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Satisfaction Survey for Caregivers and Care recipients

Alzheimer's Disease and other dementias are common and significant conditions. Primary care Providers (PCPS) have different levels of training and knowledge in how to support caregivers and patients living with memory and brain health concerns

Virginia Commonwealth University and the Virginia Geriatric Education Center are developing programs to enhance dementia primary care. We want to understand how caregivers and care recipients feel about brain health and dementia care management they are receiving from
primary care providers.

Please complete this survey to let us know about your care! We also invite you to enroll in the Virginia Memory Project and join us for Caregiver Conversations this fall. (Information below)

Thank you,

With any questions reach out to Dr. Dan Bluestein, MD at bluesteinda@vcu.edu

Are you a caregiver AND/OR someone living with a memory concern (either you noticed changes in your own memory, or a healthcare worker told you your memory was changing)?

You are a caregiver if you regularly look after a child or a sick or disabled person, or older adult. Caregivers can be paid, or they can be friends and family.

You are a care recipient: If you regularly receive ongoing assistance with everyday tasks as a result of a chronic brain health or memory condition.

Note: You CAN be both a CAREGIVER and a CARE RECIPIENT

* must provide value

Caregiver

Care Recipient

Neither

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Do you have a primary care provider?

A Primary Care Provider is a health care practitioner who sees people who have common medical problems. Generally this practitioner will be involved in your care for a long period of time

* must provide value

Yes

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Date and time

What is your zip code?

How old are you?

What is your gender

Female

Male

Non-binary

Other

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Which one or more of the following would you say is your race?

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

Don't know/ Not sure

Refused

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What best describes your marital status?

Are you...?

Are you Hispanic or Latino/a/x?

Yes

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In what kind of clinic or practice do you primarily receive primary care?

Outpatient Office

Free Clinic or Charitable Clinic

PACE Center

Home Visiting Clinic

Residential Setting (Nursing Home, Assisted Living)

Other

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Other: Please Indicate

What kind of practitioner do you visit for primary care?

Physician (MD or DO)

Midlevel (Nurse Practitioner, Physician Assistant)

Interdisciplinary team

Not Sure

Other

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Other: Please Indicate

How KNOWLEDGEABLE is your primary care provider about memory loss, brain health, caregiving, or dementia?

Knowledgable would indicate your provider's ability to thoroughly answer your questions and address any concerns

Not Applicable/Never Discussed

Not knowledge

Little knowledge

Average

Good knowledge

Extremely knowledgeable

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How HELPFUL is your primary care provider about memory loss, brain health, caregiving, or dementia?

HELPFUL would indicate your provider's ability to listen to you and offer suggestions, solutions and resources for your concerns related to memory loss, brain health, dementia, or caregiving

Not Applicable/Never Discussed

Not helpful

A little helpful

Average

Good help

Extremely helpful

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How SATISFIED are you with your primary care provider about memory loss, brain health, caregiving, or dementia?

SATISFIED indicates if your expectations for care are met

Not Applicable/Never Discussed

Not satisfied

A little satisfied

Average

Good satisfaction

Extremely satisfied

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What do you think primary care providers should be trained on in order to be more helpful, and knowledgable, or increase your satisfaction in care?

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What questions do you have about dementia, brain health, caregiving, or memory loss?

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.