Olympic Area Agency on Aging Area Plan Survey

Advocates for Independence, Individual Choice and Quality Community Services Serving Older Persons and Persons with Disabilities Serving Clallam, Grays Harbor, Jefferson & Pacific Counties

1-866-720-4863

Thank you for completing this survey, designed to help identify the needs of older adults, adults with disabilities, & their caregivers in our region to assist us in planning for the next two years. If you are also a caregiver, please assist the person you care for to complete a survey representing his or her needs as well. You can also respond to this survey by telephone: call 1-866-720-4863 during business hours and a staff member will happily take your responses over the phone. The survey is also available on our website: www.o3a.org.

1.Are you Male or Female?

Male

Female

Outside the Gender Binary

Prefer not to answer

2.How old are you?

Under age 60

Age 60 to 74

Age 75 to 84

Age 85 or older

3.Do you...?

Live alone

Live with a spouse or partner

Live with a friend or relative

6.Do you plan or have your already received a COVID-19 vaccine?

Yes

7.Did you contract COVID-19?

Yes

8.Did you gain or lose any weight during the pandemic & if so how much?

Lost

Gained

Stayed the same

How many lbs. lost or gained?

9.Did you choose to remain at home socially distanced from others during the Pandemic?

Yes – I/we stayed home and had all items I/we needed delivered.

No - but I/we limited the number of times we left the house and always took safety precautions of masking, social distance of 6 feet, and sanitizing/hand sanitizing.

I wanted to stay home but had to work

I stayed home due to job being closed

I wanted to work & went to work

10.To what degree have you experienced the negative effects of social isolation?

I/we have been very depressed, anxious or sad much of the time due to social isolation.

I/we have been intermittently depressed, anxious or sad due to social isolation.

I/we have only been slightly depressed, anxious or sad due to social isolation.

I/we have not experienced any depression, anxiety or sadness due to social isolation.

12.Have you been able to access needed legal services during the pandemic?

Yes

N/A

13.Are you aware that free Senior Legal Advice Clinics are offered for those 60 and older in a remote safe manner through our offices?

Yes

I did not need legal services

15.Are you caring for or supporting a family member, friend, or neighbor?

Yes

16.How have your needs changes during the pandemic?

17.If you are a caregiver of a person with dementia have you seen a change in that person during this time?

Yes

N/A

Please explain further:

18.Have you received information about the Dementia Road Map?
Available by contacting WA State Alzheimer’s Assoc: 800-272-3900 or Google ‘Dementia Road Map’.

Yes

19.Have you heard of the Palliative Care Road Map?
Contact O3A for a copy or Google ‘Palliative Care Road Map’.

Yes

21.What would you say has been your most significant unmet need during the pandemic?

22.If you would like someone to contact you with information about services, please provide your name and your contact information in the space below (email, telephone, mailing address):

Your Name:

Phone #:

Email:

Please Return Survey before June 30, 2021 to Olympic Area Agency on Aging,

2200 West Sims Way, Unit 100, Port Townsend, WA 98368