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AoA-ADRC Consumer Satisfaction Survey 1 6/24/04

Consumer Satisfaction Surveys



Soliciting consumer feedback is an important component of quality assurance and continuous program improvement. Consumer
satisfaction surveys are one method for gathering feedback. ADRC-TAE reviewed 12 consumer satisfaction instruments used by
various county, state and national programs and complied the following matrix which describes the survey elements, how the elements
relate to ADRC goals/domains, design considerations, and administrative information about the surveys. The original survey
questions are listed by domain and domain subcategories after the matrix.

Matrix of Consumer Satisfaction Survey Domains, Background, and Administration

Survey Site S
a
n

D
i
e
g
o

C
a
l
l

C
e
n
t
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

M
l
w
a
u
k
e
e

C
o
u
n
t
y

E
l
d
e
r
L
i
n
k

R
e
s
o
u
r
c
e

C
e
n
t
e
r

S
u
r
v
e
y

K
e
n
o
s
h
a

C
o
u
n
t
y

C
o
n
s
u
m
e
r

T
e
l
e
p
h
o
n
e

S
u
r
v
e
y

P
e
r
f
o
r
m
a
n
c
e

O
u
t
c
o
m
e
s

M
e
a
s
u
r
e
m
e
n
t

P
r
o
j
e
c
t

I
&
A

Q
u
e
s
t
i
o
n
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

E
l
i
g
i
b
l
e

P
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
E
l
i
g
i
b
l
e

N
o
n
-
p
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
N
o
n

E
l
i
g
i
b
l
e

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

N
o
r
t
h

C
a
r
o
l
i
n
a

C
o
l
o
r
a
d
o

N
a
t
i
o
n
a
l

A
s
s
o
c
i
a
t
i
o
n

o
f

A
r
e
a

A
g
e
n
c
i
e
s

o
n

A
g
i
n
g

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

P
e
n
n
s
y
l
v
a
n
i
a

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

S
o
u
t
h

D
a
k
o
t
a

Domain:
Information

objectivity
reliability X X X X
comprehensiveness X X X X
currency &
usefulness of info
X X X X X X X
simple & clear X X X X
Domain: Staff
Interaction

responsive to
needs
X X X X X X X X
preferences &
unique
circumstances
X X
courteous X X X X
AoA-ADRC Consumer Satisfaction Survey 2 6/24/04

Survey Site S
a
n

D
i
e
g
o

C
a
l
l

C
e
n
t
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

M
l
w
a
u
k
e
e

C
o
u
n
t
y

E
l
d
e
r
L
i
n
k

R
e
s
o
u
r
c
e

C
e
n
t
e
r

S
u
r
v
e
y

K
e
n
o
s
h
a

C
o
u
n
t
y

C
o
n
s
u
m
e
r

T
e
l
e
p
h
o
n
e

S
u
r
v
e
y

P
e
r
f
o
r
m
a
n
c
e

O
u
t
c
o
m
e
s

M
e
a
s
u
r
e
m
e
n
t

P
r
o
j
e
c
t

I
&
A

Q
u
e
s
t
i
o
n
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

E
l
i
g
i
b
l
e

P
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
E
l
i
g
i
b
l
e

N
o
n
-
p
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
N
o
n

E
l
i
g
i
b
l
e

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

N
o
r
t
h

C
a
r
o
l
i
n
a

C
o
l
o
r
a
d
o

N
a
t
i
o
n
a
l

A
s
s
o
c
i
a
t
i
o
n

o
f

A
r
e
a

A
g
e
n
c
i
e
s

o
n

A
g
i
n
g

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

P
e
n
n
s
y
l
v
a
n
i
a

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

S
o
u
t
h

D
a
k
o
t
a

knowledgeable X X X X
communication X X X
Domain:
Application for
Services

simplicity of
applying for
services
X X
Understand
reasons for being
ineligible for
services
X
Domain: General
Experience

Overall satisfaction X X X X X X
Come back for
repeat services/
Recommend
services
X X X X X


Domain:
Demographic
Information

developmentally
disabled

physically disabled
elderly
agency X
Race X X
income X X
AoA-ADRC Consumer Satisfaction Survey 3 6/24/04

