Seniors & Elders Healthy Living Questionnaire

At the Mount Waddington Health Networks (MWHN) Seniors and Elders Better Living Advisory Committee (SEBLAC) our group of caring seniors and elders volunteers, community leaders and health professionals want to better understand the challenges by aging people in these quickly changing times. We ask you to please take the time to do this short questionnaire, and add your voice to the plan for healthier living options for seniors.

If you want to do another survey on housing affordability, you can also do the "Housing and Homelessness: A Service Needs Estimation" which asked more detailed questions on those at-risk of losing housing, and addresses the circumstances of those people spending more than 30% of their monthly income on housing. The Housing and Homelessness: A Service Needs Assessment survey is available by clicking here >>>

This survey is completely anonymous. No personal information is recorded.

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* 1. Knowing the purpose of this survey and that your information is kept completely confidential, are you willing to take this survey right now?

Yes

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* 2. If answering no for this survey, for which reasons?

I don't have time today

I have taken this survey before

This survey is too long

This survey is too personal

This survey doesn't relate to me

I don't think this will help

I don't understand how this will help

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* 3. What town or municipality do you live in?

Alert Bay

Sointula/Malcolm Island

Port McNeill

Port Alice

Port Hardy

Woss

Coal Harbour

Telegraph Cove

Hyde Creek

Holberg

Winter Harbour

Indigenous Community

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* 4. What is your age group?

55-60

61-65

66-70

71-75

76-80

81-85

86-90

91+

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* 5. Who do you live with? (select all that apply)

I live alone

my spouse or partner

a child under 12, youth, young adult or grandchild

my adult offspring

another family relation

a friend

other

hired help

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* 6. If you have a spouse or partner living with you, please indicate the age group of your partner or spouse.

I live alone

55-60

61-65

66-70

71-75

76-80

81-85

86-90

91+

I prefer not to answer

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* 7. Does anyone in your home (including yourself) have a health condition lasting for six months or more that makes it difficult to get around inside the house, and into and out of the house?

Yes

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* 8. Overall, how do you feel about your current housing situation?

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

I don't have an opinion

I need help understanding my current housing situation

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* 9. This question addresses affordability in the context of housing. You may choose not to answer.

What category best described your gross household income from all sources last year? (remember, this survey is completely anonymous.)

less than $10,000

$10,000 to $25,000

$25,001 to $50,000

$50,001 to $100,000

Over $100,000

I prefer not to answer

I am not sure

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* 10. Do you own or rent your current home?

Rent

Own

I live with family

I live in an Recreational Vehicle or Boat

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* 11. How do you feel about the status your home? (please select all that apply)

My home is ideal for my needs

I feel safe aging-in-place without any changes to my house

M house is going to need a lot of work to upgrade it for aging and emergent mobility considerations

My home is too big for the number of occupants

I have too much stuff to consider moving

I have trouble keeping up with maintenance

I cannot find anyone to help with yard work

I cannot find anyone to help with house work

I cannot afford to hire anyone to support me with housework, or yard work

I worry about the condition of my house, the roof, leaks, rot, or mold

My house has a number of places I have to be careful not to slip, trip or fall

I have a lot of stairs

My home is too small for the number of occupants

I prefer not to answer this question

Other comments on my house

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* 12. Do you have or need any of the following in your home? (Select all that apply)

	Have	Need	Don't have and don't need
At least one point of entry with only one or no steps	At least one point of entry with only one or no steps Have	At least one point of entry with only one or no steps Need	At least one point of entry with only one or no steps Don't have and don't need
A ramped entrance (instead of, or in addition to steps)	A ramped entrance (instead of, or in addition to steps) Have	A ramped entrance (instead of, or in addition to steps) Need	A ramped entrance (instead of, or in addition to steps) Don't have and don't need
A front door wide enough for wheelchair passage (at least 32" clear)	A front door wide enough for wheelchair passage (at least 32" clear) Have	A front door wide enough for wheelchair passage (at least 32" clear) Need	A front door wide enough for wheelchair passage (at least 32" clear) Don't have and don't need
A bathroom door wide enough for a wheelchair	A bathroom door wide enough for a wheelchair Have	A bathroom door wide enough for a wheelchair Need	A bathroom door wide enough for a wheelchair Don't have and don't need
Room to move a wheelchair in the bathroom	Room to move a wheelchair in the bathroom Have	Room to move a wheelchair in the bathroom Need	Room to move a wheelchair in the bathroom Don't have and don't need
Room to move a wheelchair in the kitchen	Room to move a wheelchair in the kitchen Have	Room to move a wheelchair in the kitchen Need	Room to move a wheelchair in the kitchen Don't have and don't need
Grab rails in the tub or shower	Grab rails in the tub or shower Have	Grab rails in the tub or shower Need	Grab rails in the tub or shower Don't have and don't need
Grab rails need the toilet	Grab rails need the toilet Have	Grab rails need the toilet Need	Grab rails need the toilet Don't have and don't need
A washroom on the main floor	A washroom on the main floor Have	A washroom on the main floor Need	A washroom on the main floor Don't have and don't need
A lifting device between floors	A lifting device between floors Have	A lifting device between floors Need	A lifting device between floors Don't have and don't need

