The City of La Puente

Local Aging and Disability Action Plan Survey

The City of La Puente is working to become an age and ability-friendly city and needs your help. We encourage adults of all ages to complete the following survey. Your answers to this survey will help identify current and future age and ability-friendly practices in our community and will be included in a Local Aging and Disability Action Plan.

Local Aging and Disability Action Plan
A Local Aging and Disability Action Plan (LADAP) is a program of strategies and actions that aims to improve services for older adults, people with disabilities, caregivers, and their families by expanding culturally important and accessible services. La Puente’s LADAP is funded by a grant award from the California Department of Aging that aims to:

Improve services & resources for older adults, people with disabilities, caregivers, & families
Support community members who are aging and/or living with a disability
Address health and other inequities within the aging and disabled communities
Combat racism, ageism, ableism, and biases with aging and disability services

About this Survey
The following survey asks questions about your health and community. The survey takes about 20 minutes to complete. We respect your privacy.
This survey is completely anonymous. We thank you and appreciate you!!

To thank you for your time, you will receive a $10 gift card for completing this survey.
To receive your gift card, please share your mailing information at the end of the survey.

This survey is open to La Puente residents and neighboring communities. Please note, only one gift card will be issued per household. Thank you for your understanding.

Also, if you want to learn more about the Local Aging and Disability Action Plan (LADAP) Program for the City of La Puente, please write your name and contact information at the end of the survey to receive updates and information on future LADAP events. To keep the survey anonymous, your contact information will be immediately removed from your survey responses and kept separate from your completed survey.

Section One: These questions ask you about your community and home.

How would you rate La Puente as a place to live as someone ages?

Poor Fair Good Very Good Excellent

How would you rate La Puente as a place to live for someone with a disability?

Poor Fair Good Very Good Excellent

How important is it for you to stay in your own home as you age?

Very important Important Somewhat important Not very important Not important at all

How important is it for you to stay in your own home as you manage a disability or chronic illness?

Very important Important Somewhat important Not very important Not important at all

How important is it for you to stay in your community as you age?

Very important Important Somewhat important Not very important Not important at all

Do you rent or own where you live?

Rent Own

Does your home have assistive equipment like ramps and grab bars, etc. to help you move around your house?

Yes No Not sure

Would assistive equipment like ramps and grab bars make living in your home easier?

Yes No Not sure

Do you have reliable transportation to get where you need to go?

Yes No Not sure

How do you get around to shop, go to work, visit the doctor, run errands, or go to other places? Select all that apply.

Drive yourself Have others drive you Walk Ride a bike Public Transportation Car services (Ex. Taxi, Uber, Lyft, etc.) Other

Section Two: These questions ask you about your health.

Do you identify as someone with a disability?

Yes No Not sure

Do you have difficulty doing errands such as visiting a doctor's office or shopping, due to a disability or chronic illness?

Yes No Not sure

Do you have difficulty doing daily activities like dressing yourself, cooking for yourself, or cleaning your home because of a disability or chronic illness?

Yes No Not sure

Do you receive care or help in your home with activities of daily living?

Yes No Not sure

If you receive help in your home with activities of daily living, who helps you? Select all that apply.

Family Member Health Professional (like a Doctor or Nurse) Social worker Neighbor I do not receive help Other

Do you use special equipment or devices, such as a wheelchair, walker, TDD or communication device?

Yes No Not sure

If you use assistive equipment, what equipment do you use?

Wheelchair Walker Cane Hearing Aid TDD I do not use assistive equipment Other

How would you rate your general health?

Excellent Very Good Good Fair Poor

Does your existing healthcare provider network meet all of your healthcare needs?

Yes No I don't know I do not have a health care provider

Do you have difficulty leaving your home because of a disability or chronic illness?

Yes No Not sure

Do you have health insurance?

Yes No Not sure

Are you a caregiver for a family member or friend with a disability or chronic health condition?

