Aging in Place in the Tri-Lakes
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1. Introduction

 
Aging in place is the opportunity to grow older leading a full life in a community and residential setting of your choice.

Committees have been established to evaluate what might be needed in order to permit elders to successfully age in place in a Tri-Lakes Community of the Adirondacks. The committee for your community would very much like to have your thoughts on what might be needed to make the community a good place to "age in place." You can help the committee develop an "Aging in Place Action Plan."

Each elder (55+) in a household is encouraged to complete his or her own survey. If you would like additional copies of the survey, please call Mercy Care at 523-5580. This questionnaire should only take about 15 minutes to complete; your answers will be kept confidential.

Please check off your response to each question and then add, as you may wish, a brief explanation, an example or other comment that adds further meaning to your response.

1. My community is a friendly and supportive place for older people.

2. I am able to participate in the activities of the community to the extent that I want to.

3. Would you like more opportunities to do things with children and younger people?

4. I would like more opportunities to socialize and do things with other elders like myself.

5. I have knowledge or abilities which I would like to use more to benefit my community.

6. In my present living situation I sometimes feel rather lonely.

7. I have a strong sense of belonging to my community.

8. Mercy Care for the Adirondacks is sponsoring friendship volunteers who are visiting older people in the Tri-Lakes to provide friendship and companionship,to do things with them in the community, and to assist as may be needed with other particular needs.

I would like to consider having a friendship volunteer visit me or visit someone else I know.

9. Some older adults use a computer and the internet to communicate with family, friends or for news and entertainment. Others make very little or no use of the computer. How would you describe the use in your home?

10. Would you be interested in learning together with other older persons how to better use the computer?

11. If you needed some information about health or human services for yourself, friends or family member, such as home health aides, medical equipment, long-term care, health insurance, home modification, meals on wheels, nursing home, assisting living, etc., would you know how to get the information?

12. Currently the Department of Social Services, Public Health Nursing Services, Offices for the Aging, and other services often each require their own application, interview and/or assessment of need. To protect your privacy the information is not shared with any other service you may need either then or later.

13. As you grow older would you like to live in your present home as long as possible?

14. Will your home need modification or repairs in order for you to continue to live there comfortably as you grow older?

15. Are you concerned that you may not be able to afford to stay in your own home as you grow older?

16. Many realize that they may no longer be able to manage in their present housing. If and when that situation occurs, do you know what you would want to do?

17. How often do you use sidewalks in town to get to where you need to go?

18. Are the sidewalks in town that you use generally satisfactory?

19. Do you drive a car yourself or someone in your household drive you when you need to get somewhere in the community?

20. Are you or your driver experiencing difficulty finding convenient parking?

21. How much of your transportation needs are generally being met by:

 A large proportionSomeNone
The Trolley
Senior Bus
County Bus
Taxi

22. Are you satisfied with the service by

 YesNoDo not use
The Trolley
Senior Bus
County Bus
Taxi

23. Is transportation within the community or the Tri-Lakes a problem for you?

24. For what might you need some transportation assistance? (Check all that apply):

25. If available, would you now or in the future use "Dial-a-Ride," door to door, service?

26. How important is satisfying the following needs in making it possible for you to age in place in the Tri-Lakes?

 Very ImportantSomewhat ImportantNot Important
Adequate housing
Transportation
Health and human services
Having family nearby
Friendship and companionship
Involvement in the community

27. In your opinion what are the qualities of your Tri-Lakes community that tend to make it a good place to age in place?

28. What are the most significant obstacles to aging in place successfully in your community?

*
29. In order to know the characteristics of those responding to the survey we need the answers to the next few basic questions which will be kept confidential. What is your age?

30. Are you working now?

31. Are you volunteering now?

32. Residence?

33. In which town do you reside and what is your zip code?

34. Home is? (Check all that apply)

35. For how many years have you been living in the Tri-Lakes area?

36. Do you have family (parent, brother, sister, son, daughter or adult grandchildren) living in the Tri-Lakes?

37. Who is living with you in your household at this time? (Check all that apply).

38. Thank you for your help as we develop an action plan to make Tri-Lakes communities even better Places to "Age in Place."

You can send your completed survey by postal mail to:
Mercy Care for the Adirondacks
185 Old Military Road
Lake Placid, NY 12946

39. If you would like to receive a copy of the final Aging in Place Action Plan for the Tri-Lakes, please complete your contact information below.