Marina-Venice WISE Connections Survey

Thank you for taking the time to complete our survey!

The goal of WISE Connections is to enable its members to lead fulfilling, healthy, safe and secure lives as they age in their own homes. It accomplishes this by organizing and delivering programs and services that members request. WISE Connections follows-up with members every time a service is used to monitor satisfaction and maintain a strong base of service providers. It also develops and integrates new services and programs that are identified by the membership.

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* 1. How interested are you in having each of the following opportunities:

	1 - Very Interested	2	3 - Somewhat Interested	4	5 - Not Interested
Meeting new friends in your neighborhood	Meeting new friends in your neighborhood 1 - Very Interested	Meeting new friends in your neighborhood 2	Meeting new friends in your neighborhood 3 - Somewhat Interested	Meeting new friends in your neighborhood 4	Meeting new friends in your neighborhood 5 - Not Interested
Volunteer opportunities in the community	Volunteer opportunities in the community 1 - Very Interested	Volunteer opportunities in the community 2	Volunteer opportunities in the community 3 - Somewhat Interested	Volunteer opportunities in the community 4	Volunteer opportunities in the community 5 - Not Interested
Single-source of referrals to any services you need	Single-source of referrals to any services you need 1 - Very Interested	Single-source of referrals to any services you need 2	Single-source of referrals to any services you need 3 - Somewhat Interested	Single-source of referrals to any services you need 4	Single-source of referrals to any services you need 5 - Not Interested
Discounted services	Discounted services 1 - Very Interested	Discounted services 2	Discounted services 3 - Somewhat Interested	Discounted services 4	Discounted services 5 - Not Interested
Help coordinating in-home services (housekeeping, errands, healthcare, etc.)	Help coordinating in-home services (housekeeping, errands, healthcare, etc.) 1 - Very Interested	Help coordinating in-home services (housekeeping, errands, healthcare, etc.) 2	Help coordinating in-home services (housekeeping, errands, healthcare, etc.) 3 - Somewhat Interested	Help coordinating in-home services (housekeeping, errands, healthcare, etc.) 4	Help coordinating in-home services (housekeeping, errands, healthcare, etc.) 5 - Not Interested

Other (please specify)

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* 2. How important is it to you to have access to referrals and discounts to each of the following:

