Survey Purpose:

The High Country Area Agency on Aging is seeking community input regarding the needs of older adults, caregivers, and individuals with disabilities. We need your input to help us prioritize our services and supports as we develop our next four-year plan. Please complete the following survey to the best of your ability. Your assistance is greatly valued and appreciated! 

For additional information or questions, contact: 
Nicole Hiegl at nhiegl@regiond.org or (828) 265-5434 ext. 122 

Please return all hard copies of surveys to: 
High Country Area Agency on Aging
468 New Market Blvd. Boone, NC 28607

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* 1. In which county do you live or work? (Select all that apply)

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* 2. What is your age?

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* 3. What term best describes you? (Select all that apply)

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* 4. With which ethnicity do you identify? (Select all that apply)

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* 5. Do you consider yourself a member of the Lesbian, Gay, Bisexual and/or Transgender (LGBT+) community?

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* 6. In regards to yourself, please rate how you feel about the following questions:

  Never Rarely Sometimes Often Always
How often do you feel that you lack companionship?
How often do you feel left out?
How often do you feel isolated from others?

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* 7. In regards to older adults (60+) and individuals with disabilities in your area, please rate the topics below based on the current level of need for each service:

  No Need
1
2 3 4 Extreme Need
5
Prevention of Depression and Loneliness
Prevention of Physical/Emotional Abuse or Neglect
Prevention of Exploitation or Scams
Prevention of Substance Abuse/Misuse
Prevention of Caregiver Stress and Burnout
Prevention of Falling or Balance Issues

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* 8. In regards to older adults (60+) and individuals with disabilities in your area, please rate the topics below based on the current level of need for each service:

  No Need
1
2 3 4 Extreme Need
5
Assistance with Guardianship or related Legal Issues
Assistance with Home Tasks, such as meal prep or bill paying
Assistance with Personal Care, such as bathing or toileting
Assistance with Managing Chronic Conditions
Assistance with Finding Employment Opportunities
Assistance with Home Repair and Safety Improvements
Assistance with Emergency Planning or Preparedness

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* 9. In regards to older adults (60+) and individuals with disabilities in your area, please rate the topics below based on the current level of need for each service:

  No Need
1
2 3 4 Extreme Need
5
Access to Affordable Housing
Access to Transportation
Access to Nutritious Foods
Access to Medical Care
Access to Dental Care
Access to Affordable Medications
Access to Health & Wellness Programs
Access to Caregiver Resources
Access to End of Life Options and Support
Access to Volunteering/Community Engagement
Access to Long-Term Care Planning Resources
Access to Education about Aging-related Issues

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* 10. In regards to older adults (60+) and individuals with disabilities in your area, please select the TOP 3 current areas of need from the list below:

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* 11. Thank you for taking this survey! If there are any needs not listed throughout this survey you feel are important, or if you have any additional comments you believe may help us during our planning process, please let us know in the box below:

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