Q01
Message
All templatesIndustry-Specific
Nursing Home Resident Satisfaction Survey
Captures how residents and their families experience daily care, staff responsiveness, meals, activities, and communication in a nursing home or assisted living community. An AI follow-up interview digs into the story behind the lowest-rated experience so administrators know exactly what to fix first, not just where the score dropped.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
Who is completing this survey?
- The resident, myself
- A family member or friend, on the resident's behalf
- A staff member assisting the resident
Q03
Multiple ChoiceRequired
How long have you (or your loved one) lived at this community?
- Less than 3 months
- 3–12 months
- 1–3 years
- More than 3 years
Q04
Opinion ScaleRequired
How likely are you to recommend this community to another family looking for care?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q05
MatrixRequired
How would you rate each of the following?
6 rows × 5 columns
- Quality of nursing and medical care
- Friendliness and respect shown by staff
- Cleanliness of rooms and common areas
- Quality and variety of meals
- Activities and social programs
- +1 more
Columns: Poor · Fair · Good · Very Good · Excellent
Q06
Multiple ChoiceRequired
In the last month, how often did staff respond to call buttons or help requests within a few minutes?
- Always
- Most of the time
- Sometimes
- Rarely
- Never
Q07
Multiple Choice
In the last month, how often did you (or your loved one) take part in group activities or social events?
- Daily
- Several times a week
- About once a week
- Rarely
- Never
Q08
RankingRequired
If this community could improve just one area first, how would you prioritize these?
- Staff responsiveness and attentiveness
- Food and dining experience
- Activities and social engagement
- Cleanliness and upkeep
- Communication with family
- Value for the cost
Drag to rank
Q09
AI Interview
Probe the reasoning behind the respondent's recommendation score and their lowest-rated item in the ratings battery. Get a specific, recent example — a moment, incident, or interaction that shaped how they feel, not a general impression. If the resident mentioned slow response to help requests or low activity participation, ask what happened the last time this occurred and how staff or the resident reacted. If the score was high across the board, ask what one thing would make the experience even better, and probe for concreteness rather than accepting 'nothing.'
Q10
Long Text
Is there anything else you'd like management to know about the care or experience here?
Q11
Dropdown
What is the resident's age range? (Optional — for reporting purposes only)
- Under 65
- 65–74
- 75–84
- 85–94
- 95 or older
- Prefer not to say
Q12
Multiple Choice
What is the resident's gender? (Optional — for reporting purposes only)
- Male
- Female
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q13
Message
Thank you for taking the time to share this feedback. Your responses will be reviewed by our care team and used to guide improvements in daily care, dining, and activities.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Includes a dedicated AI follow-up interview that probes the reasoning behind the respondent's recommendation score and their lowest-rated experience, so administrators learn the story behind the number, not just the score itself
- Combines quantitative measures (opinion scale recommendation score, matrix ratings, frequency questions on call-button response and activity participation) with a ranking question so priorities are explicit, not inferred
- Separates resident vs. family respondent identification up front and collects optional demographic context (age range, gender) for reporting without forcing disclosure
- Closes the loop with an open-ended long-text question and a thank-you message confirming responses will be reviewed, giving respondents a clear sense of follow-through
SurveySparrow
Nursing Home Resident Satisfaction Survey TemplateA ready-to-field template built specifically for nursing home resident satisfaction, covering the same general topic area as ours. It's a static question set delivered through SurveySparrow's conversational-style form UI, but the 'conversation' is templated wording rather than adaptive follow-up logic. No mention of automated scoring or AI-generated reporting on the page.
What it does well
- Purpose-built for the nursing home resident satisfaction use case
- SurveySparrow's chat-style UI can make static forms feel more personal to complete
- Likely offers easy customization within their survey builder
Where it falls short
- No adaptive AI interview to dig deeper into a resident's lowest-rated experience — every respondent sees the same fixed questions
- No mention of automated per-response quality scoring or auto-generated administrator reports
- No transparent, published prompt/methodology since there's no AI-driven question logic to disclose
Jotform
Resident Satisfaction Survey Form TemplateA general resident satisfaction survey template (broader housing/community context, not nursing-home-specific by name) that can be adapted to senior care settings. It's a standard static form built on Jotform's drag-and-drop builder with typical form-logic branching, not adaptive interviewing. Good for basic data collection but not for uncovering the 'why' behind low scores.
What it does well
- Highly customizable drag-and-drop form builder
- Broad template library allows mixing in related form elements
- Simple to deploy quickly for basic feedback collection
Where it falls short
- No AI-driven follow-up interview — conditional logic can branch questions but can't probe reasoning like an adaptive interview
- No automated quality scoring of open-ended responses
- No auto-generated narrative reports summarizing themes across a community
SurveyMonkey
Resident Satisfaction Survey TemplateA general-purpose resident satisfaction template (property/community oriented) that could be repurposed for a nursing home context, though it isn't framed specifically for that audience. It's a static questionnaire relying on SurveyMonkey's standard analytics dashboard rather than any adaptive interviewing capability. Useful for benchmarking scores, but not for exploring the story behind a low rating.
What it does well
- Established analytics and benchmarking tools for survey results
- Wide template library with easy sharing and distribution options
- Familiar respondent experience given SurveyMonkey's broad reach
Where it falls short
- No adaptive AI follow-up interview or voice AI option to explore why a resident rated something poorly
- No automated per-response quality scoring
- No mention of transparent, published question-generation methodology
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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