Purpose of Survey

We want to understand the health and priorities of residents in our community ages 50 and older. Your participation in this important study will help local service providers and community agencies as they plan and advocate for programs and services for your community.

Completely anonymous

- Your responses are completely anonymous.

- Your answers can not be identified with your household.

Who can participate?

Any community member that is at least 50 years old.

How long will it take?

The survey should take about 10 to 15 minutes to complete.

For more information

Please direct your inquires to  LCCOAinfo@gmail.com.

Your participation in this survey is voluntary. However, your individual cooperation is very important to success of this study and is greatly appreciated! We thank you for your time.

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* 1. What is your 5-digit ZIP code?

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* 2. How long have you lived in this community?

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* 3. What type of home is your primary home?

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* 4. Which of the following best describes the status of your primary home?

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* 5. Do you have access to the internet at home?

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* 6. Does your household have transportation you can rely on (car, bus, etc.)?

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* 7. What is your household's main mode of transportation?

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* 8. Would you like to be living in this same community five years from now?

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* 9. How would you rate your community as a place for people to live as they age?

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* 10. How important is it for you to remain in your community as you age?

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* 11. How important is it for you to be able to live independently in your own home as you age?

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* 12. People sometimes need to make changes to their home so they can stay there as they age. Do you think you will need to make changes so you can stay there as you age?

  Choose one
Easier access into or within your home such as a ramp or wider doorways
Bathroom modifications such as grab bars, handrails, a higher toilet or shower chair
Putting a bedroom, bathroom and kitchen on the first floor
Improving lighting
A medical emergency response system that notifies others in case of emergency or fall

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* 13. Does the community where you live have the following?

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Accessible and convenient public transportation
Special transportation services for people with disabilities and older adults
Well-maintained streets
Enforced speed limits
Public parking lots, spaces and areas to park
Well-lit, safe streets and intersections for all users (pedestrians, bicyclists, drivers)
Audio/visual pedestrian crossings

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* 14. Is your neighborhood suitable for walking?

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* 15. Is your neighborhood suitable for wheelchairs?

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* 16. If you need a handicapped parking spot (either for yourself or for someone you are driving), how often do you have difficulty finding one?

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* 17. Do you feel that there is adequate affordable housing in your area?

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* 18. Please list up to 5 important resources you think our community needs to add to make our community more age-friendly. Please be specific.

The following questions ask about your health.

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* 19. In general, would you say your health is (please pick one)

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* 20. How often do you exercise (such as walking, running, strength training, yoga, stretching)?

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* 21. What, if anything, prevents you from exercising? Please check all that apply

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* 22. To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair? Please select one.

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* 23. About how frequently do you interact with your friends, family or neighbors (on the phone, in person, over email or through social media)?

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* 24. Do you have a personal doctor or health care provider?

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* 25. Where do you usually go to when you are sick or need advice about your health? (Please check all that apply)

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* 26. Does everyone in your household have some kind of health insurance?

Below are two statements that people have made about their food situation. For these statements, please answer whether the statement was often true, sometimes true, or never true for your household in the last 12 months--that is, since last August.

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* 27. "The food that we bought just didn't last, and we didn't have money to get more."

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* 28. "There is no one available to prepare meals for us."

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* 29. Over the past year, how often was your household worried or stressed about having enough money to pay your rent/mortgage?

The following questions ask about community resources and your quality of life.

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* 30. How would you rate the overall quality of life in this community? Please answer on a scale of 1 to 10 (1 is the worst, 10 is the best).

0 10
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i We adjusted the number you entered based on the slider’s scale.

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* 31. How do you learn about events in your community?

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* 32. How often do you participate in social/cultural events?

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* 33. What keeps you from participating more than you currently do? (Please check all that apply)

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* 34. Do you have access to volunteer opportunities in your community?

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* 35. If yes, have you volunteered in the last month?

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* 36. Do you have access to educational opportunities in your community (classes, conferences, etc.)?

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* 37. Do you feel socially isolated?

The following questions ask about your household.

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* 38. With which gender do you identify?

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* 39. With which race(s) do you identify? Please select all that apply.

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* 40. Are you of Hispanic, Latino, or Spanish origin?

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* 41. What is your age in years?

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* 42. Which of the following best describes your current employment status?

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* 43. What is your current marital status?

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* 44. What is the highest level of education that you have completed?

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* 45. What is your annual household income from all sources (before tax deductions)?

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