Survey Site S
a
n

D
i
e
g
o

C
a
l
l

C
e
n
t
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

M
l
w
a
u
k
e
e

C
o
u
n
t
y

E
l
d
e
r
L
i
n
k

R
e
s
o
u
r
c
e

C
e
n
t
e
r

S
u
r
v
e
y

K
e
n
o
s
h
a

C
o
u
n
t
y

C
o
n
s
u
m
e
r

T
e
l
e
p
h
o
n
e

S
u
r
v
e
y

P
e
r
f
o
r
m
a
n
c
e

O
u
t
c
o
m
e
s

M
e
a
s
u
r
e
m
e
n
t

P
r
o
j
e
c
t

I
&
A

Q
u
e
s
t
i
o
n
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

E
l
i
g
i
b
l
e

P
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
E
l
i
g
i
b
l
e

N
o
n
-
p
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
N
o
n

E
l
i
g
i
b
l
e

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

N
o
r
t
h

C
a
r
o
l
i
n
a

C
o
l
o
r
a
d
o

N
a
t
i
o
n
a
l

A
s
s
o
c
i
a
t
i
o
n

o
f

A
r
e
a

A
g
e
n
c
i
e
s

o
n

A
g
i
n
g

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

P
e
n
n
s
y
l
v
a
n
i
a

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

S
o
u
t
h

D
a
k
o
t
a

gender X X
age X X
education X X
Location (city,
suburban, rural)
X
zip code X X
Other persons in
home
X
Marital status X
Open ended
questions
What did
you like?
How can
services be
improved?
Add.
Comments?
Contact
made to?
Anything
else we can
help with?
Recom-
mendations
for
improving
services?


Survey Creation
and
Administration


How often is the
survey
administered?
1-2
times/year
Qrtly Qrtly To every
consumer;
currently
in pilot
phase
To every
consumer;
currently
in pilot
phase
To every
consumer;
currently
in pilot
phase

How is sample
selected?
Send out
200
surveys
and select
callers
from 2 wk
period
Randomly
selected 10
consumers
who called
I & A
service
People
who have
called
Informatio
n and
Assistance
Services in
the past
few weeks
Every
consumer
is selected
Every
consumer
is selected
Every
consumer
is selected

AoA-ADRC Consumer Satisfaction Survey 4 6/24/04

Survey Site S
a
n

D
i
e
g
o

C
a
l
l

C
e
n
t
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

M
l
w
a
u
k
e
e

C
o
u
n
t
y

E
l
d
e
r
L
i
n
k

R
e
s
o
u
r
c
e

C
e
n
t
e
r

S
u
r
v
e
y

K
e
n
o
s
h
a

C
o
u
n
t
y

C
o
n
s
u
m
e
r

T
e
l
e
p
h
o
n
e

S
u
r
v
e
y

P
e
r
f
o
r
m
a
n
c
e

O
u
t
c
o
m
e
s

M
e
a
s
u
r
e
m
e
n
t

P
r
o
j
e
c
t

I
&
A

Q
u
e
s
t
i
o
n
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

E
l
i
g
i
b
l
e

P
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
E
l
i
g
i
b
l
e

N
o
n
-
p
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
N
o
n

E
l
i
g
i
b
l
e

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

N
o
r
t
h

C
a
r
o
l
i
n
a

C
o
l
o
r
a
d
o

N
a
t
i
o
n
a
l

A
s
s
o
c
i
a
t
i
o
n

o
f

A
r
e
a

A
g
e
n
c
i
e
s

o
n

A
g
i
n
g

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

P
e
n
n
s
y
l
v
a
n
i
a

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

S
o
u
t
h

D
a
k
o
t
a

Response rate? 20% 25 surveys 10 surveys
for every
30 calls
To early;
no
numbers
yet;
response
rate low
but they
are trying
to improve
numbers
To early;
no
numbers
yet;
response
rate low
but they
are trying
to improve
numbers
To early;
no
numbers
yet;
response
rate low
but they
are trying
to improve
numbers

Cost per survey?
Postage +
staff time
to process
results=$10
per survey
No specific
info on
cost
available;
Printing in
house, no
cost; staff
hours to
make 30
calls and
get 10
surveys
Postage; no
dollar
amount
available;
no
additional
cost for
surveys
b/c intern
makes
followup
calls
Postage;
no dollar
amount
available;
no
additional
cost for
surveys
b/c intern
makes
followup
calls
Postage;
no dollar
amount
available;
no
additional
cost for
surveys
b/c intern
makes
followup
calls

