Monterey Bay Village Survey


Section I DAILY LIVING/HOME SERVICES that may be important to you and your decision to stay in your home as you grow older. (Check all that apply.)
Meal Preparation
Transportation
Shopping (groceries, other)
Services (dry cleaning, laundry, etc.)
Housecleaning
General Handyman
Companion/Friendly Visitor Services
Special Services (plumbing, electrician, etc.)
Other (briefly describe)


Section II HEALTH ASSISTANCE SERVICES that are, or may be in the future, to you should you stay in your home as you grow older. (Check all that apply.)
Medical/Dental Referrals
Skilled Nursing/Nurses Aide
Physical Therapy
Medical Equipment (wheelchairs, beds, walkers, etc)
Home Health Care (administer medication, bathing, etc.)
Nutrition (diet)
Procuring Prescriptions
Help With Forms (health insurance claims, Medicare, etc.)
Other (briefly describe)


Section III ORGANIZED PHYSICAL ACTIVITIES that you would like to participate in if you remain home as you grown older. (Check all that apply.)
Scheduled Exercise Programs
Walking Groups
Swimming
Dancing Classes
Yoga / Meditation / Tai Chi
Other (briefly describe)


Section IV ORGANIZED SOCIAL ACTIVITIES to be held at conveniently located meeting places in the Monterey/PG/Carmel/PB or scheduled trips. (Check all that apply.)
Coffee / Tea Parties
Discussion Groups
Hobbies and Crafts
Games (bridge, chess, etc.)
Entertainment Trips (museums, concerts, theatre, movies, etc.)
Volunteering (nonprofit organizations)
Other (briefly describe)


Section V CONTINUING EDUCATION opportunities available to older residents in the greater Monterey/Carmel area. (Check all that apply.)
Lectures/Workshops/Seminars on a Variety of Subjects
How-to Classes (computer/internet, cooking, bridge, etc.)
Investment Clubs
Wellness and Nutrition
Other (briefly describe)


Section VI PERSONAL AND FINANCIAL SERVICES that you believe will be important to you as you grow older. (Check all that apply.)
Bill Paying
Balancing Checkbooks
Investment Advice
Legal Advice
Tax Preparation
Transition planning (ie. advance healthcare directive, etc.)
Other (briefly describe)


Section VII We would now like you to prioritize each major category in order of importance (1 to 7, with 1 being the most important) if you were to live independently in your home as you grow older.
Daily Living/Home Services
Health Assistance Services
Organized Physical Activities
Organized Social Activities
Continuing Education
Personal and Financial Services
Transition Planning (i.e., advance healthcare directive, etc.)

Section VIII In order to help us analyze the data provided, we would appreciate if you would answer the following confidential personal background questions.
Size of household (persons)	1 2 3 4 or more
Age	55-64 65-74 75-84 85 or older
Education completed	High School College Graduate Degree
In which Zip code do you live?
Do you use email?	Yes No
Residency	Full time Part time
Do you own or rent (house, condo, apt)?	Own Rent
Annual household income	Under $25,000 $25,000-$49,999 $50,000-$100,000 Over $100,000
Do you have family living in the area?	Yes No
Would you pay $80.00-$100.00 monthly for membership?	Yes No
What skills can you offer the Village?

Thank you for participating in this project that may be important to all of us as we grow older and continue to live independently on the Monterey Peninsula. We welcome any additional confidential comments or suggestions you would like to share with us.
Your comments, if any
If you would like us to contact you about future plans for Monterey Bay Village, please provide your Name, Telephone Number, and Email Address

Compassionate Care Alliance
P.O. Box 1785, Monterey, CA 93942
(831) 655-9506
Contact Us