Area Agency on Aging :. Survey of Adult & Aging Populations in Alameda County

Alameda County Senior Needs Assessment:

Periodically the Alameda County Area Agency on Aging (AAA) conducts a survey to document the current needs, concerns and resources within the County’s 55+ population. The survey will help the AAA identify and provide support for senior services in Alameda County. If you are over the age of 55 and live in Alameda County, please take a few moments to complete the survey

If you are interested in becoming a distribution site, please call the AAA at 510-577-1970

We look forward to receiving your response!

  1. The town/city that I live in (or that is closest to me) is:

    *

*North County: Berkeley, Oakland, Emeryville, Albany, Alameda, Piedmont
South County: Fremont, Hayward, Union City, Sunol, Newark
East County: Pleasanton, Dublin, Livermore
Central County: San Leandro, Castro Valley, Cherryland, Ashland, Fairview
  1. I have lived in the community for:
    years
  1. Age:

 
  1. Gender: I am

 
  1. Marital status: I am now:
  1. My primary language is
  1. Education: (highest grade level completed)
  1. 2003 Monthly Income:

    Married (combined income before taxes)

    OR
    Single (not married income before taxes)
  1. I receive SSI/SSP:

 
  1. My ethnic group is:
    Spanish / Hispanic / Latino

    If yes, please check one of the following:
    Mexican / Mexican American
    Puerto Rican
    Cuban
    Other Spanish / Hispanic / Latino

    White
    Black /African American
    American Indian or Alaska Native
    (enter name of enrolled /principal tribe)

    Asian Indian
    Chinese
    Filipino
    Japanese
    Korean
    Vietnamese
    Other Asian (enter name to specify)

    Native Hawaiian
    Guamanian or Chamorro
    Samoan
    Other Pacific Islander (enter name to specify)

    Some other race (enter name to specify)

 

 
  1. Living Arrangements
    I live alone:

 
  1. I live with (relationship)

       

  1. Living quarters
    I live in a:


    If Other, please specify:

 
  1. Public transportation is accessible to me where I currently live:
  1. My most often used form of transportation is:


    If Other, please specify:

  1. Below is a list of issues/conditions/concerns, which could affect my quality of life.

    I have checked the box which best describes how much each one is a problem for me.

Problem No
Problem 		Minor
Problem 		Serious
Problem
(a) Crime

1

2 3
(b) Employment

1

2 3
(c) Energy/utilities

1

2 3
(d) Obtaining information about services/benefits

1

2 3
(e) Receiving services/benefits

1

2 3
(f) Health care

1

2 3
(g) Housing

1

2 3
(h) Legal affairs

1

2 3
(i) Loneliness

1

2 3
(j) Money to live on

1

2 3
(k) Nutrition/food

1

2 3
(l) Taking care of another person

 

(1) child under 18 years of age

1

2 3
(2) Adult

1

2 3
(m) Transportation

1

2 3
(n) Household chores

1

2 3
(o) Isolation

1

2 3
(p) Accidents in the home (e.g., falling)

1

2 3

  1. Below is a list of activities that are difficult for some people.

    I have checked the box which best describes how difficult each activity is for me.

Activity No
Difficulty		 Minor
Difficulty		 Serious
Difficulty		 Unable
To Do
(a) Eating

1

2 3 4
(b) Bathing

1

2 3 4
(c) Dressing/undressing

1

2 3 4
(d) Walking

1

2 3 4
(e) Getting in and out of bed

1

2 3 4
(f) Getting to the bathroom

1

2 3 4
(g) Preparing meals

1

2 3 4
(h) Shopping for personal items

1

2 3 4
(i) Medication management

1

2 3 4
(j) Managing money

1

2 3 4
(k) Using the telephone

1

2 3 4
(l) Doing heavy housework

1

2 3 4
(m) Doing light housework

1

2 3 4
(n) Transportation ability

1

2 3 4

  1. For each activity with which I have difficulty, I have checked who helps me with that activity.

    (All answers that apply are checked)

Activity Spouse Other
Relative		 Friend Agency
Volunteer		 Paid
Worker		 No One
(a) Eating

1

2 3 4 5 6
(b) Bathing

1

2 3 4 5 6
(c) Dressing/undressing

1

2 3 4 5 6
(d) Walking

1

2 3 4 5 6
(e) Getting in and out of bed

1

2 3 4 5 6
(f) Getting to the bathroom

1

2 3 4 5 6
(g) Preparing meals

1

2 3 4 5 6
(h) Shopping for personal items

1

2 3 4 5 6
(i) Medication management

1

2 3 4 5 6
(j) Managing money

1

2 3 4 5 6
(k) Using the telephone

1

2 3 4 5 6
(l) Doing heavy housework

1

2 3 4 5 6
(m) Doing light housework

1

2 3 4 5 6
(n) Transportation ability

1

2 3 4 5 6

  1. The two problems from Question 18 that affect me the most are:

    First problem:

    This is a problem to me because:


    Second problem:

    This is a problem to me because:

    Other problems that are not listed in Question 18 that are important to me are:


  2. If you need help with any problem, who would you turn to for help (check all that apply).

    1 Spouse 4 Health Care Provider 7 Neighbor
    2 Relative 5 Senior Center 8 City or County Social Services
    3 Friend 6 Church/Synagogue 9 Other


Comments:


Chet P. Hewitt, Director
Social Services Agency