AoA-ADRC Consumer Satisfaction Survey 5 6/24/04

Survey Site S
a
n

D
i
e
g
o

C
a
l
l

C
e
n
t
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

M
l
w
a
u
k
e
e

C
o
u
n
t
y

E
l
d
e
r
L
i
n
k

R
e
s
o
u
r
c
e

C
e
n
t
e
r

S
u
r
v
e
y

K
e
n
o
s
h
a

C
o
u
n
t
y

C
o
n
s
u
m
e
r

T
e
l
e
p
h
o
n
e

S
u
r
v
e
y

P
e
r
f
o
r
m
a
n
c
e

O
u
t
c
o
m
e
s

M
e
a
s
u
r
e
m
e
n
t

P
r
o
j
e
c
t

I
&
A

Q
u
e
s
t
i
o
n
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y

E
l
i
g
i
b
l
e

P
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
E
l
i
g
i
b
l
e

N
o
n
-
p
a
r
t
i
c
i
p
a
n
t
s

P
A

C
u
s
t
o
m
e
r

S
a
t
i
s
f
a
c
t
i
o
n

S
u
r
v
e
y
-
N
o
n

E
l
i
g
i
b
l
e

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

N
o
r
t
h

C
a
r
o
l
i
n
a

C
o
l
o
r
a
d
o

N
a
t
i
o
n
a
l

A
s
s
o
c
i
a
t
i
o
n

o
f

A
r
e
a

A
g
e
n
c
i
e
s

o
n

A
g
i
n
g

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

P
e
n
n
s
y
l
v
a
n
i
a

E
v
a
l
u
a
t
i
n
g

F
a
m
i
l
y

S
u
p
p
o
r
t

i
n

S
o
u
t
h

D
a
k
o
t
a

How is
information used?
Enable
Aging and
Indep.
Services to
customize
services to
better fit
customer
needs
Quality
assurance
Aimed at
improving
services in
terms of
access,
responsive
-ness of
service
(quick
turnaround
for setting
up
services),
and
minimizing
the break-
down of
the service
process
Aimed at
improving
services in
terms of
access,
responsive-
ness of
service
(quick
turnaround
for setting
up
services),
and
minimizing
the break-
down of
the service
process
Aimed at
improving
services in
terms of
access,
responsive
-ness of
service
(quick
turnaround
for setting
up
services),
and
minimizing
the break-
down of
the service
process

How were
questions
developed?
With a
consultant
with input
from staff
Area
Agency on
Aging staff
convened
work
groups to
gain
consumer
feedback
ADRC
developed
were
developed
with input
from the
RC board,
state staff,
and based
on their
experience
changes
were made
Group
effort of
the
cross-
depart-
mental
state team
that has
been
working on
Community
Choice
Group
effort of
the
cross-
depart-
mental
state team
that has
been
working on
Community
Choice
Group
effort of
the
cross-
depart-
mental
state team
that has
been
working on
Community
Choice

AoA-ADRC Consumer Satisfaction Survey 6 6/24/04

Survey Site S
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h

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Were the questions
tested? If so, how?
No No in SW
PA; in
Philadelphi
a yes- the
survey
workgroup
composed
of 10
providers
gives
surveys to
a consumer
test group
and
reworks the
questions
No in SW
PA; in
Philadelphi
a yes- the
survey
workgroup
composed
of 10
providers
gives
surveys to
a consumer
test group
and
reworks the
questions
No in SW
PA; in
Philadelphi
a yes- the
survey
workgroup
composed
of 10
providers
gives
surveys to
a consumer
test group
and
reworks the
questions

Did this include
cognitive
testing?
n/a In Philadel-
phia, yes
In Philadel-
phia, yes
In Philadel-
phia, yes

AoA-ADRC Consumer Satisfaction Survey 7 6/24/04

Survey Site S
a
n

D
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How is survey
administered?
Mail w/
postage
paid
addressed
envelope
QI staff Phone;
contract
outreach
coordinato
r devoted
15% of
time to
adm.
surveys
Phone Differs b/c
they are
testing/cha
nging;
original
surveys
given to
consumers
right after
start of
services-
none were
returned;
now
surveys are
given out
in diff
ways, some
with a
stamped
envelop
during
initial
enrollment
interviews-
this is more
successful;
none are
completed
by phone
Differs b/c
they are
testing/ch
anging;
original
surveys
given to
consumers
right after
start of
services-
none were
returned;
now
surveys
are given
out in diff
ways,
some with
a stamped
envelop
during
initial
enrollment
interviews
-this is
more
successful;
none are
completed
by phone
Differs b/c
they are
testing/ch
anging;
original
surveys
given to
consumers
right after
start of
services-
none were
returned;
now
surveys
are given
out in diff
ways,
some with
a stamped
envelop
during
initial
enrollment
interviews
-this is
more
successful;
none are
completed
by phone


