Carers who support someone who may consider a Supported Living home in the future or are on the waiting list for Supported Living.

1. I am completing this survey as:

(Required) A carer of someone who may consider supported living in the future On behalf of a carer who supports someone who may consider supported living in the future

2. How long have you been the carer of someone who may consider supported living in the future?

Less than 6 months 6 - 12 months 1 - 2 years 3 - 4 years 4 years +

3. What is your relationship to the person you care for?

Partner Daughter Son Father Mother Friend Other

If other, please provide further details

4. Where does the person you care for currently live?

In the family home with you In a private house/flat In a residential home setting

If other, please provide further details

5. Do you currently have an emergency plan in place, if you were not able to provide the care you currently do for the person you support due to an unexpected situation?

Yes No

If, yes, please tell us what your plan includes in the box below

If you do not have an emergency plan, what would you expect may happen if you are not able to continue providing the care to the person you support?

6. What is the health care need(s) of the person you support? (please tick all that apply)

Learning Disability Physical Disability Autism Visual Impairment Hearing Impairment Mental Health

If other, please provide further details

7. Does the person you support receive a direct payment to pay for any activities/day centres currently?

More information about Direct Payments More information about Direct Payments

For more information on direct payments and what they are please see the following link - Direct Payments

Yes No

8. If YES, would you expect this direct payment to continue if they moved to a supported living property to enable previous activities/day centre activity to continue?

Yes No

9. Do you have any concerns about the increase in cost-of-living expenses and energy costs for the person you support?

Yes No

10. If YES, what are your main concerns? (please tick all that apply)

Cost of food Cost of energy (gas and electricity)

Other (please tell us)

11. Do you currently have to use any of your finances as a carer to support the person you care for?

Yes No

12. If yes, do you have concerns that this would still be required if the person you support moved to a Supported Living Home?

Yes No

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Section 1 - About You

More information about Direct Payments More information about Direct Payments