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Seniors & Elders Healthy Living Questionnaire

At the Mount Waddington Health Networks (MWHN) Seniors and Elders Better Living Advisory Committee (SEBLAC) our group of caring seniors and elders volunteers, community leaders and health professionals want to better understand the challenges by aging people in these quickly changing times. We ask you to please take the time to do this short questionnaire, and add your voice to the plan for healthier living options for seniors. 

If you want to do another survey on housing affordability, you can also do the "Housing and Homelessness: A Service Needs Estimation" which asked more detailed questions on those at-risk of losing housing, and addresses the circumstances of those people spending more than 30% of their monthly income on housing. The Housing and Homelessness: A Service Needs Assessment survey is available by clicking here >>>

This survey is completely anonymous. No personal information is recorded. 
1.Knowing the purpose of this survey and that your information is kept completely confidential, are you willing to take this survey right now?
2.If answering no for this survey, for which reasons?
3.What town or municipality do you live in?
4.What is your age group? 
5.Who do you live with? (select all that apply)
6.If you have a spouse or partner living with you, please indicate the age group of your partner or spouse.
7.Does anyone in your home (including yourself) have a health condition lasting for six months or more that makes it difficult to get around inside the house, and into and out of the house?
8.Overall, how do you feel about your current housing situation?
9.This question addresses affordability in the context of housing. You may choose not to answer.

What category best described your gross household income from all sources last year? (remember, this survey is completely anonymous.)
10.Do you own or rent your current home?
11.How do you feel about the status your home? (please select all that apply)
12.Do you have or need any of the following in your home? (Select all that apply)
Have
Need
Don't have and don't need
At least one point of entry with only one or no steps 
A ramped entrance (instead of, or in addition to steps)
A front door wide enough for wheelchair passage (at least 32" clear)
A bathroom door wide enough for a wheelchair
Room to move a wheelchair in the bathroom
Room to move a wheelchair in the kitchen
Grab rails in the tub or shower
Grab rails need the toilet
A washroom on the main floor
A lifting device between floors
13.Do you either need or want to live in Senior's Housing at this time?

(Senior's housing being a place with social activities, meal options, and housekeeping services.)
14.If in the future you did need supportive services (like meals, housekeeping, yard work or social activities) would you prefer to move to a smaller space to receive those, or stay in your own home and receive services there?
15.If in the the future you anticipate downsizing and moving to a place with increased supports, when do you anticipate that may be?
16.If you anticipate downsizing in the future, to either supportive housing or smaller independent living units, would you rather rent or own?
17.If you prefer to own your next home as a senior, what size and kind of home would you like? (With no additional supports)
18.If you would prefer to own your next home as a senior, what is your price range? (With no additional supports.)
19.If you prefer to rent, which would you prefer?
20.If you prefer to rent, how many bedrooms do you need? (with no additional supports)
21.If you prefer to rent, how much can you pay per month, not including utilities? (with no additional supports)
Seniors' and Elders' Housing
22.If seniors housing that you wanted or needed were available in your community or on the North Island, you would be likely to stay in the area?
23.If you want to leave the area for later-in-life care and seniors housing, what is your reason for leaving?
24.Please indicate the type of dwelling you are most interested in for seniors housing?
25.If you moved into a shared or multi-kit seniors residence, what size housing unity would you need?
26.If you moved into a shared or multi-unit seniors residence, would you prefer to keep your car?
27.In senior's housing, what are your needs or preferences for meal preparation?
28.With your income, what are you able to pay (or willing to pay) per month for senior's housing including services such as meals, housekeeping, and social activities?
29.What kind of payment or financing arrangement are you interested in for senior's housing
30.If you own your own home: Do you need to sell your house before you can make decisions about what kind of seniors housing you can live in, or understand what kind of financial commitments you are able to make?
31."Affordable housing" for rental properties refers to units will rents that are 65%-80% of the going market rate. These units are modest in size, design and amenities in comparison with market-rate units, and are rented to people with lower incomes.

If affordable housing for seniors were available, are you likely to apply for it?
32.What is important to you about a location for seniors housing?
Not Important
No Opinion 
Somewhat Important
Very Important
N/A
Within 5 minutes walk to stores
Within 10 minutes walk to stores
Within 20 minutes walk to stores
Close to the beach 
Has an ocean, mountain or forest view
Close to the hospital 
Is in a quiet setting near parks or nature
Is in a residential setting surrounded by other homes and people
33.Please indicate if you are currently receiving any of the following supportive care services from an organization or from individuals. If you are not currently receiving supportive care but would like to, please indicate which services: (Remember: this survey is anonymous.)
Currently Receiving 
Not Receiving 
Not receiving but would like to
Meals delivered 
Housework
Laundry
Home and Yard Maintenance
Driving and Transportation
Personal care (eg, bathing, dressing, hair, feet)
Medication supervision and other advanced home care assistance
Shopping for essentials (eg groceries)
Socialization program or Seniors Club
Thank you for taking the time to take this survey on Seniors Housing Needs on the North Island!

If you feel as though you have affordability issues, problems with the condition or size of your house, we have a further survey you may wish to do that will help us in our advocacy efforts and/or funding requests for increased supportive housing. Please click this link to take our 5-8 minute "Housing and Homelessness: A Service Needs Assessment Survey." https://www.surveymonkey.com/r/XQT73T3