Residential Care Survey

How would you identify yourself for this survey?Aged care residentAged care facility ownerAged care facility staff

Your Aged Care Facility

Please tell us about your aged care facility

What is the name of this facility? *

What is the street address of this facility?

Suburb/City

State *

Postcode *Please check the postcode is correct0 / 4

Number of Independent Living Units

Number of Low Care Rooms

Number of High Care Rooms

Number of Respite Rooms

Number of Palliative Care Rooms

What is the usual number of Low Care residents at this facility?

What is the usual number of High Care residents at this facility?

In-Facility Pets

Please tell us about pets kept in your facility

Does this facility keep one or more shared whole-of-facility pets on-site? *YesNo

Other species:If the species of any of your pets are not shown, please list them here

Number of Birds on site

Number of Cats on site

Number of Dogs on site

Number of Rabbits on site

Number of Chickens on site

Number of Other Pets on site

Visiting Pets

Please tell us about pets visiting your facility

Does this facility have a visiting pets program? *YesNo

What type of pets visit the facility?

How many pets visit the facility?A rough estimate is acceptable

Are family members or friends permitted to bring pets when visiting residents? *YesNo

Does this facility have a written policy on visiting pets? *YesNo

Live-in Pets

Please tell us about pets living in your facility

Does this facility permit residents to keep their own pet? *YesNo

What species of pets are kept by residents?BirdCatDogOther - please list:

Other species:If the species of any of your pets are not shown, please list them here

Number of Birds kept by Residents

Number of Cats kept by Residents

Number of Dogs kept by Residents

Number of Other Species kept by Residents

Does this facility have a written policy on live-in pets? *YesNo

Pets in Aged Care

Please tell us your thoughts about pets in aged care

How would you rate *this* facility as a pet-friendly facility? *Not pet friendly (residents have no current or intended access to pets)Somewhat pet friendly (residents have minimal access to pets, largely ad hoc)Basically pet friendly (residents have access to shared pets on-site or as part of an official visiting pets program)Very pet friendly (residents can have their own pets in this facility)Highly pet friendly (residents have access to shared, visiting and owned pets and this facility has developed official policies and procedures on pets)

What do you think is the main impediment to pets in this facility?

Are you willing to share your pets-in-aged-care working models with other aged-care providers? *YesNo

Is there anything else you would like to tell us about the topic of pets and companion animals in aged care settings?

Your Responses

Can we contact you if we wish to discuss aspects of your responses? *YesNo

Name *

Email Address *

PhoneA phone number is optional but appreciated

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