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We are conducting a brief survey of persons 65 years of age and older regarding knowledge and access to information about home modifications and Occupational Therapy in the Montgomery area.
 
 
 
Age category:
 
Under 65
 
65-69
 
70-74
 
75-79
 
80-84
 
85+
 
 
 
Gender:
 
Male
 
Female
 
 
 
What are your current living arrangements, in terms of your relation to the people you are living with?
 
Live with spouse only
 
Live with spouse and children
 
Live alone
 
Other
 
 
 
Do you own or rent your home?
 
Own
 
Rent
 
Other
 
 
 
What is your yearly income?
 
less than 10,000
 
10,000-29,999
 
30,000-49,999
 
50,000-69,999
 
70,000-89,999
 
90,000 or more
 
 
 
Marital status:
 
Married
 
Divorced
 
Widowed
 
Never been married
 
 
 
Length of stay at current residence 
 
More than 30 years
 
21-30 years
 
11-20 years
 
6-10 years
 
1-5 years
 
Less than 1 year
 
 
 
Do you know what home modifications are? If so, in your own words, what are they?
   
 
 
 
Do you know of any agencies in your city that can help with home assessments and modifications?
 
Yes
 
No
 
Other (Please List those you know)