Senior Community Survey
The Senior Community Survey will help EightCAP, Inc. learn about seniors in the four counties we serve. Your answers will help us understand what is going well and where people may need more support. The survey has five parts: Housing, Transportation, Health, Community Concerns, and Basic Information. Thank you for taking the time to share your thoughts with us—we truly appreciate it! This survey will take 5-10 minutes and remain confidential.
Housing
Which county do you live in?
Gratiot
Ionia
Isabella
Montcalm
Other
What is your current housing status?
Own
Rent
Staying with friend/family
Camper/tent
Car
Homeless
Other
How many people live in your household?
1
2
3
4
5
More than 5
What is your current employment status?
Retired
Part-time
Full-time
Self-employed
Seasonal
Other
What is your household income?
Under $15,000
Between $15,000 and $29,999
Between $30,000 and $49,999
Between $50,000 and $74,999
Between $75,000 and $99,999
Over $100,000
Pick the one that best describes the condition of your home:
Good shape, no repairs needed
Needs minor repairs
Needs major repairs
Needs Weatherization measures (insulation, air sealing, weatherstripping)
Needs accessibility improvements (wheelchair ramp, wider doorways, etc.)
Poor condition and is not safe
Have you ever been behind more than 30 days on your rent or mortgage payments?
Yes
No
Do you have running water in your home?
Yes
No
If you have a septic tank, is it working?
Yes
No
N/A
In the last year, has anyone in your household had to choose between buying food and paying a bill to meet other basic needs (housing, heat, electricity, water, prescriptions etc.)?
Yes
No
Do you need help with any of the following to remain safely in your home?
Home repairs
Yard maintenance
Accessibility modifications
Utility assistance
Household chores
Other
Do you have access to reliable internet?
Yes
No
Do you have access to a smartphone or computer?
Yes
No
Back
Next
Transportation
What transportation challenges do you face? (Check all that apply)
No vehicle
Vehicle not reliable
Cost of gas
No public transportation (or limited routes/hours)
Other
Not a problem
Do transportation challenges make it difficult for you to:
Get to appointments
Buy groceries
Attend activities/services
Other
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Next
Health and Wellbeing
How do you normally receive medical care?
Primary Care Physicians
Urgent Care
Emergency Room
I don't normally seek medical care
What type of insurance do you have?
Medicare
Employer provided plan
Medicaid
Self-paid health insurance
Marketplace (Obamacare)
I don't have health insurance
In the last year, has anyone in your household NOT been able to receive medical care because of the cost?
Yes
No
In the last year, has anyone in your household NOT been able to get a prescription because of the cost?
Yes
No
Do you visit the dentist?
Yes, routinely
Yes, for emergencies
No
Do you have access to telehealth services?
Yes
No
In the past year, have you struggled with mental health?
Yes
No
If yes, how did you cope? (check all that apply)
Sought medical attention (therapy/medication)
Got help from family or friends
Established a self-care routine
Drugs/Alcohol
Other
How often do you feel isolated or alone?
Never
Rarely
Sometimes
Often
Are you currently caring for a spouse, family member, or grandchild?
Yes
No
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Next
Community Concerns
What are the most important community concerns for you and your family or friends? (check all that apply)
Cost of food
High utility bills
Mental health
Cost of medical care
Affordable childcare
Affordable/obtainable housing
Available rental units
Fair wage jobs
Finding safe environments/fleeing domestic violence
Other
Of the concerns listed above, which THREE are most important?
Have you ever needed help but did not seek services?
Yes
No
If yes, why not? (check all that apply)
Didn't know where to go
Transportation issues
Hours didn't work
Too much paperwork
Concern about stigma/judgement
Previous negative experience
Other
N/A
What services or resources have you used in your community? (check all that apply)
211
Churches
Diaper bank
Food pantry
988
IM Safe Child Advocacy Center
The SafeCenter
United Way
Shelters
SNAP
TANF
Health Department
Other
What services were hard to find in your community that may be helpful to see in the future?
If you had an unexpected $500 expense, could you cover it?
Yes
No
What do you think will be the biggest challenge for your household in the next 1-2 years?
Housing costs (rent/mortgage, repairs, insurance, homelessness risk)
Utility costs (heat, electricity, water)
Food costs
Finding or keeping stable employment
Low wages/not enough income
Transportation (reliable vehicle, gas costs, public transportation)
Access to healthcare (medical, dental, mental health, etc.)
Cost of prescriptions
Mental health/stress
Caring for children
Caring for aging or disabled family members
Home repairs/unsafe housing conditions
Substance use/recovery support
Legal issues (eviction, custody, etc.)
Technology access (internet/devices)
Nothing major anticipated
Other (please specify below)
If you selected "other" above, please explain:
Is there anything else you would like us to know about challenges in your community?
What is the ONE thing that would make the biggest difference in your life right now?
Have you received services from EightCAP in the past 2 years?
Yes
No
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Next
Demographics
What is your age?
55-64
65-74
75-84
85+
Prefer not to answer
Gender
Male
Female
Prefer not to answer
Marital Status
Single
Married
Separated
Divorced
Widowed
Living with a partner
Prefer not to answer
Are you a veteran?
Yes
No
Prefer not to answer
Highest level of education completed
Some school
High School graduate
GED
Some college
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
Professional Certificate/Trade Certificate
Prefer not to answer
Race (check all that apply)
White/Caucasian
Black/African American
American Indian or Alaska Native
Asian/Asian American
Other
Prefer not to answer
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Prefer not to answer
What is your zip code?
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