Questionnaire on elderly care in Shanghai - 问卷调查调研模板

Q1:1. Please tell me your age range.

A. Under 30 years old

B.31-39 years old

C.40-49 years old

D. 50 or over

E. Prefer not to answer.

Q2:2. What is the age range of your first parent?

A. Under 60 years old

B.60-69 years old

C.70-79 years old

D. 80 years old or older

E. Prefer not to answer.

Q3:3. What is the age range of your second parent?

A. Under 60 years old

B.60-69 years old

C.70-79 years old

D. 80 years old or older

E. Prefer not to answer.

Q4:4. What is your household income?

A.Net monthly household income of 40,000RMB (£4,700) or more

B.Net monthly household income of RMB20,000 (£2,300) or more

C.Net monthly household income of RMB10,000 (£1,200) or more

D.Net monthly household income of RMB10,000 (£1,200) or less

E. Prefer not to answer.

Q5:5. Are you familiar with China’s current pension system?

A. Yes

B. Somewhat

C. No

D. Prefer not to answer.

Q6:6. How do you view the health status of your parents? (Include information about both parents)

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Q7:7. How do you support your parents?

A. A child (e..g, you or a sibling) take turns to take care of them

B. They live with you in your home

C. They live alone

D. They live in a nursing home or third party institution

E. If you have any others, please specify below

F. Prefer not to answer.

Q8:8. What are the current dilemmas you face in supporting your parents in their old age?

A. Financial pressure

B. Not enough time to take care of your older parents.

C. Lack of professional elderly care institutions

D. Your older parents have different preferences for where and how to live

E. Support is physically demanding

F. Support is stressful

G. If you have any other options, please specify.

H. Prefer not to answer.

Q9:9. From your point of view, what kind of elderly care model would you like to have for your parents?

A. A model of old age care where elderly parents live with their children

B. A model in which elderly parents live alone and the community care professionals provide assistance

C. A model where elderly people are cared for by a nursing home

D. Other elderly care models, please specify:

E. Prefer not to answer.

Q10:10. What do you think about institutions for the elderly?

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Q11:11. Are you willing to send your parents to an institution for the elderly parents?

A. Yes

B. No

C. Undecided

D. Prefer not to answer.

Q12:12. How do you feel about the community-based elderly care system?

A. Very positive

B. Generally positive

C. Neither positive nor negative

D. Generally negative

E. Very negative

F. Prefer not to answer

G. I am not familiar with this model of care.

Q13:13. What kind of services would you prefer the community-based model to provide? (Select as many options as required)

A. To provide daily care for the elderly

B. To help the elderly with psychological counselling

C. Provide more options for the elderly to develop their hobbies and interests

D. provide professional education for the elderly

E. providing services for the elderly to communicate with each other

F. provide legal assistance and shelter for the elderly

G. Any other service not yet identified, please specify:

H. Prefer not to answer.