Questionnaire

Questionnaire

Introduction

I humbly pray that this survey finds you safe. My name is yyyyy yyyy, from the Chicago School of Psychology. I am currently pursuing a doctoral capstone project titled “Adult Day Care Centers and Implications of Quality of Life.”  The success of this project depends on your assistance when you take precious time to respond to the questions in the proceeding sections. The questions will enable my project to make conclusive findings and interpretation, purposed to improve both the scholarly literature and my future practice upon graduation. I assure you once more that confidentiality, anonymity, and privacy of any personal information is my priority despite the absence of personal or private related questions in this study. So kindly feel the utmost welcomed to respond to the questions succinctly.

Research Topic: Adult Day Care Centers and Implications of Quality of Life

Besides, my research questions are as followed.

Research Questions

• How has attending Adults Day Centers help with socialization?
• How has attending Adult Day Centers help with the quality of life?
• What is the level of support for Adult Day Centers?
• How does cultural diversity in adult day centers influence senior adults?
• What are the negative and positive implications of Adult Day Centers to senior adults?

Kindly Key in Your Responses by Placing a Mark Where Appropriate

Part A: Demographic Data

1. Are you from Southern California? (If yes or option b then, please proceed with the rest of the survey)
2. Yes
3. Was once a resident and is well conversant with the information from Southern California
4. No
5. What is your gender:

3. What is your age group from the options given below:

4. What is your Annual Income Level in USD ($):

5. What is your academic level?

6. Do you belong to either of this origin

7. Select your race ( You are free to mark more than one)

8. Do you know Adult Day Care Centres: (If yes or somehow proceed to the remaining questions)

Part 2: The second part of the questionnaire will seek to measure life satisfaction among the respondents.

9. From a score of 1-10, what is the rating would you recommend the Adult Day Care Centres to your family, relatives, or friend

10. Generally, how dissatisfied or satisfied was your last attendance to an Adult Day Care Centres?
11. Very Dissatisfied
12. Somewhat Dissatisfied
13. Very Satisfied
14. Somewhat Satisfied
15. Neither dissatisfied nor satisfied
16. Rate the difficulty or the ease of scheduling appointments within your convenient time with the Adult Day Care Centres.
17. Very Difficult
18. Somewhat Difficult
19. Very Easy
20. Somewhat Easy
21. Neither difficult or easy
22. Using the parameters below, rate the level of convenient do your appointment times within the Adult Day Care Centres
23. Not at all convenient
24. Not so convenient
25. Very convenient
26. Extremely convenient
27. Somewhat convenient
28. According to your experience, rate the convenience of your choice’s location of the Adult Day Care Centre.
29. Not at all convenient
30. Not so convenient
31. Very convenient
32. Extremely convenient
33. Somewhat convenient
34. Based on your experience with your Adult Day Care Centre, rate the quality of the services offered by the staffs at the reception
35. Poor
36. Fair
37. Good
38. Very Good
39. Excellent
40. Rate the comfortability of the waiting, lobbying, or reception areas
41.  Not at all comfortable
42. Not so comfortable
43. Very comfortable
44. Extremely comfortable
45. Somewhat comfortable
46. Did your once or frequent attendance or appointments with the Adult Day Care Centre staff begin on time, late, or early enough?
47. Very late
48. Somewhat late
49. On-time
50. Somewhat early
51. Very early
52. Rate the level of care you obtain from your frequently attended Adult Day Care Centre
53. Poor
54. Fair
55. Good
56. Very Good
57. Excellent
58. What level of trust will you grant the Adult Day Care Centre to make on behalf of your medical care and support that matches your convenient interest?
59. Not at all
60. A little
61. A moderate amount
62. A lot
63. A great deal
64. Rate the level at which your Adult Day Care Centre staff take care of your needs.
65. Not at all well
66. Not so well
67. Somewhat well
68. Very well
69. Extremely well
70. Rate the responses your Adult Day Care Centre offers upon request
    1. Not at all well
    2. Not so well
    3. Somewhat well
    4. Very well
    5. Extremely well
71. Rate the treatment option and healthcare support did your Adult Day Care Centre staff offer
    1. Not at all well
    2. Not so well
    3. Somewhat well
    4. Very well
    5. Extremely well
72. How well has been the Adult Day Care Centre staff follow up activities
    1. Not at all well
    2. Not so well
    3. Somewhat well
    4. Very well
    5. Extremely well
73. Rate the level of dissatisfaction or satisfaction you can offer your Adult Day Care Centre in articulating your daily needs
    1. Very Dissatisfied
    2. Somewhat Dissatisfied
    3. Very Satisfied
    4. Somewhat Satisfied
    5. Neither dissatisfied nor satisfied

Part 3: The third part is to collect data of the respondent’s current health conditions

