 and now?

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* 19. Did you raise concerns with anyone about the level of support or quality of care you received in the long-term care home between March 2020 and now?

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* 20. Who did you share your concerns with? Please check all of the people or organizations you shared your concerns with.

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* 21. Were you satisfied with the response to your concerns

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* 22. At the times when visitors were not allowed, were you able to communicate with your family and friends?

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* 23. If you answered ‘Yes’ to question 22, how were you able to communicate with your family and friends? (Please check all options available to you).

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* 24. Were you able to communicate with your family and friends often enough?

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* 25. If communication with your family and friends wasn’t possible, do you know why? Please check all options related to your experience.

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* 26. How did your inability to visit and/or communicate with friends and family affect you? Please check all options related to your experience.

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* 27. Between March 2020 and now, did you get the information you needed about what was happening in the home where you lived?

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* 28. Were you able to get answers to your questions?

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* 29. If you didn’t get all of the information you needed, what would you have liked to receive? Please check all that apply.

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* 30. Are you currently able to have visits with one or more family members or friends?

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* 31. Have you received the COVID-19 vaccine?

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* 32. If you chose to not get the vaccine, why not?

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* 33. Is there anything else you’d like to share about how the COVID-19 pandemic has affected your care and experience in your long-term care home?