LeadingAge Member Snap Survey: COVID-19 Status

As we continue to fight for you and all our members on the Hill and in the media, it’s critical that we understand the ever-changing state of your needs. Please complete the following fast questions to support our efforts. You individual responses will not be shared.

Question Title

* 1. What is the status of COVID-19 cases among residents/clients? (all that apply)

Current diagnosed case(s)

Current suspected case(s)

Past diagnosed case(s)

Past suspected case(s)

Deaths from diagnosed case(s)

Deaths from suspected case(s)

No cases to-date

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* 2. What is the status of COVID-19 cases among staff/care workers? (all that apply)

Current diagnosed case(s)

Current suspected case(s)

Past diagnosed case(s)

Past suspected case(s)

Deaths from diagnosed case(s)

Deaths from suspected case(s)

No cases to-date

Question Title

* 3. What is the status of your COVID-19 testing? (all that apply)

All staff have been tested

All staff are tested at least weekly

All residents/clients have been tested

All residents/clients are tested at least weekly

Testing plans are still being made

No plans to test

Other (please specify)

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* 4. How long do you have capacity to implement your testing plan?

One week

Two weeks

More than a month

We cannot implement testing now

No plans to test

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* 5. Please indicate the status of your supplies.

	Enough for more than a month	Enough for two weeks	Enough for one week	Less than one week	Do not have	Do not need
N95 masks	N95 masks Enough for more than a month	N95 masks Enough for two weeks	N95 masks Enough for one week	N95 masks Less than one week	N95 masks Do not have	N95 masks Do not need
Surgical masks	Surgical masks Enough for more than a month	Surgical masks Enough for two weeks	Surgical masks Enough for one week	Surgical masks Less than one week	Surgical masks Do not have	Surgical masks Do not need
Eye protection, including face shields or goggles	Eye protection, including face shields or goggles Enough for more than a month	Eye protection, including face shields or goggles Enough for two weeks	Eye protection, including face shields or goggles Enough for one week	Eye protection, including face shields or goggles Less than one week	Eye protection, including face shields or goggles Do not have	Eye protection, including face shields or goggles Do not need
Gowns	Gowns Enough for more than a month	Gowns Enough for two weeks	Gowns Enough for one week	Gowns Less than one week	Gowns Do not have	Gowns Do not need
Gloves	Gloves Enough for more than a month	Gloves Enough for two weeks	Gloves Enough for one week	Gloves Less than one week	Gloves Do not have	Gloves Do not need
Alcohol-based hand sanitizer	Alcohol-based hand sanitizer Enough for more than a month	Alcohol-based hand sanitizer Enough for two weeks	Alcohol-based hand sanitizer Enough for one week	Alcohol-based hand sanitizer Less than one week	Alcohol-based hand sanitizer Do not have	Alcohol-based hand sanitizer Do not need

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* 6. Please indicate the status of government assistance for your organization.

	Received	Did Not Receive	Not Eligible
PPE supplies from FEMA	PPE supplies from FEMA Received	PPE supplies from FEMA Did Not Receive	PPE supplies from FEMA Not Eligible
Funds from the federal government	Funds from the federal government Received	Funds from the federal government Did Not Receive	Funds from the federal government Not Eligible
Funds from your state or local government	Funds from your state or local government Received	Funds from your state or local government Did Not Receive	Funds from your state or local government Not Eligible

Other (please specify)

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* 7. Have you received FEMA PPE supplies that were expired or otherwise not fit for use?

Yes

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* 8. Without further assistance, for how many months do you estimate you can support COVID-related expenses?

One week

Two weeks

More than a month

Other (please specify)

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* 9. Provider Type (select all that apply):

Adult Day/PACE/Senior Centers

Affordable Housing

Assisted Living Communities

Home Health

Hospice

Life Plan Communities

Nursing Homes

Question Title

* 10. Contact Information

Organization Name

State

Email Address