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* 13. Do you either need or want to live in Senior's Housing at this time?

(Senior's housing being a place with social activities, meal options, and housekeeping services.)

Yes, I would like to have some seniors housing supports right now

No, I do not need support right now but I would like it in the future

No, I will never want or need supportive housing

I prefer not to answer this question

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* 14. If in the future you did need supportive services (like meals, housekeeping, yard work or social activities) would you prefer to move to a smaller space to receive those, or stay in your own home and receive services there?

I want to downsize when the time comes

I want to stay in my own home and receive support services there

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* 15. If in the the future you anticipate downsizing and moving to a place with increased supports, when do you anticipate that may be?

Within 1 to 2 years

In 3 to 5 years

In 6 to 10 years

Over 10 years

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* 16. If you anticipate downsizing in the future, to either supportive housing or smaller independent living units, would you rather rent or own?

Rent

Own

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* 17. If you prefer to own your next home as a senior, what size and kind of home would you like? (With no additional supports)

A condominium

A bungalow or small rancher

A townhouse or split level

I would like under 1,000 square feet

I would like between 1,000 to 2,000 square feet

I would like more than 2,000 square feet

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* 18. If you would prefer to own your next home as a senior, what is your price range? (With no additional supports.)

$175,000 or less

$175,000 - $250,000

More than $250,000

It depends on how much I can sell my current house for

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* 19. If you prefer to rent, which would you prefer?

An apartment or condominium in a multi-unit building

A townhouse or slightly independent unit

A bungalow or rancher

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* 20. If you prefer to rent, how many bedrooms do you need? (with no additional supports)

1 bedroom

2 bedrooms

3 or more bedrooms

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* 21. If you prefer to rent, how much can you pay per month, not including utilities? (with no additional supports)

$750 or less

$751 to $1,000

$1,001 to $1,350

$1,351 to $1,500

$1,501 to $2,000

Over $2,000

Seniors' and Elders' Housing

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* 22. If seniors housing that you wanted or needed were available in your community or on the North Island, you would be likely to stay in the area?

Yes

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* 23. If you want to leave the area for later-in-life care and seniors housing, what is your reason for leaving?

I want to be closer to family

I prefer to be in a larger urban centre

I prefer to be in a more rural setting

The transportation options here are too limiting for me

Other (please specify)

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* 24. Please indicate the type of dwelling you are most interested in for seniors housing?

Single Story House

Unit in a shared or multi-unit residence

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* 25. If you moved into a shared or multi-kit seniors residence, what size housing unity would you need?

Bedsitting unit with en-suite bathroom

One bedroom unity

Two bedroom unity

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* 26. If you moved into a shared or multi-unit seniors residence, would you prefer to keep your car?

Yes

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* 27. In senior's housing, what are your needs or preferences for meal preparation?

My own kitchen to prepare meals

A kitchenette, or access to a shared kitchen so I can prepare light meals or breakfast, but have more meals prepared for me

All meals prepared for me

I don't know

I prefer not to answer

Other (please specify)

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* 28. With your income, what are you able to pay (or willing to pay) per month for senior's housing including services such as meals, housekeeping, and social activities?

$1,000 or less

$1,001 to $1,500

$1,500 to $2,000

$2,001 to $2,500

$2,500 to $3,001

$3,001 to $3,500

Over $3,500

I prefer not to answer

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* 29. What kind of payment or financing arrangement are you interested in for senior's housing

I would be interested in month-by-month payments

I would be interested in purchasing a housing unit

I would be interested in pre-purchasing a unity in a senior's housing project

I would be interested in investing in a senior's housing project, which would give me some financial return

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* 30. If you own your own home: Do you need to sell your house before you can make decisions about what kind of seniors housing you can live in, or understand what kind of financial commitments you are able to make?

