Assisted Living Residence Survey

1.Have you or a loved one resided in an Assisted Living Residence within the past several years?

Yes

No

3.How large was the Assisted Living Residence?

Very small less than 10 beds

Small 11-30 beds

Medium 31-60 beds

Large more than 60 beds

4.How would you describe the care your loved one received in the Assisted Living Residence?

5.Would you recommend this Assisted Living Facility to your friend/family?

Yes, best care ever

Yes, but it needs some changes

No, didn't meet our needs/care

No, worst care ever

6.If the Assisted Living Residence needed some changes were they?

Minor - more of a preference change

Moderate - not harmful to our loved one, just an inconvenience

Severe - issues that were not resolved

Harmful to loved one and others

No changes were needed.

7.If changes were Moderate/Severe/Harmful which areas were impacted (select as many as you need)

Staffing (includes training, manners, not enough staff, language barrier)

Care provided (didn't meet care needs, didn't provide quality care, staff was not responsive, was rough or to fast)

Facility (my health changed - ex: couldn't do stairs; facility was not clean, lack of privacy, too small or too big)

Management (there were too many changes, didn't feel cared for, rules kept changing, didn't feel listen to,

Safety (needed a memory care unit, felt threatened by staff/residents/management, staff was not responsive to needs, medication errors, mobility concerns)

Personal (lack of autonomy, privacy issues, didn't like food, personal items disappeared, couldn't see family/friends)

Other

8.Would you be willing to send a short note about your good and bad experiences?

Yes

No

9.If yes, please send to JLHENS@hotmail.com