PURPOSEFUL AGING LOS ANGELES We thank you for participating in the Purposeful Aging Survey. Your responses and comments are greatly appreciated. * 1. What is the name of the City or Town in which your home is located? * 2. How long have you lived in this City/Town? 4 = Less than 5 years 3 = 5 years but less than 15 years 2 = 15 years but less than 25 years 1 = 25 years or more * 3. What is your 5-digit ZIP code? * 4. How would you rate your City/Town as a place for people to live as they age? 5 = Excellent 4 = Very Good 3 = Good 2 = Fair 1 = Poor * 5. How important is it for you to remain in your City/Town as you age? 5 = Extremely important 4 = Very important 3 = Somewhat important 2 = Not very important 1 = Not at all important 0 = Not sure * 6. As you age, how likely is it that you will move to a different home in your City/Town? 5 = Extremely likely 4 = Very likely 3 = Somewhat likely 2 = Not very likely 1 = Not at all likely 0 = Not sure * 7. As you age, how likely is it that you will move to a different City/Town? 5 = Extremely likely 4 = Very likely 3 = Somewhat likely 2 = Not very likely 1 = Not at all likely 0 = Not sure * 8. If you were to consider moving, why would you do so? a. Looking for a different home size that meets your needs 1 = Yes 2 = No 3 = Not Sure a. Looking for a different home size that meets your needs menu b. Maintaining your current home will be too expensive 1 = Yes 2 = No 3 = Not Sure b. Maintaining your current home will be too expensive menu c. Fearing for your personal safety or security concerns 1 = Yes 2 = No 3 = Not Sure c. Fearing for your personal safety or security concerns menu d. Looking for a home that will help you live independently as you age 1 = Yes 2 = No 3 = Not Sure d. Looking for a home that will help you live independently as you age menu e. Wanting to move to an area that has better health care facilities 1 = Yes 2 = No 3 = Not Sure e. Wanting to move to an area that has better health care facilities menu f. Wanting to be closer to family 1 = Yes 2 = No 3 = Not Sure f. Wanting to be closer to family menu g. Needing more access to public transportation 1 = Yes 2 = No 3 = Not Sure g. Needing more access to public transportation menu h. Wanting to live in a different climate 1 = Yes 2 = No 3 = Not Sure h. Wanting to live in a different climate menu i. Looking for an area that has a lower cost of living 1 = Yes 2 = No 3 = Not Sure i. Looking for an area that has a lower cost of living menu j. Other, please specify: * 9. What best describes your living arrangement? 1 = Live alone 2 = Live with a spouse/partner 3 = Live with family member(s) 4 = Live with friend(s)/roommates(s) 5 = Group 6 = Other, please specify: * 10. What type of home is your primary home? 1 = Single family home 2 = Mobile home 3 = Townhome or duplex 4 = Apartment 5 = Condominium or co-op 6 = Temporary Housing/Shelter 7 = Homeless 8 = Other, please specify: * 11. How important is it for you to be able to live in your own home as you age? 1 = Extremely important 2 = Very important 3 = Somewhat important 4 = Not very important 5 = Not at all important 6 = Not sure * 12. Have the following types of modifications or improvements been made to your home to enable you to stay there? a. Easier access into or within your home such as a ramp, chairlift or elevator, or wider doorways 1 = Yes 2 = No 3 = Not Sure a. Easier access into or within your home such as a ramp, chairlift or elevator, or wider doorways menu b. Bathroom modifications such as grab bars, handrails, a higher toilet or non-slip tiles 1 = Yes 2 = No 3 = Not Sure b. Bathroom modifications such as grab bars, handrails, a higher toilet or non-slip tiles menu c. Putting a bedroom, bathroom, or kitchen on the first floor 1 = Yes 2 = No 3 = Not Sure c. Putting a bedroom, bathroom, or kitchen on the first floor menu d. Improved lighting 1 = Yes 2 = No 3 = Not Sure d. Improved lighting menu e. Installing a medical emergency response system that notifies others in case of emergency 1 = Yes 2 = No 3 = Not Sure e. Installing a medical emergency response system that notifies others in case of emergency menu f. Other, please specify: * 13. Does the City/Town where you live have the following? a. Home repair contractors who are trustworthy, do quality work, and are affordable 1 = Yes 2 = No 3 = Not Sure a. Home repair contractors who are trustworthy, do quality work, and are affordable menu b. A home repair service for low-income and older adults 1 = Yes 2 = No 3 = Not Sure b. A home repair service for low-income and older adults menu c. Seasonal services such as lawn work or snow removal for low-income and older adults 1 = Yes 2 = No 3 = Not Sure