Pennyrile Area Agency on Aging & Independent Living FY 21 Needs Assessment Survey
Please complete the entire survey.  Surveys must be completed by November 16, 2020.
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County of Residence:
Sex:
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Age:
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Ethnic Background:
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Marital Status:
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Veteran:
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Yearly (Individual) Income Level:
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Education Level:
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Which categories best describe you? (Please check all that apply)
You live with:
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Type of housing you live in:
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Are  you satisfied with your current living arrangement?
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If "no", please explain:
Current Health Status:
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Types of health insurance you currently have: (Please check all that apply)
In the last year, you have needed help with: (Please check all that apply)
Who currently helps to provide care for you? (Please check all that apply)
Place a check mark to indicate whether a high priority or low priority should be placed on the following issues regarding senior citizens in your community.
High Priority
Low Priority
Don't Know
Meals in Senior Centers
Transportation
Leagal Services
Benefits Counseling
Adult Day Care
Respite / Sitter Services
Home Health Services
Homemaking Services
Personal Care Services
Information / Assistance
Home Repair / Ramp
Weatherization
Home Delivered Meals
Volunteer Opportunities
Senior Center Services
Counseling Services
Senior Employment
Advocacy for Seniors
Support Groups
Clear selection
Are you now using or have you ever used any of the services listed above?
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If "yes", please explain:
If you were to be placed on a waiting list for services, would you be interested in private pay services until the funded service you need is available?
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Have you felt socially isolated or lonely during the COVID-19 pandemic?  
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What services have you needed most during the COVID-19 pandemic? Check all that apply.
Are there any other needs you are aware of that are not currently being met for senior citizens within your community?
Please add any additional comments or suggestions you have which may be useful in planning toward the future of the senior citizens in this area.
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