As a family member of a resident living in one of Sun Country Health Region’s Long Term Care homes, your experience is important. Please consider completing this survey based on your experience at the home where your family member resides. Simply read the statement and check the box that matches your level of agreement. The philosophy of resident-directed care, resident involvement and choice is promoted in Sun Country Health Region.  As such, in circumstances where your family member is able to speak for him/herself, “I choose not to answer” may be the most appropriate response to some of the statements below. These specific questions have been identified by an asterisk (*). If a statement is not applicable, respond with “I choose not to answer”.

Your answers will be confidential and surveys will be collected and analyzed by Sun Country Health Region.
If you have any questions or comments, please feel free to ask a member of our home.

If you have questions about how your data will be stored and used, please contact the Ministry of Health at 306-787-1509. Completion of this survey indicates your consent to use your responses.

* Long Term Care Home (Please check which Home you live in)

* EXPERIENCE:  
The following statements regard your experiences and perceptions of how your family member is treated.
Please rate your agreement with the following statements:

  Agree Neutral Disagree I choose not to answer
1.   Staff treat my family member with respect
2.   Staff are professional, and able to provide excellent care
3.   Staff say hello to my family member and address by his/her preferred name
4.   Staff respect my family member's privacy
5.   Staff respect my family member's culture and spiritual values
6.   I feel safe here
7.   Staff respect my family member's personal belongings

* COMMUNICATION:  
The following statements are about the communication you have with staff members in this home.
Please rate your agreement with the following statements:

  Agree Neutral Disagree I choose not to answer
8.   I feel listened to
*9.  I have opportunities to discuss my family member's care and well-being with professional staff (nurses, doctors, therapists)
*10. I am involved in decisions about my family member's care
11.  I am confident that information about my family member's care is shared with appropriate team members
*12. Communication about changes in my family member's care needs is timely
13.  I know who to contact when I have concerns/questions 
14.  I feel comfortable speaking to a staff member about a problem
15.  I feel confident that my family member will not suffer as a results of having raised concerns
16.  If I raised a concern I was involved/contacted regarding the outcome

* CARE PROVISION:
Please rate your agreement with the following statements:

  Agree Neutral Disagree I choose not to answer
17.  Care team members are available when my family member need them (e.g. continuing care aides, nurses, doctors, therapists)
*18. Staff respond to my preferences or suggestions about my family member's care
19.  My family member has choices regarding my care (e.g. time to wake, what to wear, etc.)
20.  Staff support my family member to participate in activities that are meaningful to him/her
21.  Staff help my family member with personal care when needed (e.g. Assisting him/her to the washroom)
22.  My family member is well cared for 24 hours a day 7 days a week
23.  Staff offer treatment when my family member has pain
24.  Staff encourage my family member to do the things that he/she is able to do himself(herself)

* FOOD AND MEALTIME EXPERIENCE:
Please rate your agreement with the following statements:

  Agree Neutral Disagree I choose not to answer
25.  My family member receives the help he/she needs to eat and drink throughout the day
26.  There is a good variety of foods and drinks offered to my family member
27.  The dining experience is pleasant
28.  My family member gets enough to eat and drink
29.  The overall quality of the food & drinks is good

* HOME ENVIRONMENT AND SERVICES:
Please rate your agreement with the following statements:

  Agree Neutral Disagree I choose not to answer
30.  The home is kept clean
31.  The home is quiet when it should be
32.  The temperature in the home is comfortable
33.  My family member can get emotional support if I need it
34.  My family member can access spiritual services in the home
35.  My family member or I can get help with financial issues if needed
36.  Staff support my family member to access other health professionals if needed (dentist, chiropractor, massage therapists, PT/OT)
37.  The laundry services are good

* ACTIVITIES EXPERIENCE:
Please rate your agreement with the following statements:

  Agree Neutral Disagree I choose not to answer
38.  My family member likes the activities provided in this home
39.  My family member can choose whether or not to participate in activities

* GENERAL SATISFACTION
Please rate your agreement with the following statements:

  Agree Neutral Disagree I choose not to answer
40.  Overall this is a good place to live

* 43.  Sun Country Health Region wants to provide excellent service and care. We want to highlight and celebrate excellence.  What stands out as excellent at this home?

* 43. Additional Comments

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