Community Needs Assessment

Appendices

Appendix E - Survey Tool for Community Members(The Survey Tool for Community Members was adapted from the Treaty 7 Home Care Project Questionnaire and the Long Plain First Nations Community Survey.)

This HTML document is not a form. Its purpose is to display the information as found on the form for viewing purposes only. if you wish to submit a form, you must use only the PDF version

The following list of questions may be used to interview community members at large. It may be modified to include questions which are specific to your community. You may wish to interview people, have them fill out the form, or have a community meeting where a group of persons answer the questions together.

Home and Community Care
Community Members Survey

Please complete the following questions.

8. To what extent do you feel that the following services are available to the members of your community?

• Types of Home Care Services to be
  developed or changed: Client assessment to make sure Home Care is based on a person's health needs
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Health care givers are working with each other for the good of the client
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Nursing care in the home (e.g. dressings, injections, teaching etc.)
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Diabetes teaching and care
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Foot care
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Teaching to prevent complications of diseases or conditions
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Home Management - help looking after the home
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Personal care - help with such things as bathing, etc.
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Meal Service - preparing meals for people who cannot cook for themselves
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: In-Home Respite Services - care for disabled people so the care giver can have a break
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Do you think home care staff are trained, up to date and doing the jobs assigned to them?
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Is there enough home care services available to support the family, if a dying person chooses to die at home?
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  
  
• Types of Home Care Services to be
  developed or changed: Do you think that you receive care quickly enough after it has been requested? For example within 48 hours of the request?
  What we have is enough:
  Needs to be increased:
  Very much needed:
  Not Sure:
  

  

9. If the community is able to expand the home care services beyond the essential services of client assessment, home support (homemaking and personal care) and home nursing, which three of the following do you feel is most needed in your community? Please check the three most needed.
   
   
   • Adult Day Programs (care outside the home during the day)
   • Meal Programs - such as meals on wheels
   • Translation and medical escort for doctors appointments
   • Transportation needs to medical appointments etc.
   • Palliative Care Services for persons who wish to die at home
   • Mental Health Services for home care clients
   • Health Promotion, Wellness and/or Fitness Programs
   • Rehabilitation and Occupational Therapy in the community
   • Wellness Activities for the elderly and disabled
   • Support Groups for persons with diabetes and other conditions
   • Therapeutic Bath (specially equipped bath located in
           a common place) 
   • Health Classes and Workshops (please list what kinds)
     
     
10. What do you think is good about the home care services in your community?
    
    
11. Comments

Thank You for taking the time to fill this in.