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Home care client satisfaction survey: 14 plain questions

Fourteen plain questions for the person receiving care at home, about the last month of visits from your agency.

  • 14questions
  • about 4 minto answer
  • Always to Neverworded scale
  • 1 monthof visits
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Home Care Client Survey · answer to move through it
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Question 1 of 14 Who is answering
Who is answering these questions?
The person receiving the care
A relative or friend, sitting with them
A relative or friend, answering for them
Question 2 of 14 Who is answering
The questions after this are about the last month. How long have you had care from this agency?
Less than a month
One to six months
Six months to a year
More than a year
Question 3 of 14 Do the visits happen as agreed
Visits happen at the time we agreed.
Always
Usually
Sometimes
Rarely
Never
Question 4 of 14 Do the visits happen as agreed
If a visit will be late or changed, someone tells me before it is due.
Always
Usually
Sometimes
Rarely
Never
Question 5 of 14 Do the visits happen as agreed
The visit lasts as long as it should.
Always
Usually
Sometimes
Rarely
Never
Question 6 of 14 What the visit is like
The people who come know what I need help with.
Always
Usually
Sometimes
Rarely
Never
Question 7 of 14 What the visit is like
I am asked how I like things done.
Always
Usually
Sometimes
Rarely
Never
Question 8 of 14 What the visit is like
I am treated with respect in my own home.
Always
Usually
Sometimes
Rarely
Never
Question 9 of 14 What the visit is like
I feel comfortable with the people who come into my home.
Always
Usually
Sometimes
Rarely
Never
Question 10 of 14 The office behind the visits
The office is easy to reach when I need to speak to someone.
Always
Usually
Sometimes
Rarely
Never
Question 11 of 14 The office behind the visits
When I raise something, it gets sorted out.
Always
Usually
Sometimes
Rarely
Never
Question 12 of 14 In your words
Which of these would make the biggest difference to you?
Nothing, it works well as it is
Visits at times that suit me better
More warning when something changes
Longer visits
Fewer different people coming
Easier to reach the office
Something else
Question 13 of 14 In your words
What one thing would you like us to change?
Question 14 of 14 Overall
Overall, how happy are you with the care you get at home?
Very happy
Happy
Neither happy nor unhappy
Unhappy
Very unhappy

The 14 home care survey questions

A home care client satisfaction survey asks the person receiving care at home how the service is working: whether visits happen as agreed, what a visit is like, and whether the office answers. These 14 questions are ready to send, so you can create an online survey from them in minutes.

Plain text, one question per line, with the answer scale.

Who is answering

Two questions set who is answering and the month being rated.

  1. Who is answering these questions?Pick one of 3, requiredreport the three groups side by side.
  2. The questions after this are about the last month. How long have you had care from this agency?Pick one of 4, requirednew clients rate a start; long-standing clients rate a routine.

Do the visits happen as agreed

Three sides of timing: the start, the warning and the length.

  1. Visits happen at the time we agreed.Always to Never, requiredthe time the client agreed to, whatever the schedule says.
  2. If a visit will be late or changed, someone tells me before it is due.Always to Never, requiredlow here with question 3 high means changes go unannounced.
  3. The visit lasts as long as it should.Always to Never, requiredshort visits show here before they show in any schedule.

What the visit is like

Four short statements about the service, in words a client can answer when they are read aloud.[2]

  1. The people who come know what I need help with.Always to Never, requiredlow means the care plan is not reaching whoever is on shift.
  2. I am asked how I like things done.Always to Never, required
  3. I am treated with respect in my own home.Always to Never, requiredanything below Usually deserves a phone call.
  4. I feel comfortable with the people who come into my home.Always to Never, required

The office behind the visits

Whether the office can be reached, then whether raising something works.

  1. The office is easy to reach when I need to speak to someone.Always to Never, required
  2. When I raise something, it gets sorted out.Always to Never, requiredlow here: check how raised issues get closed.

In their words, then the overall answer

One tick list, one optional comment, then the overall rating.

  1. Which of these would make the biggest difference to you?Tick all that apply, requiredthe most-ticked option is your next change.
  2. What one thing would you like us to change?Short text, optional
  3. Overall, how happy are you with the care you get at home?Pick one of 5, requiredyour headline: the share answering happy or very happy.

Sending the home care feedback form and reading it

Send it every quarter. A link suits a relative; a large-print copy, or a neutral person reading it aloud, suits the person receiving care. No question asks for a name, so say that before question 1. Print your complaints and safeguarding contacts beside the link: the survey is not a safeguarding route and not a complaints procedure.

Your headline is the share answering happy or very happy at question 14, split by question 1. Score the nine Always to Never items 5 down to 1, then average three blocks: timing (questions 3 to 5), the visit (6 to 9) and the office (10 and 11). Fix the lowest block first.

After a one-off job, send a customer service survey. For reasons in a client's own words, use a customer feedback survey. Clients who also rent their home from you get the tenant satisfaction survey.

An isometric cutaway of a living room with an armchair by the window, a clock on the wall, a bag marked with a medical cross beside the front door, and a floating card to the right showing four rows of rating bars
The visits, the timing and the office behind them.

Home care survey FAQ

Can a relative answer for the person receiving care?

Yes. Question 1 asks who is answering: the person receiving the care, a relative sitting with them, or a relative answering for them. Report the three groups side by side, because a relative sees the service from a different seat.

How is this different from a caregiver satisfaction survey?

A caregiver satisfaction survey goes to the care workers and asks about the job. This one goes to clients and asks about the visits. To hear from your staff, send them a job satisfaction survey.

Is this the HHCAHPS survey?

No. HHCAHPS is the Medicare survey that approved vendors run for certified home health agencies.[1] This is your own questionnaire, ready to send any week of the year. After a hospital or clinic visit, use a patient satisfaction survey.

Is the home care survey anonymous?

Yes, as built: no question asks for a name, an address or anything about health. To follow up with one client, add an optional name question at the end and say what you will do with it.

Related satisfaction survey templates

More client and customer forms are in the satisfaction survey templates.

SatisfactionCustomer Satisfaction SurveyWhen it is one commercial interaction, not an ongoing arrangement.12 questions, 3 min SatisfactionCustomer Feedback SurveyWhen you want reasons in people's own words, not levels.12 questions, 4 min SatisfactionPatient Satisfaction SurveyWhen the care happened in a hospital or a clinic, not at home.15 questions, 3 min SatisfactionCustomer Service SurveyWhen the unit is one visit, rated straight afterwards.10 questions, 2 min EmployeeJob Satisfaction SurveyWhen the respondent is the care worker rating their own job.14 questions, 3 min BusinessTenant Satisfaction SurveyWhen the subject is the property: repairs, heating, communal areas.14 questions, about 5 min

Michael Hodge, survey methodology · Updated 2 October 2026 · How templates are reviewed

Sources (2)
  1. Home Health Care CAHPS Survey, official website. homehealthcahps.org
  2. American Association for Public Opinion Research. "Best Practices for Survey Research." aapor.org

Hear from every client before the next care review

Fourteen plain questions, about four minutes, in wording a client can answer when it is read aloud.

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