Wayne Neighbors Helping Neighbors Survey

The "Aging At Home" committee of Wayne surveyed more than 100 of Wayne's elders. We learned more about what people in town need. Almost all of Wayne's elders surveyed said it is important to them to be able to stay in our town as they grow older. Now we are beginning projects designed to help elderly Wayners and people who have disabilities meet those needs so they can stay in Wayne as they age. We would like your input and/or your help. This survey is for ALL members of the Wayne community. We want to match what people in Wayne want to do for others with what is needed.

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* 1. We plan to put together a network of people to check in with elders by phone, to build connections. Would you like to:

	Yes	No
Call others?	Call others? Yes	Call others? No
Be called?	Be called? Yes	Be called? No

If so, how often?

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* 2. Who do you know who might want to be called?

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* 3. Who do you know who might want to call others?

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* 4. We want to build a list of ways that people in town want to help others as volunteers, and also a list of local services seniors would pay for. For Wayne people of all ages (including youth and elders): what would you like to do for others? Do you want to do these things as a volunteer or for pay?

	I would like to do this as a community volunteer	I would do this for pay
Make home modifications like ramps, bright lighting, or grab bars	Make home modifications like ramps, bright lighting, or grab bars I would like to do this as a community volunteer	Make home modifications like ramps, bright lighting, or grab bars I would do this for pay
Delivering a meal or helping the elder cook a meal	Delivering a meal or helping the elder cook a meal I would like to do this as a community volunteer	Delivering a meal or helping the elder cook a meal I would do this for pay
Home maintenance or routine chores	Home maintenance or routine chores I would like to do this as a community volunteer	Home maintenance or routine chores I would do this for pay
Housecleaning	Housecleaning I would like to do this as a community volunteer	Housecleaning I would do this for pay
Errands: shop, bank,etc.	Errands: shop, bank,etc. I would like to do this as a community volunteer	Errands: shop, bank,etc. I would do this for pay
Socializing, talking and listening	Socializing, talking and listening I would like to do this as a community volunteer	Socializing, talking and listening I would do this for pay
Caregiving or Personal Care	Caregiving or Personal Care I would like to do this as a community volunteer	Caregiving or Personal Care I would do this for pay
Delivering and returning library books	Delivering and returning library books I would like to do this as a community volunteer	Delivering and returning library books I would do this for pay
Rides to medical appointments	Rides to medical appointments I would like to do this as a community volunteer	Rides to medical appointments I would do this for pay
Help with forms and taxes	Help with forms and taxes I would like to do this as a community volunteer	Help with forms and taxes I would do this for pay
Help with computers, phones and other gadgets	Help with computers, phones and other gadgets I would like to do this as a community volunteer	Help with computers, phones and other gadgets I would do this for pay
Yard work and gardening	Yard work and gardening I would like to do this as a community volunteer	Yard work and gardening I would do this for pay
Snow Removal	Snow Removal I would like to do this as a community volunteer	Snow Removal I would do this for pay
Reading out loud and recording textbooks for students	Reading out loud and recording textbooks for students I would like to do this as a community volunteer	Reading out loud and recording textbooks for students I would do this for pay
Recording or writing out elders' life stories or legacy letters	Recording or writing out elders' life stories or legacy letters I would like to do this as a community volunteer	Recording or writing out elders' life stories or legacy letters I would do this for pay
Teaching a skill	Teaching a skill I would like to do this as a community volunteer	Teaching a skill I would do this for pay
Drive someone in their van which has a wheelchair lift	Drive someone in their van which has a wheelchair lift I would like to do this as a community volunteer	Drive someone in their van which has a wheelchair lift I would do this for pay
Lend a van with a wheelchair lift	Lend a van with a wheelchair lift I would like to do this as a community volunteer	Lend a van with a wheelchair lift I would do this for pay

What else would you like to do for others?

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* 5. If you are 60 or older, which of these supports would help you? You may check as many answers as you want to.

Home modifications like ramps, brighter lighting, or grab bars

Meals delivered or help cooking a meal

Home maintenance or routine chores

Housecleaning

Errands: shop, bank,etc.

Socializing, talking and listening

Caregiving or Personal care

Library outreach

Rides to medical appointments

Help with forms and taxes

Help with computers, phones and other gadgets

Yard work and gardening

Snow Removal

Having someone help you record or write out your life stories or a legacy letter

Learning or relearning a skill

What else would you like to find help with?

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* 6. Which activities would you like to see happening in Wayne? You may check as many as you want.

Cribbage and other card games

Movies

Pot luck meals

Speakers on educational topics

Coffee and snack times

Travelogues with pictures by local travelers

Live music

What else?

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* 7. What are the best times for community events for you? You may check as many as you want.

Mornings during the week

Afternoons during the week

Evenings during the week

Weekend days

Weekend evenings

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* 8. Would you need a ride to community events?

Yes

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* 9. Would you like to find someone to go to events with you?

Yes

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* 10. We are asking for your name and address so we can create a directory of local volunteer and paid services and match those services to those who would use them. Your name and contact information will not be shared with any business or organization.

What is your name?

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* 11. What is your mailing address?

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* 12. (optional) What is your phone number?

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* 13. (optional) what is your email address?

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* 14. What is the best way for us to get in touch with you? You may contact our outreach co-ordinator Pam Chenea at 685 9378 if you have questions now or in the future about these subjects or if you would like a home visit from Pam.

Mail

Phone

Other (please specify)

If you are completing this form on paper, please drop it off at the town office or the library or mail it to Pam Chenea at 61 Moose Run Rd, Wayne ME 04284

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* 1. We plan to put together a network of people to check in with elders by phone, to build connections. Would you like to:

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* 2. Who do you know who might want to be called?

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* 3. Who do you know who might want to call others?

Question Title

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* 5. If you are 60 or older, which of these supports would help you? You may check as many answers as you want to.

Question Title

* 6. Which activities would you like to see happening in Wayne? You may check as many as you want.

Question Title

* 7. What are the best times for community events for you? You may check as many as you want.

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* 8. Would you need a ride to community events?

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* 9. Would you like to find someone to go to events with you?

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* 10. We are asking for your name and address so we can create a directory of local volunteer and paid services and match those services to those who would use them. Your name and contact information will not be shared with any business or organization.What is your name?

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* 11. What is your mailing address?

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* 12. (optional) What is your phone number?

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* 13. (optional) what is your email address?

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* 14. What is the best way for us to get in touch with you? You may contact our outreach co-ordinator Pam Chenea at 685 9378 if you have questions now or in the future about these subjects or if you would like a home visit from Pam.

* 10. We are asking for your name and address so we can create a directory of local volunteer and paid services and match those services to those who would use them. Your name and contact information will not be shared with any business or organization.

What is your name?