AoA-ADRC Consumer Satisfaction Survey 8 6/24/04



Consumer Satisfaction Survey Questions By Domain
KEY:
Q: Question
A: Answer
C: Comment
R: Rating

Domain: Information

Reliability
Kenosha:
Q: Did you find any information you received to be incorrect?
A: Yes/No answer with comments
Evaluating Family Support in North Caroline:
Q: How satisfied are you with the information you received about the cash assistance?
A: Not at all satisfied: A little satisfied: Moderately satisfied: very satisfied: extremely satisfied
Evaluating Family Support in Pennsylvania:
Q: How often does the information help you to make an informed choice?
A: Never: Seldom: Sometimes: Usually: Always
Evaluating Family Support in South Dakota
Q: How often does the information help you to make an informed choice?
A: Always: Usually: Sometimes: Seldom: Never


Comprehensiveness
Performance Outcomes:
Q: Were you referred to any other places to call for a service or more information?
A: Yes, referred to another agency/Yes, referred to another office/No/Not applicable.
PA-Eligible/Enrolled:
Q: Has anyone contacted you about setting up another meeting to discuss other services to meet your needs?
A: Yes/No
PA-Eligible/Not enrolled:
Q: Has anyone contacted you about setting up another meeting to discuss other services to meet your needs?
A: Yes/No
PA-Noneligible
Q: Has anyone contacted you about setting up another meeting to discuss other services to meet your needs?
A: Yes/No

Currency/Usefulness of Information:
San Diego:
C: When I called the Aging and Independence Services Call Center, I received information that met my needs.
R: Strong Agree, Agree, Disagree, Strongly Disagree, Not Applicable or Dont Know
Milwaukee:
C: When I called ElderLink, I received information that I could understand and use.
R: Strong Agree, Agree, Disagree, Strongly Disagree, Not Applicable or Dont Know
Kenosha:
Q: Even if the services you needed were not available was the information you received helpful?
A: Yes/No with comments
Q: Did the information help you feel better prepared to make decisions?
A: Yes/No with comments
Performance Outcomes:
Q: Do you expect that the information you received from [NAME OF SERVICE] will be helpful in resolving the
issue you called about?

AoA-ADRC Consumer Satisfaction Survey 9 6/24/04

A: Yes, definitely; Yes, I think so; No, I dont think so; No, definitely not
Evaluating Family Support in Pennsylvania:
Q: How often doe they ask for information that is unnecessary?
A: Never: Seldom: Sometimes: Usually: Always
Q: How often do they ask for information that makes you feel uncomfortable because the questions are too
personal?
A: Never: Seldom: Sometimes: Usually: Always
Evaluating Family Support in South Dakota:
Q: How often does the program staff ask for information that is unnecessary?
A: Always: Usually: Sometimes: Seldom: Never.
Q: How often does the staff ask questions that make you feel uncomfortable?
A: Always: Usually: Sometimes: Seldom: Never.
National Association of Area Agencies on Aging:
Q: After being referred by the Eldercare Locator service, were you able to get what you were looking for when you
contacted the agencies or organizations that provided the services?
A: Yes; no; dont know; refused.

Simple and Clear
Milwaukee:
C: When I called ElderLink, I received information that I could understand and use.
R: Strong Agree, Agree, Disagree, Strongly Disagree, Not Applicable or Dont Know
PA-Noneligible:
Q: Do you understand why you are not eligible for certain services?
A: Yes/No
Q: Did someone explain why you are not eligible for certain services?
A: Yes/No
Evaluating Family Support in Pennsylvania:
Q: How often is the information easy to understand?
A: Never: Seldom: Sometimes: Usually: Always
Q: How often does the process of exchanging information take too long?
A: Never: Seldom: Sometimes: Usually: Always
Evaluating Family Support in South Dakota:
Q: How often is the information easy to understand?
A: Always: Usually: Sometimes: Seldom: Never
Q: How often does the process of exchanging information take too long?
A: Always: Usually: Sometimes: Seldom: Never.


