Veterans Housing Needs Assessment Survey

Question Title

* 1. Please select your approximate age range.

49 or younger

50-60

60-65

65-75

75 and above

Question Title

* 2. Which area of Nevada are you currently living?

Northern Nevada (Washoe and Carson City counties)

Southern Nevada (Clark County)

Rural Nevada (all other counties)

Question Title

* 3. When selecting an assisted living, adult day care, or skilled nursing facility, either for yourself or a loved one, please rank the level of importance on the following factors

	Not at all Important	Somewhat Unimportant	Neutral	Somewhat Important	Very Important
Cleanliness of the facility	Cleanliness of the facility Not at all Important	Cleanliness of the facility Somewhat Unimportant	Cleanliness of the facility Neutral	Cleanliness of the facility Somewhat Important	Cleanliness of the facility Very Important
Quality/rating of facility	Quality/rating of facility Not at all Important	Quality/rating of facility Somewhat Unimportant	Quality/rating of facility Neutral	Quality/rating of facility Somewhat Important	Quality/rating of facility Very Important
Price	Price Not at all Important	Price Somewhat Unimportant	Price Neutral	Price Somewhat Important	Price Very Important
Location	Location Not at all Important	Location Somewhat Unimportant	Location Neutral	Location Somewhat Important	Location Very Important
My spouse can be cared for in the same facility	My spouse can be cared for in the same facility Not at all Important	My spouse can be cared for in the same facility Somewhat Unimportant	My spouse can be cared for in the same facility Neutral	My spouse can be cared for in the same facility Somewhat Important	My spouse can be cared for in the same facility Very Important
Facility is a state operated veterans home	Facility is a state operated veterans home Not at all Important	Facility is a state operated veterans home Somewhat Unimportant	Facility is a state operated veterans home Neutral	Facility is a state operated veterans home Somewhat Important	Facility is a state operated veterans home Very Important
Recreational activities	Recreational activities Not at all Important	Recreational activities Somewhat Unimportant	Recreational activities Neutral	Recreational activities Somewhat Important	Recreational activities Very Important
Being around other veterans	Being around other veterans Not at all Important	Being around other veterans Somewhat Unimportant	Being around other veterans Neutral	Being around other veterans Somewhat Important	Being around other veterans Very Important

Other (please specify)

Question Title

* 4. How supported do you feel by the Department of Veterans Services in your ability to access senior housing?

Extremely supported

Somewhat supported

Very little support

Absolutely no support

Other (please specify)

Question Title

* 5. Are you or any of your loved ones currently using any of the following housing or healthcare facilities?

Assisted living

Adult day care

Long-term skilled nursing care

Living independently but concerned about future healthcare housing needs

Other (please specify)