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The Community Well Assessment Tool
The Community Well is a newly formed group who have come together with the mutually focused goal to create opportunities for older adults to age in place while living healthful, independent lives.
Thank you for participating in this survey. Please respond to the questions by indicating he number that you feel is most accurate. Use the space below to expand on any of the sections. We are engaging older adults in Foam Lake and area to gain their input about current services and conditions in our community.
For more information call: Celise Hack - 306-269-8800, or Jaime Helgason - 306-272-8019
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Please check your age range:
55-64
65-74
75-84
85+
Please rate each item using the following scale:
0 - Don't Know 1 - Poor 2 - Fair 3 - Good 4 - Very Good 5 - Excellent
1) Sidewalks, Pathways, Trails or Rest Areas
Sidewalks, paths or trails are well maintained and snow cleared
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Sidewalks have flat intersections so people with wheel chairs and scooters can get around the community
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Benches or other seating are available along sidewalks, paths or trails
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Buildings in the community have good signs to direct people to public washrooms
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Ramps with slope appropriate for wheel chairs
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Handrails
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Buildings in Foam Lake have accessible entrance ways
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Please use the space below to comment or expand on Sidewalks, Pathways, Trails or Rest Areas
Your answer
2) Transportation & Roads
Roads & Streets are well maintained
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Roads & streets are appropriately lit
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Spaces for disabled parking are monitored to ensure space is available for those who need it
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
A volunteer and/or informal network of drivers is available for those who need transportation
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Please use the space below to comment or expand on Transportation & Roads
Your answer
3) Housing
Housing is located close to services
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Affordable supports are available to help older adults stay in their homes
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Affordable long-term care options are available
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Affordable services such as yard maintenance and snow clearing are available for older adults
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Information on financial assistance programs for home modification and maintenance is readily available to seniors
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Senior housing has appropriate amenities for independent living
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Please use the space below to comment or expand on Housing
Your answer
4) Respect & Social Inclusion/Participation
Community activities bring together different generations
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
There is a range of social events for older adults of all ages
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Activities include physical, recreational, indoor & outdoor, educational and cultural events
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Activities & events are held in locations that are accessible to all
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Community organizations intentionally contact older adults who may not be able to participate in most activities or events
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Organizations provide help for older adults to attend community events
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Please use the space below to comment or expand on Respect & Social Inclusion/Participation
Your answer
5) Communication & Information
Information about community events and activities is posted where older adults do their daily activities or gather
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Achievements of older adults are highlighted in local media
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
I use a computer and the internet
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
I know where to go to get the information I need
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
There are people I can call to get the information I need
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Please use the space below to comment on Communication & Information
Your answer
6) Civic Participation & Employment Opportunities
Older adults are encouraged to volunteer & remain engaged in the community
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Older adults can be employed in the community
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Older adults are represented at a municipal level
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Please use the space below to comment or expand on Civic Participation & Employment Opportunities
Your answer
7) Community Support & Health Services
Physicians & nurse practitioners are available to the community
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Public health nurses are available at health centers & to make home visits
Don't Know
0
1
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3
4
5
Excellent
Clear selection
Meal delivery is available & affordable
Don't Know
0
1
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3
4
5
Excellent
Clear selection
Delivery of groceries, medicines & other needs is available & affordable
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Transportation to medical appointments & other needs is available & affordable
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Health services such as occupational & physical therapy, vision, dental care & foot care are available
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Programs such as mental health services, mammograms', diabetes clinics & cancer support groups are available
Don't Know
0
1
2
3
4
5
Excellent
Clear selection
Please use the space below to comment or expand on Community Supports and Health Services
Your answer
Thank you for your participation in this survey!
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