Area VI Community Needs Assessment 2017 Needs Assessment We appreciate your responses to the following questions so that we can best determine how to allocate funding for services to help seniors in our nine county planning and service area of Eastern Idaho. Question Title * 1. What city do you live in? Question Title * 2. What county do you live in? Question Title * 3. What is your gender? Male Female Question Title * 4. What is your age? 17 or younger 18-20 21-29 30-39 40-49 50-59 60 or older Question Title * 5. Are you a veteran? Yes No Question Title * 6. Are you the spouse of a veteran? Yes No Question Title * 7. Are you: Widowed Divorced Single Married Question Title * 8. Is your income: Below $990 per month Between $991 and $1,237 per month Between $1,238 and $1,485 per month Over $1,486 Question Title * 9. How many people, including yourself, live in your household? Question Title * 10. Who lives with you? (Check all that apply) Spouse (wife/husband) Significant other At least one child Child(ren) and his / her / their family Other relative(s) Unrelated adults / friends Grandchildren / Great-grandchildren Parents Myself Other (please specify) Question Title * 11. Are you retired? Yes Semi-retired No Question Title * 12. Do you have ongoing, adequate access to food? Yes No Question Title * 13. Do you NEED HELP with any of the following activities? (Mark all that apply) Personal care such as bathing, dressing, toileting Transportation Housekeeping Meal Preparation Shopping Emotional Support Financial Assistance (do not have enough money to pay for the necessities) Money Management (unable to decide what to pay or need help with writing checks Companionship Chore or yard care Medicare, Medicaid or other Insurance issues Assistance with medications Legal Assistance Dental, Vision, or Hearing Housing Caregiving Access to Mental Health Services Access to Medical Health Care I do not need assistance, Go to Question 15 Other (please specify) Question Title * 14. If assistance is needed, and you are not receiving it, is it because: (Mark all that apply) I do not know what is available in our community I do not have family, friends, neighbors, or church support available I do not want to ask for help I am afraid to ask for help because someone may say I should be in a facility I do not have enough money to pay for help I do not want to pay for help The help I need is not available in our area Other (please specify) Question Title * 15. Does SOMEONE YOU KNOW NEED HELP with any of the following activities? (Mark all that apply) Personal care such as bathing, dressing, toileting Transportation Housekeeping Meal Preparation Shopping Emotional Support Financial Assistance (do not have enough money to pay for the necessities) Money Management (unable to decide what to pay or need help with writing checks Companionship Chore or yard care Medicare, Medicaid or other Insurance issues Assistance with medications Legal Assistance Dental, Vision, or Hearing Housing Caregiving Access to Mental Health Services Access to Medical Health Care If they do not need assistance, Go to Question 17 Other (please specify) Question Title * 16. If assistance is needed, and they are not receiving it, is it because: (Mark all that apply) They do not know what is available in our community They do not have family, friends, neighbors, or church support available They do not want to ask for help They are afraid to ask for help because someone may say I should be in a facility They do not have enough money to pay for help They do not want to pay for help The help they need is not available in our area Other (please specify) Question Title * 17. If you needed assistance, is there someone you could call for help? No Yes, a family member Yes, a friend or neighbor Other (please specify) Question Title * 18. Do you provide unpaid care for one or more family members or friends on a regular basis? Yes No -- Go to Question 22 Question Title * 19. If you do provide unpaid care, whom do you provide care for? Spouse (wife / husband) Significant other At least one child Child(ren) and his / her / their family Other relatives Unrelated adults / friends Grandchildren / Great-grandchildren Parents Other (please specify) Question Title * 20. How many hours per week do you spend providing care for this person or these persons? Question Title * 21. What kind of assistance could you use more help in within your caregiving duties? (Mark all that apply) Organized support groups Formal advise or emotional support (from a therapist, psychologist, psychiatrist or primary physician) on issues such as caring for grandchildren and other caregiver issues Services such as Respite (a temporary break from caregiving) Communication tips for people with reduced mental function (i.e. dementia, Alzheimer's) Physical care information (lifting, diapering, transporting, cleaning) Equipment (such as assistive devices, ramps, rails, etc.) Home Modifications for safety (wheelchair ramp, grab bars, railing, etc.) Medication Management Caregiver Education / Training Support with advocating for the care recipients rights and needs from staff at the facility they live in Question Title * 22. Does anyone in your household have behaviors due to: (Mark all that apply) Addictions Alzheimer's / Dementia Developmental Disabilities Traumatic Brain Injury (TBI) Mental Health Issues Not Applicable Other (please specify) Question Title * 23. Have you, or anyone you know, been abused, neglected, or exploited? Yes No Question Title * 24. Have you, or anyone you know, contacted Adult Protective Services? Yes No Question Title * 25. How do you find out about community activities, events, and resources? (Mark all that apply) TV News TV Advertisements Newspaper Radio Internet / Social Media Family, Friends, Neighbors, Church Area Agency on Aging Local Senior Center Other (please specify) Question Title * 26. For most of your trips, how do you travel? (Select only one) Drive myself Ride with a family member or friend Walk Use a volunteer service Public Transportation Take a taxi, van, minibus Not Applicable - I do not leave my home Question Title * 27. Within the last 12 months, how often has it been difficult for you to arrange transportation for each of the following activities? Frequently Sometimes Never Medical Trips Medical Trips Frequently Medical Trips Sometimes Medical Trips Never Shopping Shopping Frequently Shopping Sometimes Shopping Never Personal errands Personal errands Frequently Personal errands Sometimes Personal errands Never Recreational or social trips Recreational or social trips Frequently Recreational or social trips Sometimes Recreational or social trips Never Question Title * 28. When you have trouble getting the transportation you need, what would you say are the reasons? (Check all that apply) I have to rely on others Weather Not available when I need to go Car doesn't work / problems with vehicle Cant afford it Don't know who to call Disability or health related reasons Not available in my community Too far / Distance related Have trouble getting around without someone to help Not applicable Other (please specify) Question Title * 29. Do you use a computer at home? Yes No Question Title * 30. Do you send and receive email? Yes No Question Title * 31. Do you search the internet for information? Yes No Question Title * 32. Do you go to your local Senior Center for meals or activities? Yes No Question Title * 33. If so, what do you like about the Senior Center? Question Title * 34. What suggestions do you have for the Senior Center? (If any) Question Title * 35. If you do not go to the local Senior Center, why not? Question Title * 36. Have you utilized assistance or support from one or more of the following services the Area Agency on Aging is able to offer within the last 12 months? (Mark all that apply) Information and Assistance Long Term Care Ombudsman Senior Medicare Patrol Homemaker Chore Respite Services Powerful Tools for Caregivers Home Delivered Meals Congregate Meals Legal Assistance Adult Protective Services Chronic Disease Health Management (CDSMP and DSMP) Classes Fit and Fall Proof Classes Question Title * 37. Have you EVER utilized any of the following assistance or supports from any of the following services the Area Agency on Aging offers? (Mark all that apply) Information and Assistance Long Term Care Ombudsman Senior Medicare Patrol Homemaker Chore Respite Services Powerful Tools for Caregivers Home Delivered Meals Congregate Meals Legal Assistance Adult Protective Services Chronic Disease Health Management (CDSMP and DSMP) Classes Fit and Fall Proof Classes Question Title * 38. Any other comments you would like to make? Thank you for taking the time to complete this survey! If you would like further information about the services available from the Area VI Agency on Aging, you may call us at 208-522-5391 or 1-800-632-4813 and speak to an Information and Assistance Specialist. Done