OrgStory Survey 1 - The General Public At the core of our mission is speaking up for quality long-term care. VOYCE is asking you to speak out on this subject and complete this confidential questionnaire about your perceptions, attitudes and experiences related to long-term care. Your insights will help enable VOYCE to provide an annual "Report to the Region" and enable VOYCE to continue to be the leading advocate for quality long-term care. All answers are completely anonymous and confidential. Thank you for taking the time to complete this survey. Question Title * 1. What is your zip code? Question Title * 2. On a scale of 1 to 5 (1 meaning NOT concerned, 5 meaning VERY concerned), how concerned are you about the following issues around your own aging? 1 2 3 4 5 Losing independence and being reliant on others Losing independence and being reliant on others 1 Losing independence and being reliant on others 2 Losing independence and being reliant on others 3 Losing independence and being reliant on others 4 Losing independence and being reliant on others 5 Losing your memory or other mental abilities Losing your memory or other mental abilities 1 Losing your memory or other mental abilities 2 Losing your memory or other mental abilities 3 Losing your memory or other mental abilities 4 Losing your memory or other mental abilities 5 Paying for long-term care Paying for long-term care 1 Paying for long-term care 2 Paying for long-term care 3 Paying for long-term care 4 Paying for long-term care 5 Having to move into a nursing home facility of some type Having to move into a nursing home facility of some type 1 Having to move into a nursing home facility of some type 2 Having to move into a nursing home facility of some type 3 Having to move into a nursing home facility of some type 4 Having to move into a nursing home facility of some type 5 Being a burden on your family Being a burden on your family 1 Being a burden on your family 2 Being a burden on your family 3 Being a burden on your family 4 Being a burden on your family 5 Being alone Being alone 1 Being alone 2 Being alone 3 Being alone 4 Being alone 5 Question Title * 3. On a scale of 1 to 5 (1 meaning NOT concerned, 5 meaning VERY concerned), how concerned are you about the following issues around the aging of a loved one, such as a spouse or parent? 1 2 3 4 5 The loss of independence and becoming reliant on others The loss of independence and becoming reliant on others 1 The loss of independence and becoming reliant on others 2 The loss of independence and becoming reliant on others 3 The loss of independence and becoming reliant on others 4 The loss of independence and becoming reliant on others 5 The loss of memory and other mental abilities The loss of memory and other mental abilities 1 The loss of memory and other mental abilities 2 The loss of memory and other mental abilities 3 The loss of memory and other mental abilities 4 The loss of memory and other mental abilities 5 Paying for long-term care Paying for long-term care 1 Paying for long-term care 2 Paying for long-term care 3 Paying for long-term care 4 Paying for long-term care 5 Having to move into a nursing home facility of some type Having to move into a nursing home facility of some type 1 Having to move into a nursing home facility of some type 2 Having to move into a nursing home facility of some type 3 Having to move into a nursing home facility of some type 4 Having to move into a nursing home facility of some type 5 Being a burden on your family Being a burden on your family 1 Being a burden on your family 2 Being a burden on your family 3 Being a burden on your family 4 Being a burden on your family 5 Feeling alone Feeling alone 1 Feeling alone 2 Feeling alone 3 Feeling alone 4 Feeling alone 5 Question Title * 4. Which of the following statements most accurately represents your perceptions about long-term care? (choose one) Just about everyone will require ongoing living assistance at some point in their lives even if they don't become seriously ill People who have moderate or serious illnesses or mobility problems are likely to require ongoing living assistance Only people who become seriously ill or who have severe mobility problems are likely to require ongoing living assistance I haven’t given much thought to long-term care because I hope I never need it Question Title * 5. Which of the following most accurately reflects your current exploration into long-term care issues for you? (check all that apply) Have researched and gathered information about long-term care Created an advanced directive Let my family know my preferences Set aside money for long-term care Have purchased long-term care insurance Have researched long-term care living facilities Have moved into a long-term care living facility Have done nothing in regard to addressing long-term care Question Title * 6. Which of the following statements most accurately represents your perceptions about VOYCE ? (Please choose one) I had never heard of VOYCE until now I am somewhat familiar with the programs and services VOYCE provides I am very familiar with the programs and services VOYCE provides Question Title * 7. What is the biggest barrier you face in regards to easily and efficiently planning your long term care needs? (Please choose one) Fear and stigma surrounding long-term care prevents me from having conversations about planning for my long-term care needs I don’t know where to start. I am having a hard time locating resources and information that could better help me plan for my long -term care needs I have already set a plan in motion for my long-term care needs I will worry about planning for my long-term care needs when that time comes Question Title * 8. Please check the boxes that best represent you (Optional) Male Female Under 50 years old 51 - 60 years old 61 - 70 years old 71 - 80 years old Over 80 years old Done