APPENDIX

Appendix

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix

APPENDIX

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix

Appendix 1: Survey Details - Survey of Cape Cod Seniors and Elders

a. Survey Methodology b. Survey Description c. Sample Survey Questionnaires and Cover Letters

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1

Appendix 1.a Survey Methodology

Survey of Cape Cod Seniors and Elders - 2003

Introduction: In late summer 2003, staff from the Barnstable County Department of Human Services undertook a project to survey a random sample of the age 55 and older segment of the permanent, year-round resident population of Barnstable County as to their healthcare and other human service needs. Survey data were collected during late-September/- early October 2003. Data entry and analysis of survey responses commenced in mid- October 2003.

Survey Instrument: In early September 2003 a 6-page draft survey instrument was successfully pilot tested with a select group of senior/elder residents of Barnstable County. Two separate versions of the survey instrument were perfected (see samples in Appendix 1.b.). Both versions of the instrument collected a uniform set of socio-demographic information about the respondent and about his/her household. Version “A” of the instrument contained Sections C and D which focused upon the respondent’s ability to participate in activities outside of his/her home, on isolation, on identifying sources of information concerning services available to seniors/elders, and on obtaining needed in-home services. The second version (“B”), contained different Sections C and D which focused upon serious issues, problems, and challenges encountered in the senior/elder’s household, and upon identifying barriers encountered when attempting to access needed healthcare and other human services.

Survey Distribution: In September 2003, 1,137 “Watch Your Mailbox” post cards were mailed to individuals selected at random from Town Clerk’s resident lists (annual town census lists) telling recipients that a survey was on its way to them. Each addressee was a permanent, year-round resident of Barnstable County, age 55 or older. The number of individuals selected to be surveyed in each Cape Cod town was calculated from the town’s proportion of age 55 and older residents in the Barnstable County population (per Census 2000). Subsequently, 1,137 survey packets were distributed by mail to these addressees. Four hundred (400) survey packets were distributed in-the-field by trained volunteers to a convenience sample of senior/elder residents. During the field distribution, every attempt was made to obtain as random a sample of residents as possible. In total, 1,537 survey packets were distributed during late-September/early October 2003. “Reminder” post cards were mailed to a random selection of one-third of mail survey addressees one week after the survey packet mailing. In both the mail and field distributions, exactly one-half of the survey packets contained version “A” of the survey, and one-half contained the version “B” instrument.

Survey Response: Response to the survey was more than satisfactory, with both the mail distribution and the in-the-field distribution obtaining a 45% response rate. Mail survey response was noticeably boosted by the “Reminder” post cards. In total, 688 surveys were completed and returned for processing—514 from the mail distribution, and 174 from the field distribution. Completed surveys included 49% of the version “A” and 51% of the version “B” survey instrument—almost precisely mirroring the percentages distributed

CCSER21st – Vol. 2 Rev. A 4/2/04 A1.a-1 Appendix 1.a

Response Analysis: Survey response data were analyzed using SPSS For Windows Ver. 11.5 and Microsoft Excel. Descriptive statistics and frequency distributions of responses were developed. Subsequently, an independent, PH.D.-level consultant hired by Barnstable County Department of Human Services performed advanced statistical analysis procedures including Factor Analysis and Cluster Analysis. Correlation Analysis was performed on appropriate sub-sets of the response data. Limitations of These Data:

CAUTION: In citing findings contained in this Report, care should be taken to not construe any of these findings to be truly representative of the entire senior/elder population of Barnstable County.

Every attempt was made during data collection to obtain as random a sample of seniors/- elders as was possible. However, given the nature of in-the-field convenience sampling techniques and other sampling errors, only some of these data can be considered truly random. Further, non-English speaking (Spanish-, Portuguese-, Haitian-Creole-speakers, etc.) were not included in the survey sample. Thus, findings from responses to this Survey cannot be considered representative of any cultural/ethnic/linguistic minority residents of Cape Cod. The degree to which these data represent the opinions of the entire senior/- population of Barnstable County is not accurately known. These data do, however, represent the opinions of the sample of 688 seniors/elders who were surveyed and thus, provide a wealth of information concerning the healthcare and other human services needs of a large segment of the Cape’s seniors/elders.

Age 85 and Older - Sample Size Limitation: The sample of elder residents age 85 and only consist on only 38 persons. While this sample size is too small to draw any accurate conclusions about the needs of this population segment, these data do provide some trend information. In citing responses relative to the age 85+ age group, care should be taken to not construe these findings to be truly representative of the entire age 85+ resident population of Barnstable County.

