Region C - Area Agency on Aging Area Plan Survey

Question Title

* 1. Indicate the county where you (or your agency) is located

Rutherford

Cleveland

McDowell

Polk

Other (please specify)

Question Title

* 2. Select one

Male

Female

Prefer not to say

Other (please specify)

Question Title

* 3. Select the response that best describes you

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White

Other (please specify)

Question Title

* 4. Select the category that best describes your age group

18-29

30-49

50-65

66-79

80+

Please indicate how important each service is to you

Question Title

* 5. Support for people who provide unpaid care to family members

Very important

Somewhat important

Less important

Question Title

* 6. Transportation Services

Very important

Somewhat important

Less important

Question Title

* 7. Home Delivered Meals

Very important

Somewhat important

Less important

Question Title

* 8. Help to prevent elder abuse and neglect

Very important

Somewhat important

Less important

Question Title

* 9. Personal care services that help people stay in their homes (ie. bathing, dressing, etc)

Very important

Somewhat important

Less important

Question Title

* 10. Healthy living classes, including disease prevention and self-management of your condition

Very important

Somewhat important

Less important

Question Title

* 11. Legal assistance

Very important

Somewhat important

Less important

Question Title

* 12. Help to get information about health insurance and how to sign up for Medicare/Medicaid

Very important

Somewhat important

Less important

Question Title

* 13. Access to mental health services

Very important

Somewhat important

Less important

Question Title

* 14. Help finding older adult job training and placement

Very important

Somewhat important

Less important

Question Title

* 15. Support for grandparents/other relatives who are raising children

Very important

Somewhat important

Less important

Question Title

* 16. Adult Day Care

Very important

Somewhat important

Less important

Question Title

* 17. Congregate Nutrition (meals at senior centers)

Very important

Somewhat important

Less important

Question Title

* 18. Housing and Home Improvement

Very important

Somewhat important

Less important

Question Title

* 19. Senior Center Operations (recreation programs, health classes, etc)

Very important

Somewhat important

Less important

Question Title

* 20. Help for those homeless or at risk for homelessness

Very important

Somewhat important

Less important

Region C - Area Agency on Aging Area Plan Survey

Question Title

* 1. Indicate the county where you (or your agency) is located

Question Title

* 2. Select one

Question Title

* 3. Select the response that best describes you

Question Title

* 4. Select the category that best describes your age group

Question Title

* 5. Support for people who provide unpaid care to family members

Question Title

* 6. Transportation Services

Question Title

* 7. Home Delivered Meals

Question Title

* 8. Help to prevent elder abuse and neglect

Question Title

* 9. Personal care services that help people stay in their homes (ie. bathing, dressing, etc)

Question Title

* 10. Healthy living classes, including disease prevention and self-management of your condition

Question Title

* 11. Legal assistance

Question Title

* 12. Help to get information about health insurance and how to sign up for Medicare/Medicaid

Question Title

* 13. Access to mental health services

Question Title

* 14. Help finding older adult job training and placement

Question Title

* 15. Support for grandparents/other relatives who are raising children

Question Title

* 16. Adult Day Care

Question Title

* 17. Congregate Nutrition (meals at senior centers)

Question Title

* 18. Housing and Home Improvement

Question Title

* 19. Senior Center Operations (recreation programs, health classes, etc)

Question Title

* 20. Help for those homeless or at risk for homelessness

Question Title

* 21. What other community programs or services would you like to see for older adults and people with disabilities?

Region C - Area Agency on Aging
Area Plan Survey