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2024-2028 State Dementia Plan Survey, F-03040 (07/2022)

We need your help to improve dementia care in Wisconsin. The Wisconsin Department of Health Services is currently working with partners around the state to develop the 2024-2028 State Dementia Plan. This survey is a way for you to let us know what you would like to see included in the plan to help people living with dementia and their caregivers. Your answers will be shared anonymously at the state and local levels as we work to improve dementia care. 

Dementia refers to the loss of memory, language, and other thinking skills severe enough to interfere with daily life. Caregivers provide care to people who need some degree of assistance with everyday tasks on a regular or daily basis. The term caregivers refers to both those who are paid to provide care (such as home health aides) and those who are not paid to provide care (such as family members).
1. What is your relationship with dementia care? Check all that apply. *This question is required.
2. What do you think the next state plan should focus on to improve dementia care? (#1 should be the highest priority and #6 should be the lowest priority.) *This question is required. Note: for the following table each column is restricted to a single answer across all rows.
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7. How would you describe your community?  *This question is required.
8. How would you describe your gender? *This question is required.
9. How would you describe your race? Check all that apply *This question is required.
10. Do you identify as being Hispanic or Latino? *This question is required.