CCSER21st – Vol. 2 Rev. A 4/2/04 A1.a-2 Appendix 1.a

Appendix 1.b: Survey Description

CCSER21st – Vol. 2 Rev. A 4/2/04 A1.b-1 Appendix 1.b

CCSER21st – Vol. 2 Rev. A 4/2/04 A1.b-2 Appendix 1.b

Survey Research Description

TITLE OF SURVEY: Survey of Cape Cod Seniors and Elders - 2003

TITLE OF FINDINGS REPORT: Cape Cod Senior and Elderly Residents in the 21st Century, Volume 2, April 2004. Available on-line at: http://www.bchumanservices.net/thc2001/thc2001CCSER21stV2.html

UNIT OF SURVEY: Individual

SAMPLE SIZE (N): 688

TARGET POPULATION: All permanent, year-round residents of Barnstable County, MA (a.k.a. Cape Cod) age 55 or older.

SAMPLING FRAME FOR RANDOM SAMPLE: All persons age 55 or older listed in each of the fifteen Barnstable County Town Clerk’s “Residents” Lists, with the exception of police and other law enforcement officials.

SAMPLING/SURVEY DISTRIBUTION METHOD(S): Scientific Random Sample: Mail distribution of 1,137 questionnaires.

Convenience Sample: In-field distribution of 400 questionnaires distributed only to persons identifying themselves as age 55 or older.

SURVEY QUESTIONNAIRE LANGUAGE(S): English Large-Print version available.

DATA COLLECTION DATE(S): September/October 2003

PURPOSE OF SURVEY: To collect primary data relative to the type and degree of seriousness of healthcare

and other human services issues of the permanent, year-round residents of Barnstable County, MA, age 55 and older and to collect socio-demographic data with which to profile respondents and their households.

BRIEF DESCRIPTION OF SURVEY: Utilizing traditional random survey-by-mail and in-the-field convenience sampling techniques, the 2003 Survey of Cape Cod Seniors and Elders helped identify the healthcare and other human services needs of the approximately 76,000 residents of the fifteen towns of Barnstable County, MA (a.k.a. Cape Cod) age 55 or older. Survey responses provided information to decision-makers who plan healthcare and other human services for seniors and elders in Cape Cod communities. Emphasis was placed on surveying as representative a sample of the Cape’s age 55 and older, permanent, year-round resident population as was possible.

Survey of Cape Cod Seniors and Elders - 2003 3/12/04

Survey of Cape Cod Seniors and Elders - 2003 3/12/04

Appendix 1.c: Sample Survey Questionnaires and Cover Letters

Cover Letters: Cover Letter For Mail-Distributed Questionnaires

Cover Letter For In-The-Field-Distributed Questionnaires Survey Questionnaires:

Survey Questionnaire – Version “A” Survey Questionnaire – Version “B”

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

COVER LETTERS

Cover Letter For Mail Distributed Surveys

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

COVER LETTERS

Cover Letter For In-The-Field Distributed Surveys

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

SAMPLE SURVEY INSTRUMENTS

Sample of Survey Questionnaire – Version “A”

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

B. ABOUT YOUR HEALTH AND HEALTHCARE: B.1. Do you yourself have health insurance? O Yes O No

B.1.a If YES, how is it obtained? (fill in ALL THAT APPLY)

O Insurance purchased directly from insurance company (privately purchased) O State or federal program (such as MassHealth, Medicare, or VA) O Through an employer’s health insurance plan O Other (explain)_________________________________________________________________________

B.2 Do you have health insurance that pays something for your prescription drugs?

O Yes O No

B.3 Do any of these insurances provide for dental care coverage?

O Yes O No

B.4 How would you describe your current health condition? (fill in ONLY ONE)

O Excellent O Good O Fair O Poor

Comments?___________________________________________________________________ ____________________________________________________________________________ B.5 Do you feel that you get enough exercise? O Yes O No B.6. Have you been hospitalized (for medical reasons) in the past 6 months? O Yes O No

B.6.a If YES, how many times? _______ times (write in number)

B.6.b If YES, for how long? _______ days (write in number)

B.6.c If YES, for what reason(s) [OPTIONAL]_____________________________________ ___________________________________________________________________________ B.7 Are you yourself disabled or chronically ill? O Yes O No B.8 Do you receive healthcare services or other home aide services in your home?

