Age & Dementia Friendly Cape Ann, an initiative of SeniorCare Inc. and the four communities of Cape Ann, invites Cape Ann residents to share their views on how their community can become more age and dementia friendly and improve programs and services for all residents. Participation is voluntary and responses will remain anonymous unless you choose to share your contact information for future correspondence. All of your responses will be kept confidential. This survey will take about 10 minutes to complete.

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* 1. Please select your age range

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* 2. In which Cape Ann community do you live?

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

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* 4. Have you thought about whether your future needs can be met in your community as you age (e.g., housing, service providers, transportation)?

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

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* 6. Which of the following would cause you to consider leaving Cape Ann? (Check all that apply)

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* 7. Are there sufficient affordable housing options in your community?

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* 8. What kind of housing do you feel needs to be developed for older adults in your community? (Check all that apply)

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* 9. Are your transportation needs currently met?

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* 10. What barriers do you experience in getting the transportation that you need? (Check all that apply)

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* 11. Are any of the following costs are a concern to you as you age?

  Yes No
Housing
Home maintenance
Utilities (e.g., electricity, heating)
Property taxes
Health care
Medicine/prescriptions
Food
Transportation
Personal care in your home

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* 12. Do you or your spouse/partner have an impairment or condition that limits your ability to participate in your community?

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* 13. Have you or your spouse/partner been diagnosed with dementia?

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* 14. Are you currently a caregiver for someone who is not able to fully take care of themselves?

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* 15. Do you have sufficient supports and services in place to participate in the community as you wish?

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* 16. Please select your level of agreement with each statement below

  Agree Disagree Do not know
There are enough social and cultural activities and events in my community
There are adequate volunteer opportunities for older adults 
Older adults are encouraged to volunteer and remain engaged in the community
There are adequate employment opportunities available to older adults in my community
Activities and events are communicated to older adults adequately

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* 17. Please select your level of agreement with each statement below

  Agree Disagree Do not know
My community is dementia friendly
Public areas such as parks are accessible to older adults
Walkways and buildings are handicap accessible
Parking is adequate and accessible
There are adequate and accessible public restrooms
There is adequate supports to help older adults remain in their homes for as long as they would like (e.g. homecare services)

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* 18. Please rate your level of satisfaction with each of the following aspects of your community

  Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied Do not know
Fitness and recreational opportunities (e.g., exercise classes, paths or trails)
Opportunities for continued learning (e.g., workshops, tours, speakers)
Opportunities for informal social interaction
Extent to which older adults are treated respectfully

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* 19. Please rate your level of satisfaction with each of the following aspects of your community

  Very satisfied Satisfied Neutral Dissatisfied Very dissatified Do not know
Caregiver support (respite, daycare, support groups, etc)
Access to affordable, quality food
Access to physical health services for older residents
Access to mental or behavioral health services for older residents

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* 20. Please rate your level of satisfaction with each of the following aspects of your community

  Very satisfied Satisfied Neutral Dissatisfied Very dissatified
Availability of accessible parking
Accessibility of walkways and buildings
Availability of maintained sidewalks
Availability of benches in public areas
Location of public transportation

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* 21. What are your preferred sources of information about programs, activities, and services in your community? Check all that apply

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* 22. Do you have family, friends, or neighbors in the area that you can count on in an emergency?

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* 23. Do you feel informed about what to do in the case of a weather or other type of emergency?

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* 24. Please use this space to specify any other concerns or suggestions you feel would make Cape Ann more friendly to older adults and/or those with dementia.

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* 25. Please select your gender

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* 26. OPTIONAL: If you would be willing to participate in future surveys or would like to receive information regarding Age & Dementia Friendly Cape Ann in the future, please complete contact information below. 

Please select "DONE" below to submit your survey. Thank you for taking the time to participate. If you have any questions or concerns regarding this survey, please contact Carrie Johnson at 978-281-1750 or ADFCA@seniorcareinc.org. 

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