Hello Community Member:
To ensure that we are supporting you as you age, we'd like to request your feedback in the following survey. The results of this survey will allow us to plan a meaningful End of Life Resource and Education Fair in the spring of 2024. 

Please complete this survey no later than January 30, 2024.

Thank you!
NVRH Palliative Care and Community Health Improvement
Northeast Kingdom Council on Aging

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* 1. Would you come to an event designed to provide resources to make decisions for your quality of life through end of life?

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* 2. Would you need help arranging transportation to the event?

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* 3. Which part of the week would be best for you to come to this educational event? (select all that apply)

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* 4. What time of the day would be best for you to come to this educational event? (select all that apply)

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* 5. Please read the list of topics below and rank them based on how important you feel it is to be part of the End of Life Resource and Education Fair, or select unsure:

  Very Important Important Not Important Unsure what this is, would like to learn more
Advanced Directives, Clinician Orders for Life-Sustaining Treatment (COLST)/Physician Orders for Life-Sustaining Treatment (POLST), Living Wills
Legal Aid, Financial Power of Attorney, Wills, Funeral Expenses
Medical Aid in Dying in Vermont (Act 39)
Spiritual Care at End of Life
Healthy Aging (i.e. mobility, medications, transportation, nutrition)
Aging in Place at Home (i.e. state benefits and programming (3squaresVT, Choices for Care), companions/volunteers, home safety, home health, planning for home death)
Other Options for Aging in Place (i.e. nursing home, assisted living, community options)
Mental Health
Tissue, Body and Organ Donation
Palliative Care
Hospice Care
Death Doulas
Caregiver Support
What to do after Death (i.e. burials, cremation, green burials, funeral homes, planning such as obituaries)
Veterans Affairs (i.e. care coordination, medications, insurance)

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* 6. Please share any other thoughts you may have as we plan the End of Life Educational Fair for Spring 2024:

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* 7. Please tell us about who you are from the list below (select all that apply):

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* 8. OPTIONAL: If you would like to receive information about this event once it's planned, please provide your contact information below:

For more information, please contact Anne Cowles, NVRH Palliative Care Provider, at (802) 748-7390.
Thank you for your time! 

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