FULLER LIVES Survey of Housing Needs for Adults with Intellectual Disabilities
Presented by Fuller Lives, a parent-created nonprofit working to ensure our children lead meaningful and fulfilling adult lives.

Question Title

1. This survey is intended for the PRIMARY DECISION MAKER OF A PERSON WITH INTELLECTUAL DISABILITIES. Are you the guardian and/or primary decision maker for a person with Intellectual Disabilities? w 0

Yes

No, but I have insight into their care management

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2. What is the birthdate of the person you care for? w 0

Date

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3. What is the age of the current primary care provider? w 0

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4. What is the home community of the person you care for? (Where do they presently live?) w 0

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5. Check those areas where the person you care for requires help. w 0

Grocery shopping

Cooking /food preparation

Eating

Dressing

Personal hygiene

Mobility

Toileting

Transportation

Money management

Behavior management

Setting schedules

Staying on schedule

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6. Do they have physical or medical issues that require assistance? If so please list below: w 0

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7. Has the person you care for applied for IDD services through the
State of Hawaii? w 0

Awarded waiver services provided by Medicaid. Currently receiving services.

Awarded waiver services provided by Medicaid. Not currently receiving services.

Awarded LAZAR services through the State of Hawaii. Currently receiving services.

Awarded LAZAR services through the State of Hawaii. Not currently receiving services.

Awarded services but not aware of which kind. Currently receiving services.

Awarded services but not aware which kind. Not currently receiving services.

Applied but denied waiver services.

Have not applied for any services.

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8. If the person you care for was awarded waiver services, what was their SIS score? w 0

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9. Where does the person you care for reside at present! w 0

FOSTER CARE HOME

GROUP HOME

APARTMENT. RUN BY AN AGENCY

INDEPENDENT APARTMENT OR HOME

IN FAMILY HOME WITH FAMILY MEMBERS

SHELTER, EMERGENCY OR OTHERWISE

UNSHELTERED

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10. If/When a change in housing is needed, where would you like the new housing to be located? (check as many as apply. w 0

Hawaii Kai to Kaimuki

Kaimuki to Kalihi/Moanalua

Central Oahiu

North Shore Oahu

Leeward Coast Oahu

Windward Coast Oahu

Kaua'i

Big Island

Lana'i

Maui

Moloka'i

Question Title

11. Have you made plans for a change in the present living arrangement if and when it is necessary? w 0

Yes. A family member has agreed to provide necessary care and a place to live has agreed to provide necessary care and a place to live.

Yes. A non-family member has agreed to provide necessary care and a place to live.

Yes. We have chosen Independent Living

Yes. We have chosen Foster Care home.

YES. We have chosen a Group Home setting.

Not really. We've talked about it but have made no decisions or plans.

No. We have nobody and no place to provide future care and no real ideas.

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12. If you have not decided upon future housing, what difficulties do you face in doing so? w 0

Lack of information about options.

Fear of affordabioity

Uncertainty about future needs.

Disagreement among decision makers.

Unclear and uncertain about how their future medical needs may be met.

Concerned as to how personal guardianshipand financial guardianship will be managed effectively.

other

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13. How soon would you anticipate a change in housing needs? w 0

Within a year

Within 1-5 years

Within 5-10 years

More than 10 years

We do not anticipate the need for a change

FULLER LIVES Survey of Housing Needs for Adults with Intellectual Disabilities Presented by Fuller Lives, a parent-created nonprofit working to ensure our children lead meaningful and fulfilling adult lives.

Question Title

* 1. This survey is intended for the PRIMARY DECISION MAKER OF A PERSON WITH INTELLECTUAL DISABILITIES. Are you the guardian and/or primary decision maker for a person with Intellectual Disabilities? w 0

Question Title

* 2. What is the birthdate of the person you care for? w 0

Question Title

* 3. What is the age of the current primary care provider? w 0

Question Title

* 4. What is the home community of the person you care for? (Where do they presently live?) w 0

Question Title

* 5. Check those areas where the person you care for requires help. w 0

Question Title

* 6. Do they have physical or medical issues that require assistance? If so please list below: w 0

Question Title

* 7. Has the person you care for applied for IDD services through theState of Hawaii? w 0

Question Title

* 8. If the person you care for was awarded waiver services, what was their SIS score? w 0

Question Title

* 9. Where does the person you care for reside at present! w 0

Question Title

* 10. If/When a change in housing is needed, where would you like the new housing to be located? (check as many as apply. w 0

Question Title

* 11. Have you made plans for a change in the present living arrangement if and when it is necessary? w 0

Question Title

* 12. If you have not decided upon future housing, what difficulties do you face in doing so? w 0

Question Title

* 13. How soon would you anticipate a change in housing needs? w 0

FULLER LIVES Survey of Housing Needs for Adults with Intellectual Disabilities
Presented by Fuller Lives, a parent-created nonprofit working to ensure our children lead meaningful and fulfilling adult lives.

1. This survey is intended for the PRIMARY DECISION MAKER OF A PERSON WITH INTELLECTUAL DISABILITIES. Are you the guardian and/or primary decision maker for a person with Intellectual Disabilities? w 0

2. What is the birthdate of the person you care for? w 0

3. What is the age of the current primary care provider? w 0

4. What is the home community of the person you care for? (Where do they presently live?) w 0

5. Check those areas where the person you care for requires help. w 0

6. Do they have physical or medical issues that require assistance? If so please list below: w 0

7. Has the person you care for applied for IDD services through the
State of Hawaii? w 0

8. If the person you care for was awarded waiver services, what was their SIS score? w 0

9. Where does the person you care for reside at present! w 0

10. If/When a change in housing is needed, where would you like the new housing to be located? (check as many as apply. w 0

11. Have you made plans for a change in the present living arrangement if and when it is necessary? w 0

12. If you have not decided upon future housing, what difficulties do you face in doing so? w 0

13. How soon would you anticipate a change in housing needs? w 0