Snohomish County Follow-Up COVID-19 Seniors Survey

Please help us understand how the COVID-19 pandemic is impacting you by completing this ANONYMOUS survey.

Estimated time to complete: 5-10 minutes.

Select the best answer for each of the following questions:

Question Title

* How often do you utilize senior center services?

Daily

2 to 4 times per week

1 time per week

1 to 3 times per month

1 time per month

Less than once per month

Never

Question Title

* How long have you been visiting a senior center?

Never

Less than 1 year

1 to 5 years

6 to 10 years

Over 10 years

Question Title

* In the past month, how often have you left home?

Daily

2 to 4 times per week

1 time per week

1 to 3 times per month

1 time per month

Less than once per month

Question Title

* Which best describes who you live with?

I live alone

I live with my partner/spouse

I live with family

I live with a roommate

Other (please specify)

Question Title

* Do you have a pet?

Yes

Question Title

* Which best describes where you live?

I live in a rental

I live in my home with a mortgage

I live in my home without a mortgage

I live in a nursing home or assisted living facility

I live in a shelter or motel

Other (please specify)

Question Title

* What is your zip code?

Question Title

* Do you have a disability?

Yes

Question Title

* Do you take 5 or more prescriptions and/or over-the-counter medicines a day?

Yes

Question Title

* A caregiver is someone who provides paid or unpaid support, even minimally, and can be a friend, family member, or professional. Do you rely on a caregiver?

Yes

No, but I need a caregiver

Question Title

* Since the start of the pandemic, have you used any of the following services? (Check all that apply)

COVID-19 vaccines/boosters

Home-delivered meals

Congregate meals

Food banks/food boxes

Senior Farmers Market Nutrition Program

Rental assistance

Utility assistance

Transportation assistance

Phone reassurance counseling

Relied on friends and family

Question Title

* Are you a Veteran?

Yes

Question Title

* Please indicate your age:

18-59 years old

60-69 years old

70-79 years old

80-89 years old

90 years or older

Question Title

* Please indicate which gender you identify as:

Male

Female

Transgender

Other (please specify)

Question Title

* Please indicate which race and/or ethnicity you identify as:

Race

Ethnicity

Question Title

* What is your employment status?

Working full-time

Working part-time

Seeking employment

Retired or not seeking employment

Not working due to a disability

Question Title

* What is your primary source of income?

Employment

Social Security

Retirement Savings

Pension(s)

Other (please specify)

Question Title

* What is your household's average monthly income?

Less than $1,200

$1,201 - $2,500

$2,501 - $3,500

$3,501 - $4,500

$4,501 - $5,500

$5,501 - $6,500

$6,501 - $7,500

$7,501 or more