Healthy Aging MV Transportation Survey for Individuals

Healthy Aging MV Transportation Survey

The purpose of this survey is to determine the needs of older adults for on-island transportation. Please fill out this survey for yourself or a loved one or friend (one survey per person, please). Mail the completed survey to Healthy Aging MV, 111 Edgartown Rd., Vineyard Haven MA 02568 or drop it off at your local Council on Aging. If you prefer, take the survey online at www.hamv.org. If you have questions, please call 508-693-7900 ext. 455.

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* 1. Please let us know who is filling out the survey:

I am the person using the service(s) and filling out the survey

I am a caregiver (or other person) filling out the survey for the person using the service(s)

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* 2. What is your age in years?

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* 3. Do you live on the Vineyard year-round?

yes

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* 4. If not, what months do you live on-island?

January

February

March

April

May

June

July

August

September

October

November

December

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* 5. In what town or area do you reside?

Aquinnah

Chappaquiddick

Chilmark

Edgartown

Oak Bluffs

Tisbury

West Tisbury

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* 6. Is your home or residence

in town, convenient to most places

rural, close to a VTA bus stop

rural, more than 3/4 mile to a VTA bus stop

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* 7. Which form(s) of transportation do you currently use? (mark all that apply):

VTA bus service

VTA lift service

Volunteer service

IEH or COA van

Vineyard Village at Home

Taxi

Uber

Friend

Drive myself

Paid caregiver

Other (please specify)

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* 8. If you currently use a paid service, how much, on average, do you pay for a one-way trip?

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* 9. How many days per week do you need transportation service?

2-4

5-7

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* 10. Do you usually purchase an annual VTA bus pass?

Yes

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* 11. When you travel

I require a caregiver/companion travels with me

I prefer a caregiver/companion travels with me

I do not require a caregiver, and I travel independently

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* 12. Are you homebound?

Yes

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* 13. If you used a transportation service that picked you up at your home and was on-call or could be scheduled, where would you be most likely to go? (check all that apply)

medical appointments

councils on aging

YMCA/exercise facility

library

food pantry

restaurants

meetings

hair salon

work/employment

to volunteer

pharmacy

place of worship

shopping or grocery store

post office, bank, and household errands

social events and entertainment

to visit family members or friends

classes or workshops, education

evening performances

Other (please specify)

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* 14. When do you most need transportation support? (check all that apply)

in the morning

around lunch

early afternoon

late afternoon/evening

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* 15. How much are you willing to pay for a transportation service that is on-call (or can be scheduled) and pick you up at your home?

nothing

$1-$2 per one-way trip

$3-$5 per one-way trip

$5-$10 per one-way trip

More than $10 per one-way trip

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* 16. Would you be interested in a service to take you to the nearest bus stop?

yes

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* 17. Do you have a vehicle but only need a driver?

yes

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* 18. Do you require assistance boarding a van or bus?

yes, I need person to assist

yes, I use a wheelchair or walker

no assistance is needed

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* 19. Are you at risk of having to move away from the Island because of:

lack of transportation

lack of (secure or affordable) housing

yes, for other reasons

I'm not at risk of having to move away.

Other (please specify)

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* 20. Sign me up to receive Healthy Aging MV newsletters and emails.

Name

Email Address

Phone Number