Olympic Area Agency on Aging Area Plan Survey

Advocates for Independence, Individual Choice and Quality Community Services Serving Older Persons and Persons with Disabilities Serving Clallam, Grays Harbor, Jefferson & Pacific Counties

1-866-720-4863

Thank you for completing this survey, designed to help identify the needs of older adults, adults with disabilities, & their caregivers in our region to assist us in planning for the next two years. If you are also a caregiver, please assist the person you care for to complete a survey representing his or her needs as well. You can also respond to this survey by telephone: call 1-866-720-4863 during business hours and a staff member will happily take your responses over the phone. The survey is also available on our website: www.o3a.org.

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* 1. Are you Male or Female?

Male

Female

Outside the Gender Binary

Prefer not to answer

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* 2. How old are you?

Under age 60

Age 60 to 74

Age 75 to 84

Age 85 or older

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* 3. Do you...?

Live alone

Live with a spouse or partner

Live with a friend or relative

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* 4. Do you live in…?

Clallam

Grays Harbor

Jefferson

Pacific (north)

Pacific (south)

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* 5. How would you rate your quality of life?

Excellent

Good

Okay

Poor

Bad

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* 6. Do you plan or have your already received a COVID-19 vaccine?

Yes

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* 7. Did you contract COVID-19?

Yes

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* 8. Did you gain or lose any weight during the pandemic & if so how much?

Lost

Gained

Stayed the same

How many lbs. lost or gained?

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* 9. Did you choose to remain at home socially distanced from others during the Pandemic?

Yes – I/we stayed home and had all items I/we needed delivered.

No - but I/we limited the number of times we left the house and always took safety precautions of masking, social distance of 6 feet, and sanitizing/hand sanitizing.

I wanted to stay home but had to work

I stayed home due to job being closed

I wanted to work & went to work

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* 10. To what degree have you experienced the negative effects of social isolation?

I/we have been very depressed, anxious or sad much of the time due to social isolation.

I/we have been intermittently depressed, anxious or sad due to social isolation.

I/we have only been slightly depressed, anxious or sad due to social isolation.

I/we have not experienced any depression, anxiety or sadness due to social isolation.

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* 11. What problems do you have with your current housing situation? Please check all that apply.

Do not have problems with housing

Upkeep and maintenance

I am at risk of foreclosure

I live in an assisted living facility

I live in a skilled nursing facility

The cost of my housing is a challenge (rent, mortgage, utilities, taxes)

My home needs modifications to improve safety (such as ramp, or changes to the bathroom)

I live in temporary situation with family or friends

I live in an RV

I live in a shelter

I do not have stable housing

Other (please specify):

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* 12. Have you been able to access needed legal services during the pandemic?

Yes

N/A

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* 13. Are you aware that free Senior Legal Advice Clinics are offered for those 60 and older in a remote safe manner through our offices?

Yes

I did not need legal services

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* 14. Since the COVID-19 pandemic began, what do you need help with?

	Not Needed	Need & have access	Cannot access	Need some help	Need more help
Food/Cooking meals	Food/Cooking meals Not Needed	Food/Cooking meals Need & have access	Food/Cooking meals Cannot access	Food/Cooking meals Need some help	Food/Cooking meals Need more help
Transportation Services	Transportation Services Not Needed	Transportation Services Need & have access	Transportation Services Cannot access	Transportation Services Need some help	Transportation Services Need more help
Respite Services	Respite Services Not Needed	Respite Services Need & have access	Respite Services Cannot access	Respite Services Need some help	Respite Services Need more help
Health Care Services	Health Care Services Not Needed	Health Care Services Need & have access	Health Care Services Cannot access	Health Care Services Need some help	Health Care Services Need more help
Dental Services	Dental Services Not Needed	Dental Services Need & have access	Dental Services Cannot access	Dental Services Need some help	Dental Services Need more help
Mental Health Treatment	Mental Health Treatment Not Needed	Mental Health Treatment Need & have access	Mental Health Treatment Cannot access	Mental Health Treatment Need some help	Mental Health Treatment Need more help
Substance Use Treatment	Substance Use Treatment Not Needed	Substance Use Treatment Need & have access	Substance Use Treatment Cannot access	Substance Use Treatment Need some help	Substance Use Treatment Need more help
Pharmacy/Medicines	Pharmacy/Medicines Not Needed	Pharmacy/Medicines Need & have access	Pharmacy/Medicines Cannot access	Pharmacy/Medicines Need some help	Pharmacy/Medicines Need more help

