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Which most closely represents your knowledge of and past experience(s) with senior living communities?
(Check all that apply.)
I am aware of senior living communities in the area
I have visited family/friends who live in a community
I have inquired to at least one senior living community but have never toured
I have toured at least one senior living community
I live in a 55+ or senior living community
I have no knowledge of senior living communities
Have your ever seriously considered any senior living communities as a place to live?
Yes
No
If Yes, which ones?
What type of senior living community would you be most likely to consider?
(Check all that apply.)
Independent Living with no care services on-site
Independent Living with supportive services available
Assisted Living, if needed
Memory Care, if needed
Retirement community with a full continuum of care
I would not consider a move to senior living
If you would not consider a move to a senior living community, please indicate why:
As you think about your future years and potential needs, where do you envision living?
(Please choose only ONE.)
In my current home
Downsizing to a smaller home or apartment
Moving to a senior living community
Moving in with family
Other
(please specify):
What is your current living situation?
Single-family home or townhome
Apartment or condominium
Live in a senior living or 55+ community
Live with adult child(ren) or another family member
Other
(please specify):
How long do you think it will be before you make your next move?
Within 1 year
1 to 3 years
3 to 5 years
5+ years
Not planning to move
When you think about your ideal residence for the coming years, please indicate the importance of the following items:
Very Important
Somewhat Important
Not Important
Square footage
Very Important
Somewhat Important
Not Important
Floor plan type
Very Important
Somewhat Important
Not Important
View from residence
Very Important
Somewhat Important
Not Important
Storage space
Very Important
Somewhat Important
Not Important
Reserved parking
Very Important
Somewhat Important
Not Important
Upgraded finishes/flooring
Very Important
Somewhat Important
Not Important
Access to technology
Very Important
Somewhat Important
Not Important
Patio/balcony
Very Important
Somewhat Important
Not Important
Keeping in mind that size relates to price, what floor plan type would you consider to be ample in a senior living community?
Studio
1-bedroom
2-bedroom
How important are the following items when considering a senior living community?
Very Important
Somewhat Important
Not Important
Community atmosphere
Very Important
Somewhat Important
Not Important
Overall lifestyle
Very Important
Somewhat Important
Not Important
Services available
Very Important
Somewhat Important
Not Important
Access to care
Very Important
Somewhat Important
Not Important
Pricing structure
Very Important
Somewhat Important
Not Important
Dining options
Very Important
Somewhat Important
Not Important
Community security
Very Important
Somewhat Important
Not Important
Community location
Very Important
Somewhat Important
Not Important
Amenities
Very Important
Somewhat Important
Not Important
Activities and events
Very Important
Somewhat Important
Not Important
Transportation
Very Important
Somewhat Important
Not Important
New construction
Very Important
Somewhat Important
Not Important
What types of activities do you enjoy most?
(Check all that apply.)
Cards/games
Cooking/culinary
Crafting
Educational lectures
Fine arts
Fitness/exercise
Film/movies
Gardening
Museums/exhibits
Music/concerts
Outdoor activities
Performing arts
Reading
Spiritual/religious
Sports
Swimming/aquatics
Technology
Traveling
Volunteering
Other
(please specify):
What are your primary concerns as you think about the future?
(Check all that apply.)
Social interaction/companionship
Accessing care/support when needed
Financial resources
Staying engaged and active
Managing medications
Memory issues
Losing independence
Safety and security
Transportation challenges
Home maintenance
I have no concerns at this time
What type of support do you and/or your spouse (if applicable) have at this time, if any?
(Check all that apply.)
No support is needed at this time
Support from adult child(ren)
Support from a spouse
Support from another family member
Support from friends/neighbors
Utilizing a home health agency
Paying for a private caregiver
Utilizing an adult day service
Other
(please specify):
How effective do you feel your current living arrangement is with regard to meeting your specific needs?
Effective
Somewhat effective
Not effective
Not applicable
When it comes to making a decision about future care plans/needs, who will be helping with this decision, and what impact will they have?
Large Impact
Some Impact
No Impact
Adult child(ren)
Large Impact
Some Impact
No Impact
Medical professional
Large Impact
Some Impact
No Impact
Caregiver
Large Impact
Some Impact
No Impact
Financial advisor
Large Impact
Some Impact
No Impact
Other family member
Large Impact
Some Impact
No Impact
Do you have long-term care insurance?
Yes
No
Are you a Veteran or the spouse of a Veteran?
Yes
No
What types of seminars/events most interest you?
(Check all that apply.)
Real estate/downsizing/moving
Understanding senior living lifestyles and options
Health and wellness
Financial planning/estate planning
Entertainment/social events
Continuing education/lectures
Caregiver education/tips
Other
(please specify):
How do you prefer to communicate?
In person
Phone
Email
Text
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Name
Email address
Phone number
