Senior Centers and Nutrition Sites: Planning for our Future

 

We are interested to see if these programs are meeting the needs of our older and “to be older” adults in our community.  Please take a few minutes to answer these questions. Please circle the best answer.

 

1. How important are the following services/ activities to you?

                                                                                       Not important      Marginal        Important           Very important  

A)                Adult day services for frail elders                   1                      2                      3                      4

B)                Help with Medicare Part D enrollment                 1                      2                      3                      4

C)                Legal services                                                      1                      2                      3                      4

D)                Elder abuse prevention                                         1                      2                      3                      4

E)                Falls prevention education                               1                      2                      3                      4

F)                 Financial planning services                                  1                      2                      3                      4

G)                Programs to enhance mental vitality             1                      2                      3                      4

H)                Prevention education for physical health 1                      2                      3                      4

I)                    Help/advocacy for nursing home residents            1                      2                      3                      4

J)                  Blood pressure screening                         1                      2                      3                      4

K)                Diabetes and/or cholesterol testing               1                      2                      3                      4

L)                 Help fixing up my house/home repairs                1                      2                      3                      4

M)               Help paying for prescription drugs                1                      2                      3                      4

N)                Fitness programs(stretching/walking etc.)          1                      2                      3                      4

O)                Intimacy in later years                                        1                      2                      3                      4

P)                Medication/alcohol abuse information/help        1                      2                      3                      4

Q)                Grandparents raising grandchildren             1                      2                      3                      4

R)                Volunteer opportunities                                         1                      2                      3                      4

S)                Transportation     services                                1                      2                      3                      4

T)                 Hot meals at senior centers                                  1                      2                      3                      4

U)                Home delivered meals                                       1                      2                      3                      4

V)                Food pantry/having enough food to eat               1                      2                      3                      4

W)              Oral health screening                                         1                      2                      3                      4

X)                Computer access & training                                 1                      2                      3                      4

Y)                 Day field trips                                                       1                      2                      3                      4

Z)                 Music & dance/ parties                                         1                      2                      3                      4

AA)           Employment Opportunities                              1                      2                      3                      4

BB)           Information on memory loss                                  1                      2                      3                      4

CC)          Someone to talk to about grief/loss               1                      2                      3                      4

Please turn over 

 

-2-

 

2. Do you feel the term “Senior Center” encourages you to attend Senior Centers?   Yes             No

3. Do you feel the name “Senior Center” has a negative connotation?                   Yes        No

            If yes, what could be an alternate name? __________________________________________

Demographics

4. Are you…                                       Male           Female

5. Are you…                                       White         Black         Hispanic    Other

 

6. How old were you on your last birthday?           

Please give your exact age today ________

 

7. How far did you go in school?     8th Grade or below  Some High School   High School  

Some College      College degree    Advance degree

 

 8. Are you…                                      Single        Married      Widow/widower    Divorced  

                                                            Other (please specify)__________________________           

 

9. What county do you live in? (Jackson, Williamson, Perry, etc) _________________________

10. Do you have any additional ideas about what services or programs would be helpful for older           adults living in their homes within the community?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Thank-you for your input!

Egyptian Area Agency on Aging

200 E. Plaza Dr., Carterville, IL

1-888-895-3306

 

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