HOME HEALTHCARE SURVEY

WHO SHOULD COMPLETE THE SURVEY:
Residents of Jefferson County, IA who currently or in the past 5 years have needed skilled or unskilled caregiving assistance.

This survey will identify gaps in availability, accessibility, 

adequacy, & coordination of health, 

social, and other services that allow

the aging and disabled to remain in their homes.

WHO SHOULD FILL OUT THIS SURVEY

Caregivers who provide skilled and/or unskilled services 

to assist the elderly and/or those with a temporary or permanent disability

or chronic illness with their daily living activities.

Your answers to the following questions will provide data 

to help us build partnerships and resources in Jefferson County.