Consumer Evaluation of Consumer Directed Personal Care Assistance Program

We want to learn from your experiences, this survey will be utilized to evaluate how AssistedCare Services is working in order to gain insight into systems change strategies that work and those that miss the mark.
Consumers served by AssistedCare Services are asked to complete the surveys periodically as part of the CDPCA Program requirement. This Information is strictly confidential; no names will be attached to the survey. This survey takes approximately 20 minutes to complete. Your contribution is valued and greatly appreciated.

Your Email Address:
Information About You:
1.  What is your age group?	18-21 22-64 65 and older
2.  What is your gender?	Male Female
3.  What is your race or ethnic background?	White African American Hispanic or Latino Somalian Ethiopian Nigerian Liberian Russian Asian or Pacific Islander Hmong Vietnamese Laotian Cambodian American Indian Bosnian Other
4.  What city do you live in?
5.  What is your zip code?
6.  Are you from rural Alaska?	Yes No
7.  What is your disability type?	Physical Mental Health Cognitive Sensory Multiple Disabilities Other
8.  What is your specific disability?
Information about your Personal Care Assistant Use
9.  Approximately how long have you used PCA Services?	Less than a year 1-5 years 5-10 years 10-15 years 15-20 years More than 20 years
10.  How many PCA hours do you use in the average week?	Less than 14 hours 15-28 hours 29-42 hours 43-56 hours 57-70 hours 71-84 hours More than 85 hours
11.  How many paid PCAs work for you on a regular basis, not counting PCAs who work only in emergency or backup situations?	One Two Three Four Five Six Seven Eight Nine Ten
12.  Who do you receive PCA services from other than your paid assistant?	Spouse Child Parent Friend Neighbor Other
13. How often do you have trouble finding PCA to work for you?	Never 1 or 2 times a year Once every 2 to 3 months Once a month Once a week Once a day
14.  Which of these statements is most true for you regarding Personal Assistant turnover within the past year?  Personal Assistant turnover has been...	Not a problem A minor problem, causing some inconvenience A major problem, causing a major inconvenience A critical problem, causing a health and safety hazard for you Don't know / refuse to answer
15.  How many of your regular Personal Assistants have stopped working for you within the past year?	None 1 2 - 4 5 or more Don't know / refuse to answer
16.  What are the MAIN reasons these PCAs have stopped working for you?	They took a different job They weren't able to work the hours you needed them None have stopped working for me You didn't offer health insurance you did not want them to continue working for you The travel distance to your home was too far They had an injury that prevented them from doing the job You had cultural differences Other
17.  How often do you use PCAs for backup or emergency situations?	Never 1 or 2 times a year Once every 2 to 3 months Once a month Once a week Once a day
18.  Which of the following times are the most difficult for you to find PCAs to work for you?	Early Morning Late morning Afternoon Evenings / nights Overnights Weekends Holidays Emergencies For Travel
19.  Where do you recruit most of your PCAs from?	From an agency Family members friends neighbors advertisements other
20.  How many PCAs have you recruited that were first time PCAs?	One Two Three Four Five Six Seven Eight Nine Ten
21.  Do your PCAs complete the tasks that you need.	Almost Always Usually Sometimes Seldom Don't know
22.  Would you say that the quality of your care your PCA provide is:	Very good Good Average Poor don't know
Your Experience With AssistedCare Services and CDPCA Program
23.  You can choose the amount and types of services you use:	Always True Sometimes True Neutral Sometimes False Always False
24.  You direct the decisions that affect your life:	Always True Sometimes True Neutral Sometimes False Always False
25.  You are able to choose who works for you:	Always True Sometimes True Neutral Sometimes False Always False
26.  You are able to train and direct the PCAs about the work they do:	Always True Sometimes True Neutral Sometimes False Always False
27.  The training that either you or AssistedCare Services provided to the PCA was adequate:	Always True Sometimes True Neutral Sometimes False Always False
28. You are able to decide what time of the day PCAs should come:	Always True Sometimes True Neutral Sometimes False Always False
29.  You are able to make the final decision about letting a PCA go if the relationship is not working out:	Always True Sometimes True Neutral Sometimes False Always False
30.   How important is it to be able to control PCA recruiting:	Critical Very Important Somewhat Important Not Important
31..  How important is it to be able to control PCA hiring:	Critical Very Important Somewhat Important Not Important
32.  How important is it to be able to control PCA training:	Critical Very Important Somewhat Important Not Important
33.  How important is it to be able to control PCA scheduling:	Critical Very Important Somewhat Important Not Important
34.  How important is it to be able to control Personal Assistant firing:	Critical Very Important Somewhat Important Not Important
35.  What type of support do you receive from other CDPCA consumers?	Personal Assistant referrals Resources and information Advice Support Other
36.  Please rate to what degree the CDPCA Program and AssistedCare Services has met your expectations	Exceeds Expectations Meets Expectations Somewhat meets expectations Does not meet expectations I am extremely disappointed
37. Would you say that the quality of AssistedCare Services grievance process is:	Very good Good Average Poor don't know
38.  Would you recommend AssistedCare Services PCAs to others?	Yes No
Why?
Comments:
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