Community Partners in Parkinson's Care Client Survey

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As a member of the Parkinson’s Foundation Community Partners in Parkinson’s Care network, our care staff receives education about how Parkinson’s disease can cause changes in movement, speech, eating, sleep and other daily activities.

We ask you to kindly complete this short client survey to help us better understand your experiences with our Care Partner Members. Although we do have record of your Senior Community or Home Care Agency, this is an anonymous survey.

It is very important for us to hear about your experience and level of satisfaction about the care we provide. Thank you for taking the time to complete this survey.

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 recording client response

Are you reporting from a senior care community/rehab hospital or home care agency/hospice? *

Senior Care community/Rehab hospital

Home Care agency/Hospice

What is the name of this community/agency?

(Please include specific location if your community/agency has multiple locations.)

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.

	Never	Sometimes	I don't know	Usually	Always
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? - Never	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? - I don't know	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? - Always
Are the staff patient and give you the time you need?	Are the staff patient and give you the time you need? - Never	Are the staff patient and give you the time you need? - Sometimes	Are the staff patient and give you the time you need? - I don't know	Are the staff patient and give you the time you need? - Usually	Are the staff patient and give you the time you need? - Always
Does the staff give you help when you need it?	Does the staff give you help when you need it? - Never	Does the staff give you help when you need it? - Sometimes	Does the staff give you help when you need it? - I don't know	Does the staff give you help when you need it? - Usually	Does the staff give you help when you need it? - Always
Do you have opportunities to exercise?	Do you have opportunities to exercise? - Never	Do you have opportunities to exercise? - Sometimes	Do you have opportunities to exercise? - I don't know	Do you have opportunities to exercise? - Usually	Do you have opportunities to exercise? - Always
Do you receive the support you need for your Parkinson’s?	Do you receive the support you need for your Parkinson’s? - Never	Do you receive the support you need for your Parkinson’s? - Sometimes	Do you receive the support you need for your Parkinson’s? - I don't know	Do you receive the support you need for your Parkinson’s? - Usually	Do you receive the support you need for your Parkinson’s? - Always

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

	Never	Sometimes	I don't know	Usually	Always
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? - Never	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? - I don't know	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? - Always
How often do you receive your Parkinson’s pills on time?	How often do you receive your Parkinson’s pills on time? - Never	How often do you receive your Parkinson’s pills on time? - Sometimes	How often do you receive your Parkinson’s pills on time? - I don't know	How often do you receive your Parkinson’s pills on time? - Usually	How often do you receive your Parkinson’s pills on time? - Always
Are the staff patient and give you the time you need?	Are the staff patient and give you the time you need? - Never	Are the staff patient and give you the time you need? - Sometimes	Are the staff patient and give you the time you need? - I don't know	Are the staff patient and give you the time you need? - Usually	Are the staff patient and give you the time you need? - Always
Does the staff give you help when you need it?	Does the staff give you help when you need it? - Never	Does the staff give you help when you need it? - Sometimes	Does the staff give you help when you need it? - I don't know	Does the staff give you help when you need it? - Usually	Does the staff give you help when you need it? - Always
Do you have opportunities to exercise?	Do you have opportunities to exercise? - Never	Do you have opportunities to exercise? - Sometimes	Do you have opportunities to exercise? - I don't know	Do you have opportunities to exercise? - Usually	Do you have opportunities to exercise? - Always
Do you receive the support you need for your Parkinson’s?	Do you receive the support you need for your Parkinson’s? - Never	Do you receive the support you need for your Parkinson’s? - Sometimes	Do you receive the support you need for your Parkinson’s? - I don't know	Do you receive the support you need for your Parkinson’s? - Usually	Do you receive the support you need for your Parkinson’s? - Always

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

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?

Is there anything your care community could do better for people with Parkinson’s?

Is there anything your home care agency could do better for people with Parkinson’s?

Leave this field blank

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