c. Seasonal services such as lawn work or snow removal for low-income and older adults menu d. Affordable housing options for adults of varying income levels, such as older active adult communities, assisted living and communities with shared facilities and outdoor spaces 1 = Yes 2 = No 3 = Not Sure d. Affordable housing options for adults of varying income levels, such as older active adult communities, assisted living and communities with shared facilities and outdoor spaces menu e. Well-maintained and safe parks that are within walking distance of your home 1 = Yes 2 = No 3 = Not Sure e. Well-maintained and safe parks that are within walking distance of your home menu f. Public parks with enough benches 1 = Yes 2 = No 3 = Not Sure f. Public parks with enough benches menu g. Sidewalks that are safe for pedestrians or wheelchairs 1 = Yes 2 = No 3 = Not Sure g. Sidewalks that are safe for pedestrians or wheelchairs menu h. Well-maintained public buildings and facilities that are accessible to people of different physical abilities 1 = Yes 2 = No 3 = Not Sure h. Well-maintained public buildings and facilities that are accessible to people of different physical abilities menu i. Neighborhood watch program 1 = Yes 2 = No 3 = Not Sure i. Neighborhood watch program menu * 14. How do you get around for things like shopping, visiting the doctor, running errands, or going to other places? a. Drive yourself b. Have others drive you c. Walk d. Ride a bike e. Use public transportation f. Take a taxi/cab g. Uber/Lyft h. Use a special transportation service, such as one for older adults or persons with disabilities i. Other, please specify: * 15. To your knowledge, does your City/Town have the following? Answer a. Accessible and convenient public transportation 1 = Yes 2 = No 3 = Not Sure a. Accessible and convenient public transportation Answer menu b. Affordable public transportation 1 = Yes 2 = No 3 = Not Sure b. Affordable public transportation Answer menu c. Well-maintained public transportation vehicles 1 = Yes 2 = No 3 = Not Sure c. Well-maintained public transportation vehicles Answer menu d. Reliable public transportation 1 = Yes 2 = No 3 = Not Sure d. Reliable public transportation Answer menu e. Safe public transportation stops or areas 1 = Yes 2 = No 3 = Not Sure e. Safe public transportation stops or areas Answer menu f. Special transportation services for people with disabilities and older adults 1 = Yes 2 = No 3 = Not Sure f. Special transportation services for people with disabilities and older adults Answer menu g. Well-maintained streets 1 = Yes 2 = No 3 = Not Sure g. Well-maintained streets Answer menu h. Easy to read traffic signs 1 = Yes 2 = No 3 = Not Sure h. Easy to read traffic signs Answer menu i. Enforced speed limits 1 = Yes 2 = No 3 = Not Sure i. Enforced speed limits Answer menu j. Public parking lots, spaces and other areas to park 1 = Yes 2 = No 3 = Not Sure j. Public parking lots, spaces and other areas to park Answer menu k. Affordable public parking 1 = Yes 2 = No 3 = Not Sure k. Affordable public parking Answer menu l. Well-lit, safe streets and intersections for all users (pedestrians, bicyclists, drivers) 1 = Yes 2 = No 3 = Not Sure l. Well-lit, safe streets and intersections for all users (pedestrians, bicyclists, drivers) Answer menu m. Safe pedestrian crossings 1 = Yes 2 = No 3 = Not Sure m. Safe pedestrian crossings Answer menu n. Driver education/refresher courses 1 = Yes 2 = No 3 = Not Sure n. Driver education/refresher courses Answer menu * 16. When compared to most people your age, how would you rate your health? 5 = Excellent 4 = Very good 3 = Good 2 = Fair 1 Poor * 17. How often do you engage in some form of physical exercise (such as walking, running, biking, swimming, sports, strength training, yoga, stretching)? 5 = Every day 4 = Several times a week, but not every day 3 = About once a week 2 = Less than once a week 1 = Never * 18. Does the City/Town where you live have any of the following? a. Health and wellness programs and classes in areas such as nutrition, smoking cessation, and weight control 1 = Yes 2 = No 3 = Not Sure a. Health and wellness programs and classes in areas such as nutrition, smoking cessation, and weight control menu b. Fitness activities specifically geared to older adults 1 = Yes 2 = No 3 = Not Sure b. Fitness activities specifically geared to older adults menu c. Conveniently located health and social services 1 = Yes 2 = No 3 = Not Sure c. Conveniently located health and social services menu d. A service that helps older adults find and access health and supportive services 1 = Yes 2 = No 3 = Not Sure d. A service that helps older adults find