Hospice at Home Carer Satisfaction Survey

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Hospice at Home Carer Satisfaction Survey Powered By Docstoc
					           RELATIVE / CARER SATISFACTION SURVEY
1)   Who introduced the Hospice at Home service to you?
     Please tick only one box, the individual who made you aware of the H@H service

     GP

     District Nurse

     Hospital Staff

     Hospice Staff

     Social Services / Social Worker

     Other (please specify)

     Don’t know

2) Do you think the introduction to the Hospice at Home service was at the right time?

     Too soon

     About right

     Would have been useful earlier

     Please comment if you wish:
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3) How did you expect the Hospice at Home service to help you? (please tick all boxes
   that apply)

     By providing practical care and support

     By providing help to control symptoms

     By providing advice

     By providing moral support

     By being available over 24 hours

     To allow you time out from caring (respite support)




                                                                                                                            At the end of service
            To allow you to sleep knowing the patient was safe

            To be available only in crisis situations

            To enable your relative to remain at home
            No expectations

            Other (please specify)
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      4) Did you receive a clear explanation of what the service provided?

            Yes                                    No                                     Can’t remember

      5) How satisfied were you, or your family members, with contacting the Hospice at Home
         team whenever you needed to (please tick)

         Completely                           To a large extent                          To some extent                                 Not at all


Please comment if you wish:
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      6) How helpful was the service provided by the Hospice at Home team? Please complete
         the boxes that are relevant to the care your relative received?

                                                           Very                         A Little                     Not at all                Not applicable

Practical care & support

Symptom control

Emotional support

Telephone Advice (daytime)
(from the Hospice Team)
Telephone Advice overnight
(between 8pm – 8am) (from
the Hospice Team)
Providing Day and /or Night
respite

Night Visits

Dealing with Crisis

Enabling patient to stay at
home
Please add further comments if you wish:
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                                                                                                                                    At the end of service
      7)     Where did your relative die?

            At home

            In hospital

            In the hospice

            Nursing home / residential home

            Other (please specify)                                                                     ........................................................


      8) Is this where they wanted to be?                                    Yes                       No                        Not Sure


      9) Thinking back to the last few days of your relative’s care, is there any additional care
         and support that the Hospice at Home service could have provided to help you?

            Yes                                    No

            Please comment:
            .....................................................................................................................................................
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      10) What things however small did not go well?
          .....................................................................................................................................................
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      11) What things however small went better than expected?
          .....................................................................................................................................................
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      12) Thinking back to your experience of the Hospice at Home service, could you say how
          satisfied you were with the care and support? (please tick)

           Completely                         To a great extent                          To some extent                                 Not at all



Please feel free to add any additional comments on any aspect of the Hospice at Home service:
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                                                                                                                                    At the end of service

				
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posted:2/1/2012
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