O Yes O No

Explain? [OPTIONAL]_________________________________________________________

B.9 How often do you feel sad or have feelings of depression? O Never O Seldom O Often O Very Often

Explain? [OPTIONAL]__________________________________________________________

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_____________________________________________________________________________________________

C. AVAILABLE SERVICES: C.1 Do you often NEED help in your home for? (fill in ALL THAT APPLY)

O Bathing O House repairs (“handyman,” etc) O Eating O Lawn/yard maintenance O Gardening O Meal preparation O Housekeeping O Snow shoveling

O Other (explain) _________________________________________________________ Comments (write in) ___________________________________________________________ __________________________________________________________________________ C.2. Can you generally GET needed help in your home for? (fill in ALL THAT APPLY)

O Bathing O House repairs (“handyman,” etc) O Eating O Lawn/yard maintenance O Gardening O Meal preparation O Housekeeping O Snow shoveling

O Other (explain) _________________________________________________________ Comments (write in) ___________________________________________________________ __________________________________________________________________________ C.3 Are you familiar with services for seniors offered in your community? (fill in ONLY ONE)

O Yes O No O Don’t Know C.4 My current sources of INFORMATION include: (fill in ALL THAT APPLY)

O Community college or local high school adult classes O Doctors/Physicians’ Assistants O Elder Services of Cape Cod & Islands, Inc. O Council On Aging (COA) or Senior Center O Internet O Newspapers/Magazines O Neighbors/Friends O TV O Visiting Nurses Assn. (VNA) O Other (explain)_____________________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

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D. OUTSIDE ACTIVITIES: D.1 Do you sometimes do volunteer work? O Yes O No D.1.a If YES, about how often do you volunteer? O Daily O Twice weekly O Weekly O Twice monthly O Monthly O Other_________________________ D.1.b If YES, what kind of volunteer work do you usually do? (write in) _______________

_____________________________________________________________________ Comments (write in) ______________________________________________________ _____________________________________________________________________

D.1.c If NO, would you like to do volunteer work? O Yes O No Comments (write in) ______________________________________________________

D.2 Do you have friends/family with whom you socialize regularly? O Yes O No Comments (write in) ____________________________________________________________

D.3. About how often do you normally get out of the house?

O Daily O Twice a week O Weekly O Twice a month O Monthly

O Other (explain)__________________________________________________________________________ D.4 Would you like to get out of the house more often than you normally do? O Yes O No

D.4.a If YES, what prevents you from getting out more often? (fill in ALL THAT APPLY)

O Afraid for my safety O Lack of transportation O Can’t afford it O Need someone to help me O Disabled, not physically capable O Too much physical exertion O Other (write in) ____________________________________________________________________ Comments (write in) ________________________________________________________ _______________________________________________________________________

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E. MORE ABOUT YOU: E.1 What is your gender? O Female O Male E.2 What is your age group? (fill in ONLY ONE)

O 55 – 64 O 65 – 69 O 70 - 74 O 75 - 79 O 80 - 84 O 85 - 89 O 90+ F. MORE ABOUT YOUR HOUSEHOLD: F.1. Including yourself, how many persons in your household are retired? (fill in ONLY ONE)

O All O None O 1 O 2 O 3 O 4 or more Comments? ________________________________________________________________ F.2. How many children (age 17 or younger) live in your household? (fill in ONLY ONE)

O None O 1 O 2 O 3 O 4 or more F.3. Including yourself, how many adults in your household are employed (fill in ONLY ONE)

O All O None O 1 O 2 O 3 O 4 or more F.3.a Are any of these employed adults working, (fill in ALL THAT APPLY) O Full-Time-year round O Part-Time-year round O Full-Time-seasonally O Part-Time-seasonally O Full-Time plus Part –Time O Two or more Part-Time jobs

Comments? ___________________________________________________________ F.4. How many household members are currently covered by health insurance?

Number of Adults covered by health insurance is: _____ (write in number)

Number of Children covered by health insurance is: _____ (write in number) (including Children’s Medical Security Plan-CMSP) F.5 How many persons in your household receive Social Security income? (fill in ONLY ONE)

O None O 1 O 2 O 3 O 4 O 5 O 6 O 7+ F.6 How many persons in your household receive public financial assistance such as; Temporary Aid To Dependent Children (TAFDC), Food Stamps, fuel assistance,

Supplemental Security Income (SSI), SSDI, or housing vouchers? (fill in ONE)

O None O 1 O 2 O 3 O 4 O 5 O 6 O 7+ F.7 What is the primary language spoken in your household? (fill in ONLY ONE)

O English O French O Portuguese O Spanish O American Sign Language O Other__________________________

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F.8 Counting income from all sources (including earnings from jobs, pensions, alimony,

unemployment compensation, public financial assistance, interest, etc.) and counting income from everyone in your household, what was the combined household income last year?

