Community Action for Seniors survey
The social isolation of seniors is a significant issue in Canada and has been identified as a national priority. Actions are being taken at the government, organization and community level. This survey is an initiative funded by the Alberta Ministry of Seniors and Housing and carried out by CCCSA (Calgary Chinese Community Service Association). By completing this survey, you will be helping organizations in your community to better understand seniors in the community, leading to social innovation to improve the quality of life for local area seniors. Your input is important to us. This survey will take about 10 minutes. Thank you for taking the time.
1. In which community do you live in?
2. Indicate the number of people in your family who fall under the following age ranges.
0
1
2
3
4
5
0 - 10 years
11 - 18 years
19 - 54 years
55 - 64 years
65+ years
3. If there are no older adults (age 55-64) or seniors (age 65+) in your household, please proceed to answer Questions 15-20.
4. Who is the primary caretaker for the older adult and/or senior in your home?
5. Who is the primary caretaker for the children in the household?
Mark all that apply.
6. Does your household participate in community activities?
Older Adult
Senior
Children
Other Adults
Yes
No
7. If yes for older adult and/or senior, what & where are those activities?
Your answer
8. If no for older adult and/or senior, why not?
Mark all that apply.
9. Please provide responses below pertaining to the OLDER ADULT in your home.
0 = No, lowest or non existent; 4 = highest, yes, very fluent, very regularly. Mark only one box per row.
0
1
2
3
4
Not Applicable
English proficiency
Drives
Has a vehicle
Takes transit
Takes taxi/Uber
Has friends to go out with
10. Please provide responses below pertaining to the SENIOR in your home.
0 = no, lowest or non-existent; 4 = highest, yes, very fluent, very regularly. Mark only one box per row.
0
1
2
3
4
Not Applicable
English proficiency
Drives
Has a vehicle
Takes transit
Takes taxi/Uber
Has friends to go out with
11. Is information about community programs and services easily available in your area?
12. How do you access information about your community?
Mark all that apply.
13. Is the older adult and/or senior in your home able to access the information?
Older Adult
Senior
Not Applicable
Yes
No
14. If not, why not?
Your answer
15. Below is a list of social services & agencies. Please select any you have used for you and your family.
Mark all that apply
16. Are these services available in your community?
17. If not, how far did you have to travel to access the service/s?
Your answer
18. Which of the following volunteer-led inter-generational activities would you support having in your community?
Mark all that apply.
19. Are you interested in leading inter-generational activities in your area?
20. If yes, please provide contact information.
Your answer
21. What is your country of origin?
Your answer
22. What is the main language spoken at home?
Your answer
23. Any other comments or suggestions?
Your answer
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