and access health and supportive services menu e. Conveniently located emergency care centers 1 = Yes 2 = No 3 = Not Sure e. Conveniently located emergency care centers menu f. Easy-to-find information on local health and supportive services 1 = Yes 2 = No 3 = Not Sure f. Easy-to-find information on local health and supportive services menu g. Home care services, including health, personal care and housekeeping 1 = Yes 2 = No 3 = Not Sure g. Home care services, including health, personal care and housekeeping menu h. Well-trained certified home health care providers 1 = Yes 2 = No 3 = Not Sure h. Well-trained certified home health care providers menu i. Affordable home health care providers 1 = Yes 2 = No 3 = Not Sure i. Affordable home health care providers menu j. Well-maintained hospitals and health care facilities 1 = Yes 2 = No 3 = Not Sure j. Well-maintained hospitals and health care facilities menu k. A variety of health care professionals, including specialists 1 = Yes 2 = No 3 = Not Sure k. A variety of health care professionals, including specialists menu l. Health care professionals who speak different languages 1 = Yes 2 = No 3 = Not Sure l. Health care professionals who speak different languages menu m. Easily understandable and helpful local hospital or clinic answering services 1 = Yes 2 = No 3 = Not Sure m. Easily understandable and helpful local hospital or clinic answering services menu n. Respectful and helpful hospital clinical staff 1 = Yes 2 = No 3 = Not Sure n. Respectful and helpful hospital clinical staff menu * 19. About how frequently do you have contact with your friends, family, or neighbors? This interaction could be by phone, in person, e-mail, or social media (such as Facebook). 4 = More than once a day 3 = About once a day 2 = Several times a week 1 = Less than once a week 0 = Never * 20. Is the contact described above… 3 = Too much 2 = Just right 1 = Not enough * 21. Do you participate in continuing education or self-improvement classes/workshops? (CHECK ALL THAT APPLY) 1 = University/Community College 2 = Department of Parks and Recreation 3 = Faith community 4 = Local organizations or businesses 5 = Community center 6 = Senior center 7 = Offerings through my work 8 = Online programs 9 = Other 10 = I do NOT participate in any continuing education/self-improvement classes Other, please specify: * 22. Does the City/Town where you live have the following? a. Conveniently located entertainment 1 = Yes 2 = No 3 = Not Sure a. Conveniently located entertainment menu b. Activities specifically geared to older adults 1 = Yes 2 = No 3 = Not Sure b. Activities specifically geared to older adults menu c. Activities that offer older adults discounts 1 = Yes 2 = No 3 = Not Sure c. Activities that offer older adults discounts menu d. Activities that are affordable to all residents 1 = Yes 2 = No 3 = Not Sure d. Activities that are affordable to all residents menu e. Activities that involve both younger and older adults 1 = Yes 2 = No 3 = Not Sure e. Activities that involve both younger and older adults menu f. Accurate and widely publicized information about social activities 1 = Yes 2 = No 3 = Not Sure f. Accurate and widely publicized information about social activities menu g. A variety of cultural activities for diverse populations 1 = Yes 2 = No 3 = Not Sure g. A variety of cultural activities for diverse populations menu h. Local schools that involve older adults in events and activities 1 = Yes 2 = No 3 = Not Sure h. Local schools that involve older adults in events and activities menu i. Continuing education classes 1 = Yes 2 = No 3 = Not Sure i. Continuing education classes menu j. Social clubs, such as for books, gardening, crafts or hobbies 1 = Yes 2 = No 3 = Not Sure j. Social clubs, such as for books, gardening, crafts or hobbies menu k. A range of volunteer activities to choose from 1 = Yes 2 = No 3 = Not Sure k. A range of volunteer activities to choose from menu l. Volunteer training opportunities to help people perform better in their volunteer roles 1 = Yes 2 = No 3 = Not Sure l. Volunteer training opportunities to help people perform better in their volunteer roles menu m. Opportunities for older adults to participate in decision making bodies, such as community councils or committees 1 = Yes 2 = No 3 = Not Sure m. Opportunities for older adults to participate in decision making bodies, such as community councils or committees menu n. Easy-to-find information about local volunteer opportunities 1 = Yes 2 = No 3 = Not Sure n. Easy-to-find information about local volunteer opportunities menu * 23. Which of the following best describes your current employment status? 