1. SWRPC Age-Focused Initiative: Community Assessment

Dear Survey Participant,

We invite you to complete the Community Assessment that has been developed as part of the Southwest NH Age-Focused Planning initiative.  This represents an effort by the Southwest Region Planning Commission in partnership with Cheshire Medical Center to collect information and develop a report on the Region's relative ability to serve and accommodate residents of all ages as well as assessments for each community within the Commission's membership.  The information collected will help us understand current conditions along with the wants and needs of residents of all age groups.  With that in mind, please respond with the understanding that some questions may be considered long term planning.  For example, if a particular question seems to have a focus on the concerns and needs for an older age group, all are encouraged to respond since the intent is to gather information that will be used for short and long term planning.  Attracting and retaining younger residents is part of this effort while also addressing the needs of older residents.

The survey will take approximately 10 minutes of your time and will provide us with valuable information in helping to complete this project.  We invite everyone in your household to participate in the survey and ask that you encourage others to participate as well.  Greater participation will ensure a more comprehensive understanding of the wants and needs of all age groups within our Region.

If you have any questions, or would like to receive additional information, please contact Lisa Murphy at (603) 357-0557 or lmurphy@swrpc.org.

Thank you for participating!

Lisa Murphy, Senior Planner
Southwest Region Planning Commission

This initiative is funded through a grant from the Tufts Health Plan Foundation and administered by Cheshire Medical Center. 

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* 1. What is your age category?

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* 3. How long have you lived in that town/city?

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* 4. How would you rate your town/city as a place for people to live as they age? (Select one choice for each age group)

  0-18 years 19-65 years 66 years and over
Excellent
Good
Fair
Poor

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* 5. How would you rate your town/city on working to attract and/or keep younger residents in town?

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* 6. How would you rate your town/city on working to keep older residents in town?

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* 7. What is your employment status? (Check all that apply)

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* 8. What concerns do you have about aging in your town/city? (Check all that apply)

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* 9. How do you typically travel to meet your daily needs? (Check all that apply)

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* 10. Please describe your physical level of mobility.

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* 11. If you find it difficult to get around and/or rarely leave your home, please check the reason(s) why. (Check all that apply)

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* 12. How would you rate your transportation options in your town/city if you were unable to drive?

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* 13. Please rate the following regarding accessibility to public buildings and parks in your town/city:

  Satisfied No Opinion Not Satisfied
Available sidewalks
Sidewalks in good condition
Ramps at the end of sidewalks
Available parking
Public parks with benches
Designated bike lanes on some roads
Sidewalks are kept free of snow and ice
Public restrooms accessible to all physical abilities
Appropriate signage and easy to read 

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* 14. Who do you live with? (Check all that apply)

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* 15. Please respond based on your current living arrangement.

  Yes No Neutral
Living space meets my needs
Living space is more than I need
Quality/condition of housing is poor/unsatisfactory
Rent/mortgage is fair price
Overall, satisfied with current housing
I rent my home/apartment
I own my home/apartment
I live with family or friends rent-free

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* 16. What type of housing do you live in?

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* 17. If you have looked for housing options in your town/city in the past 5 years, have you been able to find decent options in your affordability range?

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* 18. Describe the access to your home/apartment: (Check all that apply)

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* 19. In thinking about the future, which of the following would be reasons for your decision to remain in your town/city? (Check all that apply)

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* 20. Similar to the previous question, what might influence your decision to move out of your town/city? (Check all that apply)

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* 21. What change(s) would you like to see to improve your living experience in your town/city?

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* 22. How frequently do you do some form of physical activity? (sports, walking, running, biking, yoga, exercise, etc.)

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* 23. How frequently do you spend time socializing with family and/or friends? This interaction could be in person, phone, email, Facebook or other social media, etc.

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* 24. If you would like to socialize more, what prevents you from doing so? (Check all that apply)

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* 25. Social Activities: Please check the appropriate choice for each activity.

  Available in my community; I use frequently. Available in my community; I use sometimes (once per month or less). Available in my community; I do not use. Out of town but within reasonable distance; I use sometimes. Out of town but within reasonable distance; I do not use. Don't know
Concerts, Mixers, Socials, Dances
Theaters, Cinemas
Fitness Centers, Exercise Classes, Intermural Sports
Community Centers, Boys & Girls Clubs, YMCA (youth, young adult, family)
Senior Center, Activities for Seniors
Stores and Restaurants
Civic Service Clubs, Volunteer Organizations
Lakes, Rivers (boating, fishing, swimming, relaxing)
Parks with ball fields, and playgrounds
Nature trails and associated activities (hiking, mountain biking, snow mobiling)
Library, Book Clubs
Arts and Crafts (studios, classes, events)
Community events

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* 26. What changes could be made in your town/city to expand the social activities of interest to all ages?

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* 27. How important is it to have the following in your town/city?

  Very important Important Not important
Affordable housing choices
Employment opportunities
High speed internet
 Free access to computers and the Internet in public places
Outdoor recreational opportunities
Social activities
Transportation options
Sidewalks
Bike lanes
Shopping
Restaurants

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* 28. How do you find information about community services, news, and events? (Check all that apply)

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* 29. Do you or any member of your household have access to the Internet using the following (check all the apply)

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* 30. What are your main uses for your personal computer, laptop or smart phone? (Check all that apply)

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* 31. How would you describe your at home internet service?

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* 32. What is your annual income level?

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* 33. What is the highest level of education that you have completed?

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* 34. If you would like to receive additional information about the project, please provide your email address.

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