Yes, I need to sell my house before I make any decisions

No, I can make decisions before I sell my house

I have trouble understanding my options

I prefer not to answer

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* 31. "Affordable housing" for rental properties refers to units will rents that are 65%-80% of the going market rate. These units are modest in size, design and amenities in comparison with market-rate units, and are rented to people with lower incomes.

If affordable housing for seniors were available, are you likely to apply for it?

Yes

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* 32. What is important to you about a location for seniors housing?

	Not Important	No Opinion	Somewhat Important	Very Important	N/A
Within 5 minutes walk to stores	Within 5 minutes walk to stores Not Important	Within 5 minutes walk to stores No Opinion	Within 5 minutes walk to stores Somewhat Important	Within 5 minutes walk to stores Very Important	Within 5 minutes walk to stores N/A
Within 10 minutes walk to stores	Within 10 minutes walk to stores Not Important	Within 10 minutes walk to stores No Opinion	Within 10 minutes walk to stores Somewhat Important	Within 10 minutes walk to stores Very Important	Within 10 minutes walk to stores N/A
Within 20 minutes walk to stores	Within 20 minutes walk to stores Not Important	Within 20 minutes walk to stores No Opinion	Within 20 minutes walk to stores Somewhat Important	Within 20 minutes walk to stores Very Important	Within 20 minutes walk to stores N/A
Close to the beach	Close to the beach Not Important	Close to the beach No Opinion	Close to the beach Somewhat Important	Close to the beach Very Important	Close to the beach N/A
Has an ocean, mountain or forest view	Has an ocean, mountain or forest view Not Important	Has an ocean, mountain or forest view No Opinion	Has an ocean, mountain or forest view Somewhat Important	Has an ocean, mountain or forest view Very Important	Has an ocean, mountain or forest view N/A
Close to the hospital	Close to the hospital Not Important	Close to the hospital No Opinion	Close to the hospital Somewhat Important	Close to the hospital Very Important	Close to the hospital N/A
Is in a quiet setting near parks or nature	Is in a quiet setting near parks or nature Not Important	Is in a quiet setting near parks or nature No Opinion	Is in a quiet setting near parks or nature Somewhat Important	Is in a quiet setting near parks or nature Very Important	Is in a quiet setting near parks or nature N/A
Is in a residential setting surrounded by other homes and people	Is in a residential setting surrounded by other homes and people Not Important	Is in a residential setting surrounded by other homes and people No Opinion	Is in a residential setting surrounded by other homes and people Somewhat Important	Is in a residential setting surrounded by other homes and people Very Important	Is in a residential setting surrounded by other homes and people N/A

Other (please specify)

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* 33. Please indicate if you are currently receiving any of the following supportive care services from an organization or from individuals. If you are not currently receiving supportive care but would like to, please indicate which services: (Remember: this survey is anonymous.)

	Currently Receiving	Not Receiving	Not receiving but would like to
Meals delivered	Meals delivered Currently Receiving	Meals delivered Not Receiving	Meals delivered Not receiving but would like to
Housework	Housework Currently Receiving	Housework Not Receiving	Housework Not receiving but would like to
Laundry	Laundry Currently Receiving	Laundry Not Receiving	Laundry Not receiving but would like to
Home and Yard Maintenance	Home and Yard Maintenance Currently Receiving	Home and Yard Maintenance Not Receiving	Home and Yard Maintenance Not receiving but would like to
Driving and Transportation	Driving and Transportation Currently Receiving	Driving and Transportation Not Receiving	Driving and Transportation Not receiving but would like to
Personal care (eg, bathing, dressing, hair, feet)	Personal care (eg, bathing, dressing, hair, feet) Currently Receiving	Personal care (eg, bathing, dressing, hair, feet) Not Receiving	Personal care (eg, bathing, dressing, hair, feet) Not receiving but would like to
Medication supervision and other advanced home care assistance	Medication supervision and other advanced home care assistance Currently Receiving	Medication supervision and other advanced home care assistance Not Receiving	Medication supervision and other advanced home care assistance Not receiving but would like to
Shopping for essentials (eg groceries)	Shopping for essentials (eg groceries) Currently Receiving	Shopping for essentials (eg groceries) Not Receiving	Shopping for essentials (eg groceries) Not receiving but would like to
Socialization program or Seniors Club	Socialization program or Seniors Club Currently Receiving	Socialization program or Seniors Club Not Receiving	Socialization program or Seniors Club Not receiving but would like to

Other services you are not receiving but would like to:

Thank you for taking the time to take this survey on Seniors Housing Needs on the North Island!

