INTEREST SURVEY
A new concept for aging in place

Camarillo Council on Aging has undertaken a feasibility study on the concept of a community-based membership organization focused on empowering older adults to live happily, healthfully, and successfully in their own homes as they age.

Completing the Survey and providing input is important to completing the study.

* 1. Are you a:

* 2. What year were you born?

* 3. If you live with a spouse, in what year was your spouse/partner born?

* 4. Do you currently live in:

* 5. As of today how interested are you in having each of the following opportunities:

  Very Interested Somewhat Interested Not Interested
Meeting new friends in your neighborhood
Volunteer opportunities in the community
Single-source of referrals to any services you need
Discounted services
Getting help coordinating in-home services (housekeeping, errands, healthcare, etc.)

* 6. As of today how important is it to you to have access to referrals and discounts to each of the following:

  Very Important Somewhat Important Not Important
Housekeeping.
Yard Maintenance
Handyman/ Plumber/ Electrician
Pet Sitting
House Sitting
Computer Repair
Personal Services - Activities of Daily Living (bathing, dressing, cooking, meds, etc)
Transportation to appointments, errands
Home delivered meals
Grocery delivery
Emergency-call system at home
Personal Care Coordination and Monitoring
Daily telephone checks on your wellbeing
Referral to “vetted” home health & support services (personal aids, nursing, rehabilitation, etc.)

* 7. The organization will also facilitate access to social, recreational, fitness and wellness programs, by utilizing existing services or coordinating their own.  How interested would you be in:

  Very Interested Somewhat Interested Not Interested
Discussion groups (book clubs, current affairs)
Craft clubs (needle work, woodworking, etc.)
Card groups (bridge, poker, etc.)
Cultural trips (museums, concerts, theatre)
Educational classes/lectures
Electronics training (TV, remote control, cell phone, computer)
How-to classes (musical instrument, art, writing, etc.)
Fitness and Wellness (Tai Chi, yoga, pilates, aerobics, etc.)
Walking/Hiking Groups
Nutritionist

* 8. As of today how important are the following items to help keep you in your home?

  Very Important Somewhat Important Not Important
Knowing what services are available and how to access them
Transportation to store, appointments, errands
Meals delivered, nutritional information, meals with friends
Having someone to talk to when lonely
Help with activities of daily living.
Assistance with cleaning and maintaining home and yard
Someone to call when you feel threatened or taken advantage of

* 9. Would you pay an annual membership fee in the range of $100.00 to $200.00 for a Village operated strictly by volunteers providing a prioritized but limited range of volunteer services?

* 10. Would you pay a membership fee in the range of $1.65 per day ($600 annually) to $2.50 per day ($900 annually) for a Village operated by paid staff providing volunteer services, vetted service providers and social activities?

* 11. Why do you feel this way?

* 12. Please add any additional comments in the space below.

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