Public Aged Care Survey Question Title * 1. In which region do you currently live? Biggenden Gayndah Monto Mundubbera Eidsvold Mt Perry Other (please specify) Question Title * 2. In which of the following age groups do you belong? 0-17 18-35 36-45 46-55 56-65 66-75 76-85 86-95 96+ Question Title * 3. With which gender do you most identify? Male Female Other Question Title * 4. Which of the following statements best describes you? Aged person Carer of an aged person Person with a disability Carer of a person with a disability Person with a mental health challenge Carer of a person with mental health challenges Young and fit None of the above Question Title * 5. My GP is currently located in the following town Biggenden Gayndah Monto Mundubbera Eidsvold Mt Perry Other (please specify) Question Title * 6. Do you think we have adequate aged care facilities in the North Burnett? Yes No Question Title * 7. What aged care facilities are not adequate or available in your region? Couples accommodation (housing for two) Day respite (relieving carers) In home support (personal care, domestic help, meals, transport, social support, counselling, home maintenance and modifications) Independent living accommodation (housing for one) Low care (accommodation and personal care) Nursing Home (high care, 24 hour nursing) Palliative care (end of life care in a facility) Respite palliative care (end of life care at home relieving carers) None Other (please specify) Question Title * 8. What services would you consider using yourself? Couples accommodation (housing for two) Day respite (relieving carers) In home support (personal care, domestic help, meals, transport, social support, counselling, home maintenance and modifications) Independent living accommodation (housing for one) Low care (accommodation and personal care) Nursing Home (high care, 24 hour nursing) Palliative care (end of life care in a facility) Respite palliative care (end of life care at home relieving carers) None Other (please specify) Question Title * 9. What services and facilities do you use today? Couples accommodation (housing for two) Day respite (relieving carers) In home support (personal care, domestic help, meals, transport, social support, counselling, home maintenance and modifications) Independent living accommodation (housing for one) Low care (accommodation and personal care) Nursing Home (high care, 24 hour nursing) Palliative care (end of life care in a facility) Respite palliative care (end of life care at home relieving carers) None Other (please specify) Question Title * 10. Would the town you live in / close by be your first choice for long term aged care accommodation? Yes No Why? Question Title * 11. What considerations other than Aged Care & accommodation services themselves will drive your choice in location for Aged Care Services? social interests cultural interests recreational interests proximity to friends and family shopping Other (please specify) Question Title * 12. What community groups are you involved in? Question Title * 13. Do you know anyone that may need aged care support and when? within 2 years within 5 years within 10 years within more than 10 years no Question Title * 14. Do you have a carer? Yes No Question Title * 15. Would you prefer aged care accommodation with a carer? Yes No Question Title * 16. Do you think people would come to the region to access residential or aged care services if there were sufficient available? Yes No Question Title * 17. Do you know anyone who had to leave the region to access residential or aged care services? Yes No Question Title * 18. What considerations lead to the person leaving the region for aged care services? aged care service availability medical transport availability medical service availability shopping entertainment social interest cultural interest access to government services Other (please specify) Question Title * 19. What recreational, social or cultural offering do you believe would enable more people to choose to stay in the North Burnett? Question Title * 20. Do you have a parent/partner or relative that you need to care for? Yes No Question Title * 21. Do you have a parent/partner or relative living in an aged care facility? Yes No Question Title * 22. Do you have a parent/partner or relative living in your own home that you need to care for? Yes No Question Title * 23. Would you or do you know anyone who would be interested in work as one of the following? registered nurse personal carer divisional therapist activities staff cooks / catering / kitchen staff property management property maintenance Question Title * 24. Please add you own comments For more information, please contact: North Burnett Regional Council Community Development Project Officer PO Box 390 34-36 Capper St GAYNDAH QLD 4625 Ph: 1300 696 272 (1300 MY NBRC) E: admin@northburnett.qld.gov.auWeb: www.northburnett.qld.gov.auFacebook: www.facebook.com/north.burnett.regional.council Information Privacy Act 2009 - Collection Notice: This information will be used for the purpose of an aged care service audit. Personal information will not be disclosed to any other third party without your written or verbal authorisation or as we are required by law. No personal information is collected in this survey. Done
