Community Needs Assessment Survey FY22

Lake Cumberland Area Agency on Aging and Independent Living

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* 1. What is your county of residence?

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* 2. What is your age?

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* 3. What is your gender?

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* 4. What is your race or ethnic background?

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* 5. What is your current living situation?

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* 6. Please indicate your annual household income.

Less than $10,800

$10,801 - $16,425

$16,426 - $25,000

$25,001 - $55,000

$55,001 - $85,000

$85,001 +

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* 7. What is your marital status?

Married

Widowed

Separated

Divorced

Never Married

Living with Significant Other

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* 8. What level of school have you completed?

Elementary School

High School Diploma

GED

Some College

College Degree

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* 9. Are you a U.S. Military Veteran or Spouse of a Military Veteran?

Yes

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* 10. Are you registered to vote?

Yes

Not interested in registering to vote

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* 11. Do you have the following? Check all that apply.

Telephone/Land Line

Cellular Phone

Internet Accessibility

Computer/Tablet

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* 12. What is your primary language?

English

Spanish

Other

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* 13. Do you identify as having a disability or impairment? Check all that apply.

Cognitive (i.e. dementia, Alzheimer's)

Physical (i.e. hearing, vision, mobility)

None

Decline to answer

Other

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* 14. What type of transportation do you typically use?

Drive my own car

Walk

Use Taxi or Ride Share Service (Uber or Lyft)

Ride with family or friend

Pay someone to drive me

Use public transportation

Use Senior Citizens Center bus

No transportation is available to me

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* 15. Do you have any of the following chronic health issues?

Diabetes

Osteoporosis

Lung Condition

Arthritis

High Blood Pressure

Prostate Condition

Urinary Infections

Heart Condition

Cancer

Other

Other (please specify)

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* 16. How often do you experience difficulties in paying for your medications?

Never

2-3 times per year

Every month

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* 17. How much of your out of pocket medical costs are you able to pay?

None

Most

All

About half

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* 18. Do you utilize assistance to select a plan during Medicare Open Enrollment?

Yes

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* 19. Do you participate in community health screenings?

Yes

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* 20. How many times have you been hospitalized in the past 6 months?

None

1-2

3-4

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* 21. If you were being released from the hospital back to your home, which of the following services would be helpful to you?

Help in understanding the hospital discharge information

Help in understanding the type and use of medications

Help getting durable medical equipment

Help with personal care/homemaking

Help in understanding the medical bills

Help with transportation to follow-up medical appointments

Help with food assistance

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* 22. Are you a caregiver for someone in your household or someone living nearby?

Yes

Not applicable

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* 23. Who is the person you care for?

My spouse

A grandchild

A disabled adult child

Another relative

A non-relative

Not applicable

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* 24. How old is the person that you care for?

Under 18-years-old

18 to 59-years-old

60-years-old and older

Not applicable

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* 25. Does the person you are caring for have a diagnosis of dementia or Alzheimer's?

Yes

Not applicable

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* 26. Do you use technology devices while caring for your loved one? If so, which ones?

Yes

Other (please specify)

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* 27. Do you eat most meals alone?

Yes

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* 28. Do you have difficulty preparing and cooking meals?

Yes

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* 29. Do you ever eat meals at your local senior center?

Yes

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* 30. Do you have enough money to pay for food?

Yes

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* 31. Do you receive home delivered meals?

Yes

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* 32. Do you utilize a local food pantry to supplement your food supply?

Yes

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* 33. Do you have regular access to fresh fruits and vegetables?

Yes

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* 34. Have you ever used on-line grocery shopping/delivery?

Yes

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* 35. In the last 6 months, were you ever hungry but didn't eat because there wasn't enough money for food?

Yes

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* 36. In the last 6 months, did you ever cut the size of your meals or skip meals because there wasn't enough money for food?

Yes