2019 Area Agency on Aging of Western Michigan Community Needs Survey

COMMUNITY SURVEY FOR OLDER ADULTS (Age 60 and older)

Please complete the survey only once. You may skip any question that you do not understand or are not comfortable answering.

This survey will be open through February 24th, 2019.

Question Title

* Right now, how concerned are you about:

	Not Concerned	Somewhat Concerned	Very Concerned	Not Applicable
Being able to live in your home as you get older	Being able to live in your home as you get older Not Concerned	Being able to live in your home as you get older Somewhat Concerned	Being able to live in your home as you get older Very Concerned	Being able to live in your home as you get older Not Applicable
Being physically, emotionally or financially abused	Being physically, emotionally or financially abused Not Concerned	Being physically, emotionally or financially abused Somewhat Concerned	Being physically, emotionally or financially abused Very Concerned	Being physically, emotionally or financially abused Not Applicable
Being the victim of a financial scam	Being the victim of a financial scam Not Concerned	Being the victim of a financial scam Somewhat Concerned	Being the victim of a financial scam Very Concerned	Being the victim of a financial scam Not Applicable
Driving safely or not being able to drive	Driving safely or not being able to drive Not Concerned	Driving safely or not being able to drive Somewhat Concerned	Driving safely or not being able to drive Very Concerned	Driving safely or not being able to drive Not Applicable
Falling or the fear of falling	Falling or the fear of falling Not Concerned	Falling or the fear of falling Somewhat Concerned	Falling or the fear of falling Very Concerned	Falling or the fear of falling Not Applicable
Feeling lonely or being alone	Feeling lonely or being alone Not Concerned	Feeling lonely or being alone Somewhat Concerned	Feeling lonely or being alone Very Concerned	Feeling lonely or being alone Not Applicable
Having enough money in retirement	Having enough money in retirement Not Concerned	Having enough money in retirement Somewhat Concerned	Having enough money in retirement Very Concerned	Having enough money in retirement Not Applicable
Losing your memory or having dementia	Losing your memory or having dementia Not Concerned	Losing your memory or having dementia Somewhat Concerned	Losing your memory or having dementia Very Concerned	Losing your memory or having dementia Not Applicable
Maintaining and repairing your home	Maintaining and repairing your home Not Concerned	Maintaining and repairing your home Somewhat Concerned	Maintaining and repairing your home Very Concerned	Maintaining and repairing your home Not Applicable
Obtaining or understanding benefits (Social Security, Medicare, Medicaid)	Obtaining or understanding benefits (Social Security, Medicare, Medicaid) Not Concerned	Obtaining or understanding benefits (Social Security, Medicare, Medicaid) Somewhat Concerned	Obtaining or understanding benefits (Social Security, Medicare, Medicaid) Very Concerned	Obtaining or understanding benefits (Social Security, Medicare, Medicaid) Not Applicable
Providing care to a spouse, partner or other loved one	Providing care to a spouse, partner or other loved one Not Concerned	Providing care to a spouse, partner or other loved one Somewhat Concerned	Providing care to a spouse, partner or other loved one Very Concerned	Providing care to a spouse, partner or other loved one Not Applicable
Raising a grandchild or grandchildren	Raising a grandchild or grandchildren Not Concerned	Raising a grandchild or grandchildren Somewhat Concerned	Raising a grandchild or grandchildren Very Concerned	Raising a grandchild or grandchildren Not Applicable
The amount of clutter or belongings in your home	The amount of clutter or belongings in your home Not Concerned	The amount of clutter or belongings in your home Somewhat Concerned	The amount of clutter or belongings in your home Very Concerned	The amount of clutter or belongings in your home Not Applicable

Question Title

* How often do you:

	Never	Sometimes	Often	Not Applicable
Attend community activities or events	Attend community activities or events Never	Attend community activities or events Sometimes	Attend community activities or events Often	Attend community activities or events Not Applicable
Depend on someone else to drive you somewhere	Depend on someone else to drive you somewhere Never	Depend on someone else to drive you somewhere Sometimes	Depend on someone else to drive you somewhere Often	Depend on someone else to drive you somewhere Not Applicable
Feel lonely or isolated	Feel lonely or isolated Never	Feel lonely or isolated Sometimes	Feel lonely or isolated Often	Feel lonely or isolated Not Applicable
Visit with friends or family	Visit with friends or family Never	Visit with friends or family Sometimes	Visit with friends or family Often	Visit with friends or family Not Applicable
Volunteer in the community	Volunteer in the community Never	Volunteer in the community Sometimes	Volunteer in the community Often	Volunteer in the community Not Applicable

Question Title

* Do you:

	No	Yes	Not Applicable
Actively move about or exercise daily	Actively move about or exercise daily No	Actively move about or exercise daily Yes	Actively move about or exercise daily Not Applicable
Eat fruits and vegetables daily	Eat fruits and vegetables daily No	Eat fruits and vegetables daily Yes	Eat fruits and vegetables daily Not Applicable
Go to the dentist at least once a year	Go to the dentist at least once a year No	Go to the dentist at least once a year Yes	Go to the dentist at least once a year Not Applicable
Go to the doctor at least once a year	Go to the doctor at least once a year No	Go to the doctor at least once a year Yes	Go to the doctor at least once a year Not Applicable

