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1. I am always able to find a ride when I need to go somewhere.

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2. Do you face any of the challenges listed below when traveling to an appointment, event or community location? (select all that apply)

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3. I like where I live. I live in a safe and affordable place.

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4. Are the following available in your community?

  Yes No Not Sure
Affordable home repair contractors who are trustworthy, and do quality work
Seasonal services such as lawn work or snow removal which are affordable
Affordable housing options (such as active adult communities, assisted living and communities with shared facilities and outdoor spaces)
Homes that are equipped with features such as no-step entry, wider doorways, first floor bedroom and bath, grab bars in bathrooms
A low-cost or free home repair service

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5. How important is it to you to be able to remain in your home as you age?

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6. How important is it to you to be able to remain in your neighborhood as you age?

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7. How important is it to you to be able to remain in Stark County as you age?

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8. I feel respected by the people in my community.

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9. Do you agree with the following statements?

  Strongly Disagree Disagree Not Sure Agree Strongly Agree
Older persons are generally treated with respect
Older persons are valued in the community
People with disabilities are treated with respect
There are negative stereotypes about older adults

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10. It was easy to go to social events in my community.

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11. Indicate how often you feel the way described

  Never Rarely Sometimes Always
How often do you feel that you lack companionship?
How often do you feel alone?
How often do you feel that you are no longer close to anyone?
How often do you feel left out?
How often do you feel that no one really knows you well?
How often do you feel that people are around you but not with you?

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12. Sidewalks, parks and public buildings where I live are clean, safe and easy to get to.

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13. Where you live, do you have access to the following?

  Yes No Not Sure
Well-maintained and safe parks that are within walking distance of your home
Neighborhood watch programs, block clubs, or ward or police district meetings
Well-lit public streets and walkways
Recreation or wellness activities

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14. Do you agree with the following statements?

  Yes No Not Sure
Sidewalks are uneven or unsafe
Pedestrian crossings are difficult to navigate
There are no sidewalks where I want to walk

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15. I know how to find information when I need it.

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16. Do you have access to community information through the following?

  Yes No Not Sure
By the phone through one central source
Printed information you can clearly read
Internet and computers
Information delivered in person
Information delivered in your language

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17. Visiting a doctor or going to a hospital is easy and affordable.

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18. Please answer the following:

  Yes No Not Sure Sometimes
Can you afford your medical bills without sacrificing other necessities?
Can you afford your prescriptions without sacrificing other necessities?
Can you afford your utility bills without sacrificing other necessities?

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19. Are the following available in your community?

  Yes No Not Sure
Service provider who will come to your home?
Health and wellness programs and classes in areas such as nutrition, smoking cessation, and weight control
Places where you can socialize or attend programs (i.e. library, community center)

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20. There are lots of opportunities for people 50 years and over to work and volunteer.

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21. What is your employment status?

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22. Where you live, do you have access to the following?

  Yes No Not Sure
Job training or skill building opportunities for older adults
Jobs that are a good fit for my skills and abilities
Places to find out about available jobs
Professional networking opportunities for older adults
Help with resume writing, online applications, interview practice, etc.

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23. Where you live, do you have access to the following?

  Yes No Not Sure
A range of volunteer options for individuals with a variety of physical abilities and interests
Opportunities for older adults to participate in decision making bodies such as community councils or committees
Easy to find information about local volunteer opportunities
Transportation to/from volunteer activities for those who need it
Opportunities to discuss issues that impact older adults in my community

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24. What are some challenges that people living in long-term care facilities in Stark County experience?

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25. What would you like to see change for people in Stark County living in long-term care facilities?

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26. What is your date of birth?

Date

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27. What is your race/ethnicity? Please select all that apply.

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28. Do you rent or own?

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29. What is your current gender identity?

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30. What is your annual household income?

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31. What is your zip code?

T