Assessment Form
Needs Assessments are due back by December 10th. Please fill out to its entirety and either email the completed form to seiaoa.general@gmail.com or to our address at 602 E. 5th St. Mt. Carmel, IL 62863. Thank you for your feedback!
Needs Assessment Form
Need back by December 10th
PSA 10’s Needs Assessment for the 2028-2030 Area Plan
Dear Interested Person or Organization:
Southeastern Illinois Agency on Aging (SEIAOA) is in the process of writing our Public Information Document and Area Plan Amendment, which will begin in October. As part of the planning process, we need your feedback on funding priorities. Please take a moment and answer the following questions. Feel free to use additional pages and/or just send us an email at 
seiaoa.general@gmail.com or Southeasternaaaceoshana@gmail.com with your comments. We appreciate your time.
Glossary Terms:
Southeastern Illinois Agency on Aging (SEIAoA): Is the funding agency and one that designated the Senior Community Resource Center & Café (Senior Center) in your county.
Information & Assistance: Information & Assistance helps you find services, understand benefits, and get referrals for transportation, meals, housing, Medicare/Medicaid, caregiver support, and other aging-related needs. Staff guide individuals, answer questions, and connect them to the right local programs.
Transportation: Any assistance used through the Senior Center, utilizing either RIDES Mass Transit or our NEW Community Rural Transportation Assistance program (CROI).
Legal: Legal services assist older adults with benefits issues, advice, simple wills and powers of attorney, and linking someone to elder rights protection, ensuring they get the support and advocacy they need.
Ombudsman: The Illinois Ombudsman advocates for long‑term care residents, investigates complaints, resolves problems, and ensures seniors are treated with dignity and respect.
Caregiver Support Program & GAP Funding: Caregiver (CRG) or Relatives Raising Relatives (RRR) Caregiver GAP provides support, resources, information & assistance and limited financial assistance to older adults (RRR-usually age 55+ & CRG 60+) who are caring for an older adult, a child, or an adult with disabilities. It helps caregivers stay stable, reduce stress, and access services such as respite, counseling, and support groups.
Options Counseling: Also known as Choices of Care, Options Counseling provides one-on-one guidance to help seniors explore and compare services such as in-home care, transportation, housing, benefits, caregiver support, and community programs. Staff walk individuals through available options, costs, eligibility, and next steps so they can choose what works best for their situation.
Respite: Respite offers temporary care and supervision for an older adult, giving caregivers a break through in-home support.
StressBusters: Stress-Busters is an evidence-based stress-management program offered at your local Senior Center to support caregivers and older adults.
Mental Health (including Alzheimer’s/Dementia): Mental health services at Illinois senior centers provide resources/supports to screenings, counseling referrals, support groups, education on depression and anxiety, and connections to community mental‑health providers.
In-Home Supports/Services: In-home supports/services include Community Care Organizations, Respite, and GAP dollars to purchase items to help you live independently. Services like light housekeeping, personal care, meal help, safety checks, caregiver relief, and referrals for home-based programs. These services assist seniors with daily tasks so they can remain living at home longer.
Fall Concerns: Falls are a major safety concern for older adults, they are common, dangerous, and often lead to serious injury, hospitalization, or loss of independence. Illinois data shows high rates of fall‑related ER visits, hospitalizations, and deaths among adults 65+, making fall prevention a critical priority.
Name of Organization / Person (optional): ______________________________________
1.Home & Community-Based Services
SEIAOA currently funds the following community services. Please indicate if the funding is adequate or inadequate, and add any relevant comments
Adequate Inadequate Comment
a. Information and Assistance □ □ _______________
b. Transportation □ □ _______________
c. Legal □ □ _______________
d. Ombudsman □ □ _______________
e. GAP financial help □ □ _______________
f. Options Counseling □ □ _______________
g. In Home Supports/Services □ □ _______________
Are there needs for you that you don’t currently receive, or are there not enough funds available to receive that SEIAOA should know about or fund? ___________________________________________
2. Congregate or Home-Delivered Meals
SEIAOA funds both congregate and home-delivered meals. Please indicate if the funding is adequate or inadequate, and add any relevant comments.
Adequate Inadequate Comment
a. Congregate meal □ □ _______________
b. Home delivered meals □ □ _______________
Any suggestions for improving the meal programs?__________________________________
Are you feeling pressured to donate?______________________________________________
3. Disease Prevention & Health Promotion
SEIAOA funds services for Caregiver Health/Burnout called StressBusters at Senior Centers, Libraries, etc. Do you have any suggestions or comments regarding these services?___________________________________________________________________________
4. Caregiver Support Program GAP, Respite, Caregiver Information & Assistance
SEIAOA funds the Caregiver Support Program. Do you have any suggestions or comments regarding these services?_________________________________________________________________________
5. Minimum Wage Impact/Inflation-How are Social Security Benefits keeping up
Has the increase in minimum wage impacted how you can pay for your medications, rent, gas, maintenance of your vehicle or house, food, or other necessities of life? What should we be made aware of? __________________________________________________________________________________
6. Mental Health (including Alzheimers/Dementia): Do you receive enough education on Mental Health? Is it easy or difficult to obtain Mental Health Services for you or a Care Receiver in your area?
7. Fall Concerns: Do you feel confident about having what you need to live independently at home? Have you had any recent falls this year?
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