2021 Area Plan Survey

Thank you for participating in this short survey.The information will be used to help plan services in our region.

Question Title

* 1. Age

0-59 years old

60 and older

Question Title

* 2. County

Allen

Adams

DeKalb

Huntington

LaGrange

Noble

Steuben

Wells

Whitley

Other (please specify)

Question Title

* 3. Do you live alone?

Yes

Question Title

* 4. Would you be interested in learning about programs or other information using:

	Yes	No
Online video	Online video Yes	Online video No
Facebook	Facebook Yes	Facebook No
Twitter	Twitter Yes	Twitter No
Interactive Website	Interactive Website Yes	Interactive Website No

Question Title

* 5. Currently or in the future, what do you believe is your greatest need to remain independent?

Personal care

Transportation

Meals

Other (please specify)

Question Title

* 6. Are you currently receiving or have you received services in your home (such as homemaking, personal care assistance, meals, nursing care)?

Yes

If yes, what is the one thing that would best improve the care?

Question Title

* 7. Are you a caregiver for someone who is 60 or older?

Yes

Question Title

* 8. If you answered yes to being a caregiver, what is your greatest need to continue caregiving?

Respite/Relief from caregiving

Information on services available

Education/training

Other (please specify)

You have completed the survey. Please click the "Done" button below to submit your answers. If you have any questions or comments, please contact Beth Krudop at info@agingihs.org. Thank you!