If you feel as though you have affordability issues, problems with the condition or size of your house, we have a further survey you may wish to do that will help us in our advocacy efforts and/or funding requests for increased supportive housing. Please click this link to take our 5-8 minute "Housing and Homelessness: A Service Needs Assessment Survey." https://www.surveymonkey.com/r/XQT73T3

Seniors & Elders Healthy Living Questionnaire

Question Title

* 1. Knowing the purpose of this survey and that your information is kept completely confidential, are you willing to take this survey right now?

Question Title

* 2. If answering no for this survey, for which reasons?

Question Title

* 3. What town or municipality do you live in?

Question Title

* 4. What is your age group?

Question Title

* 5. Who do you live with? (select all that apply)

Question Title

* 6. If you have a spouse or partner living with you, please indicate the age group of your partner or spouse.

Question Title

* 7. Does anyone in your home (including yourself) have a health condition lasting for six months or more that makes it difficult to get around inside the house, and into and out of the house?

Question Title

* 8. Overall, how do you feel about your current housing situation?

Question Title

* 9. This question addresses affordability in the context of housing. You may choose not to answer. What category best described your gross household income from all sources last year? (remember, this survey is completely anonymous.)

Question Title

* 10. Do you own or rent your current home?

Question Title

* 11. How do you feel about the status your home? (please select all that apply)

Question Title

* 12. Do you have or need any of the following in your home? (Select all that apply)

Question Title

* 13. Do you either need or want to live in Senior's Housing at this time? (Senior's housing being a place with social activities, meal options, and housekeeping services.)

Question Title

* 14. If in the future you did need supportive services (like meals, housekeeping, yard work or social activities) would you prefer to move to a smaller space to receive those, or stay in your own home and receive services there?

Question Title

* 15. If in the the future you anticipate downsizing and moving to a place with increased supports, when do you anticipate that may be?

Question Title

* 16. If you anticipate downsizing in the future, to either supportive housing or smaller independent living units, would you rather rent or own?

Question Title

* 17. If you prefer to own your next home as a senior, what size and kind of home would you like? (With no additional supports)

Question Title

* 18. If you would prefer to own your next home as a senior, what is your price range? (With no additional supports.)

Question Title

* 19. If you prefer to rent, which would you prefer?

Question Title

* 20. If you prefer to rent, how many bedrooms do you need? (with no additional supports)

Question Title

* 21. If you prefer to rent, how much can you pay per month, not including utilities? (with no additional supports)

Question Title

* 22. If seniors housing that you wanted or needed were available in your community or on the North Island, you would be likely to stay in the area?

Question Title

* 23. If you want to leave the area for later-in-life care and seniors housing, what is your reason for leaving?

Question Title

* 24. Please indicate the type of dwelling you are most interested in for seniors housing?

Question Title

* 25. If you moved into a shared or multi-kit seniors residence, what size housing unity would you need?

Question Title

* 26. If you moved into a shared or multi-unit seniors residence, would you prefer to keep your car?

Question Title

* 27. In senior's housing, what are your needs or preferences for meal preparation?

Question Title

* 28. With your income, what are you able to pay (or willing to pay) per month for senior's housing including services such as meals, housekeeping, and social activities?

Question Title

* 29. What kind of payment or financing arrangement are you interested in for senior's housing

Question Title

* 30. If you own your own home: Do you need to sell your house before you can make decisions about what kind of seniors housing you can live in, or understand what kind of financial commitments you are able to make?

Question Title

Question Title

* 32. What is important to you about a location for seniors housing?

Question Title

* 33. Please indicate if you are currently receiving any of the following supportive care services from an organization or from individuals. If you are not currently receiving supportive care but would like to, please indicate which services: (Remember: this survey is anonymous.)

* 9. This question addresses affordability in the context of housing. You may choose not to answer.

What category best described your gross household income from all sources last year? (remember, this survey is completely anonymous.)

* 13. Do you either need or want to live in Senior's Housing at this time?

(Senior's housing being a place with social activities, meal options, and housekeeping services.)