Attachment B-5: Case Management Services

For respondents marking “No” or “Uncertain” to Question #1, enter their response to Question #1 ONLY in the corresponding Excel file for calculating responses. Do not enter their responses to the other questions. However, do include these in the count when calculating the response rate for the survey as a “survey respondent.”
Item # HCBS Case Management Survey Questions Answer Options

1.

I know who my Case Manager is.

  • Yes

  • No

  • Uncertain

2.

I know how to contact my Case Manager.

  • Yes

  • No

3.

Does your Case Manager return your phone calls in a timely manner?

  • Always

  • Sometimes

  • Never

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4.

Does your Case Manager explain your services in a way that you can understand?

5.

Does your Case Manager treat you with respect?

6.

Does your Case Manager involve you in discussing and planning for your services?

7.

Does your Case Manager do a good job setting up care for you?

8.

Is your Case Manager familiar with the services available to you in your area?

9.

Is your Case Manager familiar with the requirements to receive the services available to you?

10.

Is your situation better because of your Case Manager’s help?

  • Yes

  • No

11.

Does your Case Manager help you to get services that you did not have before?

12.

Do Case Management Services help you to continue to be able to live at home?

13.

Overall, how satisfied are you with the Case Management Service you receive?

  • Satisfied

  • Somewhat Satisfied

  • Dissatisfied

14.

Who would you contact first if you had a problem with your Case Manager?

  • Case Manager’s Supervisor or Agency

  • Area Agency on Aging

  • Division of Aging Services

  • Do Not Know

  • Others:

15.

Please tell us any suggestions you have to improve the quality of the Case Management Service you receive.

Comments:
If the survey is to be administered by mail, please do not ask the consumer to identify him/herself, unless he or she wishes to be contacted for follow-up. Add lines at the end of the survey for the consumer to indicate voluntarily a desire for a contact and to provide his or her name and telephone contact information.