Age & Dementia Friendly Cape Ann
Survey of Cape Ann Residents

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

Under 50 years

50-59

60-69

70-79

80-89

90+

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

Essex

Gloucester

Manchester By-The-Sea

Rockport

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

Extremely important

Somewhat important

Not important

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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)?

Yes

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

Excellent

Good

Fair

Poor

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

Cost of living

Lack of available affordable housing

Lack of available medical services

Lack of family nearby

Lack of home health or support service

Lack of available public transportation

Lack of preferred housing type (e.g., condominiums, assisted living)

Other (please specify)

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

Yes

I don't know

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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)

Existing housing is adequate

Rental units

Condominiums or town homes for home owners

Housing with services (such as assisted living)

Other (please specify)

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* 9. Are your transportation needs currently met?

My transportation needs are adequately met

My transportation needs are sometimes met

My transportation needs are not met

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

I have no difficulties

Door-to-door assistance is not available

Costs too much

Physical limitations or other impairments

COA/volunteer transportation does not meet needs

Public transportation unavailable or inconvenient

Other (please specify)

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

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

Other (please specify)

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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?

Yes, I do

Yes, both my spouse/partner AND I do

Yes, my spouse or partner does

No, neither my spouse nor I do

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

Yes, I have been diagnosed

Yes, both my spouse/partner AND I have been diagnosed

Yes, my spouse/partner has been diagnosed

No, neither my spouse/partner nor I have been diagnosed

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

Yes

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

Yes

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

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

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

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

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

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

Newspaper

Newsletter

Television

Internet / Social media

Faith Organization

Radio

Other (please specify)

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

Yes

I don't know

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

Yes

I don't know

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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

Male

Female

Prefer not to respond

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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.

Name

Company

Address

Address 2

City/Town

State

ZIP Code

Email Address

Phone Number

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.