Assess Caregivers Dementia Capable Communities Toolkit

Dementia Capable Communities Toolkit Community Needs Assessment — Caregiver Supports Survey

Caregiver supports is among the key elements in a dementia capable community. It includes caregiver counseling, support groups, adult day, respite and education and training on dementia.

The information gathered here supports a portion of a full Community Needs Assessment. Each survey question is cross-referenced to the full assessment. These questions are best investigated by someone with experience or interest in social or senior services. Assessing Caregiver Supports for a Dementia Capable Community

1. Review the information and resources on the ACT on Alzheimer’s Dementia Capable Communities Toolkit website related to Caregiver Supports to have a general familiarity when discussing the topic with others. 2. Develop a list of all of the caregiver support service providers in your community. Area Agencies on Aging (AAA) and the Alzheimer’s Association may be able to help you identify many of these organizations that support people with dementia in your community. 3. Prioritize and determine which organizations to contact. 4. Identify the appropriate contact(s) in these offices. 5. Keep track of your data sources, including who you interview and their responses to the questions in your interview. 6. Create a code for each interviewee, using the sector abbreviation, plus a number. For example, caregiver supports interviewees would be CS1 for first interviewee, CS2 for second, etc. 7. Use the Community Information Gathering - Survey/Call Script to introduce yourself and the project. 8. Conduct interviews. 9. After your information gathering, organize the data and summarize it in the Synthesizing the Assessment – Team Worksheet, which will be the basis for how your community rates its current level of activity and prioritizes what to focus on.

Caregiver Supports Survey www.ACTonALZ.org Page 1 of 6 ©2014. This toolkit was made possible by funding from the Greater Twin Cities United Way. Rev. 08/01/14 Interviewer/Your Name______Date of Interview______Community Member/Interviewee ______Interviewee Code: CS Name______Title______Address______Phone______Email______

1. Have you had personal experience with someone with dementia? ☐ Yes ☐ No Caregiver Counseling and Support Groups - Section D

2. Do you currently offer any of the following counseling/support groups for caregivers of people with dementia? (Q10 in full assessment)

Counseling and support groups specific for caregivers Currently available of people with dementia Individual counseling ☐ Yes ☐ No

Family counseling ☐ Yes ☐ No

Support groups ☐ Yes ☐ No

Other (please specify) ☐ Yes ☐ No

Level of Current Activity Priority for Action Indicate your level of agreement with this Indicate your level of agreement with this statement: statement: Our community has an adequate Increasing the level of counseling/support groups for level of counseling/support groups for caregivers caregivers of people with dementia should be a priority of people with dementia. for action in our community. 1. Strongly disagree 1. Strongly disagree 2. Disagree 2. Disagree 3. Neither agree or disagree 3. Neither agree or disagree 4. Agree 4. Agree 5. Strongly agree 5. Strongly agree 0. Do not know 0. Do not know

What do you see as barriers and opportunities for providing counseling/support groups for caregivers of people with dementia and/or their families?

Caregiver Supports Survey www.ACTonALZ.org Page 2 of 6 ©2014. This toolkit was made possible by funding from the Greater Twin Cities United Way. Rev. 08/01/14 Caregiver Supports - Section H 3. Do you currently offer any of the following services for caregivers of people with dementia? (Q15 in full assessment)

Services for caregivers Currently Tailored to dementia? available Describe how. Caregiver Coaching ☐ Yes ☐ No ☐ Yes Care Consultation ☐ Yes ☐ No ☐ Yes Other (please specify) ☐ Yes ☐ No ☐ Yes

Level of Current Activity Priority for Action Indicate your level of agreement with this Indicate your level of agreement with this statement: statement: Our community provides an Increasing the level of services for caregivers of people adequate level of services for caregivers of with dementia should be a priority for action in our people with dementia. community. 1. Strongly disagree 1. Strongly disagree 2. Disagree 2. Disagree 3. Neither agree or disagree 3. Neither agree or disagree 4. Agree 4. Agree 5. Strongly agree 5. Strongly agree 0. Do not know 0. Do not know

What do you see as barriers and opportunities for providing services for caregivers of people with dementia?

