Aging at Home in Weathersfield
 “Aging at Home in Weathersfield is a group of neighbors helping neighbors.  We are volunteers who help seniors and others who need assistance to remain in their homes in comfort and safety.”

If completing this survey on paper, please mail to:

Aging at Home in Weathersfield, Attn: Lynn Esty, PO Box 550, Ascutney, VT 05030-0550
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Thinking about your future and where you will live, how appealing are each of the following options? Please check one box for each option. (Some options overlap.)
This is my hope
Appealing
Unappealing
This is NOT for me
Stay in my current home
Move to a smaller, easier to manage home
Move in with family or friends
Move to a Continuing Care Retirement Community
Move to a Senior Housing Facility
Stay in Weathersfield
Have help with support services, such as delivered meals, household chores and rides
Have someone move in with me to help me out
Participate in an Aging at Home in Weathersfield community initiative
Independently figure out how to get help when and if I need it
Other Future Items? Please list!
Which of the following supportive services are important to you?
Now
In the Future
Never
Central resource for information and references about community services ( Weathersfield Directory )
Transportation (to medical appointments, events, social visits)
Household Services (home repair, cleaning, errands)
Food and Meals (grocery shopping, home delivered meals, community meals, dining groups)
Health Care Coordination (home health aid and personal care services, doctor visits, care management, help with decision -making, advance care planning)
Wellness Programs (fitness evaluations, fitness classes, wellness seminars)
Legal and Financial Support (bill-paying, health and long-term care insurance, powers of attorney, wills)
Social and Cultural Activities (social gatherings and events, trips, educational seminars, home computer classes, individual and group travel)
Concierge Services (mail packages, bring car in for repairs, pick up event tickets, water plants/pick up mail during vacation, wait for repair person, pet care)
Volunteering (within Aging at Home in Weathersfield community and/or outside of it)
Other Supportive Services? Please List!
How might you support the development of the Aging at Home in Weathersfield initiative in Weathersfield, VT?
Definitely Yes
Possibly Yes
Possibly No
Definitely No
Encourage others' efforts
Volunteer time and skills
Provide financial support
Participate in program development (help set up 501c3, write grants, fundraise)
The organizers would like to discuss your views on Aging at Home in Weathersfield with you. Please enter your name, address, telephone number and/or email address in the box below if you would like to share your ideas with us. (Optional)
If you would like to participate in Aging at Home in Weathersfield meetings, participate in organizing and facilitating opportunities, please share your name, best contact number or email address!
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