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Unpaid carers study (Bexley residents)
Healthwatch Bexley
1. Who are you a carer for? (Please tick all that apply) *
Required
2. What is your age? *
3. Are you: *
4. What is your ethnicity? *
5. What is the age of the person you care for? *
6. Why does the person you care for need your help? (Please tick all that apply) *
Required
7. What care do you provide? (Please tick all that apply) *
Required
8. a) Do you: *
Yes
No
Sometimes
Drive?
Own a car?
Use public transport?
Use specialist transport services?
8. b)Please enter any transport related comments
Your answer
9. How many people do you care for? *
10. a). Do you share caring responsibility? *
10. b) If yes, who with?
Your answer
11. Do you live with the person/people you are a carer for? *
12. Are you a long term or short term carer? *
13. a) How long have you been a carer? *
Your answer
13. b) How long do you expect to be a carer? *
Your answer
13. c) How long did you expect to be carer for?
Your answer
14. How many hours a week are you a carer? *
Required
15. a) Do you consider yourself to have a disability or long term health condition or illness? *
15. b) Please comment
Your answer
16. a) Does being a carer affect your: *
No not at all
Yes in a positive way sometimes
Yes in a positive way always
Yes in a negative way sometimes
Yes in a negative way always
Physical health
Emotional health
Social life
Work life/ability to volunteer
Financial wellbeing
Relationships with family
Relationships with friends
16. b) Please comment on how being a carer affects you
Your answer
17. Do you know where to find information about support for carers? *
18. a) Where do you get information about support for carers? (Please tick all that apply) *
Required
18. b) Please comment on how you get information
Your answer
19. a) Do you feel supported to: *
Yes
No
Sometimes
Have a life outside caring?
Look after your own physical health
Look after your own emotional wellbeing?
Take a break from your caring role if you need to?
Take a break from caring at a time that is convenient for you?
Plan for the future?
19. b) Please comment on your support
Your answer
20. a) Do you feel: *
Yes
NO
Sometimes
That you are listened to and involved in decisions taken about carers services in Bexley?
Valued and recognized as a carer?
That you receive the practical support you need for your caring role?
20. b) Please comment
Your answer
21. a) Do you feel that you have the right support for the person you care for? *
21. b) Please comment
Your answer
22. a) Carers assessment *
Yes
No
Not sure
Have you had a carers assessment?
Have you had an annual review since your initial assessment?
22. b) When was your carers assessment?
MM
/
DD
/
YYYY
22. c) What was put in place for you after your assessment/review and what difference has this made?
Your answer
22. d) Please comment on what was put in place after your review and what difference this has made
Your answer
23. If you are unwell who takes over your role as a carer? *
Your answer
24. a) Do you worry what will happen if you are no longer able to look after the person you care for? *
24. b) Please comment on your concerns *
Your answer
25. In an emergency a) Do you have a plan in place for emergency care? *
25. b) Are you confident that the right support would be provided for the person you care for in an emergency? *
25. c) Who do you think would provide care in an emergency? *
Your answer
25. d) What support would help you in an emergency? *
Your answer
25. e) Please comment on emergency care provision
Your answer
26. What is the best thing about being a carer and the support you receive?
Your answer
27. Please list and comment on the support services you use, rating them on a scale of 1-5. 1=Excellent 2=Good 3=OK 4=Poor 5=Very Poor *
Your answer
28. What are the biggest challenges you face as a carer? *
Your answer
29. What would help you most as a carer? *
Your answer
30. I am a Bexley resident *
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