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Home Caregivers

Caregiver Survey: Adult Day Program Needs Assessment

Jewish Family Service is considering creating an Adult Day program. We want the community's input because you are the most important voices in determining the need/interest in the possible implementation of this program in the future.

Section 1: About You (the Caregiver)

Your age:(Required)
Your relationship to the person you care for:(Required)
please specify
Do you live in the same household as the person you care for?(Required)
Are you currently employed?(Required)
How often do you feel overwhelmed or stressed as a caregiver?(Required)
Would having daytime support improve your quality of life?(Required)

Section 2: About the Care Recipient

Age of the person you care for:(Required)
Primary condition (select any that apply):(Required)
please specify
Daily functioning (select all that apply):(Required)
Would the care recipient be willing to undergo an assessment in order determine appropriateness to attend this program?(Required)

Section 3: Need for Adult Day Services

If offered by JFS, how likely would you be to utilize this program?(Required)
How often would you be interested in using an Adult Day Program?(Required)
What hours would be most helpful?(Required)
What services might be most appreciated by your care recipient, and most important to you? (select all that apply)(Required)

Section 4: Jewish Community Considerations

Is it important that the program reflects Jewish values and culture?(Required)
Would kosher meals be needed?(Required)

Section 5: Financial Considerations

What daily rate would you consider reasonable for an Adult Day Program?(Required)
Would you need a sliding-scale or scholarship option?(Required)

Section 6: Final Thoughts

Jewish Family Service

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333 South 132nd Street
Omaha, NE 68154
402-330-2024

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