Domain: Staff Interaction

Responsive to Needs
San Diego:
C: Would you say that the representative who answered your call showed . . .
R: A sincere desire to understand your needs, Some desire to understand your needs, No desire at all to understand
your needs, Dont know/Not applicable
C: The Aging and Independence Services Call Center representative who answered my call was able to process it to
my satisfaction.
R: Strong Agree, Agree, Disagree, Strongly Disagree, Not Applicable or Dont Know
Milwaukee:
C: When I called ElderLink, my call was quickly answered and I was able to talk with a Resource Center staff
person.
R: Strong Agree, Agree, Neutral, Disagree, Strongly Disagree
C: When I called ElderLink, we talked about my concerns.
R: Strong Agree, Agree, Neutral, Disagree, Strongly Disagree
Kenosha:
Q: Did you feel you were given assistance?

AoA-ADRC Consumer Satisfaction Survey 10 6/24/04

A: Yes/No with comment
Performance Outcomes:
Q: How quickly was your call answered?
A: Immediately, such as after 1 ring or 2 rings; Quickly, less than 5 rings; After a little while, 5-15 rings; Had to
wait a long time, more than 15 rings
Q: If you left a voicemail when you called, did someone call you back?
A: Yes/No
Q: If you left a voicemail, when did the person call you back?
A: Within the hour, in the same day, in the same week, more than a week
Q: Overall, did the person(s) listen carefully to what you wanted?
A: Yes, definitely; Yes, I think so; No, I dont think so; No, definitely not
PA-Eligible/Enrolled:
Q: How long did it take for services to begin?
A: xxxxx days
PA-Eligible/Not enrolled:
Q: How long did it take for services to begin?
A: xxxxx days
Evaluating Family Support in North Carolina:
Q: How satisfied are you with the way you were treated by the people involved in the family support program?
A: Not at all satisfied: A little satisfied: Moderately satisfied: very satisfied: extremely satisfied
Q: How satisfied are you with the time in which in took for you to receive cash payments?
A: Not at all satisfied: A little satisfied: Moderately satisfied: very satisfied: extremely satisfied
National Association of Area Agencies on Aging:
Q: How satisfied are you with the ability of the representative who answered your call to respond to you in a timely
manner?
A: Very satisfied; somewhat satisfied; not too satisfied; not at all satisfied; dont know/refused.
National Association of Area Agencies on Aging:
Q: To what extent do you agree that you were able to get quick and useful responses to your requests?
A: Strongly agree; somewhat agree; somewhat disagree; strongly disagree; does not apply; dont know/refused.
Q: To what extent do you agree that they asked you all the necessary questions in providing me the services I
requested?
A: Strongly agree; somewhat agree; somewhat disagree; strongly disagree; does not apply; dont know/refused.

Preferences/Unique Circumstances
Milwaukee:
C: When I called ElderLink, we talked about my concerns.
R: Strong Agree, Agree, Neutral, Disagree, Strongly Disagree

Courteus
San Diego:
Q: Was the representative who answered your call . . .
A: Very courteous, somewhat courteous, not at all courteous, dont know/not applicable

Milwaukee:
C: When I called ElderLink, I was treated with respect and courtesey.
R: Strong Agree, Agree, Neutral, Disagree, Strongly Disagree
Kenosha:
Q: When you called the Aging and Disability Resource Center did the person that you spoke to make you feel that
your call was welcome?
A: Yes/No with comment
Q: Was assistance given in a friendly manner?
A: Yes/No

Colorado:
C: The staff I worked with dont make assumptions about my limitations because of my disability.
R: Dont know, Strongly agree, Disagree, No opinion, Agree, Strongly agree, Comment-suggested improvements

AoA-ADRC Consumer Satisfaction Survey 11 6/24/04


National Association of Area Agencies on Aging:
Q: How satisfied are you with the courteousness of the representative?
A: Very satisfied; somewhat satisfied; not too satisfied; not at all satisfied; dont know/refused.
Q: To what extent do you agree that they were thoughtful and caring in their assistance?
A: Strongly agree; somewhat agree; somewhat disagree; strongly disagree; does not apply; dont know/refused.

