2009 Needs Assessment for Senior Citizens Services

2017 Needs Assessment for Senior Citizens’ Services

The Area Agency on Aging of the Alabama Tombigbee Regional Commission provides assistance to older adults, disabled individuals, their families, and their caregivers. We want to hear from residents in our region. We will use this information to improve upon our services. Please respond to the items in this survey as they relate to you personally.

NOTE: Your responses are anonymous and will be kept completely confidential. Please encourage others to participate in this very important process. This survey can also be found at www.atrcregion6.com. If you have any questions, please call the Area Agency on Aging at 1-888-617-0500.

ABOUT YOU:

1. Your county?

Choctaw Clarke Conecuh Dallas Marengo

Monroe Perry Sumter Washington Wilcox

2. Your age:

<65 65-69 70-74 75-79 80-84 85 or older

3. Your gender? Male Female

4. Your race? (Check only one.)

African American/Black Asian Caucasian/White

Native American Native Hawaiian/Pacific Islander Other __________

5. Are you of Spanish, Latino, or Hispanic origin? Yes No

6. Your marital status? (Check only one.)

Never Married Separated Divorced Widowed Married

7. Your living situation?

Alone With spouse or family members With non-relatives

8. The highest grade or year you finished in school? (Check only one.)

8th grade or less Some high school High school diploma/GED Technical school

Some college Two-year college degree Four-year college degree

Post graduate degree (masters/doctorate)

9. Your household monthly income (total monthly income after taxes)?

Less than $900 $991 - $1,238 $1,239 - $1,485 More than $1,832

10. I already receive services from:

Meals AT a Senior Center Ombudsman Program

HOME DELIVERED meals from a Senior Center SenioRx

Alabama Cares None of the above

Medicaid Waiver I’m not sure

To what degree is each of these items a problem for you personally? Please select the most appropriate response to each item.

No Some Serious Problem problem problem

1. Bathing or showering

2. Getting dressed/undressed

3. Grooming (combing hair, shaving, etc.)

4. Getting in and out of bed

5. Getting to the bathroom in time

6. Preparing nutritious meals

7. Having enough money to purchase food at a grocery store

8. Heavy house work (deep cleaning, yard work, etc.)

9. Light house work (laundry, dusting, etc.)

10. Maintaining and repairing your home

11. Adding safety features to your home (grab bars, ramp, etc.)

12. Using the telephone

13. Taking your own medication

14. Feeding yourself

15. Caring for my relatives or friends

16. Transportation (doctor, shopping, church, senior center)

17. Paying for prescription drugs

18. Paying bills and balancing my checkbook

19. Planning for retirement

20. Completing and understanding income tax forms

21. Completing and understanding legal paperwork

22. Obtaining and understanding benefits

(Social Security, Medicare, Medicaid, health insurance)

Please check any of the following items that might be of interest to you.

Diseases and health problems Health insurance Keeping a healthy mind

Planning a healthy diet Finding an exercise program Services/benefits available to seniors

Finding a nursing home Finding an apartment Finding an assisted living facility

Fixing things in home Finding a full-time job Finding a part-time job

Senior center activities Nursing care or physical therapy at home

Finding things to do in town Getting job training (job skills, resume, interviewing, etc.)

Please check any of the following items that might be affecting your quality of life.

Isolation Loneliness Depressed mood Untreated mental health issues

Physical abuse Mental/emotional abuse Financial exploitation

Accidents in/out of the home (falling, etc.) Decline in memory

Is there anything else you would like to tell us? IS Anything threatENing your independence or quality of life?

_________________________________________________________________________________________

Thank you very much for taking the time to answer our questions. The information you have provided will be very helpful in designing services for older adults in the future.

Did you complete this survey on your own or receive assistance? On my own Had assistance

If you received assistance, what is your relationship to the assistant? __________________________________

Please explain why you needed assistance. _______________________________________________________

__________________________________________________________________________________________

PLEASE RETURN THIS SURVEY BY APRIL 15, 2017 TO:

EVETTE WOODS, 107 BROAD ST., CAMDEN, AL 36726