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NIAAA Required Outcome Survey

What types of assistance were you helped with?

Information and Assistance (I&A)
1.I received the help needed.
2.I was offered assistance with other programs or services.
3.I have more knowledge about senior benefit programs.
4.Because of the help I received, I have more money to spend on other needs.
5.The approximate value of the benefits I received was $
Caregiver Assistance
6.I was offered support for my own needs as a caregiver.
7.My health and outlook on life improved because of this service.
8.I received the information I requested.
9.I received the help I needed for the person I was caring for.
10.I provide better assistance to the person I am caring for because of the information I received.
Congregate Meals
Because of the meal site program:
11.I eat a more nutritious diet.
12.It is easier to keep to the special diet prescribed by my doctor.
13.I have maintained a healthy weight.
14.I have something to look forward to.
15.I save money on my food bill.
16.I save money on my food bill.
17.How long have you participated in the program?
Home Delivered Meals
Since receiving home delivered meals:
18.I eat a more nutritious diet.
19.It is easier to keep the special diet prescribed by my doctor.
20.I have maintained a healthy weight.
21.I have something to look forward to.
22.The meals help me stay in my own home.
23.Receiving the meals has added to my peace of mind.
24.How long have you participated in the program?
Transportation
25.I get around more than I did before I had this service.
26.I rely on this service for all or most of my local trips.
27.I can continue to live in my home because of this service.
28.I am less dependent on family and friends for rides.
Health Promotion
29.I have used information presented in the program.
30.If SA or A was marked, what information was used?
31.The program helped me with specific concerns or questions.
32.If SA or A was marked, how did it help?
33.I have made changes because of what was learned?
34.If SA or A was marked, what changes have been or will be made?
35.My health and outlook on life has improved because of this service?
Let’s finish with some basic background information about you:
36.What is your 5-digit zip code?
37.Age
38.Gender
39.Ethnicity
40.Race
41.County
42.Living Arrangements
Current Progress,
0 of 42 answered