Dementia Care Survey

People with dementia and their carers deserve the best care, services and information to help them make the most of their lives. This survey is designed to find out what you need and how you would prefer to receive the care you need from us as a service provider. The results will help UPA understand how to achieve our objective for developing an innovative resident/client focused Dementia Strategy to provide good-quality care and services for the future.

All information will be treated confidentially. If you have any questions about this questionnaire, please call your local care or home care manager.

Thank you for sharing your views.

Please select the one that best describes you.

Question Title

* 1. Please select the one that best describes you.

Please select the age of the person with dementia.

Question Title

* 2. Please select the age of the person with dementia.

Please select the age of the Carer.

Question Title

* 3. Please select the age of the Carer.

How long ago did the person find out they had dementia?

Question Title

* 4. How long ago did the person find out they had dementia?

Where does the person with dementia live? 

Question Title

* 5. Where does the person with dementia live? 

What is your ethnic or cultural background?

Question Title

* 6. What is your ethnic or cultural background?

Would you like information about Dementia from us as a service provider?

Question Title

* 7. Would you like information about Dementia from us as a service provider?

In what format would you prefer to receive information about Dementia? (please select all that apply):

Question Title

* 8. In what format would you prefer to receive information about Dementia? (please select all that apply):

How important is it that you have regular contact and social involvement with your family, carer’s and friends?

Question Title

* 9. How important is it that you have regular contact and social involvement with your family, carer’s and friends?

How would you like to see this be made possible or easier?

Question Title

* 10. How would you like to see this be made possible or easier?

How important is it that you have engagement and access to the community and community services?

Question Title

* 11. How important is it that you have engagement and access to the community and community services?

What features would you like your room to have?

Question Title

* 12. What features would you like your room to have?

What features would you like the home environment to have? For example e.g. no locked areas, locked areas, outdoor space, gardens, pets, music.

Question Title

* 13. What features would you like the home environment to have? For example e.g. no locked areas, locked areas, outdoor space, gardens, pets, music.

Would you like to have access to IT (Information technology) to help you stay connected to family, friends and the internet? (e.g. Computers, IPad/ tablets, Skype, FaceTime) What and how?

Question Title

* 14. Would you like to have access to IT (Information technology) to help you stay connected to family, friends and the internet? (e.g. Computers, IPad/ tablets, Skype, FaceTime) What and how?

How important is it to you to have choice and involvement with Food choices and times

Question Title

* 15. How important is it to you to have choice and involvement with Food choices and times

How important is it to you to have choice and involvement with your personal care

Question Title

* 16. How important is it to you to have choice and involvement with your personal care

How important is it to you to have choice and involvement with sleeping and waking times?

Question Title

* 17. How important is it to you to have choice and involvement with sleeping and waking times?

How important is it to you to have space for privacy and intimacy?

Question Title

* 18. How important is it to you to have space for privacy and intimacy?

How can we meet your spiritual and cultural needs?

Question Title

* 19. How can we meet your spiritual and cultural needs?

How can we help you to maintain your personal identity and independence with day to day lifestyle activities?

Question Title

* 20. How can we help you to maintain your personal identity and independence with day to day lifestyle activities?

Would you like to be involved in a focus group as a carer?

Question Title

* 21. Would you like to be involved in a focus group as a carer?

Would you like to be involved in a focus group as a resident?

Question Title

* 22. Would you like to be involved in a focus group as a resident?

T