BrooklineCAN “Living with Covid-19” Survey

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* 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

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* 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

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* 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

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* 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

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* 5. How comfortable are you in wearing a face mask or face covering?

Comfortable

Somewhat uncomfortable

Very uncomfortable

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* 6. Do you have a medical condition that makes it difficult for you to use a face mask or face covering?

Yes

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* 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

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* 8. If you were to test positive for Covid-19, do you have someone to take care of you?

Yes

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* 9. How do you rate your health?

Excellent

Good

Fair

Poor

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* 10. In the past 6 months, has there been a change in your health?

Improved

No change

Declined

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* 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

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* 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

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* 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

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* 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

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* 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.

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* 16. Are you in a high-risk group for Covid-19 because of one or more chronic health problems?

Yes

Not sure

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* 17. Do you have a computer or tablet at home with internet access?

Yes

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* 18. Do you have a smartphone?

Yes

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* 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

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* 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

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* 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

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* 22. Do you know someone who has been diagnosed with Covid-19?

Yes

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* 23. Have you tested positive for Covid-19

Yes

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* 24. What is your age?

Under 60

60 – 69

70 -79

80 – 89

90 and over

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* 25. With what gender do you identify:

Female

Male

Non-binary/third gender

Prefer not to say

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* 26. Where do you live?

Brookline, Massachusetts

Somewhere else in the Boston metropolitan area

Outside of the Boston metropolitan area

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* 27. Including yourself, how many people live in your household?

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* 28. Do you live in some form of senior housing?

Yes

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* 29. Are you Spanish, Hispanic, or Latino?

Yes

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* 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

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* 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

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* 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

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* 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

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* 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.