Herkimer County Older Resident Survey

Herkimer County Older Resident Community Survey

Dear Herkimer County Resident,

As a valuable member of our community, Herkimer County Office for Aging is interested in hearing what you have to say about what is important to you about living in Herkimer County. Our mission is to help make Herkimer County a great place for older adults. Specifically, we’re interested in what is important to you in order to live here in Herkimer County, safely and happily.

We would like your help in determining the services that are important to enabling you to live independently in your community. Nationwide, the cost of assisted living is now over $51,000 per year, and care in a skilled nursing facility is around $110,000 annually. In communities where services are not readily available, nursing homes may be the only option for older adults who need care, even though a older adult may prefer to remain at home, and may be able to do so, with various kinds of supports in place.

Our hope is that you will assist us in determining what kinds of services are important and necessary in our community to support our residents as they age, by taking a moment to complete the brief survey that is attached.

At the end of the survey, there are some personal questions that will assist us in planning, but we assure you that we will not know who returned the survey, and your identity will not be known to us, unless you share that information so that we may contact you with information.

If you have any questions, please feel free to contact me. I’m available during weekdays at 315-867-1121, or by email at hcofa@herkimercounty.org. If you need assistance completing the survey, please call us and we can assist. Thank you in

advance for helping to make Herkimer County a better place to live for older residents!

Sincerely,

Kathy L. Fox
Herkimer County AAA Director

Question Title

* 1. Please enter the zip code where you reside:

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* 2. Housing- Able to perform household chores (cleaning, etc.)

Important, is a concern

Important, but NOT a concern

Not important, not a concern

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* 3. Housing- Finding reliable help to perform home maintenance/repairs

Important, is a concern

Important, but is NOT a concern

Not important, not a concern

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* 4. Housing- Ability to pay rent or taxes

Important, is a concern

Important, but NOT a concern

Important, not a concern

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* 5. Housing-Able to pay for home heating

Important, is a concern

Important, but NOT a concern

Important, not a concern

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* 6. Transportation- To medical Appointments

Important, is a concern

Important, but is NOT a concern

Not important, Not a concern

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* 7. Transportation- To out of county medical Appointments

Important, is a concern

Important, but is NOT a concern

Not important, Not a concern

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* 8. Transportation- To the grocery store and other errands

Important, is a concern

Important, but is NOT a concern

Not important, Not a concern

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* 9. Transportation- Driving my own car

Important, is a concern

Important, but is NOT a concern

Not important, Not a concern

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* 10. Nutrition/Food- Have enough money for nutritious food

Important, is a concern

Important, but NOT a concern

Not important, not a concern

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* 11. Nutrition/Food- Being able to shop and cook for myself

Important, is a concern

Important, but NOT a concern

Not important, not a concern

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* 12. Nutrition/Food- Able to follow a special diet recommended by my doctor

Important, is a concern

Important, but NOT a concern

Not important, not a concern

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* 13. Respite services for caregivers, such as adult day programs, for people with dementia or other functional impairements

Important and Satisfied

Important and Not Satisfied

Not Important and Satisfied

N/A

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* 14. Access to senior centers

Important and Satisfied

Important and Not Satisfied

Not Important and Satisfied

N/A

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* 15. In-Home personal care services

Important and Satisfied

Important and Not Satisfied

Not Important and Satisfied

N/A

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* 16. Ability to participate in Congregate Meal Sites or receive Home Delivered Meals

Important and Satisfied

Important and Not Satisfied

Not Important and Satisfied

N/A

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* 17. Ability to obtain help in applying for government programs

Important and Satisfied

Important and Not Satisfied

Not Important and Satisfied

N/A

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* 18. Elder Abuse-Scams-Financial Exploitation
Are you or anyone you know a victim of abuse?

Yes

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* 19. Elder Abuse-Scams-Financial Exploitation
If yes, did you or the victim seek assistance?

Yes

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* 20. Elder Abuse-Scams-Financial Exploitation
Are you or anyone that you know been a victim of a scam?

Yes

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* 21. Elder Abuse-Scams-Financial Exploitation
Have you or anyone that you know had money taken without your permission?

Yes

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* 22. Elder Abuse-Scams-Financial Exploitation
Do you know where to get assistance if you have been a victim of abuse, a scam, or financial exploitation?

Yes

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* 23. Elder Abuse-Scams-Financial Exploitation
If you answered yes, where would you get assistance?

If you are caring for another individual, please answer the following questions.

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* 24. For whom do you provide care?

Spouse

Parent

Adult child (over 21)

Minor child (20 or younger)

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* 25. Does the individual for who you care live with you?

Yes

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* 26. Does the individual you care for have memory problems and/or dementia?

Yes

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* 27. Do you feel overwhelmed and/or stressed in providing care?

Yes

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* 28. Where I turn for help:
If you, or someone you know has been in the hospital in the past year, did you/they have the information and supports needed to return home?

Yes

N/A

Don't know

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* 29. Have you heard of "NY Connects", the local program that helps consumers with information, assistance and connections to needed long term services and supports?

Yes

N/A

Health

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* 30. Are you or someone that you are caring for managing any ongoing health condition?

Yes

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* 31. Do you feel overwhelmed and/or stressed due to this condition?

Yes

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* 32. Are you or someone that you are living with experienced?
Check all that apply

Loss of a partner

Loss of housing

Difficulty managing everyday activities

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* 33. Have you felt sad in the last 6 months?