Knowledgable
San Diego:
C: When I called the Aging and Independence Services Call Center, the representative who first answered my call
was knowledgable and competent.
R: Strong Agree, Agree, Disagree, Strongly Disagree, Not Applicable or Dont Know
Kenosha:
Q: Did you feel that the worker understood and respected your concerns?
A: Yes/No with comments
Evaluating Family Support in Pennsylvania:
Q: How often are FDSS Staff knowledgeable about the various public benefits available to assist families?
A: Never: Seldom: Sometimes: Usually: Always
National Association of Area Agencies on Aging:
Q: How satisfied are you with the representatives ability to understand your questions or requests?
A: Very satisfied; somewhat satisfied; not too satisfied; not at all satisfied; dont know/refused.
Q: How satisfied are you with the representatives ability to help you get the information you needed?
A: Very satisfied; somewhat satisfied; not too satisfied; not at all satisfied; dont know/refused/
Q: To what extent do you agree that they were able to address all your requests?
A: Strongly agree; somewhat agree; somewhat disagree; strongly disagree; does not apply; dont know/refused.
Q: To what extent do you agree that they were knowledgeable about the information you asked for?
A: Strongly agree; somewhat agree; somewhat disagree; strongly disagree; does not apply; dont know/refused.

Communication
Colorado:
C: Staff know how to make people with disabilities feel comfortable.
R: Dont know, Strongly agree, Disagree, No opinion, Agree, Strongly agree, Comment-suggested improvements
C: Staff seem comfortable relating to people with all types of disabilities.
R: Dont know, Strongly agree, Disagree, No opinion, Agree, Strongly agree, Comment-suggested improvements
C: Staff asked me if I needed information in alternative formats (e.g., Braille, signage, etc.).
R: Dont know, Strongly agree, Disagree, No opinion, Agree, Strongly agree, Comment-suggested improvements
C: It was explained to me that informational materials and instructions are available in alternate formats upon
request.
R: Dont know, Strongly agree, Disagree, No opinion, Agree, Strongly agree, Comment-suggested improvements
C: Staff can respond to my special need for assistance (e.g., Braille readers, sign language interpreters, etc.).
R: Dont know, Strongly agree, Disagree, No opinion, Agree, Strongly agree, Comment-suggested improvements
Evaluating Family Support in Pennsylvania:
Q: How often are FDSS staff in touch with your community and the resources it has available for families?
A: Never: Seldom: Sometimes: Usually: Always
National Association of Area Agencies on Aging:
Q: To what extent do you agree that they were thorough in the information they provided?
A: Strongly agree; somewhat agree; somewhat disagree; strongly disagree; does not apply; dont know/refused.

Domain: Application for Services

Simplicity of Applying for Services
Performance Outcomes:
Q: Were you referred to any other places to call for a service or more information?
A: Yes, I was referred to another agency; Yes, I was referred to another office in this agency; No; NA
If answer was yes . . .
Q: Did you contact any of them?

AoA-ADRC Consumer Satisfaction Survey 12 6/24/04

A: Yes/No
If the answer was yes . . .
Q: Have you started receiving services from any of the places you were referred to?
A: Yes/No

If the answer was no . . .
Q: May I ask why you did not contact them?
A: Havent had a chance to yet; I tried to, but havent heard from them yet; They called and left
message, but I havent called them back; I got help from somewhere else; Other

Understands Reasons for Being Ineligible
PA-Non eligible:
Q: Do you understand why you are not eligible for certain services?
A: Yes/No
Q: Did someone explain why you are not eligible for certain services?
A: Yes/No
Evaluating Family Support in North Carolina:
Q: How satisfied are you with the application process?
A: Not at all satisfied: A little satisfied: Moderately satisfied: very satisfied: extremely satisfied
Q: How satisfied are you with the amount of paperwork you were asked to complete or provide during the
application process?
A: Not at all satisfied: A little satisfied: Moderately satisfied: very satisfied: extremely satisfied
Domain: General Experience

Overall Satisfaction
San Diego:
C: Thinking of your total experience with Aging and Independence Services Call Center (800.510.2020), would you
say overall you were:
R: Very satisfied, Somewhat satisfied, Not very satisfied, Not at all satisfied, Dont know/Not applicable
Kenosha:
Q: Did you feel you were given assistance?
A: Yes/No with comments
Performance Outcomes:
Q: Overall, did you receive the information from [Name of I &A Service] that you were looking for?
A: Yes, definitely; Yes, I think so; No, I dont think so; No, definitely not
Q: Overall, how satisfied were you with the way your call was handled?
A: Excellent, Very good, Good, Fair, Poor
PA-Eligible/Enrolled:
Q: Are you satisfied with the services that you are receiving in your home and/or community?
A: Very satisfied; Somewhat satisfied, Undecided, Somewhat Dissatisfied, Very Dissatisfied
PA-Eligible/Not Enrolled:
Q: Are you satisfied with the services that you are receiving in your home and/or community?
A: Very satisfied; Somewhat satisfied, Undecided, Somewhat Dissatisfied, Very Dissatisfied
National Association of Area Agencies on Aging:
Q; Overall, how satisfied were you with the help you received from the Eldercare Locator information referral
service?
A: Very satisfied; somewhat satisfied; not too satisfied; not at all satisfied; dont know; refused.

