* 1. What is the name of the parent organization that you work for?

* 2. What type of organization is it?

* 3.

Which areas of the state does your parent agency serve?

* 4.

Which areas of the state does your program serve?

* 5.

What type(s) of services does your program provide for seniors? (Check all that apply.)

* 6.

What type(s) of funding does your program receive, either for specific services or generally? (Check all that apply.)

* 7.

How does your fiscal year 2014 number of clients compare to the number of clients you served five years ago (fiscal year 2010)

* 8.

How many senior clients do you expect to be serving five years from now?

* 9.

If you expect to serve fewer clients in fiscal year 2015, what are the reasons for this (check all that apply):

* 10.

Are you familiar with the State Plan for Senior Services, FY 2012 - FY 2015? (Check the best answer.)

* 11.

OTHER PRIORITIES. Based on your contact with senior clients, please rank the following issues according to how often seniors ask for help with these issues:

  Quite Frequently Occasionally Rarely
Finding Home- and Community-Based Services
Finding Assisted Living in the Community
Caregiving for Adults with Disabilities
Raising Grandchildren
Emergency Planning and Preparedness
Senior Services Workforce - Recruitment, Retention, Training
Transportation - Motor
Transportation - Pedestrian (Icy Sidewalks, No Sidewalks, etc.)
Social Engagement Opportunities
Community Inclusion and Leadership Opportunities
Finding Information About Community Services

* 12. Please rank the four most pressing issues facing older adults today with #1 being the most pressing, #2 being less pressing, #3 being less pressing and #4 less pressing. When choosing your options, they will be placed on the top of the answers.

* 13.

If there are any senior priorities we missed that are important to your clients, please list them:

* 14.

CONTINUUM OF CARE. Which services for seniors are lacking (either missing or inadequate to meet the needs) in the community(ies) your program serves? (Check all that apply.)

* 15.

* 16.

GOALS. The current state plan has four goals. Please tell us whether you think we should keep each one as-is, modify it, or drop it.

  Keep it as-is Drop it Modify it - narrow the focus Modify it - expand the focus No opinion
Goal 1:
Alaskan seniors are healthy, safe, financially secure, and make vital contributions to their communities.
Goal 2:
Seniors have the choice to remain in their own homes, living with high quality of life for as long as possible through the provision of home- and community-based services, including support for family caregivers.
Goal 3:
Seniors have access to a range of attractive, safe, affordable housing options.
Goal 4:
Seniors are protected from abuse, neglect, self-neglect, and exploitation.

* 17.

FUNDING FORMULA. Currently, the state plan funding formula contains the following components in the percentages shown. (If a component represents, say, 25% of the funding formula, that means 25% of the available funds will be apportioned to each region based on its share of individuals in that component.) Federal regulations require that we allocate funding based on greatest social and economic need. Please tell us if you think each component's percentage should remain the same, increase, decrease, or if you think that component should be dropped.

  Keep it the same Increase the percentage Decrease the percentage Drop this component
Population aged 60 and older: 17%
Population aged 80 and older: 16%
Minority population aged 60 and older: 21%
Population aged 60 and over living in poverty: 23%
Rural population aged 60 and over: 23%

* 18.

Can you suggest other factors we might want to consider using as funding formula components? If so, please list them here.

* 19.

Did we miss anything? Please tell us anything else you'd like us to know about seniors in your area.