	1 - Very Important	2	3 - Somewhat Important	4	5 - Not Important
Housekeeping	Housekeeping 1 - Very Important	Housekeeping 2	Housekeeping 3 - Somewhat Important	Housekeeping 4	Housekeeping 5 - Not Important
Yard Maintenance	Yard Maintenance 1 - Very Important	Yard Maintenance 2	Yard Maintenance 3 - Somewhat Important	Yard Maintenance 4	Yard Maintenance 5 - Not Important
Pet Sitting	Pet Sitting 1 - Very Important	Pet Sitting 2	Pet Sitting 3 - Somewhat Important	Pet Sitting 4	Pet Sitting 5 - Not Important
House Sitting	House Sitting 1 - Very Important	House Sitting 2	House Sitting 3 - Somewhat Important	House Sitting 4	House Sitting 5 - Not Important
Handyman Services	Handyman Services 1 - Very Important	Handyman Services 2	Handyman Services 3 - Somewhat Important	Handyman Services 4	Handyman Services 5 - Not Important
Electrician	Electrician 1 - Very Important	Electrician 2	Electrician 3 - Somewhat Important	Electrician 4	Electrician 5 - Not Important
Plumber	Plumber 1 - Very Important	Plumber 2	Plumber 3 - Somewhat Important	Plumber 4	Plumber 5 - Not Important
Computer Repair	Computer Repair 1 - Very Important	Computer Repair 2	Computer Repair 3 - Somewhat Important	Computer Repair 4	Computer Repair 5 - Not Important
Homemaker (cooking, dressing, etc.)	Homemaker (cooking, dressing, etc.) 1 - Very Important	Homemaker (cooking, dressing, etc.) 2	Homemaker (cooking, dressing, etc.) 3 - Somewhat Important	Homemaker (cooking, dressing, etc.) 4	Homemaker (cooking, dressing, etc.) 5 - Not Important
Transportation to shopping, errands	Transportation to shopping, errands 1 - Very Important	Transportation to shopping, errands 2	Transportation to shopping, errands 3 - Somewhat Important	Transportation to shopping, errands 4	Transportation to shopping, errands 5 - Not Important
Rides for medical appointments	Rides for medical appointments 1 - Very Important	Rides for medical appointments 2	Rides for medical appointments 3 - Somewhat Important	Rides for medical appointments 4	Rides for medical appointments 5 - Not Important
Home delivered meals	Home delivered meals 1 - Very Important	Home delivered meals 2	Home delivered meals 3 - Somewhat Important	Home delivered meals 4	Home delivered meals 5 - Not Important
Grocery delivery	Grocery delivery 1 - Very Important	Grocery delivery 2	Grocery delivery 3 - Somewhat Important	Grocery delivery 4	Grocery delivery 5 - Not Important
Emergency-call system at home	Emergency-call system at home 1 - Very Important	Emergency-call system at home 2	Emergency-call system at home 3 - Somewhat Important	Emergency-call system at home 4	Emergency-call system at home 5 - Not Important
Medication assistance (preparing pill boxes, etc.)	Medication assistance (preparing pill boxes, etc.) 1 - Very Important	Medication assistance (preparing pill boxes, etc.) 2	Medication assistance (preparing pill boxes, etc.) 3 - Somewhat Important	Medication assistance (preparing pill boxes, etc.) 4	Medication assistance (preparing pill boxes, etc.) 5 - Not Important
Assessment of personal & health needs	Assessment of personal & health needs 1 - Very Important	Assessment of personal & health needs 2	Assessment of personal & health needs 3 - Somewhat Important	Assessment of personal & health needs 4	Assessment of personal & health needs 5 - Not Important
Coordination of appropriate services	Coordination of appropriate services 1 - Very Important	Coordination of appropriate services 2	Coordination of appropriate services 3 - Somewhat Important	Coordination of appropriate services 4	Coordination of appropriate services 5 - Not Important
Daily telephone checks on your well-being	Daily telephone checks on your well-being 1 - Very Important	Daily telephone checks on your well-being 2	Daily telephone checks on your well-being 3 - Somewhat Important	Daily telephone checks on your well-being 4	Daily telephone checks on your well-being 5 - Not Important
Referral to "vetted" home health & support services (personal aids, nursing, rehabilitation, etc.)	Referral to "vetted" home health & support services (personal aids, nursing, rehabilitation, etc.) 1 - Very Important	Referral to "vetted" home health & support services (personal aids, nursing, rehabilitation, etc.) 2	Referral to "vetted" home health & support services (personal aids, nursing, rehabilitation, etc.) 3 - Somewhat Important	Referral to "vetted" home health & support services (personal aids, nursing, rehabilitation, etc.) 4	Referral to "vetted" home health & support services (personal aids, nursing, rehabilitation, etc.) 5 - Not Important

Other (please specify)

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* 3. WISE Connections facilitates access to social, recreational, fitness and wellness programs by utilizing existing services or coordinating their own. How interested would you be in:

