ADRC Area plan 2019 Question Title * 1. Have you ever used SWIRCA & More services? Yes No Question Title * 2. If you answered yes to question #1, what services have you used? Meals Attend events Activity Center Information and referral Case Management Other (please specify) Question Title * 3. How do you stay informed about events happening in your community? Computer/websites Facebook Printed literature TV Newspaper Word of mouth Maturity Journal Other (please specify) Question Title * 4. Are you taking this survey as: A member or a recipient of in-home services? A caregiver? A professional? Other (please specify) Question Title * 5. What zip code do you live in? Question Title * 6. Are you aware that SWIRCA & More has an ADRC (Aged & Disabled Resource Center) to help individuals navigate community services to help meet their needs to remain independent in their homes? Yes No Question Title * 7. When would you most likely participate in activities such as those provided by SWIRCA & More? 7 – 9 am weekdays 9-12 am weekdays 12-4 pm weekdays 4-8 pm weekdays 9-12 am Saturday Any weekend hours Question Title * 8. Where would you most likely to visit a meal site? Please rank as 1 being your top choice and 7 being your least favorite. 1 2 3 4 5 6 7 Activity Center 1 2 3 4 5 6 7 Union Hall 1 2 3 4 5 6 7 Restaurant 1 2 3 4 5 6 7 Club (elks, lions) 1 2 3 4 5 6 7 Church 1 2 3 4 5 6 7 Grocery Store 1 2 3 4 5 6 7 Apartment building/clubhouse Question Title * 9. Have you ever used the website resources.swirca to find needed information? Yes No Question Title * 10. Were you aware that SWIRCA & More’s ADRC can link you to resources such as? (check all that apply) Transportation Farmer’s market vouchers Case management Medicare and insurance information Financial assistance Government programs Long-term care options Medicaid Question Title * 11. Do you have access to the internet? Yes No Question Title * 12. In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food? Yes No Question Title * 13. In the last 12 months, has your utility company shut off your service for not paying your bills? Yes No Question Title * 14. Are you worried that in the next 2 months, you may not have stable housing? Yes No Question Title * 15. In the last 12 months, have you needed to see a doctor but could not because of cost? Yes No Question Title * 16. In the last 12 months, have you ever had to go without health care because you didn’t have a way to get there? Yes No Question Title * 17. In the last 12 months, have you missed medications because you could not afford your prescriptions? Yes No Question Title * 18. Do you feel that there are adequate transportation options for the elderly & disabled in our community? Yes No Question Title * 19. What transportation options do you use? Bus/Trolley Cab Uber/Lyft Own vehicle Family Other (please specify) Question Title * 20. What additional services could SWIRCA provide to aid the Aged & Disabled in our community? 1 2 3 Question Title * 21. What is your age range? Under 50 51 -60 61-70 71-80 81 or older Question Title * 22. Gender Male Female Other Question Title * 23. If willing, please share your story of how SWIRCA & More services has made a difference for you. Done