(fill in ONLY ONE) O Less than $5,000 O $40,000 - $49,999 O $5,000 - $9,999 O $50,000 - $74,999 O $10,000 - $14,999 O $75,000 - $99,999 O $15,000 - $24,999 O $100,000 -$149,999 O $25,000 - $39,999 O $150,000 or above G. YOUR COMMENTS, IDEAS, AND SUGGESTIONS: (continued)

G.1 If you could, what would you change about healthcare and human services

for seniors and elders here on Cape Cod? G.2 Please write in any other ideas or suggestions that you may have for improving

the quality of life of Cape Cod seniors and elders. (If needed, attach an additional sheet with any other comments, ideas, or suggestions).

THANKS FOR ANSWERING THIS IMPORTANT SURVEY = = = = = = = = = = = = = = = = = = = = = == = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

INSTRUCTIONS: Please fold your survey, place it in the postage paid, self-addressed envelope provided, and DROP IN ANY MAILBOX OR if survey was not received by mail, return questionnaire to Survey Volunteer. QUESTIONS? Call (508) 375-6630 SOCCSE

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SAMPLE SURVEY INSTRUMENTS

Sample of Survey Questionnaire – Version “B”

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

CCSER21st – Vol. 2 Rev. A 4/2/04 Appendix 1.c

B. ABOUT YOUR HEALTH AND HEALTHCARE: B.1. Do you yourself have health insurance? O Yes O No

B.1.a If YES, how is it obtained? (fill in ALL THAT APPLY)

O Insurance purchased directly from insurance company (privately purchased) O State or federal program (such as MassHealth, Medicare, or VA) O Through an employer’s health insurance plan O Other (explain)_________________________________________________________________________

B.2 Do you have health insurance that pays something for your prescription drugs?

O Yes O No

B.3 Do any of these insurances provide for dental care coverage?

O Yes O No

B.4 How would you describe your current health condition? (fill in ONLY ONE)

O Excellent O Good O Fair O Poor

Comments?___________________________________________________________________ ____________________________________________________________________________ B.5 Do you feel that you get enough exercise? O Yes O No B.6. Have you been hospitalized (for medical reasons) in the past 6 months? O Yes O No

B.6.a If YES, how many times? _______ times (write in number)

B.6.b If YES, for how long? _______ days (write in number)

B.6.c If YES, for what reason(s) [OPTIONAL]_____________________________________ ___________________________________________________________________________ B.7 Are you yourself disabled or chronically ill? O Yes O No B.8 Do you receive healthcare services or other home aide services in your home?

O Yes O No

Explain? [OPTIONAL]_________________________________________________________

B.9 How often do you feel sad or have feelings of depression? O Never O Seldom O Often O Very Often

Explain? [OPTIONAL]__________________________________________________________

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_____________________________________________________________________________________________

C. HOUSEHOLD ISSUES: C.1 Some of the following list of issues may have been a problem for you or someone else in your household. If a listed item has been a problem in your household over the past 12- months, please tell us if it has been a minor problem or a major problem. (fill in ONLY ONE PER LINE) NOT a Minor Major Don’t Type of Problem Problem Problem Problem Know

Adult substance abuse (alcohol, drugs, etc.) …….... O O O O A lot of depression in the household………………… O O O O Discrimination (due to HIV, AIDS, TB, etc.)…………. O O O O Discrimination (due to race, age, language, sexual identity/orientation, etc.)…………………………….. O O O O Experiencing an alcohol and/or drug problem .…….. O O O O Experiencing physical conflict in the household……. O O O O Finding time for exercise or to work out…..…………. O O O O Finding time for friends, relatives, social activities…. O O O O Having a lot of anxiety or stress in household……… O O O O Inadequate opportunities to learn new skills or for advancement at work…………………………. O O O O Inadequate time for recreation……………………….. O O O O Inadequate time to spend with spouse/partner…….. O O O O Not being able to afford legal help.…………………... O O O O Not being able to afford recreational activities …….. O O O O Not enough room in your house for all the people who live there………………….……………… O O O O Not having enough money to pay for housing.……… O O O O Not having enough money to pay the doctor, the dentist, or to buy prescription medications……. O O O O Paying for a mental health counselor .…..…………... O O O O Paying for or getting dental insurance..……………… O O O O Other (explain)______________________________ O O O O

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

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D. BARRIERS TO GETTING NEEDED HELP D.1. We are interested in learning about difficulties people have when they try to find help for their problems. If you or someone in your household has had difficulty when looking for help with any of the above problems in the past 12 months, please tell us how serious that difficulty was. (fill in ONLY ONE PER LINE) So Serious NOT Moderately Very Did NOT Type of Difficulty Serious Serious Serious Get Help

