Covid-19 Self Advocate and Family Check In Survey

Question Title

* 1. Please list any specific questions you have for Division of Developmental Disabilities Director Stark for the May 8, 2 pm Speak Up and Speak Out Webinar?

Question Title

* 2. I am a:

Person with a disability

Family member

Other

Question Title

* 3. How old are you or your family member with I/DD?

Under 22

22 or older

Question Title

* 4. If you or your family member is at home, do you have appropriate care in place?

Yes

Maybe

n/a

Question Title

* 5. Does you or your family have their basic needs met?

Yes

Question Title

* 6. If your family does not have their basic needs met, where are the gaps?

Question Title

* 7. What are your major areas of concern currently?

Being able to remain in my own home

Unable to get help if there is a medical emergency

Not getting the routine daily care needed.

Losing the workers I have hired to support me

Getting the food and medicines I need

Being able to afford delivery or other services

My mental health

Being isolated from my support network and community

Not knowing what to do if I am not getting the help I need

Losing my job

Losing physical strength or daily living skills

Other (please list)

Question Title

* 8. Specifically, please check the services and supports that you are concerned about:

Personal Care, Direct Support or Home Health Care

Prescription medication supply

Durable medical equipment supply

Rehabilitative or Habilitative therapies

Mental Health services

Transportation to get to needed medical appointments

Transportation to get to food stores, pharmacies, and other essential businesses

Employment services

Day services

Respite

Residential services or placement (Group homes, adult family homes etc.)

Other (please list)

Question Title

* 9. What are your greatest concerns for the upcoming weeks/months?

Question Title

* 10. For those who usually participate in day services, what would you like day services to look like when they re-open.

Question Title

* 11. Are there any specific safety measures, you would like to see in place when day services re-open? If yes, what are they?

Question Title

* 12. Are you getting enough information from the state agencies/programs that support your family members?

Yes

Question Title

* 13. What information would be most helpful to you this public health emergency continues?

Question Title

* 14. Contact Information (Optional)

Name

Email Address

Phone Number

Thanks so much for sharing your current experiences. Please do not hesitate to call The Arc of Illinois if you have any questions, concerns, need for information or desire to advocate at 815-464-1832! Best, Meg Cooch