CONSENT FORM FOR FAMILY MEMBERS
MEASURING QUALITY IN ASSISTED LIVING FACILITIES
This focus group is being conducted by Research Triangle Institute for a project funded by the Alzheimer's Association. In today's discussion we will be talking about your experiences and those of your loved ones who are in assisted living facilities. This meeting includes 6-8 other family members in your area. The meeting will last for about 2 hours, during which you will be asked to share your thoughts with us about what constitutes good quality and what family members and others should look for when visiting a facility and trying to make a judgement about whether it is a "good" place for a loved one with Alzheimer's disease or other dementia.
Your participation in the focus group is voluntary and confidential, and you may refuse to comment on any question that is asked.
Everything you say in this group is confidential. Nothing you might say about a particular facility will ever be made public or reported in any way that would allow you or your loved one or a particular facility to be identified. Your participation in today's group will not affect your family member's care, not will the information be released to the facility where they are living.
While the meetings will be tape recorded, the recording is only to help us make sure we "hear" everything that is said. Only people working on this project will ever hear any of the recordings or read the notes we take. The same thing goes for the questionnaire that you will be asked to complete. When we report our findings to the Alzheimer's Association, all identifying information from comments will be removed.
We will provide the local Alzheimer's Association chapter with copies of our findings, and you may have a copy if you'd like. Just let us or the Chapter representative know if you want a copy of the report.
If you have any questions after today, you may direct them to _______________ [NAME OF LOCAL CHAPTER CONTACT] at the _______________ [NAME OF LOCAL CHAPTER]. The telephone number is _______________ [LOCAL PHONE NUMBER]. You may also contact Angela Greene at Research Triangle Institute (RTI). Her number is 800-334-8571. If you have questions about being a participant in a research project, you can contact Dr. Wendy Visscher of RTI's Committee for the Protection of Human Subjects at 1-800-334-8571.