Cost of taking time away from work………………….. O O O O Could not afford fees or costs for services………….. O O O O Did not like the services ……………………………… O O O O Services located too far away………………………… O O O O Had a bad experience in the past……………………. O O O O Hours of service were not convenient……………….. O O O O Lacked handicap access……………………………… O O O O Lacked information on available services.………….. O O O O Lack of information on where to go for services……. O O O O Lack of transportation to services………………….…. O O O O Feared a bad experience……………………………… O O O O Feelings of discrimination……………………………... O O O O Service did not provide expected result……………... O O O O Service(s) not accepting new patients/clients………. O O O O Unable to take time away from work to go to services…………………………………………….. O O O O Was not eligible for help.……………………………… O O O O Worried about the quality of service………………….. O O O O Other (explain)_____________________________ O O O O D.2 How often do household members have the use of adequate transportation when they need it for travel on Cape Cod: (fill in ONLY ONE PER LINE) Does NOT

Never Seldom Often Always Apply

To Work O O O O O To School or Job Training O O O O O To Healthcare/Social Services O O O O O To Shopping (food/clothes) O O O O O Other______________________ O O O O O

D.3

Who owns the vehicle most often used for these trips? (fill in ONLY ONE) O My household O Friend O Neighbor O Relative O Other__________________

D.3.a If NOT a private vehicle, are these trips most often via: O B-Bus O COA Van O P&B Bus O Taxi Cab O Volunteer Driver

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E. MORE ABOUT YOU: E.1 What is your gender? O Female O Male E.2 What is your age group? (fill in ONLY ONE)

O 55 – 64 O 65 – 69 O 70 - 74 O 75 - 79 O 80 - 84 O 85 - 89 O 90+ F. MORE ABOUT YOUR HOUSEHOLD: F.1. Including yourself, how many persons in your household are retired? (fill in ONLY ONE)

O All O None O 1 O 2 O 3 O 4 or more Comments? ________________________________________________________________ F.2. How many children (age 17 or younger) live in your household? (fill in ONLY ONE)

O None O 1 O 2 O 3 O 4 or more F.3. Including yourself, how many adults in your household are employed (fill in ONLY ONE)

O All O None O 1 O 2 O 3 O 4 or more F.3.a Are any of these employed adults working, (fill in ALL THAT APPLY) O Full-Time-year round O Part-Time-year round O Full-Time-seasonally O Part-Time-seasonally O Full-Time plus Part –Time O Two or more Part-Time jobs

Comments? ___________________________________________________________ F.4. How many household members are currently covered by health insurance?

Number of Adults covered by health insurance is: _____ (write in number)

Number of Children covered by health insurance is: _____ (write in number) (including Children’s Medical Security Plan-CMSP) F.5 How many persons in your household receive Social Security income? (fill in ONLY ONE)

O None O 1 O 2 O 3 O 4 O 5 O 6 O 7+ F.6 How many persons in your household receive public financial assistance such as; Temporary Aid To Dependent Children (TAFDC), Food Stamps, fuel assistance,

Supplemental Security Income (SSI), SSDI, or housing vouchers? (fill in ONE)

O None O 1 O 2 O 3 O 4 O 5 O 6 O 7+ F.7 What is the primary language spoken in your household? (fill in ONLY ONE)

O English O French O Portuguese O Spanish O American Sign Language O Other__________________________

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F.8 Counting income from all sources (including earnings from jobs, pensions, alimony,

unemployment compensation, public financial assistance, interest, etc.) and counting income from everyone in your household, what was the combined household income last year?

(fill in ONLY ONE) O Less than $5,000 O $40,000 - $49,999 O $5,000 - $9,999 O $50,000 - $74,999 O $10,000 - $14,999 O $75,000 - $99,999 O $15,000 - $24,999 O $100,000 -$149,999 O $25,000 - $39,999 O $150,000 or above G. YOUR COMMENTS, IDEAS, AND SUGGESTIONS: (continued)

G.1 If you could, what would you change about healthcare and human services

for seniors and elders here on Cape Cod? G.2 Please write in any other ideas or suggestions that you may have for improving

the quality of life of Cape Cod seniors and elders. (If needed, attach an additional sheet with any other comments, ideas, or suggestions).

THANKS FOR ANSWERING THIS IMPORTANT SURVEY = = = = = = = = = = = = = = = = = = = = = == = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

INSTRUCTIONS: Please fold your survey, place it in the postage paid, self-addressed envelope provided, and DROP IN ANY MAILBOX OR if survey was not received by mail, return questionnaire to Survey Volunteer. QUESTIONS? Call (508) 375-6630 SOCCSE

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