You are invited to participate in a 10-20 minute survey that aims to identify the needs of the elderly living in the North Idaho and South East Washington communities. The information obtained from this survey will be utilized to foster the program development of curriculum relevant to a multidisciplinary “Aging” certificate program of study at Lewis-Clark State College. Your participation in this survey is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey or choose not to answer specific questions at any point. Your survey responses will be strictly anonymous and data from this research will be reported with no identifying information. PLEASE DO NOT PUT YOUR NAME ON THE SURVEY.
By taking the time to complete and submit the survey, you are acknowledging acceptance of the informed consent provided. If you require assistance or have any questions regarding this survey please feel free to contact Dr. Brian L. Christenson at (208) 792-2476; blchristenson@lcsc.edu, or the Institutional Review Board of Lewis-Clark State College at (208) 792-2460. Thank you very much for your time and support.
1. In what county are you currently living? (please check one)
Asotin Benewah Bonner Boundary Clearwater
Idaho Kootenia Latah Lewis Nez Perce
Shoshone Whitman
2. What is your gender? (please check one)
Female Male
3. Please provide the year of your birth. (please type in)
4. What is your household income range? (please check one)
$0-$13,689 $13,690-$17,169 $17,170-$20,649
$20,670-$24,129 $24,130-$27,609 $27,610+
5. How many are living in your household? (Please type in)
6. In your opinion, what are the general unmet needs of elders living in rural communities in your area? (For example: home health care, transportation, etc.) (please type in)
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7. In your opinion, what Community Based Services are inadequate for the aging population
in your area? (For example: Respite care, Home Health Care, Meals on Wheels, Home/ Yard and Maintenance, Chore Services, Need of Area Agency on Aging in each County, Grocery Shopping, Companion Services Community based Assisted Living and Nursing Homes, etc.) (please type in)
8. In your opinion, what Community Based Services are absent for the aging population in
your area? (please type in)
9. In your opinion, is lack of transportation for the aging living in your area a concern? (please check one)
Yes No
If yes, what do you feel would help solve this issue? (please type in)
10. Do you feel you have access to quality caregivers? (please check one) Yes No
Please explain the reasons why. (please type in)
11. Use the scale below to answer the following question. How easily can you access services in your area?
(please check one)
Always Occasionally Neutral Seldom Never
12. Please explain any other concerns you may have related to aging. (please type in)
13. Please check the box next to the items that you are interested in learning more about if workshops or trainings were available. (Please check the boxes that apply to your interests)
I would like more I would consider
Information attending a workshop
Rural Facts in Health and Aging
Physical Changes in Aging, Sexuality
Common Disease of Aging, Medications
Common Health Problems in Aging
Diet, Exercise, Impact of Nutrition
Importance of Socialization
Impact of Isolation
Spirituality
Mental Health Needs of Aging Adults
Depression, Dementia, Alzheimer’s
Grief and Loss, Death and Dying
Death and Dying Issues
Housing Estate Planning
Health Insurance/Policy Coverage
Budgeting, Money Management
Retirement, Taxes, Financial Accounts
Employment Opportunities
Home Health Care, Respite Care
Public Transportation
Adult Day Care, Assisted Living
Nursing Homes/Long Term Care
Locating Resources, Caregivers
Adult Protection
Area Agency on Aging
Meals on Wheels
14. Please provide any additional comments.
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Thank you for your participation!