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.

* 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?
Be called?

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

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

* 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
Delivering a meal or helping the elder cook a meal
Home maintenance or routine chores
Errands: shop, bank,etc.
Socializing, talking and listening
Caregiving or Personal Care
Delivering and returning library books
Rides to medical appointments
Help with forms and taxes
Help with computers, phones and other gadgets
Yard work and gardening
Snow Removal
Reading out loud and recording textbooks for students
Recording or writing out elders' life stories or legacy letters
Teaching a skill
Drive someone in their van which has a wheelchair lift
Lend a van with a wheelchair lift

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

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

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

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

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

* 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?

* 11. What is your mailing address?

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

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

* 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.

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