Services During Coronavirus Questionnaire

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This survey is meant to collect information about services being provided to Mainers with disabilities who receive those services under MaineCare sections 21 and 29. Thank you for your participation!

Please answer the following about your services (or the services of the family member/person you support) since the COVID-19 outbreak:

What is your (the person receiving services) zip code and/or town/city? (this is for statistical purposes only - your answers will remain anonymous)

Case management:

The information and support I receive from my case manager meets my needs.

The information and support I receive from my case manager does not meet my needs.

I have not heard from my case manager.

Other:

Clear selection

Section 29 waiver - Day Program - Check all that apply

This does not apply to me

I have been offered modified services.

The information and support I receive from my day program meets my needs

I have not been offered any services.

I have not heard from my day program.

Other:

Sections 21/29 waiver - Home Supports - check all that apply

This does not apply to me

I am receiving my usual services

The information and support I receive from my home support provider meets my needs.

I have been offered modified services.

I have not been offered any services.

I have not heard from my home support provider.

Other:

Sections 21/29 - Shared Living - please check all that apply

This does not apply to me

I am receiving my usual services

The information and support I receive from my provider meets my needs.

I have been offered modified services.

I have not been offered any services.

I have not heard from my provider.

Other:

Section 21 - Residential - check all that apply

This does not apply to me

I am receiving my usual services

The information and support I receive from my residential provider meets my needs.

I have been offered modified services.

I have not been offered any services.

I have not heard from my home support provider.

Other:

Please tell us why you are not receiving your usual services

There are not enough staff available

I am not able to access technology

I do not want the services because of concerns about the virus

I don’t know

Other:

Please tell us about the information that you are receiving about your services.

I receive helpful information from DHHS when I need it.

I receive some information from DHHS

I do not have enough information from DHHS

I receive helpful information from my service provider when I need it.

I receive some information from my service provider

I do not have enough information from my service provider.

Other:

Are there things you or your family need, but can't get? What are they?

Is there anything else you'd like us to know about your services right now?

Submit

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