Survey for Concerned Family and Friends
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- Jasper Hart
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1 Survey for Concerned Family and Friends We need your help. Your ideas and experiences with persons with Alzheimer's disease and related dementias will help inform the creation of a Florida state plan to address the growing public health impact of Alzheimer's disease. Your ideas and insights will help the state identify the needs of individuals with Alzheimer's disease or related dementias and their caregivers. This survey is being conducted by the Florida Purple Ribbon Task Force, which is a project of knowledgeable leaders, appointed by the Governor, the President of the Florida Senate, and the Speaker of the Florida House of Representatives, who are concerned about the impact of Alzheimer s disease on our communities and want to address the needs of Florida's citizens. Thank you for sharing your ideas and advice! Page 1
2 Please tell us about yourself 1. Where do you live or work? City: County: State: 2. What is your involvement or relationship to those with Alzheimer's disease and related dementias and their families? (Check all that apply.) Family Friend Neighbor Co worker Other (please specify below) 3. If you provide support to someone with Alzheimer's disease or related dementia or their family, please indicate approximately how many hours per week of help you provide. Average hours per week Page 2
3 Challenges for Families 4. How challenging do you feel the following issues are for families involved with Alzheimer's disease and related dementias and caregiving? Not Challenging A Little Somewhat Challenging Challenging Quite Challenging Very Challenging Don't Know Getting helpful information on Alzheimer's disease and related dementias Getting information about community resources Caregivers feeling depressed or anxious Caregivers feeling resentful Access to medical care for caregivers Access to medical care for people with Alzheimer's disease and related dementias Dealing with financial, legal, and insurance issues Access to support groups Access to respite care, adult day care, and other services Paying for services Changing relationships in the family Communication with the person with Alzheimer's disease or related dementia Becoming a financial burden on children Dying before the person with Alzheimer's disease or related dementia Losing control of lifestyle Loss of employment Getting an appropriate diagnosis Understanding the disease Other (please specify below) Page 3
4 Challenges for Individuals 5. How challenging do you feel the following issues are for individuals with Alzheimer's disease and related dementias and their families? A Little Somewhat Not Challenging Quite Challenging Very Challenging Don't Know Challenging Challenging Loss of ability to drive Depression or anxiety of the person with Alzheimer's disease or related dementia Difficult behaviors Wandering or safety Becoming a financial burden Losing control over lifestyle Other (please specify below) Page 4
5 Creating a State Plan Public Awareness 6. The Alzheimer's Purple Ribbon Task Force wants to increase general awareness and understanding of Alzheimer's disease across Florida. Which of the following would be best ways to raise public awareness of Alzheimer's disease and related dementias in your community? (Check all that apply.) Employers and workplaces Hospitals Aging services and senior centers Churches and faith communities Veterans Administration Public service announcements on radio and TV Medical training schools Law enforcement Physicians Nursing schools Religious organization Website with updated information Other (please specify below) 5 6 Page 5
6 Creating a State Plan Critical Issues 7. In your opinion, what are the most critical issues the state government in Florida should address in the next few years? Please rate the importance of the following possible issues that Florida might address. Not Important A Little Important Somewhat Important Quite Important Very Important Don't Know Research on prevention, treatment, and clinical trials Clinical assessment, diagnosis, and testing Assisting families in paying for care Protecting people with Alzheimer's disease and related dementias Ensuring quality of care Education and training for caregivers Economic impact of Alzheimer's disease and related dementias on communities, workplaces, and citizens Access to affordable and appropriate dementiaspecific care Having an educated and trained workforce on Alzheimer's disease and related dementias Transportation Employment Tax credits for caregivers Access to non dementiaspecific services Specialized care facilities Emergency Management/ Disaster Preparedness Medical care Mental health/ Depression Other (please specify below) Page 6
7 Please help us by providing some background information The following section will help us better understand your survey responses. All responses provided are anonymous and you can skip any question you do not wish to answer, but we appreciate any answers you are willing to provide. 8. What is your gender? nmlkj nmlkj Female Male 9. What is your age? 10. Are you of Hispanic, Latino, or Spanish origin? nmlkj nmlkj No Yes 11. What is your race? (Check all that apply.) White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Other (please specify below) Page 7
8 THANK YOU! Thank you for taking the time to fill out this survey. Your responses will help efforts to address the impact of Alzheimer's disease and related dementias on Florida's citizens. You can follow the work of the Purple Ribbon Task Force at the website below: Please feel free to make any comments that you believe will help us in understanding the needs of people with Alzheimer's disease and related dementias. 12. Any other comments or suggestions? 5 6 This survey was created by the Purple Ribbon Task Force of Florida, but has been based in large part upon surveys conducted by the State Plan for Alzheimer's Disease in Oregon (SPADO) Task Force. Page 8
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