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100% of survey complete.
To assist the Office for the Aging in planning future programs, please fill out the survey and return to the Office for the Aging, or complete and submit online through
by clicking on the link to SurveyMonkey.

Please rate your level of concern by checking the box of the following factors in regard to their importance to your community, and whether it is a concern for you.
Housing

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* 1. Able to perform household chores (cleaning, etc)

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* 2. Finding reliable help to perform home maintenance/repairs

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* 3. Ability to pay rent or taxes

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* 4. Ability to pay for home heating

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* 5. Ability to safely remain in your home

Transportation

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* 6. To medical appointments

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* 7. To out of county medical appointments

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* 8. To the grocery store or other errands

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* 9. Driving my own car

Insurance/Health

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* 10. Understanding Medicare and various options

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* 11. Understanding low-income health insurance subsidies

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* 12. Understanding long term care services and support options

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* 13. Understanding long term care insurance options

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* 14. Recurring falls, in and out of home

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* 15. Managing a chronic health condition(s)

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* 16. Accessing services for individuals with Alzheimer's or dementia and their caregivers

Nutrition/Food

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* 17. Having enough money for nutritious food

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* 18. Being able to shop and cook for myself

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* 19. Being able to follow a special diet recommended by my doctor

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* 20. Having access to information about nutrition assistance programs

Services and Supports

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* 21. Respite services for caregivers, such as adult day programs for people with dementia or other functional impairments

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* 22. Access to senior centers

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* 23. Transportation options for those unable to drive

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* 24. In-home personal care services

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* 25. Ability to participate in Congregate Meal Sites or receive Home Delivered Meals

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* 26. Ability to obtain help applying for government programs

If you are caring for another individual, please answer the following questions: (select multiple answers if applicable)

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* 27. For whom do you provide care?

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* 28. Does the individual for whom you care live in your home?

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* 29. Does the individual have memory problems and/or dementia?

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* 30. Do you feel overwhelmed and/or stressed in providing care?

Where to find help

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* 31. If you, or someone you know, has been in the hospital in the last year, did you/they have the information and supports needed to return home?

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* 32. Have you heard of "NY Connects," the local program that helps consumers with information, assistance and connections to needed long term services and supports?

Demographics

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* 33. Sex

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* 34. Age

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* 35. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 36. What are your living arrangements?

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* 37. If you are a 1 person household- What is your estimated income (per year)?

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* 38. If you are a 2 or more person household - What is your estimated income (per year)?

Thank you for taking the time to complete this survey. If you have any questions , please call 631-853-8200. All manually completed surveys should be mailed to:

Suffolk County Office for the Aging
P.O. Box 6100
Hauppauge, N.Y. 11788

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