Community Partners in Parkinson's Care Client Survey

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Thank you for taking the time to complete this survey. Community Partners for Parkinson’s Care (formerly the Struthers Parkinson’s Care Network) uses your responses to improve care for people with Parkinson’s at care communities and home health care agencies across the country.

Your responses will be kept confidential. Please mark your response thinking about the last month.

Who is completing this survey? *

Client

Family Member or Care Partner

Staff Member with Client Input

Are you reporting from a care community or home health care agency? *

Care community

Home Health Care agency

Please answer based on your level of satisfaction:

	Very Unsatisfied	Unsatisfied	Neither Unsatisfied or Satisfied	Satisfied	Very Satisfied
How satisfied are you with your overall experience at your site?	How satisfied are you with your overall experience at your site? - Very Unsatisfied	How satisfied are you with your overall experience at your site? - Unsatisfied	How satisfied are you with your overall experience at your site? - Neither Unsatisfied or Satisfied	How satisfied are you with your overall experience at your site? - Satisfied	How satisfied are you with your overall experience at your site? - Very Satisfied

Please answer based on your level of satisfaction:

	Very Unsatisfied	Unsatisfied	Neither Unsatisfied or Satisfied	Satisfied	Very Satisfied
How satisfied are you with your overall experience from your agency?	How satisfied are you with your overall experience from your agency? - Very Unsatisfied	How satisfied are you with your overall experience from your agency? - Unsatisfied	How satisfied are you with your overall experience from your agency? - Neither Unsatisfied or Satisfied	How satisfied are you with your overall experience from your agency? - Satisfied	How satisfied are you with your overall experience from your agency? - Very Satisfied

Below are questions about staff understanding and sensitivity on topics related to Parkinson’s disease.

	Always	Usually	Sometimes	Never	I don't know
How satisfied are you with your Parkinson’s specific care from your agency?	How satisfied are you with your Parkinson’s specific care from your agency? - Always	How satisfied are you with your Parkinson’s specific care from your agency? - Usually	How satisfied are you with your Parkinson’s specific care from your agency? - Sometimes	How satisfied are you with your Parkinson’s specific care from your agency? - Never	How satisfied are you with your Parkinson’s specific care from your agency? - I don't know
Is the staff patient when you are walking or moving slowly?	Is the staff patient when you are walking or moving slowly? - Always	Is the staff patient when you are walking or moving slowly? - Usually	Is the staff patient when you are walking or moving slowly? - Sometimes	Is the staff patient when you are walking or moving slowly? - Never	Is the staff patient when you are walking or moving slowly? - I don't know
Does the staff give you the time you need to get ready each day?	Does the staff give you the time you need to get ready each day? - Always	Does the staff give you the time you need to get ready each day? - Usually	Does the staff give you the time you need to get ready each day? - Sometimes	Does the staff give you the time you need to get ready each day? - Never	Does the staff give you the time you need to get ready each day? - I don't know
Does the staff give you help when you need it?	Does the staff give you help when you need it? - Always	Does the staff give you help when you need it? - Usually	Does the staff give you help when you need it? - Sometimes	Does the staff give you help when you need it? - Never	Does the staff give you help when you need it? - I don't know
Do you have opportunities to exercise?	Do you have opportunities to exercise? - Always	Do you have opportunities to exercise? - Usually	Do you have opportunities to exercise? - Sometimes	Do you have opportunities to exercise? - Never	Do you have opportunities to exercise? - I don't know
Are there activities you enjoy that help you manage your Parkinson’s	Are there activities you enjoy that help you manage your Parkinson’s - Always	Are there activities you enjoy that help you manage your Parkinson’s - Usually	Are there activities you enjoy that help you manage your Parkinson’s - Sometimes	Are there activities you enjoy that help you manage your Parkinson’s - Never	Are there activities you enjoy that help you manage your Parkinson’s - I don't know
Do you receive the support you need for your Parkinson’s?	Do you receive the support you need for your Parkinson’s? - Always	Do you receive the support you need for your Parkinson’s? - Usually	Do you receive the support you need for your Parkinson’s? - Sometimes	Do you receive the support you need for your Parkinson’s? - Never	Do you receive the support you need for your Parkinson’s? - I don't know

Below are questions about staff understanding and sensitivity on topics related to Parkinson’s disease.

	Always	Usually	Sometimes	Never	I don't know
How satisfied are you with your Parkinson’s specific care at your site?	How satisfied are you with your Parkinson’s specific care at your site? - Always	How satisfied are you with your Parkinson’s specific care at your site? - Usually	How satisfied are you with your Parkinson’s specific care at your site? - Sometimes	How satisfied are you with your Parkinson’s specific care at your site? - Never	How satisfied are you with your Parkinson’s specific care at your site? - I don't know
How often do you receive your Parkinson’s pills on time?	How often do you receive your Parkinson’s pills on time? - Always	How often do you receive your Parkinson’s pills on time? - Usually	How often do you receive your Parkinson’s pills on time? - Sometimes	How often do you receive your Parkinson’s pills on time? - Never	How often do you receive your Parkinson’s pills on time? - I don't know
Is the staff patient when you are walking slowly?	Is the staff patient when you are walking slowly? - Always	Is the staff patient when you are walking slowly? - Usually	Is the staff patient when you are walking slowly? - Sometimes	Is the staff patient when you are walking slowly? - Never	Is the staff patient when you are walking slowly? - I don't know
Does the staff give you the time you need to get ready each day?	Does the staff give you the time you need to get ready each day? - Always	Does the staff give you the time you need to get ready each day? - Usually	Does the staff give you the time you need to get ready each day? - Sometimes	Does the staff give you the time you need to get ready each day? - Never	Does the staff give you the time you need to get ready each day? - I don't know
Does the staff give you help when you need it?	Does the staff give you help when you need it? - Always	Does the staff give you help when you need it? - Usually	Does the staff give you help when you need it? - Sometimes	Does the staff give you help when you need it? - Never	Does the staff give you help when you need it? - I don't know
Do you have opportunities to exercise?	Do you have opportunities to exercise? - Always	Do you have opportunities to exercise? - Usually	Do you have opportunities to exercise? - Sometimes	Do you have opportunities to exercise? - Never	Do you have opportunities to exercise? - I don't know
Are there activities you enjoy that help you manage your Parkinson’s	Are there activities you enjoy that help you manage your Parkinson’s - Always	Are there activities you enjoy that help you manage your Parkinson’s - Usually	Are there activities you enjoy that help you manage your Parkinson’s - Sometimes	Are there activities you enjoy that help you manage your Parkinson’s - Never	Are there activities you enjoy that help you manage your Parkinson’s - I don't know
Do you receive the support you need for your Parkinson’s?	Do you receive the support you need for your Parkinson’s? - Always	Do you receive the support you need for your Parkinson’s? - Usually	Do you receive the support you need for your Parkinson’s? - Sometimes	Do you receive the support you need for your Parkinson’s? - Never	Do you receive the support you need for your Parkinson’s? - I don't know

Have you received education on the importance of taking your Parkinson’s pills on time?

Yes

Do you have access to materials about Parkinson’s disease? If not, would you like access to materials about Parkinson’s?

Yes

If no, would you like access to materials about Parkinson’s?

Yes

Is there anything your care community does really well for people living with Parkinson’s?

Is there anything your home care agency does really well for people living with Parkinson’s?

Leave this field blank

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