Unpaid Carers Needs Assessment

Carer Recognition

When did you realise you were an unpaid carer? *

Does your GP Practice offer you any support in relation to your caring role? For example, support from Practice Managers or Practice Nurses. *

Yes
No
Unsure

If yes, please give brief detail of support received

Do any other organisations offer you any support in relation to your caring role? *

Yes
No
Some support
Unsure

If yes, please give details

Health and Well-being

Do you have health needs of your own? *

Yes
No

Are you able to manage these and attend appointments around your caring responsibilities? *

Yes
No
Other

If other - please provide details.

Has your health been affected by your caring role? *

Yes
No
Other

If other - please provide details.

Do you provide care through the night? *

Yes
No
Sometimes

If you wish to exercise or undertake physical activity, are you able to do so? *

Yes
No

If no, what are the barriers?

Are you able to leave the person you are caring for at home alone? *

Yes
No

If yes, for how long?

If no, why is this?

Time out from caring

Are you able to have time out from the demands of the caring role, such as a few hours to yourself, a day away, a holiday, etc? *

Yes
No
Somewhat
Unsure

Comments

What would you need to be able take time out? (Please select all that apply *

Replacement care – a budget to enable you to access respite services
At home sitting service
24-hour homebased care
Nursing care
Overnight home-based sleeping service
Residential overnight care
Day services with support e.g., access to community activities
Buildings based day care e.g., access to a day centre
Family based respite care
Ad hoc / on demand care service
Community based support and activities
Other

If other - please provide details.

What are the barriers to you being able to take time out?(Please select all that apply) *

Lack of appropriate services
Lack of paid carers with appropriate skills
Lack of choice and flexibility
Lack of knowledge of local services and organisations
Don’t know who to contact
Resistance of cared for
Insufficient personal budget
Unawareness of carers rights
Transport
Location
Other

If other - please provide details.

What would make the biggest difference to you and the person you care for?

Information

Where do you get information to support you in your caring role?

What would improve access to information for you?

Transport

Do you have adequate access to transport?(Please select all that apply) *

access to a car
public transport – bus service
public transport – train service
Community Transport
others help provide transport

Is transport a problem? *

Yes
No

If transport is a problem, please tell us why

Supplementary questions

Caring role *

I am a parent carer
I am a young carer(17 years and under)
I care for my spouse/partner/other family member
I care for a friend
Prefer not to say
Other

If other - please provide details.

Carer age group *

17 years and under
18 – 64 years
65+ years
Prefer not to say

Carer gender *

Male
Female
Non-binary
Prefer not to say

Carer ethnicity *

White
Mixed/multiple ethnicity
Asian, Asian Scottish, Asian British
African, Caribbean, Black
Other ethnic background
Ethnicity not known
Prefer not to say

Do you live with the person you are caring for? *

Yes
No
Prefer not to say

Which locality do you live in? *

Berwickshire (for example Eyemouth, Duns, Coldstream)
Cheviot (for example Kelso, Jedburgh)
Eildon (for example Galashiels, Selkirk, Melrose)
Teviot & Liddesdale (for example Hawick, Newcastleton)
Tweeddale (for example Peebles, Innerleithen)

What age is the person you are caring for? *

17 years and under
18 – 64 years
65+ years
Prefer not to say

What is their gender? *

Male
Female
Non-binary
Prefer not to say

What is their ethnicity? *

White
Mixed/multiple ethnicity
Asian, Asian Scottish, Asian British
African, Caribbean, Black
Other ethnic background
Ethnicity not known
Prefer not to say

What is the diagnosis of the person you are caring for?(Please select all that apply) *

Addiction
Dementia
Cancer
End of Life Care
Frailty
Mental Health
Learning Disability
Physical Disability
Neuro-developmental (e.g., Communication Disorders, Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, Motor Disorders, Tic Disorders)
Neurological (Brain Injury, Epilepsy, Motor-neurone disease, Muscular dystrophy, Multiple Sclerosis, Parkinson’s disease, Stroke)
Life-limiting conditions
Prefer not to say
Other

Message

Unpaid Carers Needs Assessment

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Unpaid Carers Needs Assessment

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