Please provide additional details of how your needs have changed during the pandemic:

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* 15. Are you caring for or supporting a family member, friend, or neighbor?

Yes

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* 16. How have your needs changes during the pandemic?

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* 17. If you are a caregiver of a person with dementia have you seen a change in that person during this time?

Yes

N/A

Please explain further:

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* 18. Have you received information about the Dementia Road Map?
Available by contacting WA State Alzheimer’s Assoc: 800-272-3900 or Google ‘Dementia Road Map’.

Yes

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* 19. Have you heard of the Palliative Care Road Map?
Contact O3A for a copy or Google ‘Palliative Care Road Map’.

Yes

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* 20. Do you ever skip paying for or buying any of the following items because of family finances? Please check all that apply to your household.

Housing

Transportation

Insurance

Utilities (water, electric, heat, landline phone)

Food

Medicine

Dental Care

Vision or glasses

Pets (care or food)

Internet

Cell phone

My family does not have financial stress.

Other (please specify)

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* 21. What would you say has been your most significant unmet need during the pandemic?

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* 22. If you would like someone to contact you with information about services, please provide your name and your contact information in the space below (email, telephone, mailing address):

Your Name:

Phone #:

Email:

Please Return Survey before June 30, 2021 to Olympic Area Agency on Aging,

2200 West Sims Way, Unit 100, Port Townsend, WA 98368

Olympic Area Agency on Aging Area Plan Survey

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* 1. Are you Male or Female?

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* 2. How old are you?

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* 3. Do you...?

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* 4. Do you live in…?

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* 5. How would you rate your quality of life?

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* 6. Do you plan or have your already received a COVID-19 vaccine?

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* 7. Did you contract COVID-19?﻿

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* 8. Did you gain or lose any weight during the pandemic & if so how much?

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* 9. Did you choose to remain at home socially distanced from others during the Pandemic?

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* 10. To what degree have you experienced the negative effects of social isolation?

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* 11. What problems do you have with your current housing situation? Please check all that apply.

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* 12. Have you been able to access needed legal services during the pandemic?

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* 13. Are you aware that free Senior Legal Advice Clinics are offered for those 60 and older in a remote safe manner through our offices?

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* 14. Since the COVID-19 pandemic began, what do you need help with?

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* 15. Are you caring for or supporting a family member, friend, or neighbor?

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* 16. How have your needs changes during the pandemic?

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* 17. If you are a caregiver of a person with dementia have you seen a change in that person during this time?

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* 18. Have you received information about the Dementia Road Map? Available by contacting WA State Alzheimer’s Assoc: 800-272-3900 or Google ‘Dementia Road Map’.

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* 19. Have you heard of the Palliative Care Road Map?Contact O3A for a copy or Google ‘Palliative Care Road Map’.

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* 20. Do you ever skip paying for or buying any of the following items because of family finances? Please check all that apply to your household.

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* 21. What would you say has been your most significant unmet need during the pandemic?

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* 22. If you would like someone to contact you with information about services, please provide your name and your contact information in the space below (email, telephone, mailing address):

* 7. Did you contract COVID-19?

* 18. Have you received information about the Dementia Road Map?
Available by contacting WA State Alzheimer’s Assoc: 800-272-3900 or Google ‘Dementia Road Map’.

* 19. Have you heard of the Palliative Care Road Map?
Contact O3A for a copy or Google ‘Palliative Care Road Map’.