Senior Survey

Senior Citizen Survey 2016

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* 1. What is your gender?

Female

Male

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* 2. What is your age?

50 to 59

60 to 69

70 to 79

80 to 89

90 or older

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* 3. Are you Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

No, not Hispanic or Latino

Yes, Hispanic or Latino

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* 4. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single, but cohabiting with a significant other

Single, never married

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* 5. What is your current employment status? Please check all that apply

I am employed full-time

I am employed part-time

I am self-employed

Not employed, but looking for work

Not employed by choice

Disability pension

Retired

Homemaker

Other:_____________________________________________________________

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* 6. How do you stay up to date with current events?

National paper (e.g. The New York Times)

Miami Herald or other Miami-area newspaper

The Islander News or other local paper

El Nuevo Herald

Other non-English paper/magazine

Television

Radio station

Friends and family

Notices in the mail

Posters

Internet/Email

Other (please specify)

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* 7. In the last 12 months, have you needed help with any of the following?

	I have not needed any help	I have needed help and help WAS accessible	I have needed help but help WAS NOT accessible	N/A
Filling out forms	Filling out forms I have not needed any help	Filling out forms I have needed help and help WAS accessible	Filling out forms I have needed help but help WAS NOT accessible	Filling out forms N/A
House cleaning	House cleaning I have not needed any help	House cleaning I have needed help and help WAS accessible	House cleaning I have needed help but help WAS NOT accessible	House cleaning N/A
Laundry	Laundry I have not needed any help	Laundry I have needed help and help WAS accessible	Laundry I have needed help but help WAS NOT accessible	Laundry N/A
Income tax preparation	Income tax preparation I have not needed any help	Income tax preparation I have needed help and help WAS accessible	Income tax preparation I have needed help but help WAS NOT accessible	Income tax preparation N/A
Yard care/ gardening	Yard care/ gardening I have not needed any help	Yard care/ gardening I have needed help and help WAS accessible	Yard care/ gardening I have needed help but help WAS NOT accessible	Yard care/ gardening N/A
Grocery shopping	Grocery shopping I have not needed any help	Grocery shopping I have needed help and help WAS accessible	Grocery shopping I have needed help but help WAS NOT accessible	Grocery shopping N/A
Transportation to & from events	Transportation to & from events I have not needed any help	Transportation to & from events I have needed help and help WAS accessible	Transportation to & from events I have needed help but help WAS NOT accessible	Transportation to & from events N/A
Transportation to & from health facilities	Transportation to & from health facilities I have not needed any help	Transportation to & from health facilities I have needed help and help WAS accessible	Transportation to & from health facilities I have needed help but help WAS NOT accessible	Transportation to & from health facilities N/A
Home repair & maintenance	Home repair & maintenance I have not needed any help	Home repair & maintenance I have needed help and help WAS accessible	Home repair & maintenance I have needed help but help WAS NOT accessible	Home repair & maintenance N/A
Preparing meals/ meal delivery	Preparing meals/ meal delivery I have not needed any help	Preparing meals/ meal delivery I have needed help and help WAS accessible	Preparing meals/ meal delivery I have needed help but help WAS NOT accessible	Preparing meals/ meal delivery N/A
Garbage removal	Garbage removal I have not needed any help	Garbage removal I have needed help and help WAS accessible	Garbage removal I have needed help but help WAS NOT accessible	Garbage removal N/A
Mail	Mail I have not needed any help	Mail I have needed help and help WAS accessible	Mail I have needed help but help WAS NOT accessible	Mail N/A
Personal Hygiene	Personal Hygiene I have not needed any help	Personal Hygiene I have needed help and help WAS accessible	Personal Hygiene I have needed help but help WAS NOT accessible	Personal Hygiene N/A

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* 8. If you think about your future senior years, are you worried by any of the following?

