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Public Hearing 2010-2011
3.
Default Section
*
1.
In which county do you live?
(Required.)
Baker County, FL
Clay County, FL
Duval County, FL
Flagler County, FL
Nassau County, FL
St. Johns County, FL
Volusia County, FL
Other Florida County
Outside Florida
2.
Are you
over age 60
a family or unpaid caregiver
a paid caregiver
employeed in the aging field
Other
Other (please specify)
3.
How would you rate the following as needs of older adults living in your community:
No Need
Limited Need
Moderate Need
Great Need
Adult Day Care
No Need
Limited Need
Moderate Need
Great Need
Caregiver Support
No Need
Limited Need
Moderate Need
Great Need
Assistance with Chores
No Need
Limited Need
Moderate Need
Great Need
Gerontological Counseling
No Need
Limited Need
Moderate Need
Great Need
Mental Health Counseling
No Need
Limited Need
Moderate Need
Great Need
Emergency Response (push button for help)
No Need
Limited Need
Moderate Need
Great Need
Meals Delivered to Home
No Need
Limited Need
Moderate Need
Great Need
Assistance with Housekeeping
No Need
Limited Need
Moderate Need
Great Need
Assistance with Personal Care
No Need
Limited Need
Moderate Need
Great Need
Housing Modifications
No Need
Limited Need
Moderate Need
Great Need
Legal Assistance
No Need
Limited Need
Moderate Need
Great Need
Nutritional Education
No Need
Limited Need
Moderate Need
Great Need
Respite (relief for primary caregiver)
No Need
Limited Need
Moderate Need
Great Need
Assistance with Shopping
No Need
Limited Need
Moderate Need
Great Need
Transportation
No Need
Limited Need
Moderate Need
Great Need
Comments
4.
How would you rate the following as needs of the caregivers of older adults living in your community:
No Need
Limited Need
Moderate Need
Great Need
Caregiver Support and Education
No Need
Limited Need
Moderate Need
Great Need
Respite (relief for primary caregiver)
No Need
Limited Need
Moderate Need
Great Need
Adult Day Care for the Senior
No Need
Limited Need
Moderate Need
Great Need
Legal Assistance
No Need
Limited Need
Moderate Need
Great Need
Meals Delivered to Home for the Senior
No Need
Limited Need
Moderate Need
Great Need
Nutritional Education for the Senior
No Need
Limited Need
Moderate Need
Great Need
Assistance to the Senior with Chores
No Need
Limited Need
Moderate Need
Great Need
Assistance to the Senior with Housekeeping
No Need
Limited Need
Moderate Need
Great Need
Assistance to the Senior with Personal Care
No Need
Limited Need
Moderate Need
Great Need
Home Modifications to adapt for the Senior
No Need
Limited Need
Moderate Need
Great Need
Emergency Response (push button for help)
No Need
Limited Need
Moderate Need
Great Need
Assistance to the Senior with Shopping
No Need
Limited Need
Moderate Need
Great Need
Transportation for the Senior
No Need
Limited Need
Moderate Need
Great Need
Comments
5.
We welcome any additional comments:
If you would like a response, please include your email address or phone number.
