Type of Enteral Feeds Available in the Home
Feeds available in the nursing home	Please indicate ALL the feeds CURRENTLY available in your Home (e.g. Ensure Powder, Resource Plus): __________________________________________ __________________________________________ __________________________________________ __________________________________________
Other Components. (Please indicate NA if not applicable)	(a)How often are nasogastric feeding tubes changed (e.g. once a month): ___________________ (b)How much time (minutes) does it take to change a nasogastric feeding tube (estimate): ___________ (c)For residents on continuous/gravity feeding, how often are feeding bags changed: ________ (d)Can special feeds (e.g. renal feeds or high calories feeds) not usually available in your Home be ordered in for the resident if requested/required? □Yes □No □Not Sure
Manpower / Nursing Time
Number of Staff (Please indicate NA if not applicable)	(a)Total Number of Staff Nurses in the Home: ________________ (b)Number of Staff Nurses per shift: ________________________ (c)Total Number of Enrolled Nurses: _______________________ (d)Number of Enrolled Nurses per shift: _____________________ (e)Total Number of Nursing Aides: _________________ (f)Number of Nursing Aides per shift: _______________ (g)Nursing to Patient Ratio (e.g. 1 Staff Nurse: 10 patients): __________
Feeding Administration	Who performs the enteral feeding? (please tick all that is applicable) □Staff Nurse □Enrolled Nurse □Nursing Aide How long does it take to perform ONE enteral tube feeding? (Please give an estimate e.g. 10min, 15min, 20min) __________________________________________ Do you think that continuous feeding (with pump) should be made available in nursing homes? □Yes □No □Not Sure
Training	How many hours of training on Nutrition Support do Nursing Staff receive per year? □< 1 h □1 to < 3 h □3 to < 5 h □≥ 5 h As a Healthcare Professional in a Nursing Home, do you think you are provided with adequate education/training in Nutritional Support for your residents? □Yes □No □Not Sure