7 = Retired, not working at all 6 = Not in labor force for other reasons 5 = Self-employed, part-time 4 = Self-employed, full-time 3 = Employed, part-time 2 = Employed, full-time 1 = Unemployed, but looking for work * 24. If employed, how likely is it that you will retire? 5 = Extremely likely 4 = Very likely 3 = Somewhat likely 2 = Not very likely 1 = Not at all likely 0 = Not sure If not likely or not at all likely, why not? * 25. Does the City/Town where you live have the following? a. A range of flexible job opportunities for older adults 1 = Yes 2 = No 3 = Not Sure a. A range of flexible job opportunities for older adults menu b. Job training opportunities for older adults who want to learn new job skills within their job or get training in a different field of work 1 = Yes 2 = No 3 = Not Sure b. Job training opportunities for older adults who want to learn new job skills within their job or get training in a different field of work menu c. Jobs that are adapted to meet the needs of people with disabilities 1 = Yes 2 = No 3 = Not Sure c. Jobs that are adapted to meet the needs of people with disabilities menu * 26. Would you turn to the following resources if you, a family member or friend needed information about services for older adults, such as caregiving services, home-delivered meals, home repair, medical transport or social activities? (CHECK ALL THAT APPLY) a. Local senior centers b. Local Area Agency on Aging (AAA) c. Family or Friends d. Local nonprofit organizations e. AARP f. Faith-based organizations, such as churches or synagogues g. Internet h. Phone books i. Your doctor or other health care professional j. Local government offices, such as the Department of Health k. Library l. Other, please specify: * 27. Does the City/Town where you live have the following? a. Access to community information in one central source 1 = Yes 2 = No 3 = Not Sure a. Access to community information in one central source menu b. Clearly displayed printed community information with large lettering 1 = Yes 2 = No 3 = Not Sure b. Clearly displayed printed community information with large lettering menu c. An automated community information source that is easy to understand, such as a toll-free telephone number 1 = Yes 2 = No 3 = Not Sure c. An automated community information source that is easy to understand, such as a toll-free telephone number menu d. Free access to computers and the Internet in public places, such as the library, senior centers or government buildings 1 = Yes 2 = No 3 = Not Sure d. Free access to computers and the Internet in public places, such as the library, senior centers or government buildings menu e. Community information that is delivered in person to people who may have difficulty or may not be able to leave their home 1 = Yes 2 = No 3 = Not Sure e. Community information that is delivered in person to people who may have difficulty or may not be able to leave their home menu f. Community information that is available in a number of different languages 1 = Yes 2 = No 3 = Not Sure f. Community information that is available in a number of different languages menu * 28. Do you have dental insurance? 1 = Yes 2 = No * 29. Have you had a dental exam in the last 3 years? 1 = Yes 2 = No * 30. Have you had a flu shot in the last year? 1 = Yes 2 = No * 31. In case of an emergency, do you have a plan to evacuate? 1 = Yes 2 = No * 31a. Would you like help in creating a plan? 1 = Yes 2 = No * 32. In case of a major disaster, do you have a plan, including having basic supplies, water, contact information, etc.? 1 = Yes 2 = No * 32a. Would you like help in creating a plan? 1 = Yes 2 = No * 33. Have you prepared a supply of your prescription medications to have on hand in the event of a disaster? 1 = Yes 2 = No * 34. Are you or someone else in your home caring for family members or friends who are experiencing problems with memory/thinking that is affecting their ability to work or live a normal life? 1 = Yes 2 = No * 34a. If “YES”, have they been diagnosed with Alzheimer’s or another type of dementia by a doctor? If “NO”, please go to the next question. 1 = Yes 2 = No * 34b. If “YES” to either question above, please tell us what kind of help you feel might be useful? If “NO”, please go to the next question. (CHECK ALL THAT APPLY): a. Information about Alzheimer’s or dementia and/or how to manage the symptoms b. Someone to talk with who knows about dementia and can help me understand and cope with the disease (for example a Care Counselor) c. A low-cost or no-cost way for police or fire department to identify our person(s) if they get lost d. A doctor to provide a diagnosis and help with care or treatment e. Legal help in planning for care needs or with financial problems f. A support group g. Financial assistance to help pay for a caregiver h. Help in the home so that I/someone else can work, do chores, or get away i. An adult day care center j. An assisted living facility or nursing home k. Other, please specify: ABOUT YOU… * D1. Are you male or female? 