24. Do you get healthcare support from the Adult Day Care Centre or anywhere of your choice? If yes, proceed to the rest of the questions.
25. Yes
26. No
27. If you get hurt, fall sick, need a regular check-up, or advise, do you have specific healthcare personnel do you visit.
    1. Yes
    2. No
28. What is the duration you have visited your healthcare provider?
29. Less than 3 months
30. At least 3 months but less than 6 months
31. More than 6 months but less than 1 year
32. At least a year but less than 4 years
33. At least 4 years but less than 6 years
34. More than 6 years
35. In the last 6 months, what is the frequency of your healthcare visit or appointments?
36. 0
37. Once
38. Twice
39. Thrice
40. Four times
41. 5-9
42. More than 9 times
43. What was the purpose of your last appointment or visit to your healthcare provider?
44. Fully Body check-up
45. Specific healthcare treatment or check-up
46. Did you ring your healthcare provider to book an appointment for either of the options in (27 above)?
47. Yes
48. No
49. How often or did you get the healthcare provider’s appointment that you ringed in question 29 the way you expected?
50. Never
51. Sometimes
52. Normally
53. Always
54. Did you receive the healthcare service offered in the appointment referred to in question 29 on the same day?
    1. Never
    2. Sometimes
    3. Normally
    4. Always
55. In your recent appointment or medical check-up or treatment, did the healthcare provider explain your condition with ease to widen your comprehension?
56. Yes, Somewhat
57. Yes, somewhat
58. No
59. Did your healthcare provider seem to understand your healthcare condition substantially, especially your medical history?
    1. Yes, Somewhat
    2. Yes, somewhat
    3. No
60. In your most recent healthcare visit, did the healthcare providers undertake any of the following tests, x-ray, blood sample test, stool, urinalysis, or other tests?
61. Yes
62. No
63. Did you or someone close to you receive any of the test results in question 34?
64. Yes
65. No
66. From the results in question 34, is there any indication that you are suffering from any chronic disease?
67. Yes (Specify)
68. No
69. Is there any other medical condition or history that you have despite the one specified in question 36?
    1. Yes (Specify)
    2. No
70. Adults Day Centres have a significant influence on senior adults’ socialization ability.
    1. Strongly agree
    2. Agree
    3. No opinion
    4. Disagree
    5. Strongly disagree
71. Rate how well is the attended Adult Day Centres in terms of providing care at the center.
    1. Not at all well
    2. Not so well
    3. Somewhat well
    4. Very well
    5. Extremely well
72. Rate how well is the attended Adult Day Centres in terms of food provision.
    1. Not at all well
    2. Not so well
    3. Somewhat well
    4. Very well
    5. Extremely well
73. There is high multidisciplinary teamwork in adult daycare centers, which positively influence the senior adults.
    1. Strongly agree
    2. Agree
    3. No opinion
    4. Disagree
    5. Strongly disagree
74. From a general perspective, Adults Day Centers have a high significance of improving the senior adults’ quality of life (such as providing care at the center, food, multidisciplinary team).
    1. Strongly agree
    2. Agree
    3. No opinion
    4. Disagree
    5. Strongly disagree
75. The adult day centers influence senior adult’s cultural diversity
76. Strongly agree
77. Agree
78. No opinion
79. Disagree
80. Strongly disagree
81. From a general perspective, rate the state of your healthcare based on your regular visit of Adult Day Care Centres.
    1. Poor
    2. Fair
    3. Good
    4. Very Good
    5. Excellent
82. Rate the level of healthcare conditions provided in adult daycare centers on a scale of 1-10.

Part 4: The fifth part of the questionnaire is to find out where they stand regarding financially.

46. Do you have any healthcare insurance plan?
47. Yes, I have
48. No, I do not have any
49. In case you have an insurance plan, is it comprehensive enough to cater for all your healthcare needs in any facility?
50. Yes, I have
51. No
52. Who caters to the healthcare plans mentioned in (question 46 above)?
53. Self-funded
54. Current employer
55. Former employer
56. National government
57. State government

Local government

1. Others (Specify)
2. What option is your health insurance plan charge falling?
3. Co-insurance,
4. Co-pays,
5. Deductibles,
6. Premiums
7. What is the cost in USD ($), do you spend on one of the chosen options in question 49 per year?
8. Less than $1500
9. $1501-$2500
10. $2501-$3500
11. $3501-$4500
12. $4501-$5500
13. $5501-$6500
14. $6501-$7500
15. $7501-$8500
16. $8501-$9500
17. $9501-$10,500
18. $15,001-$20,000
19. $20,001-$25,000
20. $25,001-$30,000
21. Above $30,000
22. Do you spend other extra expenses on health coverage, other than the cover expenses in question 50?
23. Do you consider the option you picked from question 50 and the additional expenses on question 51 above expensive?
24. Yes
25. No
26. Did lack of money or proper medical coverage hamper you from receiving sufficient medical attention in the last month?
    1. Yes
    2. No
27. If question 53 is yes, is it the reason why you would prefer or opt for the Adult Day Care Centre?
    1. Yes
    2. No
28. From your experience with Adult Day Care Centre, do you consider it relatively cheaper than other care homes?
29. Yes
30. No

Part 5: The sixth part is determining their physical activity

56. From the list of the physical activities offered in the Adult Day Care Centre, please select that you have witnessed being offered or have personal experience. Please pick and tick where you deem appropriate

The End! Thank you for your time and responses. God Bless You!