	Very worried	Somewhat worried	Not worried
Growing old alone	Growing old alone Very worried	Growing old alone Somewhat worried	Growing old alone Not worried
Declining health	Declining health Very worried	Declining health Somewhat worried	Declining health Not worried
Moving into more suitable housing	Moving into more suitable housing Very worried	Moving into more suitable housing Somewhat worried	Moving into more suitable housing Not worried
Financial concerns (e.g. paying your monthly bills)	Financial concerns (e.g. paying your monthly bills) Very worried	Financial concerns (e.g. paying your monthly bills) Somewhat worried	Financial concerns (e.g. paying your monthly bills) Not worried
Difficulty physically getting around	Difficulty physically getting around Very worried	Difficulty physically getting around Somewhat worried	Difficulty physically getting around Not worried
Finding transportation to get around	Finding transportation to get around Very worried	Finding transportation to get around Somewhat worried	Finding transportation to get around Not worried
Falling	Falling Very worried	Falling Somewhat worried	Falling Not worried
Losing my driver's license	Losing my driver's license Very worried	Losing my driver's license Somewhat worried	Losing my driver's license Not worried
Losing my independence	Losing my independence Very worried	Losing my independence Somewhat worried	Losing my independence Not worried
Having no one to take care of me	Having no one to take care of me Very worried	Having no one to take care of me Somewhat worried	Having no one to take care of me Not worried
Illness/incapacitation	Illness/incapacitation Very worried	Illness/incapacitation Somewhat worried	Illness/incapacitation Not worried
Not being busy enough	Not being busy enough Very worried	Not being busy enough Somewhat worried	Not being busy enough Not worried
Death	Death Very worried	Death Somewhat worried	Death Not worried

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* 9. Do you wish to be involved in future planning meetings for Key Biscayne seniors?

Yes

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* 10. If you answered 'yes', please complete the information below.

Name:

E-mail:

Telephone number:

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* 11. About how long have you lived in Key Biscayne?

Years

Months

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* 12. How many people currently live in your household?

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* 13. Do you feel that Key Biscayne understands the needs of senior citizens?

Yes

No opinion.

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* 14. Does Key Biscayne host enough events for seniors?

Yes

Yes, but more would be nice.

No opinion.

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* 15. Do you feel valued and respected as a senior on Key Biscayne?

Very

Somewhat

Not really

Not at all

No opinion

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* 16. Would you be interested in a program for a senior facility on Key Biscayne?

Yes

No opinion.

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* 17. Please indicate which of the following best describes your living arrangements (Please check all that apply)

I live alone

I live with my spouse/partner

I live with my roommate(s)

I live with my children

Other:_____________________________________________________________

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* 18. Where do you live? Please check one

Home/condo/apartment that I own

Home/condo/apartment that I rent

Home/condo/apartment that my family owns or rents

Retirement home

Seniors 55+ complex

Assisted-living

Care facility/nursing home

Subsidized housing

Other:_____________________________________________________________

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* 19. Do you plan to move to more suitable housing within the next... Please indicate the one that best reflects your plans

1 year

2-3 years

4-5 years

Beyond 5 years

I have no long-term plans for moving

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* 20. If you do plan on moving within Key Biscayne, what type of housing do you think you will need? Please check one

Smaller house that I will rent

Smaller house that I will buy

Apartment/condo/townhouse that I will rent

Apartment/condo/townhouse that I will buy

Retirement home

Seniors 55+ complex

Assisted living

Subsidized housing

Care facility/nursing home

Do not plan to move within Key Biscayne

Other:_____________________________________________________________

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* 21. Please indicate your level of mobility (your ability to walk/get around) Please check all that apply

I can walk with ease unassisted

I walk unassisted but with difficulty

I use a cane or walker when walking

I use a scooter

I use a wheelchair

Other:_____________________________________________________________

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* 22. How often do you do the following or go to the following? Please check one response for each item

