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Long-Term Care Ombudsman Family Forum Survey-Family Council
Complete this short survey about family councils to share your experiences with the State Long-Term Care Ombudsman. Questions with an asterisk are required. We appreciate your willingness to share your stories.
1.
First Name [Optional]
2.
Last Name [Optional]
*
3.
County of Residence [Required]
(Required.)
*
4.
County that Long-Term Care Facility is Located In [Required]
(Required.)
5.
Will you be attending the State Long-Term Care Ombudsman Family Forum?
Yes
No
6.
How would you like to receive additional information about the State Long-Term Care Ombudsman Family Forum? [Optional]
Phone call
Email
Include phone number or email address
7.
Is there a family council at your loved one's long-term care facility?
Yes
No
Not Sure
8.
Are you involved in a family council?
Yes
No
9.
If you are involved in a family council, do you find it helpful in advocating for your loved one's care?
Yes
No
Not Sure
10.
If you are involved in a family council, how did you meet during COVID?
We met via online meetings
We met via phone
We met in-person
We didn't meet
11.
Are you interested in starting a family council?
Yes
No
Not Sure
There is already a family council at the setting.
12.
What topics are discussed during family council meetings?
13.
If you participate in a family council, does the facility listen to your views and act upon the grievances presented?
Yes
No
Not sure
14.
What topics would you most like to learn about or discuss at the State Long-Term Care Ombudsman Family Forum?
15.
Are there any questions you would like to be addressed at the State Long-Term Care Ombudsman Family Forum?
16.
Is there anything else you would like to add?
Current Progress,
0 of 16 answered