Yes No Not sure

Caregiving: These questions ask you about caregiving.

If you answered the previous question as "no/not sure", please jump to the next section 3 and leave this section empty.

Does your community offer resources that make it easier for you to care for a family member or friend, like respite services, social activities, or support groups?

Yes No Not sure

Do your social groups like family, friends, and faith-based groups provide help for you as a caregiver?

Yes No Not sure

If you are a caregiver, are you interested in learning about resources and services to help support you in your caregiving?

Yes No Not sure

Section Three:These questions ask you about your social interactions.

How many people live in your household?

Who do you live with? Select all that apply.

I live alone Spouse/Partner Family Member Friend Roommate Other

Do you have family and/or friends you communicate with on a regular basis?

Yes No Not sure

Do you want to find more ways to meet people and be more socially active?

Yes No Not sure

Do you want to find ways to volunteer within your community?

Yes No Not sure

Are you interested to learn ways to become an aging and disability advocate?

Yes No Not sure

Where do you go to connect and be with other people? Select all that apply.

Community Center Senior Center Faith-based Organization (Ex. church, temple, mosque, etc.) Social support groups Other

Where do you go for information about resources, events, and programs in your community? Select all that apply.

Senior Center Faith-based Organization (Ex. church, temple, mosque, etc.) Nonprofit organizations (like AARP) Your doctor or other health care professionals Family or friends Library Radio Newspaper Television Internet Social Media (Ex. Facebook, YouTube, Instagram, etc. Other

How often do you interact with your friends, family, or neighbors who do not live with you?
This could be by phone, in person, email, or social media like Facebook.

Several times a day About once a day 3-6 days a week 1-2 days a week Once every few weeks Once a month or less I do NOT interact with others

How often do you use the Internet for activities like email, getting news and information, paying bills or managing finances and/or shopping?

Several times a day About once a day 3-6 days a week 1-2 days a week Once every few weeks Once a month or less I do NOT use the Internet

What technologies do you use? Select all that apply.

Cellphone/Smartphone Desktop computer Laptop computer Tablet Email Social Media (Facebook, YouTube, etc.)

Do you or anyone in your household use any of the following in La Puente? Select all that apply.

La Puente Library Senior Center La Puente Community Center La Puente Youth Learning Activity Center Other

Section Four:These questions ask you about your financial well-being.

Does your community have employment opportunities for you to work and earn money for yourself?

Yes No Not sure

Does the cost of health care prevent you from getting care that you need?

Yes No Not sure

Does the cost of groceries and food prevent you from eating enough?

Yes No Not sure

Does your community have resources like discount programs that help you save money on the things you need for daily living?

Yes No Not sure

Section Five: These questions ask you to rate resources in your community.

How important is it for you to have the following in your community?

1 - Safe buildings and enjoyable parks and spaces that are accessible and close to where you live

Very important Important Somewhat important Not very important Not important at all

2 - Reliable and affordable transportation options

Very important Important Somewhat important Not very important Not important at all

3 - Affordable and accessible housing that is or can be adapted to your needs

Very important Important Somewhat important Not very important Not important at all

4 - A wide range of opportunities for you to engage and socialize with your community

Very important Important Somewhat important Not very important Not important at all

5 - The sense that people of all ages are valued and respected

Very important Important Somewhat important Not very important Not important at all

6 - A wide range of work opportunities for people of all ages and abilities

Very important Important Somewhat important Not very important Not important at all

7 - Opportunities to get involved with local government and support issues important to you

Very important Important Somewhat important Not very important Not important at all

8 - Access to information about resources, events and in your community

Very important Important Somewhat important Not very important Not important at all

9 - Quality healthcare, as well as fitness and wellness resources

Very important Important Somewhat important Not very important Not important at all

Section Five (continued): These questions ask you to rate resources in your community.

How would you CURRENTLY rate the following in La Puente?