	At least once a day	At least once per week	At least once per month	Less than once a month	Never
Grocery shopping	Grocery shopping At least once a day	Grocery shopping At least once per week	Grocery shopping At least once per month	Grocery shopping Less than once a month	Grocery shopping Never
Shopping for non-grocery items	Shopping for non-grocery items At least once a day	Shopping for non-grocery items At least once per week	Shopping for non-grocery items At least once per month	Shopping for non-grocery items Less than once a month	Shopping for non-grocery items Never
Doctor or health practitioner	Doctor or health practitioner At least once a day	Doctor or health practitioner At least once per week	Doctor or health practitioner At least once per month	Doctor or health practitioner Less than once a month	Doctor or health practitioner Never
Local community centre	Local community centre At least once a day	Local community centre At least once per week	Local community centre At least once per month	Local community centre Less than once a month	Local community centre Never
Walk or other exercise	Walk or other exercise At least once a day	Walk or other exercise At least once per week	Walk or other exercise At least once per month	Walk or other exercise Less than once a month	Walk or other exercise Never
A class (e.g. crafts, exercise, English)	A class (e.g. crafts, exercise, English) At least once a day	A class (e.g. crafts, exercise, English) At least once per week	A class (e.g. crafts, exercise, English) At least once per month	A class (e.g. crafts, exercise, English) Less than once a month	A class (e.g. crafts, exercise, English) Never
Church or religious group	Church or religious group At least once a day	Church or religious group At least once per week	Church or religious group At least once per month	Church or religious group Less than once a month	Church or religious group Never
Visit friends or family	Visit friends or family At least once a day	Visit friends or family At least once per week	Visit friends or family At least once per month	Visit friends or family Less than once a month	Visit friends or family Never
Cultural events (e.g. plays, concerts)	Cultural events (e.g. plays, concerts) At least once a day	Cultural events (e.g. plays, concerts) At least once per week	Cultural events (e.g. plays, concerts) At least once per month	Cultural events (e.g. plays, concerts) Less than once a month	Cultural events (e.g. plays, concerts) Never
Hospital/clinic	Hospital/clinic At least once a day	Hospital/clinic At least once per week	Hospital/clinic At least once per month	Hospital/clinic Less than once a month	Hospital/clinic Never
Library	Library At least once a day	Library At least once per week	Library At least once per month	Library Less than once a month	Library Never
Planned excursions/outings with a group of seniors	Planned excursions/outings with a group of seniors At least once a day	Planned excursions/outings with a group of seniors At least once per week	Planned excursions/outings with a group of seniors At least once per month	Planned excursions/outings with a group of seniors Less than once a month	Planned excursions/outings with a group of seniors Never
Restaurant	Restaurant At least once a day	Restaurant At least once per week	Restaurant At least once per month	Restaurant Less than once a month	Restaurant Never

LAST TWO ITEMS...

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* 23. How often do you use the following modes of transportation? Please check one response for each item

	At least once a day	At least once per week	At least once per month	Less than once a month	Never
My own personal vehicle	My own personal vehicle At least once a day	My own personal vehicle At least once per week	My own personal vehicle At least once per month	My own personal vehicle Less than once a month	My own personal vehicle Never
Taxi	Taxi At least once a day	Taxi At least once per week	Taxi At least once per month	Taxi Less than once a month	Taxi Never
Uber	Uber At least once a day	Uber At least once per week	Uber At least once per month	Uber Less than once a month	Uber Never
Bus	Bus At least once a day	Bus At least once per week	Bus At least once per month	Bus Less than once a month	Bus Never
Key Ride	Key Ride At least once a day	Key Ride At least once per week	Key Ride At least once per month	Key Ride Less than once a month	Key Ride Never
Village of Key Biscayne Transportation	Village of Key Biscayne Transportation At least once a day	Village of Key Biscayne Transportation At least once per week	Village of Key Biscayne Transportation At least once per month	Village of Key Biscayne Transportation Less than once a month	Village of Key Biscayne Transportation Never
Scooter	Scooter At least once a day	Scooter At least once per week	Scooter At least once per month	Scooter Less than once a month	Scooter Never
Friends/family driving me	Friends/family driving me At least once a day	Friends/family driving me At least once per week	Friends/family driving me At least once per month	Friends/family driving me Less than once a month	Friends/family driving me Never
Walking	Walking At least once a day	Walking At least once per week	Walking At least once per month	Walking Less than once a month	Walking Never
Bicycle	Bicycle At least once a day	Bicycle At least once per week	Bicycle At least once per month	Bicycle Less than once a month	Bicycle Never

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* 24. Would you be interested in the future to participate in planning activities for seniors on Key Biscayne?

Yes

No opinion

Thank you!

Your opinions are much appreciated & will help make Key Biscayne a more age-friendly community.