Stanislaus County Older Adult Survey

 

1. Is planning for retirement an issue or concern for you?

Is planning for retirement an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

2. Is the cost of energy/utilities an issue or concern for you?

Is the cost of energy/utilities an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

3. Is getting information about services/benefits an issue or concern for you?

Is getting information about services/benefits an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

4. Is housing an issue or concern for you?

Is housing an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

5. Is remaining in your home an issue or concern for you?

Is remaining in your home an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

6. Is loneliness an issue, condition or concern for you?

Is loneliness an issue, condition or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

7. Do you feel sad frequently?

Do you feel sad frequently?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

8. Is needing legal assistance an issue or concern for you?

Is needing legal assistance an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

9. Is meeting expenses an issue or concern for you?

Is meeting expenses an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

10. Is transportation an issue or concern for you?

Is transportation an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

11. Are accidents/falls an issue, condition or concern for you?

Are accidents/falls an issue, condition or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

12. Is physical, emotional and/or financial abuse an issue or concern for you?

Is physical, emotional and/or financial abuse an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

13. Is relief from caregiving responsibilities an issue or concern for you?

Is relief from caregiving responsibilities an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

14. Is accessing services for caregiving an issue or concern for you?

Is accessing services for caregiving an issue or concern for you?   Not a Problem

Minor Problem

Serious Problem

Very Serious Problem

15. What other issues or concerns do you have? Please state.

What other issues or concerns do you have? Please state.

16. Which category below includes your age?

Which category below includes your age?   under 55

55-59

60-64

65-74

75-84

85+

17. Please indicate your 2011 monthly income:

Please indicate your 2011 monthly income:   If married:

$0-$1,2226

$1,227-$1,532

$1,533 and above

18. Please indicate your 2011 monthly income:

Please indicate your 2011 monthly income:   If single:

$0-$907

$908-$1,134

$1,135 and above

19. What is your primary language?

What is your primary language?   English	Spanish	Other
Other (please specify)

20. Do you drive your own vehicle?

Do you drive your own vehicle?   Yes

No

21. If you do not drive, what form of transportation do you use most often?

If you do not drive, what form of transportation do you use most often?   Ride with family/friends

City Bus

Dial-a-Ride

Volunteer Service

22. Is public transportation accessible where you live?

Is public transportation accessible where you live?   Yes

No

23. If you would like information about senior services in Stanislaus County, please supply your name and contact information.

If you would like information about senior services in Stanislaus County, please supply your name and contact information.