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COMMUNITY NEEDS SURVEY
For Older Adults, People with Disabilities, and Caregivers
Help Shape Services in Your Community
We want to hear from you. Your responses will help improve services for older adults, people with disabilities, and caregivers in our region.
This survey takes about 5 minutes. Your answers are confidential, and you may skip any question.
Thank you for sharing your experience.
1.
I am: (Choose one):
Age 50-59
Age 60-74
Age 75-84
Age 85+
Under 50
Adult with a disability
Caregiver
2.
I live in:
Clallam
Grays Harbor
Jefferson
Pacific
Tribal Lands
3.
Zip code:
4.
How did you complete this survey?
QR Code
Paper (in person)
With help
Online
5.
What are the biggest challenges you are facing right now?
(Select up to 3)
Affordable housing
Cost of food
Transportation
Access to healthcare
In-home care/services
Social isolation
Internet Access
Caregiver support
Other:
6.
In the past 12 months, have you had trouble paying for Housing?
Yes
No
7.
In the past 12 months, have you had trouble paying for Utilities?
Yes
No
8.
In the past 12 months, have you had trouble paying for Food?
Yes
No
9.
In the past 12 months, have you had trouble paying for Medical care?
Yes
No
10.
What is the hardest cost for you to manage right now?
Housing
Healthcare
Food
Transportation
Other (please specify)
HEALTHCARE ACCESS
11.
How easy is it to get the healthcare you need?
Very easy
Somewhat easy
Difficult
Very difficult
12.
What are the biggest barriers? (Select up to 2)
Long distance to providers
No transportation
Cost
Long wait times
Lack of specialists
Internet/telehealth issues
13.
Have you used telehealth in the past year
Yes
No
Tried but could not access it
14.
If a mobile health clinic could come to your area, which of the following services, if any, would you use?
Blood pressure screening
Blood glucose screening or A1C testing
Mental health screening and referral to telehealth
Chronic disease self-management education
Vaccines
Foot care
Naloxone and opiod prevention
Dementia screening and resources
Telehealth for primary or urgent care
15.
In a typical week, how many times do you go somewhere other than medical appointments?
Less than once a week
1-3 times a week
More than 3 times a week
16.
Do you have any of the following close to home that you can easily get to? (check all that apply)
Senior center (if you are 55+)
Community center
Gym
Accessible parks and/or walking trails
Other public places where you can exercise or socialize (please list)
SERVICES
17.
Have you used local aging or disability services at O3A
Yes
No
Not sure what is available
18.
What would help you most right now?
Help paying for basic needs
Transportation services
Healthcare access
In-home support
Social activities
Information about services
Other (please list)
19.
What is one change that would most improve your quality of life?
20.
What services are missing in your community?
Thank you for your input!
Please Return Survey before June 30, 2026 to Olympic Area Agency on Aging,
2500 West Sims Way, Unit 201, Port Townsend, WA 98368