Comeback for repeat services/Recommend Services
Milwaukee:
C: If I needed, I will call ElderLink again for more information.
R: Strongly agree, Agree, Neutral, Disagree, Strongly Disagree
Kenosha:
Q: Would you recommend a friend/relative contact the ADRC?
A: Yes/No with comments

AoA-ADRC Consumer Satisfaction Survey 13 6/24/04

Performance Outcomes:
Q: Would you recommend this service to a friend or colleague who needs the kind of information and assistance you
did?
A: Yes, definitely; Yes, I think so; No, I dont think so; No, definitely not
National Association of Area Agencies on Aging:
Q: How many times have you used the Eldercare Locator to receive information on services for the elderly?
Q: How likely would you be to use the Eldercare Locator for information again?
A: Very likely; somewhat likely; not too likely; not at all likely; dont know; refused.

Domain: Demographic Information
Agency
Performance Outcomes:
Q: What type of service provider are you?
A: Hospital, Long-term care, Social service agency, Other (Describe)

Race
Performance Outcomes:
Q: What is your race [Check all that apply.]?
A: White or Caucasian, Black or African American, Asian, American Indian or Alaska Native, Native Hawaiian or
Other Pacific Islander, Other (Specify)
National Association of Area Agencies on Aging:
Q: Which of the following best describes your racial or ethnic background?
A: White; African American or Black; Hispanic; Asian or Pacific Islander; Native American; Or Something Else;
dont know; refused.

Income
Performance Outcomes:
Q: Thinking about the total combined income from all sources for all persons in this household, was your total
household annual income during the year of 2002 above or below $20,000?
A: Below $20,000, Above $20,000
If answer is below $2,0000 . . .
Q: Which category best describes your total household annual income during the year 2002?
A: $10,000 or less; $10,001 to $15,000; $15,001 to $20,000

If answer is above $20,000
Q: Which category best describes your total household annual income during the year 2002?
A: $20,001 to $25,000; $25,001 to $30,000; $30,001 to $35,000; $35,001 to $40,000; over $40,000
National Association of Area Agencies on Aging:
Q: Would you say your total household income, before takes is . . . ?
A: Under $10,000; $10,000 to less than $20,000; $20,000 to less than $30,000; $30,000 to less than $40,000;
$50,000 or more; dont know; refused.

Gender
Performance Outcomes:
Q: Are you male or female?
A: Male/Female
National Association of Area Agencies on Aging:
Q: Gender (do not ask)?
A: Male; Female.

Age
Performance Outcomes:
Q: What is your age (years?)
National Association of Area Agencies on Aging:
Q: In what year were you born?


AoA-ADRC Consumer Satisfaction Survey 14 6/24/04

Education
Performance Outcomes:
Q: What is your highest educational level?
A: Less than High School Diploma, High School Diploma, Some college, including Associate degree, Bachelors
Degree, some post-graduate work or advanced degree
National Association of Area Agencies on Aging:
Q: What is the highest level of education you have completed?
A: High school or less; high school graduate; some college; college graduate; post graduate degree or higher; dont
know; refused.

Location
Performance Outcomes:
Q: Where is your home located?
A: In a city, in a suburban area, in a rural area

Zipcode
Performance Outcomes:
Q: What is your home zip code?
National Association of Area Agencies on Aging:
Q: What is your zip-code?

Other Persons in Home
Performance Outcomes:
Q: Wed like to ask you about the persons who live in this household. Does anyone else live with you in this
household?
A: Yes/No
If answer is yes . . .
Q: Do you . .
A: Live with a spouse, live with your children, live with other relatives, live with non relatives?

Marital Status
Performance Outcomes:
Q: What is your marital status?
A: Now married, widowed, divorced, separated, never married