10 - Safe buildings and enjoyable parks and spaces that are accessible and close to where you live

Excellent Very good Good Fair Poor

11 - Reliable and affordable transportation options

Excellent Very good Good Fair Poor

12 - Affordable and accessible housing that is or can be adapted to your needs

Excellent Very good Good Fair Poor

13 - A wide range of opportunities for you to engage and socialize with your community

Excellent Very good Good Fair Poor

14 - The sense that people of all ages are valued and respected

Excellent Very good Good Fair Poor

15 - A wide range of work opportunities for people of all ages and abilities

Excellent Very good Good Fair Poor

16 - Opportunities to get involved with local government and support issues important to you

Excellent Very good Good Fair Poor

17 - Access to information about resources, events and in your community

Excellent Very good Good Fair Poor

18 - Quality healthcare, as well as fitness and wellness resources

Excellent Very good Good Fair Poor

Demographics.

What is your current relationship status?

Married Not married, living with a partner Separated Divorced Widowed Never married

What is the highest level of education you have completed?

K-12th grade (no diploma) High school graduate, or GED Trade school or associates degree 4-year college degree Graduate or professional degree(s)

What is your race and/or ethnicity? Select all that apply.

American Indian or Alaska Native Asian/Asian American Black or African American Hispanic or Latino White or Caucasian

Which of the following best describes your current employment status?

Self-employed, part-time Self-employed, full-time Employed, part-time Employed, full-time Unemployed, but looking for work Retired, not working at all Retired, working part-time Not in labor force for other reasons

What is your household income?

Less than $10,000 $10,000 to $19,999 $20,000 to $29,999 $30,000 to $49,999 $50,000 to $59,999 $60,000 to $69,999 $70,000 to $79,999 $80,000 to $89,999 $90,000 to $99,999 $100,000 to $149,999 $150,000 or more

Contact Information.

Thank you for completing the survey. As a thank you for taking the survey, you will receive a $10 gift card.
To receive your gift card and/or to receive more information on the City of La Puente LADAP Program and future events, please fill in your mailing information below.

The survey you just completed is anonymous and your contact information will be immediately removed from your survey responses.

Thank You!

Name

Email Address

Phone Number

Mailing Address

Do you want to receive emails and updates on The City of La Puente LADAP Program and future events?

Yes No

Additional questions on the age and ability friendliness of La Puente:

If you have some extra time, and you are interested to answer some extra questions about the age and ability friendliness of La Puente.

If not, feel free to submit the survey now by pressing the button at the bottom. Thank you!

How are outdoor spaces and buildings in your community CURRENTLY Age and Ability Friendly?

How can outdoor spaces and buildings in your community BECOME more Age and Ability Friendly?

How is transportation in your community CURRENTLY Age and Ability Friendly

How can transportation in your community BECOME more Age and Ability Friendly?

How is housing in your community CURRENTLY Age and Ability Friendly

How can housing in your community BECOME more Age and Ability Friendly?

How does your community CURRENTLY encourage social participation for people of all ages and abilities?

How can your community IMPROVE social participation for people of all ages and abilities in the future?

How does your community CURRENTLY respect and include people of all ages and abilities?

How can your community IMPROVE respect for and better include people of all ages and abilities in the future?

How does your community CURRENTLY encourage civic participation and employment opportunities for people of all ages and abilities?

How can your community IMPROVE civic participation and employment opportunities for people of all ages and abilities in the future?

How does your community CURRENTLY keep people of all ages and abilities well informed with accessible information about the community?

How can your community IMPROVE communication with people of all ages and abilities and keep them better informed in the future?

How are community and health services in your community CURRENTLY Age and Ability Friendly?

How can community and health services in your community BECOME more Age and Ability Friendly in the future?

Improve services & resources for older adults, people with disabilities, caregivers, & families
Support community members who are aging and/or living with a disability
Address health and other inequities within the aging and disabled communities
Combat racism, ageism, ableism, and biases with aging and disability services