Age & Dementia Friendly Cape AnnSurvey 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.

2.In which Cape Ann community do you live?

Essex

Gloucester

Manchester By-The-Sea

Rockport

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

Extremely important

Somewhat important

Not important

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

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

Excellent

Good

Fair

Poor

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)

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

Yes

I don't know

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)

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

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)

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

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

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

Yes

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

Yes

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

Other (please specify)

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

Yes

I don't know

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

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.

25.Please select your gender

Male

Female

Prefer not to respond

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.