MVES LGBT Needs Assessment

Welcome to our Community Conversation about LGBT Older Adult Issues Sponsored by Mystic Valley Elder Services and the LGBT Aging Project.

We ask that you take a few moments to complete this survey. Our hope is to gather information regarding the needs and interests of LGBT older adults so that we may work with you to move forward in addressing some of these needs in our community.

Parts 1, 2, 3, & 4 are questions for LGBT older adults.
Parts 5 & 6 are questions for anyone (allies, community members, LGBT adults).

Part 1: General Demographics

Question Title

* 1. What community do you live in?

Question Title

* 2. What is your age range?

Question Title

* 3. What is your living situation? (Check all that apply)

Question Title

* 4. What is your gender?

Question Title

* 5. Your racial/ethnic background?

Question Title

* 6. Are you currently caregiving for a loved one?

Question Title

* 6a. If Yes, what is your relation/association to this person? (brother, niece, friend, spouse, etc.)

Question Title

* 7. Are you currently receiving any home care or elder services?

Question Title

* 7a. If Yes, what kind of services? (homemaker, chore, meals, etc.)

Question Title

* 8. How did you hear about the MVES LGBT Community Conversation?

Question Title

* 9. We serve the following areas:
Everett, Malden, Medford, Melrose, North Reading, Reading, Stoneham, Wakefield.
How many LGBT older adults do you know in any of these towns?

Question Title

* 10. What is your transportation situation?

Part 2: Your Concerns

Question Title

* 11. What are your concerns? (Check all that apply)

Part 3: Programs

Question Title

* 14. What programs would you like? (Check all that apply)

Part 4: Your Availability for an LGBT Community Meal Program

Question Title

* 15. What is your availability for an LGBT Community Meal Program (or similar LGBT program)?

  I am available: (choose yes to all that apply) Best day of the week you are available for each of the slots: My overall preference is: (choose yes to one only)
Weekday mornings (10am -12pm)
Weekday afternoons (12pm -2pm)
Early evenings (5pm – 7pm)
Weekend mornings (10am -12pm)
Weekend afternoons (12pm -2pm)

Question Title

* Which areas would you like to attend the LGBT Meal Program?

Question Title

* 16. Any other comments, suggestions or questions we should have asked?

Part 5: Getting Your Help

A few final questions to help us know who wants to be part of this effort. The following sections are for anyone (allies, community members, LGBT adults) to fill out.

Question Title

* 1. Would you be willing to be on a planning committee to organize LGBT Programs? (Note: this would meet 3-4 times a year.)

Question Title

* 2. Would you be willing to volunteer at upcoming events or programs for LGBT older adults?

Question Title

* 3. Would you be willing to be a Friendly Visitor for an LGBT elder?

Question Title

* 5. Can you recommend other groups, people or LGBT friendly organizations who might be interested in being a part of a local coalition on LGBT aging?

Question Title

* 6. Are you connected with any groups, schools or faith communities in this area that you could share information about our upcoming events for LGBT older adults? If so please list?

Question Title

* 7. Would you be willing to be interviewed for a story in our electronic newsletter?

Part 6: Staying in Touch!

This is optional!

Question Title

* *Your Contact Information (If you indicated you want more info or to help out in any way!)

Question Title

* Would you like to receive newsletters from Mystic Valley Elder Services and LGBT Aging Project?

( Privacy & Cookie Notice

T