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 $20,000 per year, and care in a skilled nursing facility is around $90,000 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


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

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

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

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* 4. Housing- Ability to pay rent or taxes

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* 5. Housing-Able to pay for home heating

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* 6. Transportation- To medical Appointments

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* 7. Transportation- To out of county medical Appointments

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

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* 9. Transportation- Driving my own car

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

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

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

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

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* 14. Access to senior centers

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* 15. In-Home personal care services

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

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

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

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

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

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

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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?

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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?

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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?

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

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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? 

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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?

Health

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

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

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* 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. Falls
Do you have a fear of falling?

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* 36. Falls
Have 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?

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

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* 42. Persons living in your home, including yourself

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* 43. Living Arrangements

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* 44. Income- 1 person household

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* 45. Income- 2 person household

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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, 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. 
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