2019 Ulster County Senior Survey
Dear Ulster County Senior: As a valued member of our community, Acting Ulster County Executive Adele B. Reiter and the Ulster County Office for the Aging want to hear from you! Our mission is to assist Ulster County seniors to be as independent as possible, for as long as possible. We hope that you will complete this survey to let us know what you feel is important in order to age safely and happily in Ulster County.

By filling out the survey, you will be assisting us in determining what kinds of services are important and necessary in our community to support Ulster County residents as they age.

Please note that at the end of the survey there are some personal questions that will assist us in planning, but we assure you that your information will remain confidential and your identity will remain anonymous.

If you need assistance completing the survey, or would like to request a paper version of the survey, please call our office at 845-340-3456.

Thank you in advance for your participation and contribution!


Judy Riley
Interim Director
Ulster County Office for the Aging

Your Zip Code:
Your answer
Your Town:
Your answer
Please select a response for each question:
This IS a concern for me now
This MAY BE a concern for me within 5 years
This is NOT a concern for me
Are you able to perform household chores (cleaning, etc.)?
Are you able to pay rent or taxes independently?
Are you able to pay for home heating and/or cooling independently?
Are you able to drive your own car?
Are you able to get to medical appointments (within Ulster County)?
Are you able to get to out-of-county medical appointments?
Are you able to get to the grocery store and do other errands when you want?
Are you able to navigate public transportation options for those who are unable to drive (bus, taxi)?
Are you able to go places when you want to go?
Are you able to shop and cook for yourself?
Do you have enough money for nutritious food?
Do you need to/can you afford to follow a special diet recommended by your doctor (such as low salt)?
Do you participate in OFA Community Cafes or receive Home Delivered Meals?
Do you understand Medicare and other insurance options?
Not applicable
Do you understand low-income health insurance subsidies such as Medicare Savings Program?
Are you able to obtain help in applying for government programs such as HEAP or SNAP?
Do you understand long term services and support options?
Are you aware of availability of services for individuals with Alzheimer's or dementia and respite services for their caregivers?
Are you able to manage a chronic health condition (such as diabetes, pain, high blood pressure) to your satisfaction?
Have you had a fall or recurring falls or fear of falling in and/or out of the home?
Are you able to access senior centers, senior activities or OFA events?
Are you able to access in-home personal care services?
If you have been in the hospital in the past year, did you have the necessary information and services needed to return to your home?
Have you heard of "NY Connects," the State and local program that helps consumers with information, assistance and connections to needed long term services and supports?
Do you provide care for someone?
If you provide care for someone, who do you provide care for?
Your answer
Does the individual for whom you care live in your home?
Does the individual for whom you care have memory problems and/or dementia?
Do you feel overwhelmed and/or stressed in providing care?
Please identify your gender:
How many persons, including yourself, live in your home:
Your answer
In what year were you born?
Your answer
Your Race/Ethnicity:
Do you own or rent your home?
Which best describes your annual income:
Please share any other comments, thoughts or ideas with the Ulster County Office for the Aging:
Your answer
If you would like to be on the OFA email list, please provide your email address:
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service