FY25 Long-term Care Ombudsman Satisfaction Survey

Question Title

* 2. What is your admittance status?

Long-term care

Short-term rehab

Question Title

* 3. Who do you contact when you have a problem with your care in the facility? Check all that apply.

Administrator

Social worker

Nurse/ CNA

Ombudsman

Family member

Other (please specify)

Question Title

* 4. How did you hear about the Ombudsman program?

Ombudsman

Another resident

Facility staff person

Poster

Agency or hospital

Radio, television or newspaper

Kentucky Department on Aging

I don't know or don't remember

Other (please specify)

Question Title

* 5. Do you understand your resident's rights?

Yes

Question Title

* 6. How did you learn about resident's rights?

Ombudsman

Another resident

Staff person

Poster

Agency or hospital

Kentucky Department on Aging

Radio, television or newspaper

I don't know or don't remember

Question Title

* 7. Do you understand what the Ombudsman Program does?

Yes

Question Title

* 8. Do you want to know more about the Ombudsman Program?

Yes

Question Title

* 9. Do you know how to contact the Ombudsman?

Yes

Question Title

* 10. Have you ever asked the Ombudsman for help?

Yes

If yes, please describe.

Question Title

* 11. Below are a few statements that describe how you feel about the Ombudsman services. For each statement, please check the box of response that best describes the statement that applies to you. Skip this question if you have never received assistance from the Ombudsman.

	Strongly agree	Agree	Disagree	Strongly disagree
I am satisfied with the way the Ombudsman handled my problem	I am satisfied with the way the Ombudsman handled my problem Strongly agree	I am satisfied with the way the Ombudsman handled my problem Agree	I am satisfied with the way the Ombudsman handled my problem Disagree	I am satisfied with the way the Ombudsman handled my problem Strongly disagree
My problem was resolved to my satisfaction	My problem was resolved to my satisfaction Strongly agree	My problem was resolved to my satisfaction Agree	My problem was resolved to my satisfaction Disagree	My problem was resolved to my satisfaction Strongly disagree
I am satisfied with the time it took to handle my problem	I am satisfied with the time it took to handle my problem Strongly agree	I am satisfied with the time it took to handle my problem Agree	I am satisfied with the time it took to handle my problem Disagree	I am satisfied with the time it took to handle my problem Strongly disagree
I had sufficient contact with the Ombudsman while my problem was being resolved	I had sufficient contact with the Ombudsman while my problem was being resolved Strongly agree	I had sufficient contact with the Ombudsman while my problem was being resolved Agree	I had sufficient contact with the Ombudsman while my problem was being resolved Disagree	I had sufficient contact with the Ombudsman while my problem was being resolved Strongly disagree
My problem has not reoccurred	My problem has not reoccurred Strongly agree	My problem has not reoccurred Agree	My problem has not reoccurred Disagree	My problem has not reoccurred Strongly disagree
I would recommend the Ombudsman program to other residents who need help	I would recommend the Ombudsman program to other residents who need help Strongly agree	I would recommend the Ombudsman program to other residents who need help Agree	I would recommend the Ombudsman program to other residents who need help Disagree	I would recommend the Ombudsman program to other residents who need help Strongly disagree

Other (please specify)

FY25 Long-term Care Ombudsman Satisfaction Survey

Question Title

* 1. Facility name:

Question Title

* 2. What is your admittance status?

Question Title

* 3. Who do you contact when you have a problem with your care in the facility? Check all that apply.

Question Title

* 4. How did you hear about the Ombudsman program?

Question Title

* 5. Do you understand your resident's rights?

Question Title

* 6. How did you learn about resident's rights?

Question Title

* 7. Do you understand what the Ombudsman Program does?

Question Title

* 8. Do you want to know more about the Ombudsman Program?

Question Title

* 9. Do you know how to contact the Ombudsman?

Question Title

* 10. Have you ever asked the Ombudsman for help?

Question Title

* 11. Below are a few statements that describe how you feel about the Ombudsman services. For each statement, please check the box of response that best describes the statement that applies to you. Skip this question if you have never received assistance from the Ombudsman.

Question Title

* 12. If you were dissatisfied with the outcome of your complaint, please explain why.

FY25 Long-term Care Ombudsman Satisfaction Survey

Question Title

* 1. Facility name:

Question Title

* 2. What is your admittance status?

Question Title

* 3. Who do you contact when you have a problem with your care in the facility? Check all that apply.

Question Title

* 4. How did you hear about the Ombudsman program?

Question Title

* 5. Do you understand your resident's rights?

Question Title

* 6. How did you learn about resident's rights?

Question Title

* 7. Do you understand what the Ombudsman Program does?

Question Title

* 8. Do you want to know more about the Ombudsman Program?

Question Title

* 9. Do you know how to contact the Ombudsman?

Question Title

* 10. Have you ever asked the Ombudsman for help?

Question Title

* 11. Below are a few statements that describe how you feel about the Ombudsman services. For each statement, please check the box of response that best describes the statement that applies to you. Skip this question if you have never received assistance from the Ombudsman.

Question Title

* 12. If you were dissatisfied with the outcome of your complaint, please explain why﻿.

* 12. If you were dissatisfied with the outcome of your complaint, please explain why.