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2. 
4. Respite Care Community Input Survey
   Respite care provides temporary care relief for a caregiver or caregiving family, enabling you to take a much-needed break from the demands of lovingly caring for a family member due to aging, disability, or special needs. There are different types of respite care, including:
   - In-home
   - Out-of-home
   - Paid
   - Unpaid (volunteers, family, friends)
   - Non-medical
   - Skilled health care (medical needs, bathing, dressing, feeding)
   - Homemaker services (meal prep, shopping, housekeeping)
   - Overnight
   
6. 1. Where do you live?

   1. Hinton
   2. Yellowhead County
   3. Jasper
   4. Edson
   5. Other
   6. Prefer not to answer
8. 2. Do you currently care for someone that is experiencing challenges associated with aging, has a disability, or has special needs?

   1. Yes
   2. No
   3. Prefer not to answer
10. 3. If you answered “Yes” to Question #2, does the person you are caring for need care due to:

    1. Age related mobility challenges
    2. Alzheimer’s/Dementia
    3. A disability
    4. Special needs
    5. Prefer not to answer
    6. Other
11. Other
    If "other," please describe
13. 4. Do you currently have access to any form of respite care?

    1. Yes
    2. No
    3. Prefer not to answer
15. 5. If you answered “Yes” to Question #4, which type of respite care do you have access to (check all that apply):

    1. In-home
    2. Out-of-home
    3. Paid
    4. Unpaid (volunteers, family, friends)
    5. Non-medical
    6. Skilled health care (medical needs, bathing, dressing, feeding)
    7. Homemaker services (meal prep, shopping, housekeeping)
    8. Overnight
17. 6. If you do currently have access to respite care, is this care meeting your needs? Please describe
19. 7. If you do not currently have access to respite care, what are the barriers preventing access?
21. 8. What community supports do you believe would be helpful for Hinton residents that are aging, have a disability, or have special needs (check all that apply):

    1. Respite care
    2. Day programs/activities
    3. Medical supports
    4. Housing
    5. Transportation
    6. Other
22. Other
    If "other," please describe
24. 9. What community supports would be helpful for you as a caregiver or care partner?
26. SAVE THE DATE
    Please join us on October 22 from 6-8 pm for our Respite Care Community Input Session where we will get together to discuss non-medical, temporary respite care service needs. Participants are able to join in-person or via Zoom – registration is required.

    1. Yes
    2. No

    Please indicate if you would like to register for this event. If you would, please provide your contact information below.
28. First Name
29. Last Name
31. Email Address
32. Phone Number
34. 10. Additional Comments
    (please add any additional feedback here)
36. JOIN THE CONVERSATION
    Are you a caregiver for a child with special needs or a disability? The Family Resource Network offers a monthly Exploring Abilities Support Group. Raising children with special needs may require extra resources to meet physical, intellectual, emotional, language, social, or behavioural needs. Connect with other parents who may share a similar experience to share resources, learn together, and build a community. For more information or to sign up, visit hinton.ca/123
38. Thank You!
    Your input is appreciated. If you would like more information, please contact Charlene at 780-223-8009 or csitar@hinton.ca
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