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

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* 2. Do you

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* 3. How many people live in your household including yourself?

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* 4. Are you

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* 5. What is the age group of those in your household:

  Under 55 55-64 65-74 75-84 85+ N/A
Yourself
Spouse/Partner
Other (s)

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* 6. How would you describe your general state of health?

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* 7. How would you rate the availability of health care in Portland?

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* 8. Do you have family, friends or others living in the area you can call on for help if needed?

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* 9. About how often do you get together in person with friends, family or neighbors?

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* 10. If/when you are no longer driving, how would you get around town?

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* 11. Do you find it difficult to walk in your neighborhood?

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* 12. Is it hard to find reliable and affordable services for home maintenance, repairs or improvements?

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* 13. What type of improvements might you need so that you can stay in your home as you get older? (e.g. grab bars, ramps, handrails

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* 14. How likely are you to make each of the following choices in future?

  Likely Unlikely Unsure
A. Renovate my home to meet my needs
B. Buy a smaller or better designed home
C. Rent an apartment or house
D. Move to housing with home/yard maintenance provided
E. Move to housing with dining & housekeeping services
F. Move to housing with personal care services
G.Move to affordable senior housing

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* 15. How likely is it that you will still be a West End resident ten years from now?

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* 16. Do you see a need for yourself, now or in future, for the following services:

  Now Later No thanks
A. Local office to provide information on available services
B. Community Center for all ages
C. Community Center for seniors only
D. Regularly scheduled social activities such as cards, dancing, crafts*
E. Wellness classes and programs
F. Personal enrichment programs/continuing education
G. Opportunities to serve as a volunteer
H. Opportunities to receive assistance from volunteers
I. Outdoor walking and other exercise opportunities
J. Indoor exercise opportunities
K. Accessible transportation on request
L. Affordable/downsized housing
M. Information on approved/rated home repair contractors
N. Adult day care service in Portland

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* 17. Please describe any other facilities or services not mentioned above that would help you remain in the West End as you age

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* 18. Which of the following services would aid you and help in your decision to remain in your home?

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* 19. What are your three greatest concerns about staying in your current home?

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* 20. To what extent do you agree with the following statements?

  Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree
It is important for me to remain in the West End as I age.
I want to be active and engaged as I continue to age in my home.

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* 21. Thinking about yourself or family members, what else would be helpful for us to know, as you consider aging in your home, and in the West End?

 
100% of survey complete.

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