Got COLA? Get Heard on PNA! – Resident Feedback Form

Got COLA? Get Heard on PNA! – Resident Feedback Form

Share Your Experience: Reflect on how the current PNA affects your ability to purchase personal items and services. Consider the challenges you face and how an increase could improve your daily life and well-being.
Consent and Privacy Notice:

By submitting this form, you authorize the Executive Board of Presidents of Resident Councils and the Long-Term Care Ombudsman to use your responses in our advocacy efforts to increase the Personal Needs Allowance (PNA) in Connecticut. We value your privacy and understand that you may wish to support this cause without fully disclosing your personal information.

Your Options:

Full Disclosure: Providing your full name, facility, and town allows us to demonstrate the widespread impact across the state.

Partial Disclosure: If you prefer, you may share only your first name and town, or any combination of details you are comfortable with.

Anonymity: You may choose to remain anonymous; however, please note that anonymous testimonials may have less impact in our advocacy efforts.

Rest assured, any information you provide will be used solely for the purpose of advocating for residents' rights and will be handled with the utmost care to protect your privacy.

If you have any questions or concerns, feel free to contact us at LTCOP@ct.gov. Thank you for your support and participation.
Resident Name
Last Name
Nursing Facility Name
Nursing Facility Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Impact: How does the current PNA affect your ability to buy personal items and services?
Challenges Faced: Have you had trouble meeting your personal needs becasue of the current PNA amount?
Benefits of an Increase: How would an increase in PNA improve your daily life and well-being?
Specific Needs: Are there specific items or services you currently can't afford that you would prioritize if the PNA were increased?
Additional Comments: Please share any other thoughts or suggestions about the PNA and how it affects your quality of life.
Should be Empty: