Advocates for independence, individual choice, and quality community services for older adults and persons with disabilities living in Clallam, Grays Harbor, Jefferson & Pacific Counties.
1-866-720-4863
 
Thank you for completing this survey, designed to help identify the needs of older adults, adults with disabilities, & their caregivers in our region to assist us in planning services for the next four years! If you are also a caregiver, please assist the person you care for to complete a survey representing his or her needs as well. You can also respond to this survey by telephone: call 1-866-720-4863 during business hours and a staff member will happily take your responses over the phone. The survey is also available on our website: www.o3a.org.

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* 1. Gender?

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* 2. Do you identify as a member of the LGBTQ community?

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* 3. How old are you?

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* 4. Do you...?

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* 5. Where do you live?

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* 6. How satisfied are you with your life right now?

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* 7. Do you identify yourself as someone with a disability?

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* 8. Do you plan to receive or have you already received COVID-19 vaccines?

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* 9. Did you or someone you care for contract COVID-19?

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* 10. To what degree have you experienced the negative effects of social isolation in the past year?

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* 11. What problems do you have with your current housing situation? Please check all that apply.

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* 12. Have you been able to access needed legal services?

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* 13. Are you aware that O3A offers free Senior Legal Advice Clinics for those 60 and older (targeting service to low-income elders)?

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* 14. What would you say are your most significant unmet needs?

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* 15. How are you doing with access to general services?  Do you need help with:

  Help Not Needed Have the Help I Need Cannot Access Need Help to Access Have Help but Need More
Food
Meal Preparation
Transportation
Respite Services
Health Care Services
Dental Services
Mental Health Services
Vision/Hearing Services
Substance Use Treatment
Pharmacy/Medicines

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* 16. If you need help to access any of the above services, what is the primary barrier for you?

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* 17. Did your needs change during the pandemic?  If so, which ones?

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* 18. Are you caring for or supporting a family member, friend, or neighbor?

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* 19. If you are a caregiver of a person with dementia:
Have you seen accelerated decline during the past year?

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* 20. Have you received information about the Dementia Road Map? 
Available by contacting WA State Alzheimer’s Assoc: 800-272-3900 or Google ‘Dementia Road Map’.

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* 21. Have you heard of the Palliative Care Road Map?
Contact O3A for a copy or Google ‘Palliative Care Road Map’.

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* 22. How financially stable is your family - do you ever skip paying for or buying any of the following items because of family finances?  Please check all that apply to your household.

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* 23. Which activities would you participate in if available where you live? Check all that apply:

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* 24. If you would like someone to contact you with information about services, please provide your name and your contact information in the space below :

Please Return Survey before June 30, 2023 to Olympic Area Agency on Aging,
2200 West Sims Way, Unit 100,  Port Townsend, WA  98368

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