MyOptions RI Survey

Dear Survey Participant:



Thank you for agreeing to participate in this brief, confidential survey. Your responses will help us to understand if Rhode Island’s Person-Centered Options Counseling (PCOC) Program was helpful to you and how our services might be improved.



If you are experiencing any technical issues in completing this survey, please email OHHS.LTSSNWD@ohhs.ri.gov.



Thank you for your participation.



Sincerely,

Rhode Island’s Executive Office of Health and Human Services (EOHHS)

1. Please fill out your first and last name

First name

Last name

2. Please check what applies to you:

Person seeking services

Legal representative

Family member

Caregiver

Agency representative

Other…

Other - please specify:

3. What is the name of the MyOptions Advisor that supported you?

4. If you are not currently in the long-term care setting of your choice, indicate the types of barriers you faced or are continuing to face. Check all that apply.

Services are being arranged

On waitlist for services

Could not afford services

Services not available

Not eligible for services

Unable to contact suggested agencies

Limited or no informal caregiver

Housing not available

Home not accessible

No barriers; I am in the long-term care setting of my choice

Other…

Other - please specify:

5. Overall, how would you rate your satisfaction with the Person-Centered Options Counseling that you received?

Very Satisfied

Somewhat Satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

6. Was the MyOptions Advisor able to give you the information that you needed?

Yes

No

Don't know

7. Did the MyOptions Advisor consider your opinions, likes and dislikes before recommending programs or supports?

Yes

No

Don't know

8. Did the information that you received during Person-Centered Options Counseling help you to find the services and/or supports that you needed?

Yes

No

Don't know

9. Would you recommend Person-Centered Options Counseling to a friend?

Yes

No

Don't know

10. Did the MyOptions Advisor follow-up with you?

Yes

No

Don't know

11. In regard to my contact with the MyOptions Advisors, I feel that:

Questions	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I am better informed about options for services and supports.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I was given objective, accurate, and complete information.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I was actively involved in developing my PCOC Action Plan.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
My PCOC Action Plan reflects what is important to me.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
Before I received options counseling, I considered going into a nursing facility or other institution.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
My PCOC Action Plan will help me stay in my home or community setting.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree

12. Please share comments regarding your MyOptions Advisor experience or any other suggestions for improvement.

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