Dementia Module 7 Survey

Question Title

* 1. What is your role in working with persons with dementia?

Family caregiver

Certified Family Home Provider

Case manager, care coordinator

Direct care worker

Health care provider

First responder

Community business

Other (please specify)

Question Title

* 2. What was your level of awareness of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses before and after completing Dementia Module 7?

	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
Before taking dementia training, Planning for Safety and Success, I was aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses.	Before taking dementia training, Planning for Safety and Success, I was aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Strongly Disagree	Before taking dementia training, Planning for Safety and Success, I was aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Disagree	Before taking dementia training, Planning for Safety and Success, I was aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Neither	Before taking dementia training, Planning for Safety and Success, I was aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Agree	Before taking dementia training, Planning for Safety and Success, I was aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Strongly Agree
After taking dementia training, Planning for Safety and Success, I am aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses.	After taking dementia training, Planning for Safety and Success, I am aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Strongly Disagree	After taking dementia training, Planning for Safety and Success, I am aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Disagree	After taking dementia training, Planning for Safety and Success, I am aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Neither	After taking dementia training, Planning for Safety and Success, I am aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Agree	After taking dementia training, Planning for Safety and Success, I am aware of the safety challenges that people with dementia may experience like judgement, sense of time and place, behavior, physical ability and senses. Strongly Agree

Question Title

* 3. Please rate your awareness of the steps used to Dementia-proof areas of the home for safety, Before and After taking Module 7.

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
Before taking dementia training, Planning for Safety and Success, I was aware of the steps used to Dementia-proof areas of the home for safety.	Before taking dementia training, Planning for Safety and Success, I was aware of the steps used to Dementia-proof areas of the home for safety. Strongly disagree	Before taking dementia training, Planning for Safety and Success, I was aware of the steps used to Dementia-proof areas of the home for safety. Disagree	Before taking dementia training, Planning for Safety and Success, I was aware of the steps used to Dementia-proof areas of the home for safety. Neither agree nor disagree	Before taking dementia training, Planning for Safety and Success, I was aware of the steps used to Dementia-proof areas of the home for safety. Agree	Before taking dementia training, Planning for Safety and Success, I was aware of the steps used to Dementia-proof areas of the home for safety. Strongly agree
After taking dementia training, Planning for Safety and Success, I am aware of the steps used to Dementia-proof areas of the home for safety.	After taking dementia training, Planning for Safety and Success, I am aware of the steps used to Dementia-proof areas of the home for safety. Strongly disagree	After taking dementia training, Planning for Safety and Success, I am aware of the steps used to Dementia-proof areas of the home for safety. Disagree	After taking dementia training, Planning for Safety and Success, I am aware of the steps used to Dementia-proof areas of the home for safety. Neither agree nor disagree	After taking dementia training, Planning for Safety and Success, I am aware of the steps used to Dementia-proof areas of the home for safety. Agree	After taking dementia training, Planning for Safety and Success, I am aware of the steps used to Dementia-proof areas of the home for safety. Strongly agree

Question Title

* 4. Please rate your awareness of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful, Before and After taking Module 7.

	Strongly Disagree	Disagree	Neither Agree or disagree	Agree	Strongly Agree
Before taking dementia training, Planning for Safety and Success, I was aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful.	Before taking dementia training, Planning for Safety and Success, I was aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Strongly Disagree	Before taking dementia training, Planning for Safety and Success, I was aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Disagree	Before taking dementia training, Planning for Safety and Success, I was aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Neither Agree or disagree	Before taking dementia training, Planning for Safety and Success, I was aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Agree	Before taking dementia training, Planning for Safety and Success, I was aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Strongly Agree
After dementia training, Planning for Safety and Success, I am aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful.	After dementia training, Planning for Safety and Success, I am aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Strongly Disagree	After dementia training, Planning for Safety and Success, I am aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Disagree	After dementia training, Planning for Safety and Success, I am aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Neither Agree or disagree	After dementia training, Planning for Safety and Success, I am aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Agree	After dementia training, Planning for Safety and Success, I am aware of the Reminder, Environment, Consistent Routines, Attention, Practice, Simple Steps (RECAP) tool used to help a person with dementia stay more independent and successful. Strongly Agree

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* 5. How likely are you to use the information presented in this module?

Not likely

Somewhat likely

Likely

Very likely

Not likely

Somewhat likely

Likely

Very likely

Comments?

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* 6. How likely are you to recommend this module to others?

Not likely

Somewhat likely

Likely

Very likely

Not likely

Somewhat likely

Likely

Very likely

Comments?