Harris County Area Agency on Aging Needs Questionnaire - For Providers

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* 1. Please identify yourself. You may check more than one box.

Person caring for someone over age 60.

Person caring for someone under age 60.

Person 60 years of age or older.

Person with a disability under age 60.

Direct Services Provider

Manager

Volunteer

Other (please specify)

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* 2. What do you identify as the top three (3) needs of older adults and their caregivers?

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* 3. Have you encountered an older adult (60 or older) or caregiver who has been hospitalized within the last six (6) months?

Yes

If yes, for what reasons and about how many?

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* 4. Do you encounter older adults (60 and older) taking medication(s) for an ongoing health condition(s)?

Yes

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* 5. Have you encountered older adults (60 and older) who have experienced a fall within the last six (6) months?

Yes

If yes, please provide additional information.

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* 6. About how many family members or friends do older adults (60 and older) report seeing or talking to during the week?

One (1)

Two (2)

Three or Four (3 or 4)

Five to Eight (5 to 8)

Nine or more (9 or more)

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* 7. Who do older adults report seeing or talking to almost every day?

My spouse or partner

A family member

Someone who helps me

Someone else

No one

Other (please specify)

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* 8. Do you have questions about Medicare for people 65 and older and/or people with disabilities?

Yes

If yes, what are they?

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* 9. Do you have questions about health insurance for people 60-64 years old?

Yes

If yes, what are they?

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* 10. How should the Area Agency on Aging outreach and educate the new generation of older adults (baby boomers) and their caregivers about its services and programs?

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* 11. What kinds of services and programs will make the senior centers offering senior programs and meals more inviting for the new generation of older adults?

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* 12. How do you receive information about topics that interest you most? Check all that apply.

Television

Internet

Word of Mouth

Newspaper

Other (please specify)