Caregiver Supports Survey www.ACTonALZ.org Page 3 of 6 ©2014. This toolkit was made possible by funding from the Greater Twin Cities United Way. Rev. 08/01/14 4. Do you currently offer any of the following respite programs or services? Are the respite options social only or do they include medical care as well? Are they tailored to people with dementia? If yes, how do they meet the unique needs of people with dementia? (Q14 in full assessment)

Respite options for Currently Social or medical Tailored to dementia? caregivers available model? Describe how. Adult day programs ☐ Yes ☐ No ☐ Yes Emergency or crisis ☐ Yes ☐ No ☐ Yes respite Extended respite ☐ Yes ☐ No ☐ Yes Overnight, weekend ☐ Yes ☐ No ☐ Yes respite Other (please specify) ☐ Yes ☐ No ☐ Yes

Level of Current Activity Priority for Action Indicate your level of agreement with this Indicate your level of agreement with this statement: statement: Our community has an adequate Increasing the level of respite programs or services for level of respite programs or services for caregivers of people with dementia should be a priority caregivers of people with dementia. for action in our community. 1. Strongly disagree 1. Strongly disagree 2. Disagree 2. Disagree 3. Neither agree or disagree 3. Neither agree or disagree 4. Agree 4. Agree 5. Strongly agree 5. Strongly agree 0. Do not know 0. Do not know

What do you see as barriers or opportunities for providing respite programs or services for caregivers of people with dementia?

Caregiver Supports Survey www.ACTonALZ.org Page 4 of 6 ©2014. This toolkit was made possible by funding from the Greater Twin Cities United Way. Rev. 08/01/14 Information & Education for People with Dementia & or their - Section C Caregivers of people with dementia need education and training about the disease and care needs. They also need information about services and supports available in the community.

5. For caregivers, do you provide education and training about Alzheimer’s disease and care needs? Do you offer information about services and supports in the community? (Q7 in full assessment) ☐ Yes ☐ No ☐ Unsure

If yes, list the training (title, audience, content). Rate how well these trainings are attended, on a scale from 0 to 3, with 3 being the highest.

Education and trainings offered for caregivers of people with Rate overall participation level dementia None Low Moderate High (title, audience, content) ☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 0 ☐ 1 ☐ 2 ☐ 3

Level of Current Activity Priority for Action Indicate your level of agreement with this Indicate your level of agreement with this statement: statement: Caregivers of people with dementia Increased information, education and training on in our community currently receive adequate dementia for caregivers of people with dementia should information, education and training on be a priority for action in our community. dementia. 1. Strongly disagree 1. Strongly disagree 2. Disagree 2. Disagree 3. Neither agree or disagree 3. Neither agree or disagree 4. Agree 4. Agree 5. Strongly agree 5. Strongly agree 0. Do not know 0. Do not know

What opportunities do you see for information, education and training for caregivers of people with dementia? What barriers do you see?

Caregiver Supports Survey www.ACTonALZ.org Page 5 of 6 ©2014. This toolkit was made possible by funding from the Greater Twin Cities United Way. Rev. 08/01/14 General Would you be interested in playing a greater role to help us implement this project in our community? Suggestions:  Serve on a coalition  Serve on a task force or committee  Public endorsement/testimonial  Appoint a person to work on the project  Donate resources, i.e., meeting space, advertising, personnel, funds, etc.

Could you suggest other people/organizations/groups in our community who could take part in this project?

Are there any other suggestions or ideas that you can give me as we prepare to get this project started?

Are there any questions you would like to ask me?

Thank you for your time and support.

Would you like me to be in touch with you again to let you know how the project is progressing and how you can best help to ensure is becoming more dementia capable? ☐ Yes ☐ No

Reference: Minnesota Department of Health, Community Health Promotion — Mobilizing Your Community to Promote Health, http://www.health.state.mn.us/divs/hpcd/chp/hpkit/pdf/involv_ws2.PDF, viewed 6/29/12.