Public Hearing 2010-2011 Survey

Question Title

* 1. In which county do you live?

Baker County, FL

Clay County, FL

Duval County, FL

Flagler County, FL

Nassau County, FL

St. Johns County, FL

Volusia County, FL

Other Florida County

Outside Florida

Question Title

* 2. Are you

over age 60

a family or unpaid caregiver

a paid caregiver

employeed in the aging field

Other

Other (please specify)

Question Title

* 3. How would you rate the following as needs of older adults living in your community:

	No Need	Limited Need	Moderate Need	Great Need
Adult Day Care	Adult Day Care No Need	Adult Day Care Limited Need	Adult Day Care Moderate Need	Adult Day Care Great Need
Caregiver Support	Caregiver Support No Need	Caregiver Support Limited Need	Caregiver Support Moderate Need	Caregiver Support Great Need
Assistance with Chores	Assistance with Chores No Need	Assistance with Chores Limited Need	Assistance with Chores Moderate Need	Assistance with Chores Great Need
Gerontological Counseling	Gerontological Counseling No Need	Gerontological Counseling Limited Need	Gerontological Counseling Moderate Need	Gerontological Counseling Great Need
Mental Health Counseling	Mental Health Counseling No Need	Mental Health Counseling Limited Need	Mental Health Counseling Moderate Need	Mental Health Counseling Great Need
Emergency Response (push button for help)	Emergency Response (push button for help) No Need	Emergency Response (push button for help) Limited Need	Emergency Response (push button for help) Moderate Need	Emergency Response (push button for help) Great Need
Meals Delivered to Home	Meals Delivered to Home No Need	Meals Delivered to Home Limited Need	Meals Delivered to Home Moderate Need	Meals Delivered to Home Great Need
Assistance with Housekeeping	Assistance with Housekeeping No Need	Assistance with Housekeeping Limited Need	Assistance with Housekeeping Moderate Need	Assistance with Housekeeping Great Need
Assistance with Personal Care	Assistance with Personal Care No Need	Assistance with Personal Care Limited Need	Assistance with Personal Care Moderate Need	Assistance with Personal Care Great Need
Housing Modifications	Housing Modifications No Need	Housing Modifications Limited Need	Housing Modifications Moderate Need	Housing Modifications Great Need
Legal Assistance	Legal Assistance No Need	Legal Assistance Limited Need	Legal Assistance Moderate Need	Legal Assistance Great Need
Nutritional Education	Nutritional Education No Need	Nutritional Education Limited Need	Nutritional Education Moderate Need	Nutritional Education Great Need
Respite (relief for primary caregiver)	Respite (relief for primary caregiver) No Need	Respite (relief for primary caregiver) Limited Need	Respite (relief for primary caregiver) Moderate Need	Respite (relief for primary caregiver) Great Need
Assistance with Shopping	Assistance with Shopping No Need	Assistance with Shopping Limited Need	Assistance with Shopping Moderate Need	Assistance with Shopping Great Need
Transportation	Transportation No Need	Transportation Limited Need	Transportation Moderate Need	Transportation Great Need

Comments

Question Title

* 4. How would you rate the following as needs of the caregivers of older adults living in your community:

	No Need	Limited Need	Moderate Need	Great Need
Caregiver Support and Education	Caregiver Support and Education No Need	Caregiver Support and Education Limited Need	Caregiver Support and Education Moderate Need	Caregiver Support and Education Great Need
Respite (relief for primary caregiver)	Respite (relief for primary caregiver) No Need	Respite (relief for primary caregiver) Limited Need	Respite (relief for primary caregiver) Moderate Need	Respite (relief for primary caregiver) Great Need
Adult Day Care for the Senior	Adult Day Care for the Senior No Need	Adult Day Care for the Senior Limited Need	Adult Day Care for the Senior Moderate Need	Adult Day Care for the Senior Great Need
Legal Assistance	Legal Assistance No Need	Legal Assistance Limited Need	Legal Assistance Moderate Need	Legal Assistance Great Need
Meals Delivered to Home for the Senior	Meals Delivered to Home for the Senior No Need	Meals Delivered to Home for the Senior Limited Need	Meals Delivered to Home for the Senior Moderate Need	Meals Delivered to Home for the Senior Great Need
Nutritional Education for the Senior	Nutritional Education for the Senior No Need	Nutritional Education for the Senior Limited Need	Nutritional Education for the Senior Moderate Need	Nutritional Education for the Senior Great Need
Assistance to the Senior with Chores	Assistance to the Senior with Chores No Need	Assistance to the Senior with Chores Limited Need	Assistance to the Senior with Chores Moderate Need	Assistance to the Senior with Chores Great Need
Assistance to the Senior with Housekeeping	Assistance to the Senior with Housekeeping No Need	Assistance to the Senior with Housekeeping Limited Need	Assistance to the Senior with Housekeeping Moderate Need	Assistance to the Senior with Housekeeping Great Need
Assistance to the Senior with Personal Care	Assistance to the Senior with Personal Care No Need	Assistance to the Senior with Personal Care Limited Need	Assistance to the Senior with Personal Care Moderate Need	Assistance to the Senior with Personal Care Great Need
Home Modifications to adapt for the Senior	Home Modifications to adapt for the Senior No Need	Home Modifications to adapt for the Senior Limited Need	Home Modifications to adapt for the Senior Moderate Need	Home Modifications to adapt for the Senior Great Need
Emergency Response (push button for help)	Emergency Response (push button for help) No Need	Emergency Response (push button for help) Limited Need	Emergency Response (push button for help) Moderate Need	Emergency Response (push button for help) Great Need
Assistance to the Senior with Shopping	Assistance to the Senior with Shopping No Need	Assistance to the Senior with Shopping Limited Need	Assistance to the Senior with Shopping Moderate Need	Assistance to the Senior with Shopping Great Need
Transportation for the Senior	Transportation for the Senior No Need	Transportation for the Senior Limited Need	Transportation for the Senior Moderate Need	Transportation for the Senior Great Need

Comments

Public Hearing 2010-2011

1. Default Section

Question Title

* 1. In which county do you live?

Question Title

* 2. Are you

Question Title

* 3. How would you rate the following as needs of older adults living in your community:

Question Title

* 4. How would you rate the following as needs of the caregivers of older adults living in your community:

Question Title

* 5. We welcome any additional comments:
If you would like a response, please include your email address or phone number.

Question Title

* 1. In which county do you live?

Question Title

* 2. Are you

Question Title

* 3. How would you rate the following as needs of older adults living in your community:

Question Title

* 4. How would you rate the following as needs of the caregivers of older adults living in your community:

Question Title

* 5. We welcome any additional comments:If you would like a response, please include your email address or phone number.

* 5. We welcome any additional comments:
If you would like a response, please include your email address or phone number.