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.

Question Title

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

Question Title

* 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.

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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?

Question Title

* 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 walking or moving around
Help to get out of bed
Help putting on and taking off clothes
Washing/bathing
Daily oral care (mouth care, brushing teeth, denture care)
Foot and nail care
Nursing care
Medical care 
Emotional support
Rehabilitation/therapy
Dental/denturist care
Activities and recreation
Maintenance/repairs for assistive medical devices (for example, walker, wheelchair, hearing aid)
Help with medications and drugs
Meal choice
Support for special diets
Quality or amount of food
Spiritual/religious support
 Cleaning of your room and common areas

Question Title

* 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?

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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?

Question Title

* 16. What is your mother tongue?

Question Title

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

Question Title

* 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?

Question Title

* 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?

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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).

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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?

0 of 33 answered
 

T