2024 Needs Assessment Survey

The Morris County Department of Human Services, Aging, Disabilities and Community Programming is committed to assisting seniors and disabled individuals in meeting their needs.

In order to do this and plan for the future, we need your input!

Please complete and return this survey by April 30, 2024.

Responses are confidential and results will be tallied and used for planning purposes.

Question Title

* 1. Let us know how hard it is for you, or the person you care for, to do the following:

Question Title

* 2. Check below which services you feel are critical needs in the community:

Adult Day Care - Medical

Adult Day Care - Social

Care Management (social worker develops a plan for coordinated services)

Caregivers Services (respite for caregivers)

Certified Home Health Aides

Elder Abuse

Exercise Programs

Grocery Shopper Services (for individuals who are physically unable to shop)

Health Education

Home Delivered Meals (Meals on Wheels)

Housekeeping

Assistance with Information, Applications to Programs, Benefits

Insurance Questions/Medicare Counseling

Legal Assistance

Mental Health Services (assistance with anxiety, depression, stress, etc.)

Nutrition Education and/or Counseling

Senior Centers/Congregate Dining

Oral Health (screening, assessment and treatment)

Minor Home Repair & Handyman Services

Socialization and Recreation Activities

Support Groups

Telephone Reassurance (“How are you today?)

Transportation

Question Title

* 3. What town do you live in?

Question Title

* 4. Are you permanently disabled?

Yes

Question Title

* 5. Are you a veteran, or spouse of a veteran?

Veteran

Spouse of Veteran

Not a Veteran

The following information is requested for statistical purposes only. ALL INFORMATION IS KEPT CONFIDENTIAL.

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* 6. Age Range

Under 60

60-74

75-84

85-94

95+

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* 7. Gender

Man

Woman

Non-binary

None of the above. I identify as:

Question Title

* 8. Ethnic Background (if multiple races, please select appropriate boxes)

White

Hispanic

American Indian/Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

Other

Question Title

* 9. I live:

Alone

With a spouse/life partner

With child(ren)

With a relative or friend

In shared/other housing

	Not a Problem	Sometimes a Problem	Always a Problem	N/A
Transportation to doctor/medical appointments	Transportation to doctor/medical appointments Not a Problem	Transportation to doctor/medical appointments Sometimes a Problem	Transportation to doctor/medical appointments Always a Problem	Transportation to doctor/medical appointments N/A
Addressing my own needs (bathing, dressing, etc)	Addressing my own needs (bathing, dressing, etc) Not a Problem	Addressing my own needs (bathing, dressing, etc) Sometimes a Problem	Addressing my own needs (bathing, dressing, etc) Always a Problem	Addressing my own needs (bathing, dressing, etc) N/A
Shopping for groceries	Shopping for groceries Not a Problem	Shopping for groceries Sometimes a Problem	Shopping for groceries Always a Problem	Shopping for groceries N/A
Preparing your daily meals	Preparing your daily meals Not a Problem	Preparing your daily meals Sometimes a Problem	Preparing your daily meals Always a Problem	Preparing your daily meals N/A
Cleaning your home	Cleaning your home Not a Problem	Cleaning your home Sometimes a Problem	Cleaning your home Always a Problem	Cleaning your home N/A
Being able to pay for heat or other utilities	Being able to pay for heat or other utilities Not a Problem	Being able to pay for heat or other utilities Sometimes a Problem	Being able to pay for heat or other utilities Always a Problem	Being able to pay for heat or other utilities N/A
Handling your own money and/or paying your bills	Handling your own money and/or paying your bills Not a Problem	Handling your own money and/or paying your bills Sometimes a Problem	Handling your own money and/or paying your bills Always a Problem	Handling your own money and/or paying your bills N/A
Performing household chores (shoveling, mowing, small repairs, etc)	Performing household chores (shoveling, mowing, small repairs, etc) Not a Problem	Performing household chores (shoveling, mowing, small repairs, etc) Sometimes a Problem	Performing household chores (shoveling, mowing, small repairs, etc) Always a Problem	Performing household chores (shoveling, mowing, small repairs, etc) N/A
Taking medication	Taking medication Not a Problem	Taking medication Sometimes a Problem	Taking medication Always a Problem	Taking medication N/A
Completing insurance or Medicare forms	Completing insurance or Medicare forms Not a Problem	Completing insurance or Medicare forms Sometimes a Problem	Completing insurance or Medicare forms Always a Problem	Completing insurance or Medicare forms N/A
Understanding health insurance/prescription coverage	Understanding health insurance/prescription coverage Not a Problem	Understanding health insurance/prescription coverage Sometimes a Problem	Understanding health insurance/prescription coverage Always a Problem	Understanding health insurance/prescription coverage N/A
Providing care for another person as a caregiver	Providing care for another person as a caregiver Not a Problem	Providing care for another person as a caregiver Sometimes a Problem	Providing care for another person as a caregiver Always a Problem	Providing care for another person as a caregiver N/A
Falling (loss of balance)	Falling (loss of balance) Not a Problem	Falling (loss of balance) Sometimes a Problem	Falling (loss of balance) Always a Problem	Falling (loss of balance) N/A
Help with household budgeting and finances	Help with household budgeting and finances Not a Problem	Help with household budgeting and finances Sometimes a Problem	Help with household budgeting and finances Always a Problem	Help with household budgeting and finances N/A