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. CAPTCHA What code is in the image? Enter the characters shown in the image. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank
