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Introduction

Providers are invited to complete a survey that will enable the Alabama Department of Senior Services and Alabama Lifespan Respite Network to learn about caregiver support services in Alabama. The purpose of the survey is to learn more about the availability and capacity of caregiver support services in Alabama for serving informal and unpaid caregivers.  Any provider that serves family, friends or community members caring for a frail, disabled, or chronically ill adult or child with special needs is considered eligible and appropriate for the survey. The short, confidential survey should be completed by the person in your organization who manages or supervises services for caregivers.

Please reply to questions about your experiences as a respite service provider for
family caregivers.  The information you provide will be used to plan improvements to lifespan respite services for caregivers of people with disabilities and chronic illness. 
 
We will NOT collect your name or Email address without your permission. Your personal identity will not be revealed to others. It will require about 20 minutes to reply to the survey. You may refuse to answer any question or discontinue participation at any time without penalty. Responses will be automatically submitted to this online survey.
 
You will not receive any special consideration if you take part in this assessment. If you have questions about your rights as a participant, or concerns or complaints about this activity, you may contact Mrs. Traci Dunklin, Alabama Department of Senior Services, State Director of the Alabama Caregiver Program. Mrs. Dunklin may be reached at 1-800-243-5463 or 1-800 Age Line.
Please tell us about yourself.

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* 1. What is your zip code?

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* 2. What is your job title?

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* 3. What is your race or ethnic group?

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* 4. For how many years has your agency or organization provided respite care for family caregivers?

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* 5. Estimate the number of family caregivers who have received respite services from your agency or organization during the past year.

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* 6. Does your agency or organization accept Medicaid waivers for caregiver respite services?

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* 7. How often does your agency or organization provide caregiver respite services using a Medicaid waiver? 

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* 8. What do family caregivers expect respite services to provide? 

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* 9. What event(s) most commonly lead family caregivers to seek respite services? (Select all that apply)

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* 10. What is the average length of caregiver respite services provided by your agency or organization? 

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* 11. Is the average length of time of respite services sufficient for most family caregivers?

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* 12. Are you able to identify other agencies and organizations who provide respite services to family caregivers in your community?

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* 13. In your experience, how true is each statement about respite services for family caregivers?

  Very True Somewhat True Not at all True Does Not Apply
Trained respite staff meets needs of family caregivers.
Respite offers a short-term break for family caregivers.
Respite reduces the risk of neglect or mistreatment of the family member with a disability or chronic illness. 
Respite caregivers provide safe and secure care.
Respite enables family caregivers to focus on needs of others in the household.
Respite allows family caregivers to enjoy social and recreational activities. 
Respite reduces stress levels among family caregivers.
Respite increases family ability to effectively provide care.
Most family members with disabilities or chronic illnesses feel positively about respite. 
Tell us about your experience.

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* 14. How many times have family caregivers known to you been unable to obtain respite services when needed?

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* 15. What is the average wait to receive respite services for family caregivers known to you?

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* 16. How do families learn about respite services available in your community? (Select all that apply)

Please tell us about who is eligible to receive family respite services from your agency or organization. 

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* 17. Which agencies or organizations regularly help family caregivers to find respite services? (Select all that apply)

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* 18. Which age groups of individuals with disabilities or chronic illnesses are eligible for family caregiver respite services? (Select all that apply)

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* 19. In order to receive family respite services, where may the individual with a disability or chronic illness live? (Select all that apply)

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* 20. What level of supervision is your agency or organization able to provide for individuals with disabilities or chronic illnesses during family respite care?

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* 21. What level of assistance with life skills can respite caregivers from your agency or organization provide to a person with a disability or chronic illness?

  No assistance Some assistance Complete assistance Don't know/Does not apply
Communication (e.g. speaking, hearing)
Feeding
Dressing
Bathing and hand washing
Caring for mouth and teeth
Toileting
Cooking
Taking medication as prescribed
Transportation (driving, riding a bus)
Thank you for your time and effort! Please answer these final questions. 

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* 22. What are the 3 most important training needs among employees of your agency or organization to provide family respite services?

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* 23. What are your additional comments about family caregiver respite services? 

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* 24. Would you like to receive a summary of the survey results? If so, please provide the following mailing information. 

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* 25. May we contact you again to request additional information? 

0 of 25 answered
 

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