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* 1. In what city/town do you live?

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* 2. What township/borough do you live in?

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* 3. Do you live in Armstrong County?

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* 4. What are your living arrangements?

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* 5. Do you:

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* 6. Number of persons in household:

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* 7. Age Category:

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* 8. Gender:

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* 9. Veteran?

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* 10. Annual household income:

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* 11. Ethnicity:

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* 12. Classify yourself:

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* 13. What is the best way to get information to you or your organization and/or Armstrong County older adults?

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* 14. Have you or your organization ever contacted the Armstrong County AAA for information or referral?

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* 15. Have you or your organization ever contacted the AAA for services?

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* 16. Did you receive the information or services you requested?

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* 17. Were you satisfied with the information or services received?

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* 18. If not satisfied with information or services received, why?

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* 19. How could we improve our services?

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* 20. Do you participate in lunch and activities/programs at your local senior center?

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* 21. Please give suggestions of activities/programs you would participate in at your local Senior Center:

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* 22. Do you receive any services from the Agency on Aging?

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* 23. If you receive services from any other agency/group, please list:

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* 24. If you are 60 or older, are you:

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* 25. As someone over 60, I rate my health as:

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* 26. Do you have any of the following health diagnosis?

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* 27. Do you exercise on a regular basis?

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* 28. If yes, how many times a week do you exercise?

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* 29. How many times have you been hospitalized in the past 12 months?

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* 30. Have you been hospitalized due to a fall during the past year?

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* 31. Do you have help from family or friends when needed?

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* 32. Do you have family members residing within 15 miles from your home?

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* 33. What forms of transportation do you use?

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* 34. Do you have any of the following unmet transportation needs?

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* 35. Are you familiar with property tax/rent rebate program?

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* 36. Are you familiar with the PACE program (Prescriptions)?

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* 37. Did you know that the Armstrong Co. Area Agency on Aging can be reached at (724)548-3290 or (800)368-1066?

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* 38. Do you know that a trained care manager is available 24 hours a day for Protective Service reports (these are reports of situations of elder abuse including neglect, financial, or physical/verbal)? Protective Services Toll Free Number is (800)732-6618.

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* 39. What types of new aging services do you feel should be developed to meet the needs of the older adults in your community over the next 4 years?

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* 40. Would you be interested in volunteering in any of our Agency programs? If yes, pleae call (800)368-1066.

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* 41. Check the 3 most important concerns facing older adults over the next 4 years from your point of view:

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* 42. Check the 3 most important concerns facing older adults over the next 4 years from community view:

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* 43. Below are a listing of AAA services - rate the following:

  Adequate Not Adequate Unknown
Information & Referral
Older Worker Employment Program
Ombudsman (Long Term Care Complaints)
Protective Services (Elder Abuse)
Transportation (Center/Medical)
Center Services
Family Caregiver Support Program
Personal Care (Bathing/Grooming)
Home Support
Apprise (Insurance Counseling)
Outreach Services
Personal Assistance Services
Home Health Services
Adult Day Care
Legal Services
Placement/Domiciliary Care
Volunteer Services
Nursing Home Transition
Pre-Admission Assessment Service

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* 44. If you have any additional comments, please list them below. If you would like to speak to a staff person concerning any of the questions, please call (724)548-3290 or (800)368-1066. Please complete survey by APRIL 15, 2016. THANK YOU FOR TAKING TIME TO COMPLETE THIS SURVEY!

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