	1 - Very Interested	2	3 - Somewhat Interested	4	5 - Not Interested
Discussion groups (book clubs, current affairs)	Discussion groups (book clubs, current affairs) 1 - Very Interested	Discussion groups (book clubs, current affairs) 2	Discussion groups (book clubs, current affairs) 3 - Somewhat Interested	Discussion groups (book clubs, current affairs) 4	Discussion groups (book clubs, current affairs) 5 - Not Interested
Dances	Dances 1 - Very Interested	Dances 2	Dances 3 - Somewhat Interested	Dances 4	Dances 5 - Not Interested
Singles Club	Singles Club 1 - Very Interested	Singles Club 2	Singles Club 3 - Somewhat Interested	Singles Club 4	Singles Club 5 - Not Interested
Craft clubs (needle work, woodworking, etc.)	Craft clubs (needle work, woodworking, etc.) 1 - Very Interested	Craft clubs (needle work, woodworking, etc.) 2	Craft clubs (needle work, woodworking, etc.) 3 - Somewhat Interested	Craft clubs (needle work, woodworking, etc.) 4	Craft clubs (needle work, woodworking, etc.) 5 - Not Interested
Card groups (bridge, poker, etc.)	Card groups (bridge, poker, etc.) 1 - Very Interested	Card groups (bridge, poker, etc.) 2	Card groups (bridge, poker, etc.) 3 - Somewhat Interested	Card groups (bridge, poker, etc.) 4	Card groups (bridge, poker, etc.) 5 - Not Interested
Cultural trips (museums, concerts, theatre)	Cultural trips (museums, concerts, theatre) 1 - Very Interested	Cultural trips (museums, concerts, theatre) 2	Cultural trips (museums, concerts, theatre) 3 - Somewhat Interested	Cultural trips (museums, concerts, theatre) 4	Cultural trips (museums, concerts, theatre) 5 - Not Interested
Travel opportunities	Travel opportunities 1 - Very Interested	Travel opportunities 2	Travel opportunities 3 - Somewhat Interested	Travel opportunities 4	Travel opportunities 5 - Not Interested
Monthly conversations with notable people	Monthly conversations with notable people 1 - Very Interested	Monthly conversations with notable people 2	Monthly conversations with notable people 3 - Somewhat Interested	Monthly conversations with notable people 4	Monthly conversations with notable people 5 - Not Interested
Electronics training (TV, remote control, cell phone, computer)	Electronics training (TV, remote control, cell phone, computer) 1 - Very Interested	Electronics training (TV, remote control, cell phone, computer) 2	Electronics training (TV, remote control, cell phone, computer) 3 - Somewhat Interested	Electronics training (TV, remote control, cell phone, computer) 4	Electronics training (TV, remote control, cell phone, computer) 5 - Not Interested
How-to classes (musical instrument, art, writing, etc.)	How-to classes (musical instrument, art, writing, etc.) 1 - Very Interested	How-to classes (musical instrument, art, writing, etc.) 2	How-to classes (musical instrument, art, writing, etc.) 3 - Somewhat Interested	How-to classes (musical instrument, art, writing, etc.) 4	How-to classes (musical instrument, art, writing, etc.) 5 - Not Interested
Foreign Language(s)	Foreign Language(s) 1 - Very Interested	Foreign Language(s) 2	Foreign Language(s) 3 - Somewhat Interested	Foreign Language(s) 4	Foreign Language(s) 5 - Not Interested
Investing and financial strategies	Investing and financial strategies 1 - Very Interested	Investing and financial strategies 2	Investing and financial strategies 3 - Somewhat Interested	Investing and financial strategies 4	Investing and financial strategies 5 - Not Interested
Tai Chi, yoga, pilates, aerobics, etc.	Tai Chi, yoga, pilates, aerobics, etc. 1 - Very Interested	Tai Chi, yoga, pilates, aerobics, etc. 2	Tai Chi, yoga, pilates, aerobics, etc. 3 - Somewhat Interested	Tai Chi, yoga, pilates, aerobics, etc. 4	Tai Chi, yoga, pilates, aerobics, etc. 5 - Not Interested
Walking groups	Walking groups 1 - Very Interested	Walking groups 2	Walking groups 3 - Somewhat Interested	Walking groups 4	Walking groups 5 - Not Interested
Hiking groups	Hiking groups 1 - Very Interested	Hiking groups 2	Hiking groups 3 - Somewhat Interested	Hiking groups 4	Hiking groups 5 - Not Interested
Personal trainer	Personal trainer 1 - Very Interested	Personal trainer 2	Personal trainer 3 - Somewhat Interested	Personal trainer 4	Personal trainer 5 - Not Interested
Swimming/water aerobics	Swimming/water aerobics 1 - Very Interested	Swimming/water aerobics 2	Swimming/water aerobics 3 - Somewhat Interested	Swimming/water aerobics 4	Swimming/water aerobics 5 - Not Interested
Nutritionist	Nutritionist 1 - Very Interested	Nutritionist 2	Nutritionist 3 - Somewhat Interested	Nutritionist 4	Nutritionist 5 - Not Interested
Exercise machines and weights	Exercise machines and weights 1 - Very Interested	Exercise machines and weights 2	Exercise machines and weights 3 - Somewhat Interested	Exercise machines and weights 4	Exercise machines and weights 5 - Not Interested

Other (please specify)

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* 4. What are your three greatest concerns about staying in your own home?

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* 5. To what extent would you agree with the following statements:

	1 - Strongly Agree	2	3 - Neither Agree Nor Disagree	4	5 - Strongly Disagree
I want to stay active and engaged with my community as I age	I want to stay active and engaged with my community as I age 1 - Strongly Agree	I want to stay active and engaged with my community as I age 2	I want to stay active and engaged with my community as I age 3 - Neither Agree Nor Disagree	I want to stay active and engaged with my community as I age 4	I want to stay active and engaged with my community as I age 5 - Strongly Disagree
I can identify services without the assistance of WISE Connections	I can identify services without the assistance of WISE Connections 1 - Strongly Agree	I can identify services without the assistance of WISE Connections 2	I can identify services without the assistance of WISE Connections 3 - Neither Agree Nor Disagree	I can identify services without the assistance of WISE Connections 4	I can identify services without the assistance of WISE Connections 5 - Strongly Disagree
I can coordinate services without the assistance of WISE Connections	I can coordinate services without the assistance of WISE Connections 1 - Strongly Agree	I can coordinate services without the assistance of WISE Connections 2	I can coordinate services without the assistance of WISE Connections 3 - Neither Agree Nor Disagree	I can coordinate services without the assistance of WISE Connections 4	I can coordinate services without the assistance of WISE Connections 5 - Strongly Disagree

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* 6. What are your plans for the future if you were to need additional assistance?

