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Your Opinion Is Important To Us

 

Dutchess County is conducting a study to determine the needs and concerns of our 60-plus population. Please take a few minutes to complete the survey below. Click on the 'Submit' button to send it to the Dutchess County Office for the Aging. Your participation will help the community and meet your needs. Thank you for your assistance.

Please complete only if you are over age 60.

Marcus J. Molinaro
Dutchess County Executive

  1. Please click inside the square box to check off whether each of the following items is a problem for you:

    Problem
    Understanding health insurance/Medicare
    Keeping up with medical costs
    Insufficient money for food, shelter, clothes
    Affording energy and utilities
    Managing household budgeting/bill paying
    Household chores and maintenance
    Feeling afraid or unsafe at home because you may fall or get injured
    Feeling afraid or unsafe at home because of possible crime
    Legal Affairs
    Loneliness, isolation or depression
    Disability or impaired mobility
    Transportation - including for medical, shopping, recreation, etc.
    Knowing where to obtain information about services and benefits
    Taking care of another adult
    Taking care of a grandchild
    Taking care of personal needs - bathing, dressing, preparing meals
    Conflicts with others such as family, neighbors, or creditors
  1. Are there any problems important to you that are not on the list? If so, please specify:

  1. What is your zip code:

  1. How would you rate your overall health:



  1. Is your age:


  1. Are you frail or disabled:

  1. Ethnic group: (check all that apply)
    White
    African American/Black
    Hispanic
    Asian
    American Indian/Alaskan Native
    Native Hawaiian/Pacific Islander

      Other (please specify)
  1. Is your household low income:

    Low Income defined as
    :
    Household of 1 – no more than $17,505/year   Household of 2 – no more than $23,595/year
    Household of 3 – no more than $29,685/year   Household of 4 – no more than $35,775/year
    For each additional household member, add $6,090
  1. Is there anything else you would like us to know:



    If you need information or services, please call us at 845-486-2555, or if you wish, provide your name, telephone number and nature of your service need, so we may contact you:

  


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