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Surveys
2008
October
E
Elderserve ADC Participant
Elderserve ADC Participant
Elderserve ADC Participant Satisfaction Survey
0%
Age
60-69
70-79
80-89
90 and Over
Gender
Female
Male
Race
Non Minority
African American
Hispanic
American Indian
Native Hawaiian/Pacific Islander
Asian
Other
What is your home zip code?
How did you first learn about our program?
Home Health Agency
Friend/Relative
Media (TV,Newspaper)
Other
Doctor's Office
Church
How many days per week do you attend ADC?
1 Day
2-3 Days
4-5 Days
How long have you attended ADC?
Less than 1 year
1-3 years
4-6 years
7 or more years
Reasons for attending ADC... Please check all that apply
Socialization
Supervision
Structured Activites
Health Services
To avoid placement in a nursing home
To allow caregiver to work
Other
Do you feel your level of social interaction has significantly increased since you started attending the ADC?
Yes
To some extent
No
How satisfied are you with the current days and hours of operation of our facility?
Very Satisfied
Satisfied
Dissatisfied
Excellent
Good
Fair
Poor
Do not use it
N/A
How would you rate the variety of activities offered at the ADC?
How would you rate the quality of activities offered at teh ADC?
If center transportation is available, how would you rate it?
What rating would you give the ADC programming in meeting your current needs?
How are we doing in helping you meet your goals through using our services?
How satisfied are you with the meals served at the ADC?
Very Satisfied
Satisfied
Dissatisfied
Do you find our staff courteous and professional?
Always
Usually
Sometimes
Rarely
How would you rate the ADC's communication in informing you of policies, events, news, etc.?
Excellent
Good
Fair
Poor
Based on your experiences at the ADC, would you recommend it to other seniors?
Yes
No
Not sure
Overall, how satisfied are you with the services/ programs offered at the ADC center?
Very Satisfied
Satisfied
Dissatisfied
If you are the caregiver for the ADC participant, has this service been beneficial to you?
Yes
No
If YES, please check all that apply
It allows me to continue to work
It provides me with respite
I feel less stressed
My social life has improved
Other
Additional Comments:
Please contact
[email protected]
if you have any questions regarding this survey.
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