Community Service Needs Assessment (2024)

The Cattaraugus County Department of the Aging/NY Connects is currently developing a 4-year plan and is seeking information regarding the needs, concerns and problems facing the citizens of our county. WE NEED YOUR HELP! Please complete the following survey.

Questions/Assistance

If you would like more information or assistance, please contact us at 716-373-8032 or 1-800-462-2901.

Download & Print a Survey

If you want to complete a survey on paper, then download and print a survey at CattCo.org/2024-cs-needs.

Housing

Questions	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Able to perform household chores (cleaning, etc.)	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Finding reliable help to perform home maintenance/repairs	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Ability to pay rent or taxes	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Able to pay for home heating	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me

Transportation

Questions	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
To medical appointments	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
To out-of-county medical appointments	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
To the grocery store or other errands	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Driving my own car	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me

Insurance / Health

Questions	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Understanding Medicare and various options	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Understanding low-income health insurance subsidies	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Understanding long term care services and support options	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Understanding long term care insurance options	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Recurring falls, in and out of the home	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Managing a chronic health condition	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Accessing services for individuals with Alzheimer’s or dementia and their caregivers	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me

Nutrition / Food

Questions	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Having enough money for nutritious food	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Being able to shop and cook for myself	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Able to follow a special diet recommended by my doctor	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me

Services & Supports

Questions	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Respite services for caregivers, such as adult day programs, for people with dementia or other functional impairments	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Access to senior centers	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Transportation options for those unable to drive	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
In-home personal care services	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Ability to participate in congregate meal sites or receive home delivered meals (Meals on Wheels) If you receive Meals on Wheels, you may return this completed form with your driver.	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Ability to obtain help in applying for government programs	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me

Other

Questions	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Able to feel prepared, secure, and have adequate supports in case of an emergency or disaster	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Ability to manage or find supports for mental and emotional health needs, including loneliness and isolation	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Ability to manage or find supports for drug, alcohol, or gambling issues for yourself or a loved one	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Ability to address and protect yourself against scams	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me
Ability to address and protect yourself against financial, emotional, physical, or mental abuse	Important and is a concern for me	Important but is NOT a concern for me	NOT important and is NOT a concern for me

Caregivers

If you are caring for another individual, please answer the following questions:

For whom do you provide care?

Does the individual for whom you care live in your home?

Does the individual have memory problems and/or dementia?

Do you feel overwhelmed and/or stressed in providing care?

Do you have a dependent child with developmental disabilities living in your home?

Where I Turn for Help

If you, or someone you know, have been in the hospital in the past year, did you/they have the information and supports needed to return home?

Have you heard of “NY Connects,” the local program that helps consumers with information, assistance and connections to needed long term services and support

Demographic

Demographics (This information will be kept strictly confidential; used only for statistical purposes)

Age

Sex

Persons living in your home including yourself

Living Arrangements

Village / Town / City

Income (per year)

Comments / Suggestions

Optional

Name

First

Middle

Last

Suffix

Phone Number

Please provide a phone number if you would like help or information with any of the issues discussed on this needs assessment.