Survey Form (To ask the Elderly staying in Old Folks Home)

Mr Leong, here are the 2 survey forms prepared to ask for the elderly who are staying in the old folks home to understand their actual living condition, what they really need and what are the problems they are facing living in the home, but I don't know which one should I use, the first one is more on asking about their living condition in the home and the 2nd one is asking about their opinion on how a good old folks home should look like.

* I can attend the tutorial this Thu but not next Thu (8th Oct) cz I'm going to a chess competition. TQ

1. Survey Form (Old Folks Home)

 How Long have you been staying here? ___________________

1 Strongly Agree,

2 Agree,

3 Neutral,

4 Disagree,

 5 Strongly Disagree

 

Questions:	1	2	3	4	5
1. Living in this home is comfortable & relaxed.
2. The cleanliness of the home is well maintained.
3. The staffs and workers are friendly and helpful.
4. There is a sense of belonging living in this home.
5. The spaces is sufficient to carry out different daily activities.
6. There are both public and private areas in this home.
7. The design (interior, exterior, landscape) of the home is satisfaction.
8. The space planning in this home is appropriate.
9. The location of the home is strategic.
10. The mood/feel in the interior of this home is suitable.
11. The living condition in this home is fine.
12. There are good ventilation and natural sunlight provided in this home.
13. It is best for the location of old folks home to be close to the nature.

14. What is your feel living in this home? _________________________________________

15. What is the main problem faced living in this home? ________________________________

16. What else is needed in this home? Anything which is insufficient?                                    

      ___________________________________________________________________________

[ Combine both Old folks home & Orphanage together -Live together happily like a family ]

17. Do you support with the idea above? What do you think of the it?

      ___________________________________________________________________________

18. Living together with children brings benefits to the elderly          Yes / No

Happiness	Yes / No
Respect	Yes / No
Sense of Responsibility	Yes / No
Sense of Appreciation	Yes / No
Love & Care	Yes / No

2. Survey Form (Old Folks Home)

 How Long have you been staying here? ___________________

Questions:	1	2	3	4	5
1. The most important thing to live in an old folks home is to be comfortable & relaxed.
2. The cleanliness of the home need to be well maintained.
3. The staffs & workers have to be friendly and helpful.
4. A sense of belonging is important living in the home.
5. Different spaces with different purposes are needed to carry out different daily activities.
6. Both public and private areas are needed in an old folks home.
7. Old folks home need to be well design (interior, exterior & landscape)
8. A good space planning will affect the quality of life in the home.
10. A relaxing mood and cozy feeling is needed in the home.
11. Facilities need to be well maintained to ensure the safety.
12. Good ventilation and natural sunlight add values to the home.
12. It is best for the location of old folks home to be close to the nature.

13. What is your feel living in this home? _________________________________________

14. What is the main problem faced living in this home? ________________________________

13. What else is needed in this home? Anything which is insufficient?                                    

      ___________________________________________________________________________

[ Combine both Old folks home & Orphanage together -Live together happily like a family ]

16. Do you support with the idea above? What do you think of the it?

      ___________________________________________________________________________

20. Living together with children brings benefits to the elderly          Yes / No

Happiness	Yes / No
Respect	Yes / No
Sense of Responsibility	Yes / No
Sense of Appreciation	Yes / No
Love & Care	Yes / No