NORTHEAST GEORGIA REGIONAL COMMISSION
AREA AGENCY ON AGING
NEEDS ASSESSMENT SURVEY AND QUESTIONNAIRE
SFY 2026
Please insert your county name here: __________________________________________________
Please review all services listed below and check the five (5) services that you, your family or your community needs. REMEMBER TO ONLY CHECK FIVE (5) SERVICES or your survey will be disqualified. It is not necessary to sign your name to the survey; only write in the county name. THESE SURVEYS WILL BE INSTRUMENTAL IN DETERMINING THE SERVICES YOU FEEL ARE NEEDED IN YOUR COUNTY. Please return the completed survey to Peggy Jenkins, 305 Research Drive, Athens, GA 30605-2795. Thanks for your participation.
___Transportation (someone to drive you)
___ Congregate Meals (meals served at Senior Center)
___Senior Employment (training and placement for senior jobs)
___Home Repair/Modifications (devices to assist you with daily living such as ramps, etc.)
___Nurse/Home Health/Medical Care
___Homemaker (someone to clean your home)
___Personal Care (someone to help with bathing, etc.)
___GeorgiaSHIP (someone to help you understand Medicaid/Medicare and get help with medications)
___Telephone Reassurance (someone to check on you by phone)
___Legal Assistance (help with legal issues, wills, benefits, etc.)
___Money Follows the Person / Nursing Home Transition (Transitioning persons that reside in nursing homes back into the community)
___Mental Health Services (Help / information / access related to mental illness, developmental disabilities)
___Respite Care (aide to sit with your family member while the caregiver rest)
___Housing Assistance (help locating housing resources)
___Home Delivered Meals (meals delivered to your home)
___Energy Assistance (help paying for heating and cooling bills)
___Elder Abuse Counseling (education on preventing abuse of the elderly)
___Caregiver Programs (support groups, education and training for those who are caring for someone)
___Information & Assistance (information on services that are available to you)
___Adult Day Care (a day care center for adults)
___ Wellness Program (education on becoming healthier)
___Kinship Care (information on help in raising grandchildren)
___Assistive Technology (devices that enable seniors and individuals with disabilities to accomplish daily living tasks, achieve greater independence and enhance quality of life)
Are there other services needed that we have not mentioned?
What are the most pressing problems for people in your community who are older or disabled?
Where or who would you call if you needed help obtaining services?
Have you or a member of your household had a problem for which you were unable to find appropriate services? If so, please describe the issues briefly and tell us what type of service might have helped to solve the problem.
FOR CURRENT CLIENTS ONLY
What do you like about the services you’re receiving?
How can the Area Agency on Aging improve the services you are receiving?
