Introduction

The Chicago Senior Services / Area Agency on Aging is asking seniors (60 years of age or older) and their caregivers to identify areas of need in preparation for the FY2025-27 Area Plan. Please CHECK the box below for each question that indicates your level of need.

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* 1. Do you need help with?

  Need Help Have Help Not a Concern
Help with housework and/or shopping?
Moving or removing big items in your home?
Personal care (bathing, shaving, laundry, etc.)?
Outdoor chores (raking, clearing yard debris, snow removal, etc.)?
Preventing falls (classes and/or programming)?
Pest control (extermination services)?
Finding affordable housing?
Affording your household utilities?
Affording or finding reliable help for home repairs or modifications?
Accessing health care services (e.g., medical, mental health, pharmaceutical, and / or dental)?
Identifying eligibility & signing up for government benefits?
Understanding health benefits like Medicare/Medicaid?
Someone to talk with to help assess my needs?
Money management: writing checks, paying bills?
Reading mail and completing forms?
Translation/Interpretation services?
Legal assistance (e.g. power of attorney, living wills, debt)?
Using/ learning about computers or tablets?
Using/learning cell phones?
Using smart devices (e.g., Alexa, Nest, Siri)?
Accessibility to internet or wireless services (wi-fi)?
Finding transportation that meets your needs?
Getting to a grocery store near you?
Having food or supplies delivered to your home?
Making meals or help preparing meals?
Affording food?
Staying active and exercising?
Finding a close place to spend time with others?
Finding opportunities to learn new things?
Alcohol / drug / smoking addictions?
Counseling or having someone to talk to (e.g., grief, loss)?
Assistance caring for a friend or loved one?

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* 2. Do you have other needs not covered in the questions above? 

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* 3. Do you have a disability that affects your quality of life? 

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* 4. I am interested in more services that are: (Check all that apply)

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* 5. Have you ever called Senior Services for assistance or information?

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* 6. What year were you born? 

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* 7. What is your zip code?

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* 8. Please add any additional information that we should know here. 

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* 9. Place of survey distribution.

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