Thank you for your participation!

Survey Provided
by
Alzheimer's Disease Advisory Committee (ADAC)
Department of Elder Affairs 

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* 1. Is there a protocol at admission to label a chart to identify the patient has a possible diagnosis of dementia?

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* 2. Do you have a protocol for referring patients exhibiting dementia symptoms to a state designated Memory Disorder Clinic?

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* 3. Do you provide ongoing training for the staff on dementia, specifically related to challenging behaviors?

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* 4. Do you have a protocol on grieving intervention for an individual with dementia grieving the loss of a caregiver or family member?

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* 5. Do you have an ongoing relationship with your local Area Agency on Aging to refer families to community support services?

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* 6. Do you have a protocol on identifying supportive services in rural communities for families caring for a loved one with dementia?

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* 7. Do you have a protocol for working with hospitals on admissions and a discharge plan for patients with dementia?

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* 8. Is the staff trained to use visual cues from a person with dementia who can’t express pain or feelings verbally?

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* 9. Is there a non-pharmacological protocol in treating agitated patients with dementia?

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* 10. If you have any additional comments, please share them in the box below:

0 of 10 answered
 

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