Stay at home with paid assistance

Move in with family (please specify City and State in Comment Box below)

Move to a retirement community

Other (please specify in the Comment Box below)

Comment Box

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* 7. WISE Connections offers a customized array of programs and services that the community wants, as determined by surveys such as this and input from the Members Leadership Council. Currently, services include transportation to run errands and go to medical appointments, referrals to vetted and discounted services, convenience services, fitness and social programs, and volunteer opportunities. With this in mind, would you consider joining WISE Connections?

Definitely consider

Might consider

Probably NOT consider

Definitely NOT consider

Why do you feel this way?

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* 8. How soon would you consider joining WISE Connections if it were available?

Immediately

Within 1-2 years

Within 3-4 years

More than 4 years

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* 9. Would you pay $1.50 per day per person (approximately $550 annually) or $2.25 per day per couple (approximately $820) for membership to WISE Connections?

Definitely consider

Might consider

Probably NOT consider

Definitely NOT consider

Why do you feel this way?

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* 10. To understand your advice, we would appreciate some brief information about you. All responses are anonymous.

Are you a:

Couple

Single male

Single female

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* 11. What year were you born?

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

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* 13. What is your ZIP code? (enter 5-digit Zip code)

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* 14. Do you currently have long-term care insurance?

Yes

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* 15. We are currently interested in your use of computers. Do you currently use the internet?

	Yes	No
DO NOT USE THE INTERNET	DO NOT USE THE INTERNET Yes	DO NOT USE THE INTERNET No
For e-mail	For e-mail Yes	For e-mail No
For social opportunities	For social opportunities Yes	For social opportunities No
To research information	To research information Yes	To research information No
To make purchases	To make purchases Yes	To make purchases No
To book travel or other activities	To book travel or other activities Yes	To book travel or other activities No
To pay bills	To pay bills Yes	To pay bills No
For banking or financial management	For banking or financial management Yes	For banking or financial management No

Other (please specify)

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* 16. Do you currently live in: (Select one)

A house you own

A rented home

A rental apartment

Other (please specify)

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* 17. How many years have you lived in this community?

Less than five years

Five to ten years

More than ten years

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* 18. How would you describe your health compared to others your age?

Excellent

Very Good

Good

Fair

Poor

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* 19. What is you racial/ethnic background (optional)?

African American/Black

American Indian/Alaskan Native

Asian/Pacific Islander

Caucasian/White

Hispanic/Latino

Other (please specify)

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* 20. Do you speak a language other than English at your home?

Yes

Please specify language

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* 21. Which of the following best describes your annual household income?

Under $35,000

$35,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000 or more

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* 1. How interested are you in having each of the following opportunities:

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* 2. How important is it to you to have access to referrals and discounts to each of the following:

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* 3. WISE Connections facilitates access to social, recreational, fitness and wellness programs by utilizing existing services or coordinating their own. How interested would you be in:

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* 4. What are your three greatest concerns about staying in your own home?

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* 5. To what extent would you agree with the following statements:

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* 6. What are your plans for the future if you were to need additional assistance?

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* 8. How soon would you consider joining WISE Connections if it were available?

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* 9. Would you pay $1.50 per day per person (approximately $550 annually) or $2.25 per day per couple (approximately $820) for membership to WISE Connections?

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* 10. To understand your advice, we would appreciate some brief information about you. All responses are anonymous.Are you a:

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* 11. What year were you born?

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

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* 13. What is your ZIP code? (enter 5-digit Zip code)

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* 14. Do you currently have long-term care insurance?

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* 15. We are currently interested in your use of computers. Do you currently use the internet?

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* 16. Do you currently live in: (Select one)

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* 17. How many years have you lived in this community?

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* 18. How would you describe your health compared to others your age?

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* 19. What is you racial/ethnic background (optional)?

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* 20. Do you speak a language other than English at your home?

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* 21. Which of the following best describes your annual household income?

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* 22. Please add any additional comments in the space below. MANY THANKS for your help.

* 10. To understand your advice, we would appreciate some brief information about you. All responses are anonymous.

Are you a: