Millet Senior Housing Need Assessment Survey

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* 2. What is your age range?

under 55

55 - 64

65 -74

75 - 84

85+

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* 3. If responding as a couple, what age group is your spouse or partner in?

under 44

45 - 54

55 - 64

65 - 74

75 - 84

85+

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* 4. What is your gender?

Male

Female

Non-binary

prefer not to say

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* 5. Where do you live?

In the North sector of the Town

In the South sector of the Town

I am homeless at this time

On land outside of the Town

Other (please specify)

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* 6. Check which one describes your current housing situation.

Single-family detached home

Condo or apartment

Townhouse

Secondary Suite in single-family detached home

Manufactured home

Mobile home (trailer, RV)

Sharing with friends/family

I have no permanent address

Other (please specify)

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* 7. How old is the home that you live in?

less than 10 years old

10 - 19 years old

20 - 29 years old

30 - 39 years old

40 - 49 years old

50 + years old

I have no permanent address

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* 8. How many people live in your home?

2-4

5-7

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* 9. 9. How would you rate the condition of your current home?

Great condition (no repairs)

Good condition (minor repairs needed)

Poor condition (major repairs needed)

Unliveable

I am currently homeless

10. Is your housing:

Owned without a mortgage

Owned with a mortgage

Rented/leased

Other (please specify)

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* 10. How much do you spend on housing monthly? (rent or Mortgage payments)

$0-$900

$1000-$2000

$2001-$3000

$3001-$4000

$4001-$5000

$5001-$6000

Prefer not to say

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* 11. Please estimate your household's total gross income in 2017 (before taxes) or, if you live alone, enter your personal gross income.

Under $15,000

Under $20,000

$20,001 - $40,000

$40,001 - $50,000

$50,001 - $60,000

$60,001 - $70,000

over $70,000

Prefer not to say

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* 12. Please estimate whether you spend more than 30 percent of your gross monthly income for ALL housing costs (rent, mortgage, property taxes, home insurance, utilities).

Yes

Unsure

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* 13. Do you feel your housing costs are affordable?

Yes

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* 14. Do you receive government assistance for housing?

Yes

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* 15. If yes, what type of assistance do you receive?

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* 16. Do you cut back on your food budget to pay your rent or mortgage?

Yes - sometimes

Yes - often

Yes - always

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* 17. Do you put off paying bills so you can pay your rent or mortgage?

Yes - sometimes

Yes - often

Yes - always

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* 18. Do you put off filling prescriptions so you can pay your rent or mortgage?

Yes - sometimes

Yes - often

Yes - always

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* 19. Do you or your partner/spouse have any personal limitations that might affect where you can live?

Yes

If you answered 'yes' please describe the limitation.

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* 20. Would anyone (e.g. ambulance, fire, police) have difficulty entering your current home?

Yes

If 'yes', please explain why.

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* 21. Do you feel safe in your current housing?

Yes

If 'no' why not?

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* 22. Does your present housing meet your needs at this time?

Yes

If 'no' why not?

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* 23. How long do you plan to live in your current home?

Less than 5 more years

5 - 9 more years

10 - 14 more years

As long as I can

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* 24. What reason would lead you to leave you current home?

Bills are too high

Too many repairs needed

Lonely

My current home will not meet my needs as I age

Lack of services and amenities nearby

To move closer to family

All of the above

Other (please specify)

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* 25. If you move, do you wish to remain in Millet?

Yes

Unsure

Please explain your answer

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* 26. If you move, what type of housing would you prefer to move into?

Single-family detached home

Condo or apartment

Townhouse

Secondary suite in single family-detached house

Manufactured home

Assisted or supportive living

Co-op or cohousing (e.g. shared kitchen but private bedrooms/living space

Sharing a home with friends/family

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* 27. If you move, would you prefer to

Own

Rent/lease

Other (please specify)

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* 28. Are there any other ideas or comments you would like us to consider about housing for older adults in Millet? Please share.

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* 29. How long have you lived in your current home?

Less than 5 years

5-9 years

10=14 years

15-19 years

20-24 years

25-29 years

30+ years

Millet Senior Housing Need Assessment

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* 1. Are you a resident of Millet Alberta?

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* 2. What is your age range?

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* 3. If responding as a couple, what age group is your spouse or partner in?

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* 4. What is your gender?

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* 5. Where do you live?

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* 6. Check which one describes your current housing situation.

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* 7. How old is the home that you live in?

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* 8. How many people live in your home?

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* 9. 9. How would you rate the condition of your current home?

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* 10. How much do you spend on housing monthly? (rent or Mortgage payments)

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* 11. Please estimate your household's total gross income in 2017 (before taxes) or, if you live alone, enter your personal gross income.

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* 12. Please estimate whether you spend more than 30 percent of your gross monthly income for ALL housing costs (rent, mortgage, property taxes, home insurance, utilities).

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* 13. Do you feel your housing costs are affordable?

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* 14. Do you receive government assistance for housing?

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* 15. If yes, what type of assistance do you receive?

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* 16. Do you cut back on your food budget to pay your rent or mortgage?

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* 17. Do you put off paying bills so you can pay your rent or mortgage?

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* 18. Do you put off filling prescriptions so you can pay your rent or mortgage?

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* 19. Do you or your partner/spouse have any personal limitations that might affect where you can live?

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* 20. Would anyone (e.g. ambulance, fire, police) have difficulty entering your current home?

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* 21. Do you feel safe in your current housing?

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* 22. Does your present housing meet your needs at this time?

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* 23. How long do you plan to live in your current home?

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* 24. What reason would lead you to leave you current home?

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* 25. If you move, do you wish to remain in Millet?

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* 26. If you move, what type of housing would you prefer to move into?

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* 27. If you move, would you prefer to

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* 28. Are there any other ideas or comments you would like us to consider about housing for older adults in Millet? Please share.

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* 29. How long have you lived in your current home?