Senior Services Survey

SENIOR SERVICES SURVEY

Please take a moment and fill out this senior services survey. It is vitally important for NYSCA to know what kinds of services are being provided, where in the state you are located, and so forth. This information will make it easier for us to understand better how unique and diverse senior services are and will allow us to be able to contact you should we have questions about proposed changes in programs, or to get detailed information on how a program or service is actually provided at the local level.

Please fill out the survey below. THANK YOU!

Organization Name
E-mail address	(required)
Contact Person
# Seniors You Represent
County (ies) Served
Representative(s) who's district your organization serves - (Senator)
Assemblymember (s)
Programs and Services provided by your organization (check all that apply please)
Case Management
Information and Referral
Case Management
Entitlement Assistance
Financial Management
HEAP
Other (Please list)
*Nutrition*
Congregate Meals
Nutrition Education
Home Delivered Meals
Other (Please list)
*Health Education/Prevention*
Telephone Reassurance
Accident Prevention
BP Screening
Eye Test Glaucoma
Health Prevention
Exercise
Medical Review
Flu Shots
Health Fair
Hearing Test
Crime Prevention
Other (please list)
*Programs/Services*
Intergenerational Programming
Transportation
Senior Employment
Legal Services
Volunteer Recruitment
Seminars
Ethnic Programming
Consumer Education
Tax Preparation
Creative Writing
Legal Aid
Product Safety
Shopping Assistance
Job Training
Current Events
Foreign Language
*Mental Health Services*
Support Groups
Coping with fear
Coping with major illness
Stress Management
Individual Counseling
Crisis Intervention
Art/Music Therapy
Other (please list)
*Caregiver Resource*
Respite
Caregiver Support
Social Adult Day Care
Other (please list)
Funding - (please list the approximate proportion of your funding)
Federal (%)
State (%)
Local (%)
Participant Contributions (%)
Private (%)
Waiting Lists - Do you have any current waiting lists for services	Yes No
If yes, which services and what is the number on the waiting list?
You may not have a waiting list - have you had to turn anyone away from a service in the past year?	Yes No
If so, which services?
Service Funding - If you had a choice, which services would you like to see additional resources put into - Please just name the service (i.e. EISEP, CSI, SNAP, Social Adult Day and so forth)
Do you have an advisory council made up of senior citizens?	Yes No
Are they active?	Yes No
How often do they meet?
Would you be interested in an advocacy training with you advisory council?	Yes No
Capital Needs - Do you have any capital needs (repair or replace equipment, vans, transportation funds, kitchen equipment, meal preparation equipment, construction needs, and so forth)? Please list
Staffing - Are you having difficulty hiring and/or retaining staff to provide services to seniors? If so, what are the reasons you have identified (i.e. pay too low, no benefits, transportation a problem, etc.)
EISEP - Have you or has your organization had trouble providing EISEP Services due to a shortage of home care workers?	Yes No
Do you have an active EISEP waiting list?	Yes No
Other - Are there any other new issues, trends, barriers to providing services to seniors that are not listed above that you are dealing with? Please describe:
Additional Comments