of the following services and supports does your organization provide to people with dementia? (Circle the letters of ALL that apply.) day care Personal care, companion services, home health care Information and referral/options counseling Case management/care coordination/discharge planning Health care (drop down- primary care, specialty care, occupational therapy, physical therapy) Support groups Dementia education Education on advance directives Other ____________________ Our organization does not provide any of these direct services to people with dementia Which of the following services and supports does your organization provide to caregivers of people with dementia? (Circle the letters of ALL that apply.) Information and referral/options counseling Case management/care coordination/discharge planning Respite care Support groups Dementia education Training on communicating with persons with dementia Training on behavioral symptom management Training on advance directives Other ____________________ Our organization does not provide any of these direct services to caregivers of people with dementia Identifying people with dementia When working with people who may have Alzheimer’s disease or other dementias, does your organization have a standard procedure to: (Circle the letters of ALL that apply.) Identify people with possible dementia or cognitive impairment? Refer people with possible dementia or cognitive impairment to a physician or clinic for a diagnostic evaluation? Refer people with possible dementia or cognitive impairment to dementia care services? Identify a person with dementia’s primary caregiver? Determine if a person with possible dementia or cognitive impairment lives alone? Staff training for employees working on projects related to dementia, older adults, or others at risk for dementia, such as people with intellectual or developmental disabilities, about cognitive impairment, dementia, and dementia care Do staff in your organization receive formal training on dementia? Please circle one: All staff Some staff No staff
of the following services and supports does your organization provide to people with dementia? (Circle the letters of ALL that apply.) day care Personal care, companion services, home health care Information and referral/options counseling Case management/care coordination/discharge planning Health care (drop down- primary care, specialty care, occupational therapy, physical therapy) Support groups Dementia education Education on advance directives Other ____________________ Our organization does not provide any of these direct services to people with dementia Which of the following services and supports does your organization provide to caregivers of people with dementia? (Circle the letters of ALL that apply.) Information and referral/options counseling Case management/care coordination/discharge planning Respite care Support groups Dementia education Training on communicating with persons with dementia Training on behavioral symptom management Training on advance directives Other ____________________ Our organization does not provide any of these direct services to caregivers of people with dementia Identifying people with dementia When working with people who may have Alzheimer’s disease or other dementias, does your organization have a standard procedure to: (Circle the letters of ALL that apply.) Identify people with possible dementia or cognitive impairment? Refer people with possible dementia or cognitive impairment to a physician or clinic for a diagnostic evaluation? Refer people with possible dementia or cognitive impairment to dementia care services? Identify a person with dementia’s primary caregiver? Determine if a person with possible dementia or cognitive impairment lives alone? Staff training for employees working on projects related to dementia, older adults, or others at risk for dementia, such as people with intellectual or developmental disabilities, about cognitive impairment, dementia, and dementia care Do staff in your organization receive formal training on dementia? Please circle one: All staff Some staff No staff