Skip to content
Catholic Assisted Living Preference Survey - Parish Copy
1.
Please answer the first question to begin the survey: How old are you?
Under 65
65-74
75-84
85+
2.
What is your gender?
Male
Female
3.
What is your Religious Affiliation?
Roman Catholic
Other Christian
Other Religion
No religious affiliation
4.
How often do you attend Mass or religious services?
Weekly
Monthly
Occasionally
Rarely
Never
5.
Are you currently a member of a Catholic parish?
Yes
No
6.
Who is completing this questionnaire?
I am a senior who may consider living in an assisted living community
I am an adult child or family member answering on behalf of a senior
Other
7.
If you are a family member: How important is faith to your loved one in choosing an assisted living facility?
Very important
Somewhat important
Neutral
Not so important
Unsure
8.
How important is it for your assisted living facility to reflect your Catholic faith?
Very important
Somewhat important
Neutral
Not important
9.
Which of the following Catholic services would you value in a facility? (Check all that apply)
On-Site Mass
Access to a chapel
Visits from clergy
Rosary groups
Catholic holidays and feast days observed
Catholic-based counseling or spiritual care
10.
Would you feel more comfortable in a community where staff and residents share your faith?
Yes
No
Not sure
11.
Do you believe a Catholic facility would better support your emotional and spiritual well-being?
Yes
No
Neutral
12.
How far would you be willing to travel or relocate for a Catholic-based senior housing community?
Within 5 miles
5-15 miles
15-30 miles
More than 30 miles
13.
How far would you be willing to travel or relocate for a NON-Catholic based senior housing community?
Within 5 miles
5-15 miles
15-30 miles
More than 30 miles
14.
Have you ever lived in or visited a secular assisted living facility?
Yes
No
15.
If yes, what did you feel was missing in terms of faith or spiritual support?
16.
Would you be willing to pay more for a Catholic-based assisted living facility that offers faith-centered services?
Yes
No
Depends on cost
17.
If you have any other questions, comments or suggestions please write them below.