A survey of the housing needs of area residents 60 and older
DEMOGRAPHIC INFORMATION
1. What town or municipality do you live in? *
Your answer
2. What is your age group? If you are part of a couple, please indicate the age group of your partner or spouse.
You
Your partner/spouse
60 – 64 years
65 – 69 years
70 – 74 years
75 – 79 years
80 years and over
3. Do you live alone? *
4. If you live with someone else, do you live with (select all that apply): *
Required
5. What category best describes your gross total household income from all sources – before deductions – last year? (Remember: this survey is anonymous).
6. 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 lease one entry with only one or no steps
Ramped entrance instead of or in addition to steps
Front door wide enough for wheelchair passage (at least 32” clear)
Bathroom door wide enough for wheelchair passage (at least 32” clear)
Room to maneuver a wheelchair in the bathroom
Grab rails near the tub or shower
Grab rails near the toilet
A washroom on the main floor
A lifting device between floors
7. Overall, how do you feel about your current housing situation? *
Required
HOUSING PREFERENCES
Q8. Do you need or want to live in seniors’ housing at this time? **By this we mean housing with supportive services available such as meals, housekeeping, and social activities. *
Q9. If you answered no: if seniors’ housing (housing with supportive services available such as meals, housekeeping, and social activities) were available, do you think you might want to move to it in the future:
Q10. If you needed supportive services such as meals, housekeeping, and mobility assistance in the future, would you prefer to stay in your current home and receive those services there?
Q11. If you might move to seniors’ housing (housing with supportive services available such as meals, housekeeping, and social activities) in the future, when is that likely to be?
Q12. If you prefer to rent, which would you prefer?
Q13. If you prefer to rent, how many bedrooms do you need?
SENIORS’ HOUSING
Q14. If seniors’ housing that you wanted and/or needed were available in Burlington, Hamilton, Dundas and Waterdown or in the area, would you be likely to stay in town or in the area?
Q15. If you answered no, what is your reason leaving?
Q16. Please indicate the type of dwelling you are most interested in for seniors’ housing.
Q17. If you moved into a shared or multi-unit seniors’ residence, what size housing unit would your need?
Q18. If you moved into a shared or multi-unit seniors’ residence, would you prefer to keep your car?
Q19. In seniors’ housing, where are your needs or preferences for meal preparation? *
Required
Q20. What kind of payment or financing arrangement are you interested in for seniors’ housing? If you select more than one, please rank the in order of importance to you by writing a number (1 – 5) next to the option. Example: 1 being the most important and 5 being the least important.
a. I would be interested in paying per month for housing. *
most important
least important
b. I would be interested in purchasing a housing unit. *
most important
least important
c. I would be interested in investing in a seniors’ housing project. *
most important
least important
d. I would be interested in paying a substantial refundable deposit to reserve a unit and support the building of a seniors’ housing project. *
most important
least important
Q21. If you own your own home, do you need to sell your house before you can make a decision about what kind of seniors’ housing you can live in or what kind of financial commitment you can make? *
Q22. What is important to you about a location for a seniors’ residence? *
Not at all important
No strong feeling one way or the other
Somewhat important
Very important
Within 5 minute walk to downtown
Within 10 minute walk to downtown
Within 20 minute walk to downtown
Close to a river
Has river or mountain view
Close to the hospital
On an outlet setting surrounded by nature
In a residential setting surrounded by other homes
Q23. 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, or in and out of the house? *
Q24. 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 but would like to
Meals delivered
Housework
Laundry
Home and yard maintenance (e.g. lawn mowing)
Driving and transportation
Personal care (e.g. bathing, dressing)
Medication supervision/other home health assistance
Shopping for essentials (e.g. groceries)
Q24a. Other services you are currently receiving:
Your answer
Q24b. Other services not receiving but would like to
Your answer
Q25. Do you have knowledge, experience and/or enthusiasm that you are willing to contribute to the development, building and/or operation of a housing project for seniors?
Your answer
YOUR TURN
Q26. Is there anything you would like to tell us about this survey, about seniors’ housing, or any housing issue or concern?
Your answer
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