Home Care Visit Feedback
Care in the client's home: punctuality, consistency of carers, and dignity.
4 questions · 1 page · about 2 minutes to answer · fully editable after you start
Home care is intimate by definition: strangers with keys, helping with the day's most private tasks. This survey – designed for clients or their families to complete – measures what home-care quality means at the door: visit punctuality and full duration, consistency of which carers come, dignity and warmth in the care itself, and communication when things change.
Carer consistency is the metric families watch hardest; a rotation of unfamiliar faces undoes trust that took months to build, and this survey quantifies it per client.
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Page 1
Your home care
This survey is about the care visits you or your family member receive at home. Your answers help us improve the care we provide. It takes about 2 minutes. This form is not an emergency service. If you need urgent medical help, call your local emergency number.
Q1.How would you rate each part of the care visits?*
| Poor | Fair | Good | Excellent | Not applicable | |
|---|---|---|---|---|---|
| Arriving on time | |||||
| Staying the full visit | |||||
| Seeing familiar carers, not a rotation | |||||
| Treated with dignity | |||||
| Warmth of the carers | |||||
| Communication about changes |
Q2.Who is completing this?
- The person receiving care
- A family member
- Together
Q3.What do the carers do especially well?
Q4.What concerns you about the current care?
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