1 = Male 2 = Female 3 = Prefer not to answer * D2. Do you think of yourself as…(CHECK ALL THAT APPLY) 1 = Heterosexual or Straight 2 = Homosexual or Gay or Lesbian 3 = Bisexual 4 = Prefer not to answer 5 = Something else: * D3. What year were you born? * D4. What is your current marital status? 1 = Married 2 = Not married, living with partner 3 = Separated 4 = Divorced 5 = Widowed 6 = Never Married * D5. Do you live alone? 1 = Yes 2 = No * D5 a. If "NO", how many people regularly live in your household? If “YES”, please go to the next question. 1 = 2 People 2 = 3 People 3 = 4 People 4 = More than 4 * D5 b. If “NO” to D5, are you currently living with… (CHECK ALL THAT APPLY) a. Child/children under 18 b. Child/children 18 or older c. Child/children away at college d. Parents e. Other adult relative or friend 18 or older * D5 c. If “NO” to D5, are you a family caregiver? 1 = Yes 2 = No * D5 d. If “YES” to D5 c, are you a caregiver for… (CHECK ALL THAT APPLY) a. Child/children under 18 b. Child/children 18 or older c. Spouse/partner d. Parent(s) e. Other adult relative or friend 18 or older * D6. Do you have any of the following kinds of health care coverage? a. Insurance through a current or former employer of yours or your spouse 1 = Yes 2 = No 3 = Not Sure a. Insurance through a current or former employer of yours or your spouse menu b. Insurance purchased directly from an insurance company (not through an employer) 1 = Yes 2 = No 3 = Not Sure b. Insurance purchased directly from an insurance company (not through an employer) menu c. Medicare (for people 65 and older or people with certain health disabilities) 1 = Yes 2 = No 3 = Not Sure c. Medicare (for people 65 and older or people with certain health disabilities) menu d. Medicaid [Medi-Cal] or any kind of government assistance plan for those with low incomes or a disability 1 = Yes 2 = No 3 = Not Sure d. Medicaid [Medi-Cal] or any kind of government assistance plan for those with low incomes or a disability menu e. Veterans Administration or other military health care 1 = Yes 2 = No 3 = Not Sure e. Veterans Administration or other military health care menu f. Any other insurance coverage 1 = Yes 2 = No 3 = Not Sure f. Any other insurance coverage menu * D7. Does any disability, handicap, or chronic disease keep you and/or your spouse or partner from fully participating in work, school, housework or other activities? (CHECK ONLY ONE) 1 = Yes, myself 2 = Yes, my spouse or partner 3 = Yes, both me and my spouse or partner 4 = No * D8. Are you of Hispanic, Spanish, Latino origin or descent? 1 = Yes 2 = No * D9. Which language do you prefer to speak at home? (CHECK ONLY ONE) 1 = Armenian 2 = Cambodian/Khmer 3 = Chinese 4 = English 5 = Farsi 6 = Korean 7 = Russian 8 = Spanish 9 = Tagalog 10 = Vietnamese 11 = Other * D10. What is your race and/or ethnicity? (CHECK ALL THAT APPLY) 1 = White or Caucasian 2 = Black or African American 3 = American Indian or Alaskan Native 4 = Asian 5 = Native Hawaiian or other Pacific Islander 6 = Other, please specify: * D11. What is the highest level of education you have completed? 1 = K-12th grade (no diploma) 2 = High school graduate, GED or equivalent 3 = Post-high school education/training (no degree) 4 = 2-year college degree 5 = 4-year college degree 6 = Postgraduate study (no degree) 7 = Graduate or professional degree(s) * D12. Are you registered to vote? 1 = Yes 2 = No * D13. In general, how often do you go online to access the Internet for things like sending or receiving e-mail, getting news and information, paying bills or managing finances, or buying products or services? This includes access from home, work, a mobile device (such as a smartphone), or someplace else. 1 = Often – At least daily 2 = Sometimes – One or more times a week, but not every day 3 = Occasionally – A few times a month 4 = Rarely – Once a month or less 5 = Never go online * D14. What was your annual household income before taxes in the most recent tax year? 1 = Less than $12,000 2 = $12,000 to $24,999 3 = $25,000 to $49,999 4 = $50,000 to $74,999 5 = $75,000 to $99,999 6 = $100,000 to $149,999 7 = $150,000 or more * Please use the space below for any additional comments Thank you very much for completing this survey. Your assistance in providing this information is greatly appreciated. Done