Yes

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* 34. If you answered yes to the last question, did you seek assistance?

Yes

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* 35. Falls
Do you have a fear of falling?

Yes

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* 36. Falls
Have you fallen in the last 6 months?

Yes

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* 37. Legal Services- Did you need Legal Assistance in the last 6 months?

Yes

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* 38. If yes, what types of services did you need?

Will/Power of Attorney

Credit/Financial issue

Housing/Real Property

Medical Bills

Family Court

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* 39. Where did you receive Legal Services?

Office for the Aging Legal Services

Legal Aid Society

Private Attorney

Demographics (This information will be kept in strict confidentiality, used only for statistical purposes)

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* 40. Age

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* 41. Sex

Male

Female

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* 42. Persons living in your home, including yourself

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* 43. Living Arrangements

Homeowner

Renter

Other

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* 44. Income- 1 person household

Under $11,491

Between $11,491 and $22,980

more than $22,980

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* 45. Income- 2 person household

Under $15,510

Between $15,510 and $31,020

More than $31,020

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* 46. Is there anything else you'd like to tell the Office for the Aging as they plan for future services in Herkimer County?

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* 47. If you would like to be contacted by our office to discuss available programs and services for older Herkimer County residents or you would like your name entered into the gift card drawing, please fill in your name, address, phone number and/or e-mail.

Thank you for your help. Please do not hesitate to contact us with questions at (315) 867-1121.

Herkimer County Older Resident Survey

Herkimer County Older Resident Community Survey

Question Title

* 1. Please enter the zip code where you reside:

Question Title

* 2. Housing- Able to perform household chores (cleaning, etc.)

Question Title

* 3. Housing- Finding reliable help to perform home maintenance/repairs

Question Title

* 4. Housing- Ability to pay rent or taxes

Question Title

* 5. Housing-Able to pay for home heating

Question Title

* 6. Transportation- To medical Appointments

Question Title

* 7. Transportation- To out of county medical Appointments

Question Title

* 8. Transportation- To the grocery store and other errands

Question Title

* 9. Transportation- Driving my own car

Question Title

* 10. Nutrition/Food- Have enough money for nutritious food

Question Title

* 11. Nutrition/Food- Being able to shop and cook for myself

Question Title

* 12. Nutrition/Food- Able to follow a special diet recommended by my doctor

Question Title

* 13. Respite services for caregivers, such as adult day programs, for people with dementia or other functional impairements

Question Title

* 14. Access to senior centers

Question Title

* 15. In-Home personal care services

Question Title

* 16. Ability to participate in Congregate Meal Sites or receive Home Delivered Meals

Question Title

* 17. Ability to obtain help in applying for government programs

Question Title

* 18. Elder Abuse-Scams-Financial ExploitationAre you or anyone you know a victim of abuse?

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* 19. Elder Abuse-Scams-Financial ExploitationIf yes, did you or the victim seek assistance?

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* 20. Elder Abuse-Scams-Financial ExploitationAre you or anyone that you know been a victim of a scam?

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* 21. Elder Abuse-Scams-Financial ExploitationHave you or anyone that you know had money taken without your permission?

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* 22. Elder Abuse-Scams-Financial ExploitationDo you know where to get assistance if you have been a victim of abuse, a scam, or financial exploitation?

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* 23. Elder Abuse-Scams-Financial ExploitationIf you answered yes, where would you get assistance?

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* 24. For whom do you provide care?

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* 25. Does the individual for who you care live with you?

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* 26. Does the individual you care for have memory problems and/or dementia?

Question Title

* 27. Do you feel overwhelmed and/or stressed in providing care?

Question Title

* 28. Where I turn for help:If you, or someone you know has been in the hospital in the past year, did you/they have the information and supports needed to return home?

Question Title

* 29. Have you heard of "NY Connects", the local program that helps consumers with information, assistance and connections to needed long term services and supports?

Question Title

* 30. Are you or someone that you are caring for managing any ongoing health condition?

Question Title

* 31. Do you feel overwhelmed and/or stressed due to this condition?

Question Title

* 32. Are you or someone that you are living with experienced?Check all that apply

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* 33. Have you felt sad in the last 6 months?

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* 34. If you answered yes to the last question, did you seek assistance?

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* 35. FallsDo you have a fear of falling?

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* 36. FallsHave you fallen in the last 6 months?

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* 37. Legal Services- Did you need Legal Assistance in the last 6 months?

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* 38. If yes, what types of services did you need?

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* 39. Where did you receive Legal Services?

* 18. Elder Abuse-Scams-Financial Exploitation
Are you or anyone you know a victim of abuse?

* 19. Elder Abuse-Scams-Financial Exploitation
If yes, did you or the victim seek assistance?

* 20. Elder Abuse-Scams-Financial Exploitation
Are you or anyone that you know been a victim of a scam?

* 21. Elder Abuse-Scams-Financial Exploitation
Have you or anyone that you know had money taken without your permission?

* 22. Elder Abuse-Scams-Financial Exploitation
Do you know where to get assistance if you have been a victim of abuse, a scam, or financial exploitation?

* 23. Elder Abuse-Scams-Financial Exploitation
If you answered yes, where would you get assistance?

* 28. Where I turn for help:
If you, or someone you know has been in the hospital in the past year, did you/they have the information and supports needed to return home?

* 32. Are you or someone that you are living with experienced?
Check all that apply

* 35. Falls
Do you have a fear of falling?

* 36. Falls
Have you fallen in the last 6 months?