Respite Care - Disability
This survey provides a template for considering ways of establishing ways of providing breaks and respite that are more inclusive.
Q1.
Are you
Male
Female
Q2.
What age group do you belong to?
18-29
40-49
60-65
30-39
50-59
Over 65
Q3.
Who do you live with?
On my own
Pet (dog)
Partner
Friend
Sheltered housing
Parents
Family member
Other
Q4.
Is your carer paid?
Yes
No
Q5.
What is the nature of your disability?
Mental health problems
Learning disability
Physical disability
Sight/hearing loss
Long term illness
Q6.
What respite services do you currently receive?
Direct Payments
Hospital stay
Personal care
Day sitting service
Home help service
Night sitting service
Shopping
Other organisation support
Pop in service
No respite received
Q7.
Are you receiving day care respite?
If you answered yes to the last question, please answer the next question.
Q8.
How long have you been receiving day care respite?
under 6 months
1-2 years
6 years or more
6- 12 months
3-5 years
Q9.
Where do you receive respite care?
Q10.
How frequent is your respite care?
Daily
Monthly
2-5 times a week
Twice a year
Weekly
Yearly
Fortnightly
Q11.
What do you do when you are receiving day care?
Talking to other people
Watch TV
Walks
Learning activities
Outdoor activities
Q12.
What changes would you make to the service you receive?
Q13.
What is the most useful respite care you receive?
Support for family carers
Activities at day centre
Financial support
Domestic help
Social activities