1. Very low 2. Low 3. Moderate 4. High 5. Very high 0. Do not know 1. Strongly disagree 2. Disagree 3. Neither agree or disagree 4. 5. Strongly agree 0. Do not know Question 8 This question asks about your skills for interacting with people who have dementia. (Skills for interacting with people with dementia include knowing when to repeat information or suggesting a family member should participate in conversations.) (Q7 in full assessment) Level of Interaction Skills Priority for Action Indicate your level of agreement with this statement: I have good skills for interacting with people with dementia. Indicate your level of agreement with this statement: Increasing our community members’ skills for interacting with people with dementia should be a priority for action in our community. 1. Strongly disagree 2. Disagree 3. Neither agree or disagree 4. Agree 5. Strongly agree 0. Do not know 1. Strongly disagree 2. Disagree 3. Neither agree or disagree 4. Agree 5. Strongly agree 0. Do not know Question 9 Our community may have diverse and underserved populations that would benefit from having resources tailored for people with dementia and their families (meaning programs or services that meet the needs of diverse populations). (Question 8 in full assessment) Interviewer Tip: Share relevant community demographic information. Level of Current Activity Priority for Action Indicate your level of agreement with this statement: Our community currently has adequate dementia-related resources tailored to our diverse and underserved populations. Indicate your level of agreement with this statement: Increasing dementia-related resources tailored to our diverse and underserved populations should be a priority for action in our community.
Indicate your level of agreement with this statement: Our community provides an adequate level of caregiving coaching/care consultation services for caregivers of people with dementia. Indicate your level of agreement with this statement: Increasing the level of caregiving coaching/care consultation services for caregivers of people with dementia should be a priority for action in our community. 1. Strongly disagree 2. Disagree 3. Neither agree or disagree 4. Agree 5. Strongly agree 0. Do not know 1. Strongly disagree 2. Disagree 3. Neither agree or disagree 4. Agree 5. Strongly 0. Do not know Question 13 Do you currently offer any of the following respite programs or services? Are the respite options social in nature only or do they include medical care as well? Are they tailored to people with dementia? (Q14 in full assessment) Respite options for caregivers Currently available Social or medical Tailored to dementia? Describe how. day programs ___ Yes ___ No ___ Yes Emergency or crisis respite ___ Yes ___ No ___ Yes Extended respite ___ Yes ___ No ___ Yes In home ___ Yes ___ No ___ Yes Overnight, weekend respite ___ Yes ___ No ___ Yes Other (please specify) ___ Yes ___ No ___ Yes of Current Activity Priority for Action Indicate your level of agreement with this statement: Our community has an adequate level of respite programs or services for caregivers of people with dementia. Indicate your level of agreement with this statement: Increasing the level of respite programs or services for caregivers of people with dementia should be a priority for action in our community.