BrooklineCAN “Living with Covid-19” Survey
1.
How do you get information about the Covid19 pandemic? (check all that apply)
Radio and/or television
Printed Newspapers
Various internet sources
Signs posted in public places
My health care provider
BrooklineCAN and/or Senior Center Newsletter (print or digital)
Friends, relatives, and neighbors
2.
Check all the activities in which you engaged at least once in the past month
Had a housecleaner come into my home
Had a caregiver come into my home
Had a friend or relative come into your home to visit
Went out to shop for groceries
Went out to shop at a pharmacy
Got a haircut at a salon or barber shop
Exercised at a gym or fitness studio
Attended a religious service
Went to a park
Sat on a bench in a park or along a sidewalk
Picked up take-out food at a restaurant
Ate a meal at an outdoor restaurant
Ate a meal indoors at a restaurant
Rode in an automobile with someone who does not live in my household
Rode on a MBTA bus or subway
Rode on MBTA “The Ride”
Traveled outside of New England
Did paid work away from home
Did volunteer work away from home
3.
In the past 3 months, have you (check all that apply)
Had a face-to-face meeting with a health care provider (including dentist)
Had a remote medical consultation by telephone without any video
Had a remote medical consultation with a video
Needed to see a health care provider but was not able to get an appointment
Had a medical appointment canceled because of COVID-19
4.
When are you making regular use of a face mask or face covering? (Check all that apply)
When at home with others in my household
Whenever outdoors
Whenever outdoors and other people are close by
Whenever indoors with people who do not live my household
Whenever riding on a bus or subway
Whenever riding in an automobile with others who do not live in my household
5.
How comfortable are you in wearing a face mask or face covering?
Comfortable
Somewhat uncomfortable
Very uncomfortable
6.
Do you have a medical condition that makes it difficult for you to use a face mask or face covering?
Yes
No
7.
Since the start of the Covid-19 restrictions, are you spending more time at home on the following (check all that apply)?
Talking to friends and relatives on the phone
Reading
Taking on-line classes
Doing puzzles
Playing games
Watching television
Using a computer
House cleaning
Cooking
Exercising
Doing paid work
Doing volunteer work
8.
If you were to test positive for Covid-19, do you have someone to take care of you?
Yes
No
9.
How do you rate your health?
Excellent
Good
Fair
Poor
10.
In the past 6 months, has there been a change in your health?
Improved
No change
Declined
11.
To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?
Completely
Mostly
Moderately
A little
Not at all
12.
Since Covid-19 restrictions were announced last March, has there been a change in how often you feel lonely or isolated from those around you?
I feel lonely or isolated LESS often
The has been NO CHANGE in how often I feel lonely or isolated
I feel lonely or isolated MORE often
13.
Since Covid-19 restrictions were announced in March, has there been a change in how often you have been bothered by emotional problems such as feeling anxious, depressed, or irritable?
I feel anxious, depressed, or irritable LESS often
The has been NO CHANGE in how often I feel anxious, depressed, or irritable
I feel anxious, depressed, or irritable MORE often
14.
Since Covid-19 restrictions were announced in March, has there been a change in how often you have been unable to stop or control worrying
I am Less often able to stop or control worrying
There has been no change in how often I worry
I am more often unable to stop or control worrying
15.
Since Covid-19 restrictions were announced in March, has there been a change in how often you have had little interest or pleasure in doing things?
There have been fewer times when I had little interest in doing things.
There has been no change in the number of times when I had little interest in doing things.
There have been more times when I had little interest in doing things.
16.
Are you in a high-risk group for Covid-19 because of one or more chronic health problems?
Yes
Not sure
No
17.
Do you have a computer or tablet at home with internet access?
Yes
No
18.
Do you have a smartphone?
Yes
No
19.
If yes, how satisfied are you with your skills in using the apps on your smartphone?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
20.
In the past 3 months, have you participated in a remote meeting using Zoom or another conference software either with a phone or video connection
Yes
No
21.
If yes, how satisfied are you with your skills in using Zoom or other conference software?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
22.
Do you know someone who has been diagnosed with Covid-19?
Yes
No
23.
Have you tested positive for Covid-19
Yes
No
24.
What is your age?
Under 60
60 – 69
70 -79
80 – 89
90 and over
25.
With what gender do you identify:
Female
Male
Non-binary/third gender
Prefer not to say
26.
Where do you live?
Brookline, Massachusetts
Somewhere else in the Boston metropolitan area
Outside of the Boston metropolitan area
27.
Including yourself, how many people live in your household?
28.
Do you live in some form of senior housing?
Yes
No
29.
Are you Spanish, Hispanic, or Latino?
Yes
No
30.
What is your race? (Check one or more)
Native American or Alaskan native
Asian, Asian Indian, or Pacific Islander
Black or African American
White
Other
31.
What is your employment status? (Check one)
Employed full time
Employed part time
Unemployed, looking for work
Unemployed, not looking for work
Homemaker or caregiver
Retired
Other
32.
Which category best describes your household income before taxes last year?
Less than $25,000
$25,000 to $49,999
$50,000 to $99,999
$100,000 to $199,999
$200,000 to $299,999
$300,000 and over
33.
How worried are you about having enough money to pay your bills?
Not at all worried
A little worried
Somewhat worried
Very worried
Extremely worried
34.
Since the start of the Covid-19 pandemic, has your overall financial situation become better, stayed the same, or become worse:
My financial situation has improved
My financial situation has stayed the same.
My financial situation has become worse.
Current Progress,
0 of 34 answered
