Are you, or someone you care for, preparing to age in place? Let Age in Place Partners

Tell us about yourself and your home…

    Name: *

    Email Address: *

    Phone Number:

    1. Who are you filling out this survey for? *

    2. What is your age? *

    3. What province or territory do you live in? *

    4. What is your living situation? * (check all that apply)

    5. Have you considered down-sizing or moving to an assisted living residence?

    6. Do you think you will be able to afford housing costs as you age in place (mortgage, rent, taxes, maintenance, insurance, etc.)?

    7. Is your home located with easy access to services, amenities, and community, such as your doctor, public transit, shopping, family and friends?

    8. Can you currently live independently and take care of your daily needs, such as food preparation, shopping for groceries, managing medication, and cleaning your home?

    9. Do you have friends or family that you can rely on for support if needed?

    10. If you have a pre-existing medical condition, are you aware of the support needs and services available to you as you age?

    11. Is your home equipped to support your safety and health as you age, including your mobility and accessibility needs (e.g. wide entryways, accessible cupboards, handrails, etc.)

    12. Are you aware of the risks of falls and are you taking precautions to reduce the risk?

    13. If your health and mobility declines, will you be permitted to make modifications to your home?

    14. Are you aware of the costs and funding support programs available for home modifications related to aging in place?

    15. Are you interested in smart home devices such as video monitoring systems, fall detection systems, and medication reminders to assist in home care?

    16. Can Age in Place Partners contact you to discuss how we can help you age in place? *