Santee-Lynches is conducting a region-specific needs assessment to determine the needs of seniors in the Santee-Lynches region. Please take a moment and complete the survey so that we can find ways to better serve seniors in our area.

Section 1: Demographic Information

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* 1. Are you current receiving services from a senior center or area Agency on Aging?

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* 2. What county do you live in?

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* 3. What is your gender?

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* 4. What is your race?

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* 5. How old are you?

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* 6. What is your marital status?

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* 7. What is your monthly income?

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* 8. How many people live in your household?

Section 2: Concerns and Challenges at Home

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* 9. Which of the following items are you currently experiencing? Check all that apply.

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* 10. Which of the following items are you concerned about in regards to your ability to remain independent at home?

Section 3: FAMILY CAREGIVERS: Please answer the following questions below if you provide substantial care to a love one over the age of 60 or to anyone who has been diagnosed with dementia.

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* 11. Do you provide hands-on care for a loved one? If no, skip to Section 4.

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* 12. How many hours a week do you provide direct hands-on care?

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* 13. How many people are you currently providing hands-on care for?

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* 14. Are you currently receiving funding from the Family Caregiver Support Porgram?

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* 15. If so, would your loved one be able to remain at home without the support of the Family Caregiver Support Program?

Section 4: Senior Centers

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* 16. Does your community have a Senior Center?

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* 17. If yes, do you attend?

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