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Fiscal Year 2027-2029 Multi-Year Plan
CAREGIVER SURVEY
Thank you for taking the time to complete this survey. We value your input on the needs of the community to help you continue to care for your loved one.
Every three years, Region IV Area Agency on Aging (AAA) develops a Multi-Year Plan to outline the services and activities it will fund, develop, and/or advocate for when accessing federal, state, and local funding. This Community Needs Assessment Survey will assist AAA to focus its resources and energies on the most important needs of the community. In addition, it will help shape the agency’s program development and advocacy efforts.
At the end of the survey there are demographic questions. We’re asking more about you to understand who is taking this survey. Inclusion and representation are crucial to our work. Every person brings unique strengths to our community. Learning more about your identity helps us better understand who we are serving and helps us take actions that meet the unique needs of our neighbors. You may skip any question at any time.
This survey should take 15-20 minutes to complete. All individual responses are confidential. All questions are optional. However, input is encouraged to help inform AAA efforts.
If you have any questions or would like additional information on available services, please contact:
Region IV Area Agency on Aging
800-654-2810
1.
When you have a problem that requires services where do you go to find out about services.
Please check all that apply.
211
Area Agency on Aging/Campus for Creative Aging
Community Newsletter
Doctor
Faith Community
Friend/Neighbor
Internet
Library
Local Health Department
Local Senior Center
Newspaper
Relative
Social Media
Television/Radio
I haven’t needed information or services
Other
2.
What do you believe are the five biggest unmet needs faced by older adults and persons with disabilities in your community?
Please check no more than five.
Adult Day Programming
Affordable Housing
Caregiver Education, Support & Training
Chronic Condition Care
Dementia Education & Support
Elder Abuse Prevention
Emergency Needs (help to pay for goods or services in a personal emergency)
Food or Nutritious Food Options
Help in Applying for Public Benefits
Health and Wellness Classes
Health Insurance Options Counseling
Home Maintenance/Chore Services
Home Repair/Modifications
Information about Senior Services
Legal Assistance
Long-Term Care Options Counseling
Long-Term Care Ombudsman (advocacy and education for nursing home residents of their rights; investigate, resolve and report complaints on behalf of nursing home residents)
Personal Care Assistance (help with daily care and light household tasks)
Respite Services (a break from caregiving)
Senior Centers
Social Engagement/Activities for Older Adults
Support for Adults with Disabilities
Support for Older Adults Raising Children 18 or Younger
Tax Assistance
Transportation
Other
3.
What kind of care do you provide?
Please check all that apply.
Cooking, cleaning, or other household chores
Dressing, bathing, toileting, or other personal care
Managing financial or legal matters
Managing medications or medical care
Running errands, shopping, or transportation
Socialization
Other health concerns
4.
Have you felt physically, emotionally, or financially strained by caregiving?
Yes
No
5.
Have you been able to get advice or support for yourself as a caregiver?
Yes
No
6.
Do you have family members or friends living nearby who you can ask for help or support if you need it?
Yes
No
7.
Are you able to access respite services or have someone care for the person needing assistance so you can take a break?
Yes
No
8.
If you have not accessed advice, support, and/or adequate respite services, what prevents you from doing so?
Please check all that apply.
You have no trouble accessing advice, support or respite care
You can’t afford to pay for assistance
You can’t find a provider
You are concerned about the quality of respite care
Support or assistance is too far away
You have been placed on a waiting list
You are too overwhelmed to seek help
You don’t know where to go to get assistance
Other
9.
What type of respite service do you use, or would you like to access?
In-home respite
Out-of-home respite
Adult Day programs
I don’t need or want respite services
10.
Do you have access to the Internet in your home?
Yes
No
11.
How often do you use email?
Every day
Three or four times a week
About once a week
Once a month
I rarely use email
I don’t have an email address
12.
How do you prefer to receive information about services and resources?
Please select one response.
Phone
Email
U.S. Mail
Social Media (Facebook, Instagram, etc.)
Other - Please describe
13.
Which county do you live in?
Berrien
Cass
Van Buren
14.
What is your zip code?
15.
What is your age?
16.
What is your gender?
Please check all that apply.
Female
Male
Non-binary
Prefer not to answer
Prefer to self-describe
17.
How do you describe your sexual orientation or sexual identity?
Please check all that apply.
Asexual
Bisexual
Heterosexual/Straight
Homosexual/Gay/Lesbian
Queer
Questioning or Unsure
Prefer not to answer
Prefer to self-describe
18.
Are you Spanish, Hispanic, or Latinx?
Yes
No
19.
Which of the following best describes you?
Please check all that apply.
American Indian or Alaska Native
Asian or Asian American
Black or African American
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White or Caucasian
Prefer not to answer
Prefer to self-describe
20.
What is your annual household income?
Less than $15,000
$15,000 - $24,999
$25,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000+
Prefer not to answer
21.
Please provide any additional comments here:
Thank you for completing the survey! We truly appreciate your input!
