Is Personal Supports Right for You?

1

About Personal Supports

With Personal Supports Services, clients are able to receive truly personalized one-to-one assistance for a variety of needs and interests by a paid (and trained!) staffer, including those relating to participation in the community (during safer times), independent living skills development or enhancement, support with personal care items and help with academic needs or interests! We LOVE this program and truly believe that the possibilities are endless!

Quiz Results

After you finish the quiz, our team will get to work analyzing and will follow up with your results! Please note that, due to the volume of quiz participants, it may take us up to five business days to follow up, but we WILL follow up as soon as possible get you those results! Please click "NEXT" to begin the quiz!

2

Please enter the first name of the person who would be receiving services.* This field is required.

3

Does {pleaseEnter5} need or want help finding fun or interesting activities in the community?* This field is required.

YESNO

4

Awesome, does {pleaseEnter5} need or want Staff assistance participating in activities in the community?* This field is required.

YESNO

5

Does {pleaseEnter5} want help learning any of the following independently living skills? Communication Skills, Cooking, Education Planning, Emergency and Safety Skills, Meal Preparation, Health, Housekeeping, Interpersonal/Social Skills, Knowledge of Community Resources, Money Management, Personal Appearance or Hygiene, or Transportation/Travel Training.* This field is required.

YESNO

6

Does {pleaseEnter5} need prompts to manage personal care tasks such as bathing, dressing, eating or toileting?* This field is required.

YESNO

7

Does {pleaseEnter5} want someone to enjoy hobby or leisure activities with?* This field is required.

YESNO

8

Does {pleaseEnter5} want assistance with nutrition or physical fitness activities?* This field is required.

YESNO

9

Does {pleaseEnter5} want help learning how to socialize with peers and others or does {pleaseEnter5} want to meet and socialize with new friends?* This field is required.

YESNO

10

Due to the sector's staffing challenges, we do not believe that Personal Supports is appropriate for individuals who have CRITICAL staffing needs (i.e., the individual or his/her family would experience harm or the inability to work if staffing were not available). If {pleaseEnter5} were accepted into our Personal Supports Program, would a devastating impact occur to the individual or to her/his natural supports due to a staff absence or staff attrition?* This field is required.

YESNO

11

Would {pleaseEnter5} experience substantial anxiety, depression, aggression, anger or other adverse emotion if a staffer left service abruptly?* This field is required.

YESNO

12

Our staff are not permitted to administer medicine during service times. Does {pleaseEnter5} need to have medicine administered during the desired time of the Personal Supports Services?* This field is required.

YESNO

13

Does {pleaseEnter5} have behavioral challenges?* This field is required.

YESNO

14

Does {pleaseEnter5} need to use a wheelchair?* This field is required.

YESNO

15

Does {pleaseEnter5} have equipment to assist with transfers or is {pleaseEnter5} able to transfer independently?* This field is required.

YESNO

16

Does {pleaseEnter5} live with family members?* This field is required.

YESNO

17

Are {pleaseEnter5}'s family member(s) involved with her or his ongoing care?* This field is required.

YESNO

18

We have service options that are tailored to our clients. Please select the service type that {pleaseEnter5} is interested in.* This field is required.

19

We respect and strongly support client staffing choice. Please select the type of staff that {pleaseEnter5} is interested in.* This field is required.

20

In an effort to maximize stability and service continuity, we wish to continue to partner with family members in some capacity. Does {pleaseEnter5} have a family member who is willing to serve a paid staffer (as either a primary or back-up staffer)?* This field is required.

YESNO

21

Please enter your phone number.* This field is required.

Area Code

Phone Number

22

Thank you! Please enter your email address.* This field is required.

example@example.com