Ageing in Place Survey

The Shire of Leonora are seeking your feedback regarding the new Retirement Village being constructed on Stuart Street. Please note, this is not an expression of interest for unit allocation/waitlist, which will occur closer to the construction completion date.

The Aged-Care Village consists of eight Independent-living units and is designed to provide a safe, welcoming lifestyle with older residents in mind. The Shire are keen to ensure the main user group gets to have a say about how it will operate. Details of the design plan are attached to this survey. Please complete the following short (confidential) survey for you or any family member who is over 55.

1.Are you completing this:

For Myself

On behalf of my family member/s who are over 55

2.Please provide details of who in your family may be seeking to reside in the village:

Name

Date of Birth

Australian Citizen Y/N

Town (Leonora, Laverton, Kookynie, Menzies)

3.What are the current living arrangement?

Own my own home

Private Rental

Government Housing

Other (please specify)

4.The Shire are seeking to develop an allocation policy which includes:
·       Your eligibility for social and affordable housing

·       How long you have lived in the Shire of Leonora (or surrounding Shires)

·       Your level of community contribution and participation

·       Whether you qualify for government funded aged care services

·       Whether you are able to live independently within the village or do you require higher levels of care

Could you please offer your thoughts on any of the criteria outlined above that you believe the council should or should not take into consideration

5.CONTACT INFORMATION: All information is confidential and will only be used for future consultation.

Name

Address

City/Town

Phone Number

Current Progress,

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