Question Title

* Do you have difficulty paying for:

	No	Yes	Not Applicable
Assistive devices (hearing aids, eye glasses)	Assistive devices (hearing aids, eye glasses) No	Assistive devices (hearing aids, eye glasses) Yes	Assistive devices (hearing aids, eye glasses) Not Applicable
Dental care including cleanings, extractions	Dental care including cleanings, extractions No	Dental care including cleanings, extractions Yes	Dental care including cleanings, extractions Not Applicable
Enough food to eat	Enough food to eat No	Enough food to eat Yes	Enough food to eat Not Applicable
Fresh/healthy food to eat (fruits, vegetables)	Fresh/healthy food to eat (fruits, vegetables) No	Fresh/healthy food to eat (fruits, vegetables) Yes	Fresh/healthy food to eat (fruits, vegetables) Not Applicable
Healthcare including doctor visits or hospitalizations	Healthcare including doctor visits or hospitalizations No	Healthcare including doctor visits or hospitalizations Yes	Healthcare including doctor visits or hospitalizations Not Applicable
Medication	Medication No	Medication Yes	Medication Not Applicable
Rent, mortgage or property taxes	Rent, mortgage or property taxes No	Rent, mortgage or property taxes Yes	Rent, mortgage or property taxes Not Applicable
Transportation (gas, insurance, repairs, public transit)	Transportation (gas, insurance, repairs, public transit) No	Transportation (gas, insurance, repairs, public transit) Yes	Transportation (gas, insurance, repairs, public transit) Not Applicable
Utilities (heating, cooling, water)	Utilities (heating, cooling, water) No	Utilities (heating, cooling, water) Yes	Utilities (heating, cooling, water) Not Applicable

Question Title

* How difficult is it for you to:

	Not difficult	Somewhat difficult	Very difficult	Someone does this for me	Not Applicable
Clean the house	Clean the house Not difficult	Clean the house Somewhat difficult	Clean the house Very difficult	Clean the house Someone does this for me	Clean the house Not Applicable
Do the laundry	Do the laundry Not difficult	Do the laundry Somewhat difficult	Do the laundry Very difficult	Do the laundry Someone does this for me	Do the laundry Not Applicable
Enter and/or exit your home	Enter and/or exit your home Not difficult	Enter and/or exit your home Somewhat difficult	Enter and/or exit your home Very difficult	Enter and/or exit your home Someone does this for me	Enter and/or exit your home Not Applicable
Get dressed	Get dressed Not difficult	Get dressed Somewhat difficult	Get dressed Very difficult	Get dressed Someone does this for me	Get dressed Not Applicable
Handle paperwork/pay bills	Handle paperwork/pay bills Not difficult	Handle paperwork/pay bills Somewhat difficult	Handle paperwork/pay bills Very difficult	Handle paperwork/pay bills Someone does this for me	Handle paperwork/pay bills Not Applicable
Manage your medication	Manage your medication Not difficult	Manage your medication Somewhat difficult	Manage your medication Very difficult	Manage your medication Someone does this for me	Manage your medication Not Applicable
Prepare a meal	Prepare a meal Not difficult	Prepare a meal Somewhat difficult	Prepare a meal Very difficult	Prepare a meal Someone does this for me	Prepare a meal Not Applicable
Shop for groceries	Shop for groceries Not difficult	Shop for groceries Somewhat difficult	Shop for groceries Very difficult	Shop for groceries Someone does this for me	Shop for groceries Not Applicable
Shovel snow or complete yard work	Shovel snow or complete yard work Not difficult	Shovel snow or complete yard work Somewhat difficult	Shovel snow or complete yard work Very difficult	Shovel snow or complete yard work Someone does this for me	Shovel snow or complete yard work Not Applicable
Take a shower or bath	Take a shower or bath Not difficult	Take a shower or bath Somewhat difficult	Take a shower or bath Very difficult	Take a shower or bath Someone does this for me	Take a shower or bath Not Applicable

Question Title

* Please rate the following:

	Poor	Fair	Good	Excellent	Not applicable
Your overall physical health	Your overall physical health Poor	Your overall physical health Fair	Your overall physical health Good	Your overall physical health Excellent	Your overall physical health Not applicable
Your overall mental health	Your overall mental health Poor	Your overall mental health Fair	Your overall mental health Good	Your overall mental health Excellent	Your overall mental health Not applicable
Your overall oral health	Your overall oral health Poor	Your overall oral health Fair	Your overall oral health Good	Your overall oral health Excellent	Your overall oral health Not applicable
Your ability to live life with quality and dignity	Your ability to live life with quality and dignity Poor	Your ability to live life with quality and dignity Fair	Your ability to live life with quality and dignity Good	Your ability to live life with quality and dignity Excellent	Your ability to live life with quality and dignity Not applicable
Your community as a place to age well	Your community as a place to age well Poor	Your community as a place to age well Fair	Your community as a place to age well Good	Your community as a place to age well Excellent	Your community as a place to age well Not applicable