Help Us Help You – Aging in Place in Our Community

You may complete this survey for yourself or for someone you are caring for who has concerns about aging in place. If you wish to provide information for more than one person, please complete separate surveys.

I am completing this survey for:

Myself, and I live alone Myself, and there are others living with me Someone who lives with me Someone who lives alone (outside of my home) Someone who lives with others (outside of my home)

NOTE: If you are completing for someone else, answer all questions as that person would.

If you are currently receiving support, services, or other help from individuals or organizations in Lyme or our region, please share who helps you:

Individuals Friends Family

Lyme Organizations (list)

Other Organizations (list)

Previous survey respondents identified different challenges, such as problems walking or with stairs, difficulty caring for a large home, feeling isolated, or financial uncertainty.

When you think about your aim to age in place, what is your greatest challenge or concern?

We try to use lots of ways to let people know about events and programs.

How do you get information about opportunities for education or social gatherings? Lyme Listserv CCL Calendar Personal Phone Call CCL Email Update Library Email Update Lyme Community and Church Newsletter Other (specify one or more below)

Other ways you get information

Want to help? Need more info? I would like to help with the CCL Aging in Place committee and/or program planning efforts. I would like more information about CCL programs and activities

If you have specific questions or if there is anything else you would like to tell us, please share here:

Name

Primary Contact (if different)

Mailing Address

Physical City, State Zip (If different)

Physical Street Address (If different)

This address will receive a confirmation email

Phone

Description

By “Aging in Place”, this survey means living in the home or residence you choose for as long as possible.
It typically requires some services, support, and modifications to the living spaces to adapt to changing needs as you age.

CommunityCare of Lyme is aiming to make it easier to Age in Place. Please help the CCL Aging in Our Community team learn more about what you look forward to and what you see as the challenges as you age in your home. This survey is just a start. We are eager to learn more about you and look forward to discussing your unique situation.

Contact us with any questions or suggestions at aging@cclyme.org or calling the CCL office at 603-795-0603.

Thank you!

Help Us Help You – Aging in Place in Our Community

Description

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