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Senior Survey
Senior Citizen Survey 2016
1.
What is your gender?
Female
Male
2.
What is your age?
50 to 59
60 to 69
70 to 79
80 to 89
90 or older
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
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
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:_____________________________________________________________
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)
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
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
House cleaning
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
Laundry
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
Income tax preparation
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
Yard care/ gardening
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
Grocery shopping
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
Transportation to & from events
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
Transportation to & from health facilities
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
Home repair & maintenance
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
Preparing meals/ meal delivery
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
Garbage removal
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
Mail
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
Personal Hygiene
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
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
Very worried
Somewhat worried
Not worried
Declining health
Very worried
Somewhat worried
Not worried
Moving into more suitable housing
Very worried
Somewhat worried
Not worried
Financial concerns (e.g. paying your monthly bills)
Very worried
Somewhat worried
Not worried
Difficulty physically getting around
Very worried
Somewhat worried
Not worried
Finding transportation to get around
Very worried
Somewhat worried
Not worried
Falling
Very worried
Somewhat worried
Not worried
Losing my driver's license
Very worried
Somewhat worried
Not worried
Losing my independence
Very worried
Somewhat worried
Not worried
Having no one to take care of me
Very worried
Somewhat worried
Not worried
Illness/incapacitation
Very worried
Somewhat worried
Not worried
Not being busy enough
Very worried
Somewhat worried
Not worried
Death
Very worried
Somewhat worried
Not worried
9.
Do you wish to be involved in future planning meetings for Key Biscayne seniors?
Yes
No
10.
If you answered 'yes', please complete the information below.
Name:
E-mail:
Telephone number:
11.
About how long have you lived in Key Biscayne?
Years
Months
12.
How many people currently live in your household?
13.
Do you feel that Key Biscayne understands the needs of senior citizens?
Yes
No
No opinion.
14.
Does Key Biscayne host enough events for seniors?
Yes
Yes, but more would be nice.
No
No opinion.
15.
Do you feel valued and respected as a senior on Key Biscayne?
Very
Somewhat
Not really
Not at all
No opinion
16.
Would you be interested in a program for a senior facility on Key Biscayne?
Yes
No
No opinion.
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:_____________________________________________________________
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:_____________________________________________________________
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
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:_____________________________________________________________
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:_____________________________________________________________
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
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Shopping for non-grocery items
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Doctor or health practitioner
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Local community centre
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Walk or other exercise
At least once a day
At least once per week
At least once per month
Less than once a month
Never
A class (e.g. crafts, exercise, English)
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Church or religious group
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Visit friends or family
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Cultural events (e.g. plays, concerts)
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Hospital/clinic
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Library
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Planned excursions/outings with a group of seniors
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Restaurant
At least once a day
At least once per week
At least once per month
Less than once a month
Never
LAST TWO ITEMS...
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
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Taxi
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Uber
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Bus
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Key Ride
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Village of Key Biscayne Transportation
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Scooter
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Friends/family driving me
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Walking
At least once a day
At least once per week
At least once per month
Less than once a month
Never
Bicycle
At least once a day
At least once per week
At least once per month
Less than once a month
Never
24.
Would you be interested in the future to participate in planning activities for seniors on Key Biscayne?
Yes
No
No opinion
Thank you!
Your opinions are much appreciated & will help make Key Biscayne a more age-friendly community.