Aging-In-Place Lower Bucks County (v2)

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Aging in Place of Lower Bucks County is a grass roots organization of local residents and business representatives whose aim is to provide the resources and services (e.g., volunteers, programs, vendors) to enable older persons to continue to live independently in their own homes and communities.

Many of us purchased houses some years ago and enjoy living in our communities. And while we plan to stay in our homes for the long-term, each of us will likely need some help to do so. The purpose of this survey is to help identify those services, activities and resources that you believe would help you remain in your home now and/or in the future.

Instructions:

Please take a few moments to complete this questionnaire. In the spaces provided, check those items that are important to you and your decision to remain in your home in Lower Bucks County. Your answers are completely anonymous. We do not track responses, so in no way can responses be identified with an individual.

1. HOME SERVICES that may be important to you and your decision to stay in your home as you grow older. (Select all that apply)

HOME SERVICES that may be important to you and your decision to stay in your home as you grow older. (Select all that apply) Landscaping (cut grass, weed beds, remove snow)

Skilled services (plumbing, electrical, heating, air conditioning)

House maintenance (painting, gutter cleaning, windows, screens)

General handyman (small repairs and/or improvements)

Auto maintenance (inspections, oil changes, tune-ups, tires)

Home modification specialist (disability modification – bathroom, stairs)

Other (please specify in box below)

2. DAILY LIVING SERVICES that may be important to you and your decision to stay in your home as you grow older. (Select all that apply)

DAILY LIVING SERVICES that may be important to you and your decision to stay in your home as you grow older. (Select all that apply) Pet sitting (walk dog, feed cat)

Transportation (church, events, doctor visits, etc)

Errands (food shopping, clothes, pick up medications, etc)

Meal preparation / delivery

Companionship / TLC calls (daily telephone calls, social visits)

Laundry / house cleaning

Other (please specify in box below)

3. HEALTH ASSISTANCE SERVICES that are, or may be in the future important to you should you stay in your home in Lower Bucks as you grow older. (Select all that apply)

HEALTH ASSISTANCE SERVICES that are, or may be in the future important to you should you stay in your home in Lower Bucks as you grow older. (Select all that apply) Skilled care (nursing care, physical therapy, nutrition)

Medical equipment (wheelchairs, walkers, oxygen, stair rises)

Personal care (dressing, bathing, transferring, incontinence care, feeding)

Healthcare buddy / advocate (listen & ask questions on patient’s behalf)

Insurance / health forms (insurance, claims, co-pays, etc.)

Doctor care (prescriptions, diagnosis, check-ups, etc.)

Other (please specify in box below)

4. PERSONAL AND FINANCIAL SERVICES that you believe will be important to you as you grow older. (Select all that apply)

PERSONAL AND FINANCIAL SERVICES that you believe will be important to you as you grow older. (Select all that apply) Pay bills / balance checkbook

Investment advice / financial services

Tax preparation / accounting services

Computer set-up / repair / training

Legal advice / lawyer services

Other (please specify in box below)

5. ORGANIZED PHYSICAL ACTIVITIES that you would like to participate in if you remain in Lower Bucks as you grow older. (Select all that apply)

ORGANIZED PHYSICAL ACTIVITIES that you would like to participate in if you remain in Lower Bucks as you grow older. (Select all that apply) Aerobics (including water) / step classes

Walking groups

Dancing classes

Scheduled exercise programs

Yoga / meditation

Other (please specify in box below)

6. ORGANIZED SOCIAL ACTIVITIES to be held at conveniently located meeting places in Lower Bucks or scheduled trips. (Select all that apply)

ORGANIZED SOCIAL ACTIVITIES to be held at conveniently located meeting places in Lower Bucks or scheduled trips. (Select all that apply) Hobbies and crafts

Discussion groups

Coffee/tea parties

Volunteering (non-profit organizations)

Entertainment trips (museums, concerts, theatre, movies, etc)

Bridge, chess, other games

Other (please specify in box below)

7. CONTINUING EDUCATION opportunities available to older residents in Lower Bucks County. (Select all that apply)

CONTINUING EDUCATION opportunities available to older residents in Lower Bucks County. (Select all that apply) Aging-in-Place seminars (classes in a variety of intellectual subjects)

Investment club

Lecture series (professionals/expert speaker series)

How-to classes (computer/internet training, cooking, bridge lessons, etc)

Other (please specify in box below)

8. OVERALL SERVICES We would now like you to prioritize each major category in order of importance (1 to 7, with 1 being the most important) if you were to live independently in your home in Lower Bucks as you grow older. (Each service category must have a unique score)

	1 (Most Important)	2	3	4	5	6	7 (Least Important)
Organized Physical Activities (walking groups, exercise programs, dancing)	OVERALL SERVICES We would now like you to prioritize each major category in order of importance (1 to 7, with 1 being the most important) if you were to live independently in your home in Lower Bucks as you grow older. (Each service category must have a unique score) Organized Physical Activities (walking groups, exercise programs, dancing) 1 (Most Important)	2	3	4	5	6	7 (Least Important)
Daily Living Services (errands, meals, cleaning, transportation,	Daily Living Services (errands, meals, cleaning, transportation, 1 (Most Important)	2	3	4	5	6	7 (Least Important)
Health Assistance Services (aids, nurses, equipment, insurance forms, doctors)	Health Assistance Services (aids, nurses, equipment, insurance forms, doctors) 1 (Most Important)	2	3	4	5	6	7 (Least Important)
Personal and Financial Services (book keeper, lawyer, accountant, computer tech)	Personal and Financial Services (book keeper, lawyer, accountant, computer tech) 1 (Most Important)	2	3	4	5	6	7 (Least Important)
Organized Social Activities (clubs, discussion groups, trips, volunteering)	Organized Social Activities (clubs, discussion groups, trips, volunteering) 1 (Most Important)	2	3	4	5	6	7 (Least Important)
Home Services (handyman, landscaping, auto maintenance, plumber)	Home Services (handyman, landscaping, auto maintenance, plumber) 1 (Most Important)	2	3	4	5	6	7 (Least Important)
Continuing Education (how-to classes, lectures, clubs, seminars)	Continuing Education (how-to classes, lectures, clubs, seminars) 1 (Most Important)	2	3	4	5	6	7 (Least Important)

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