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Questions marked with an asterisk (*) are mandatory.
As the Baby Boom generation races toward traditional retirement age, the number of older adults in Virginia will reach 1.8 million by 2030 – more than double that
population in 2000. In just two decades, almost one in every five Virginians will be age 65 or older, with the over 85 age group being the fastest growing segment of the population. Recognizing the coming “Age Wave,” the Virginia Department for the Aging
has partnered with other health and human service leaders to develop a Four-Year Plan for Aging Services - a comprehensive picture of where we are and where we need to go. We invite you to review the Plan and complete the following survey to assist
the Commonwealth in effectively meeting the needs and leveraging the valuable resources of Virginia’s rapidly aging population.
To review Virginia's Four-Year Plan for Aging Services, click here:
http://vda.virginia.gov/pdfdocs/FourYearPlanForAgingServices-RD461-2009.pdf
Questions marked with an asterisk (*) are mandatory.
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* In what city/county do you work (or reside if retired)?
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3
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Your Highest Level of Education (Please check only one response):
| Less than high school |
| High School
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| Associate’s Degree(s) |
| Bachelor’s Degree(s) |
| Master’s/Advanced Professional Degree(s)
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| Doctorate Degree(s) |
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Your Race/Ethnicity (Please check only one response):
| African American or Black |
| Caucasian or White |
| American Indian/Alaska Native |
| Native Hawaiian/Pacific Islander |
| Hispanic or Latino |
| Asian (Vietnamese) |
| Asian (Indian) |
| Asian (Korean) |
| Asian (Chinese) |
| Asian (Filipino) |
| Asian (Japanese) |
| Other, please specify |
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* What is your age in years?
| 0-25 |
| 26-50 |
| 51-65 |
| 66-80 |
| Over 80 |
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Are you currently employed / working?
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7
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* What is your current or retired role(s)?
(Please check all that apply):
| Family caregiver of an elder or individual with a disability |
| Aging advocate/Interested citizen |
| Staff of an Area Agency on Aging |
| Staff of a local Department of Social Services |
| Staff of a local Health Department |
| Staff of a state agency |
| Staff of a private non-profit organization |
| Staff of a long-term care facility (NH/ALF/AFC) |
| Professional health care provider (MD/PA/RN) |
| Other paid care provider (CNA) |
| Academic Faculty or Researcher |
| Other, please specify |
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* Do you feel that the current
Four-Year Plan for Aging Services is an accurate reflection of aging issues facing Virginia?
1
Completely Accurate | 2
.....Very..... Accurate | 3
Somewhat Accurate | 4
.......Not....... Accurate | Unknown or No.Opinion
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| Please rate the level of accuracy according to the scale above. |
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Are there important service areas, programs and/or issues that are NOT included in this Plan?
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If YES, please specify or comment.
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Please rate the importance of the following issues that may impact the quality of life of older persons, our families and communities.
1
Critically Important | 2
................. Important | 3
Not Very Important | 4
Not Important At.All | Unknown or No.Opinion
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| Affordable/accessible transportation to health care-related appointments (doctor, pharmacy) |
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| Affordable/accessible transportation to grocery store, senior center, etc. |
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| Affordable services that support
physical health care (physicians, hospitals, etc.) |
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| Affordable services that support mental health care |
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| Affordable
services that support personal care or other help in the home (bathing, cooking) |
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| Affordable
services that support family caregivers (respite, physical and emotional well-being) |
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| Fitness/exercise programs that promote good
health/wellness and help to manage chronic disease |
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| Educational
programs that support proper nutrition |
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| Educational programs that support
long-term care planning and financial security |
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| Affordable/accessible housing (accommodates wheelchairs, scooters and walkers) |
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| Home repairs/home modification services |
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| Home/neighborhood safety and security |
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| Opportunities for education and life-long learning |
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| Opportunities to develop computer skills |
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| Opportunities to volunteer and engage in community service |
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| Opportunities for work/employment |
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| Opportunities for socialization (senior centers, adult day centers) |
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Considering the issues you rated above, please rank the urgency of addressing these issues and their impact on older Virginians, our families, and communities.
(Rank the items from 1 as the most urgent through 8 as the least urgent, using each ranking only once.)
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Unknown or No.Opinion |
| Transportation |
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| Health care/personal care |
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| Nutrition/fitness |
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| Housing/home/neighborhood safety |
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| Education/life-long learning/skill development |
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| Volunteer/community service opportunities |
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| Employment/work opportunities |
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| Socialization |
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12
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Whose responsibility is it to prepare communities for the “Age Wave” (the impact of an aging population) by providing information/education,
identifying and promoting best practices, developing tools, and providing services and/or funding?
(Rank the items from 1 as the most responsible through 7 as the least responsible,
using each ranking only once.)
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | Unknown or No.Opinion |
| Federal government |
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| State government |
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| County/city government |
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| Non-profit/philanthropic foundations |
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| Corporate community/entrepreneurs |
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| Higher education (colleges and universities) |
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| Individuals/families (personal) |
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Whose responsibility is it to promote the concept of “Livable Communities” by providing information, education and tools for community development, and/or by providing a certification process?
(Rank the items from 1 as the most responsible
through 7 as the least responsible, using each ranking only once.)
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | Unknown or No.Opinion |
| Federal government |
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| State government |
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| County/city government |
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| Non-profit/philanthropic foundations |
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| Corporate community/entrepreneurs |
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| Higher education (colleges and universities) |
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| Individuals/families (personal) |
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Whose responsibility is it to encourage older Virginians to become resources for our communities (either paid or volunteer)?
(Rank the items from 1 as the most responsible through 7 as the least responsible,
using each ranking only once.)
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | Unknown or No.Opinion |
| Federal government |
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| State government |
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| County/city government |
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| Non-profit/philanthropic foundations |
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| Corporate community/entrepreneurs |
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| Higher education (colleges and universities) |
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| Individuals/families (personal) |
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15
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Please use this space if you wish to clarify any of your responses or make additional comments about the Plan.
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