Hospice House Room Refresh Question Title * 1. Which descriptor best identifies you? Patient Family/friend Staff/volunteer OK Question Title * 2. Rate the lighting and lighting adjustment options for the room. Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 3. Rate the brightness of the room. Does the room appear open, bright, and inviting? Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 4. Rate the bed functions. Does it meet patient needs? Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 5. Rate the comfort of the bed. Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 6. Rate the bathroom function and aesthetics for meeting needs. Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 7. Rate the TV. Does it meet the patient's needs? Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 8. Rate the function and comfort of the sleep recliner. Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 9. Rate the function and comfort of the sleep sofa. Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 10. Rate the fixed benches (if applicable) in regards to comfort and function. Poor Acceptable Good Superior N/A Poor Acceptable Good Superior N/A Other (please specify) OK Question Title * 11. Rate the folding chairs and their storage options. Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 12. How likely will the Nurse/Patient information board benefit the patient/family experience? Not likely at all to be beneficial. Could be beneficial. Somewhat beneficial. Very beneficial. Not likely at all to be beneficial. Could be beneficial. Somewhat beneficial. Very beneficial. Other (please specify) OK Question Title * 13. Rate the amenities such as USB ports and lamps. Do these meet needs? Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK Question Title * 14. Is there an amenity that we should consider adding to enhance the patient/family experience? OK Question Title * 15. Rate your overall impression of the room. Poor Acceptable Good Superior Poor Acceptable Good Superior Other (please specify) OK DONE