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pdfNational Survey of Older Americans Act Participants (NSOAAP)
2024 Rotating Module
Topic: Preferences and Needs Related to Community Living
CAREGIVER VERSION
Most older adults want to remain living in their homes and communities as they age. These next
questions are about your care receiver’s desire to remain living in their home and the types of home
modifications and community supports that can help make this possible.
1. How important is it for your care receiver to be able to stay in their current home for as long as
possible?
Very important
Somewhat important
Not important
2. Is the following statement often, sometimes, or never true?
“My care receiver worries about being able to afford living where they currently live for another
year.”
Often true
Sometimes true
Never true
3. Is there a place or organization in your care receiver’s community that feels welcoming for
people their age to socialize, exercise, and/or participate in activities?
Yes
No
Don’t know
➔ If Yes, does your care receiver go there?
Yes
No
4. Does your care receiver have any of the following in their home?
a. Grab bars in the bathroom
Yes
No
b. Shower bench/chair
Yes
No
c. Ramp into home/no stairs for
entry
Yes
No
d. Door frames wide enough for a
wheelchair (i.e., 36 inches)
Yes
No
e. Roll in shower (i.e., no step or
barrier when using a wheelchair
or walker)
Yes
No
f. Raised toilet seat height (i.e.,
chair height)
Yes
No
g. Lever door handles (i.e., can be
opened with a simple pull-down
motion)
Yes
No
h. Main floor bathroom
Yes
No
1
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
i. Main floor bedroom
Yes
No
j. Stair lift
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
If No, would this be helpful for
your care receiver?
Yes
No
Don’t know
5. How much consideration has your care receiver given to what modifications may be necessary
for their home for them to be able to stay there as they age?
A lot
Some
Little
None
Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid OMB control number (OMB
0985-0023). Public reporting burden for this collection of information is estimated to
average 45 minutes per response, including time for gathering and maintaining the data
needed and completing and reviewing the collection of information. The obligation to
respond to this collection is voluntary under the statutory authority of the Older Americans
Act (OAA) Section 202(f). This information collection gathers cross-sectional survey data of
OAA participants. The Administration for Community Living uses the information reported to
assess OAA program participants issues associated with aging. Data will be kept private to
the extent allowed by law. There are no assurances of confidentiality.
2
National Survey of Older Americans Act Participants (NSOAAP)
2024 Rotating Module
Topic: Preferences and Needs Related to Community Living
NON-CAREGIVER VERSION
Most older adults want to remain living in their homes and communities as they age. These next
questions are about your desire to remain living in your home and the types of home modifications
and community supports that can help make this possible.
1. How important is it for you to be able to stay in your current home for as long as possible?
Very important
Somewhat important
Not important
2. Is the following statement often, sometimes, or never true?
“I worry about being able to afford living where I currently live for another year.”
Often true
Sometimes true
Never true
3. If you are or become unable to do these things on your own, do you have someone in your life
who can help you with the following tasks?
a. Household chores
b. Grocery shopping
c. Personal care (such as bathing, helping to dress)
3
Definitely yes
Probably yes
Probably no
Definitely no
Definitely yes
Probably yes
Probably no
Definitely no
Definitely yes
Probably yes
Probably no
Definitely no
d. Managing your finances
e. Managing your medications
Definitely yes
Probably yes
Probably no
Definitely no
Definitely yes
Probably yes
Probably no
Definitely no
4. Is there a place or organization in your community that feels welcoming for people your age to
socialize, exercise, and/or participate in activities?
Yes
No
Don’t know
➔ If Yes, do you go there?
Yes
No
5. Do you have any of the following in your home?
a. Grab bars in the bathroom
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
b. Shower bench/chair
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
c. Ramp into home/no stairs for
entry
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
4
d. Door frames wide enough for a
wheelchair (i.e., 36 inches)
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
e. Roll in shower (i.e., no step or
barrier when using a wheelchair
or walker)
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
f. Raised toilet seat height (i.e.,
chair height)
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
g. Lever door handles (i.e., can be
opened with a simple pull-down
motion)
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
h. Main floor bathroom
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
i. Main floor bedroom
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
j. Stair lift
Yes
No
If No, would this be helpful for
you?
Yes
No
Don’t know
5
6. How much consideration have you given to what modifications may be necessary for your home
for you to be able to stay there as you age?
A lot
Some
Little
None
Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid OMB control number (OMB 0985-0023). Public reporting
burden for this collection of information is estimated to average 45 minutes per response, including time for
gathering and maintaining the data needed and completing and reviewing the collection of information. The
obligation to respond to this collection is voluntary under the statutory authority of the Older Americans Act
(OAA) Section 202(f). This information collection gathers cross-sectional survey data of OAA participants. The
Administration for Community Living uses the information reported to assess OAA program participants
issues associated with aging. Data will be kept private to the extent allowed by law. There are no assurances
of confidentiality.
6
| File Type | application/pdf |
| File Modified | 2024-03-20 |
| File Created | 2024-03-20 |