A Carer Is Generally Defined As a Person of Any Age Who Provides Unpaid Help And

Who is a carer?

A carer is generally defined as a person of any age who provides unpaid help and

support to a relative, friend or neighbour who cannot manage to live independently

without the carer’s help due to frailty, illness, disability or addiction.

Your rights

All agencies should recognise carers as partners in the provision of care, and their contribution should not be assumed or taken for granted. It is your legal right to have your support needs assessed. This Carer Assessment and Support Plan is a record of your needs.

Section one: Personal and assessment details

In this section you are asked to explain the care needs of the persons you care for, the type and level of care and support you and others provide and identify the areas where you need help or support. You are asked to consider the different aspects of your life and the impact your caring role has on you and your hopes and aspirations for the future. This is with the aim of achieving positive outcomes and appropriate support for you and the person you care for.

This section can be:

Completed by you
Completed by you and a member of staff from Social Work or Health
Completed by you and a member of staff from the Carers Centre

Help with filling out your Carer Assessment and Support Plan

The worker helping you to complete this Carer Assessment and Support Plan will be referred to as your support professional. If you do not have a support professional this can be arranged by contacting the worker who gave you this form or by contacting your local health or social work office or carers centre.

Section Two: Summary of support needs, Actions and Agreements

The information from section one is then summarised with details of your support needs, what action has been agreed to meet those needs and what the intended outcomes of the support plan are. We ask you to fill out this section with a support professional (see above). If you feel that you have needs which are not being met we would ask that you record this as well. This will help Social Work, Health and Housing to plan and develop future services withinWest Dunbartonshire.

Details of when the support plan has been completed, request for service provision/intervention and review arrangements are recorded. You are asked to confirm; that you have been involved in completing the support plan and that it reflects your support needs, you have been given a leaflet explaining information sharing, and, that you give permission for the support plan to be shared with relevant service provider and or people supporting you. Both you and your support professional are asked to sign and date your support plan.

Questionnaire

We place a very high value on delivering services to carers. It is important to understand your views and your experiences of the Carers Support Plan.

The worker who has supported you to complete this Carer Assessment and Support Plan will give you a questionnaire, within two weeks of completion. Please complete and return this.

SECTION ONE

PRACTICAL INFORMATION

Carer

/ Cared for person
Title: / Title:
Surname: / Surname:
First Name: / First Name:
Date of Birth: / Date of Birth:
Address: / Address:
Postcode: / Postcode:
Tel No: / Tel No:
G.P. (name, address & Tel): / G.P. (name, address & Tel):
Person identifier(s) if known enter in box below
Care base / Care base
CHI / CHI
PIM / PIM
NI / NI
Relationship of carer and cared for person:
Please use this box to provide details of any other people you care for and or additional carers

DETAILS OF PROFESSIONAL HELPING TO COMPLETE THIS FORM

Name:
Job Title: / Agency:
Address:
Tel No:

caring situation

Has the person you care for had an assessment of their needs? / Yes/No
If yes, provide details of assessor and date of assessment:
If no, provide reasons
Summary of cared-for persons situation ( i.e. relevant illnesses/disabilities):
Reason for carer assessment:

CARER RESPONSIBILITIES

Describe what you do for the person you care for, how often you need to do this and the services and support you currently receive. This may include a number of different things, such as, practical tasks, emotional support, prompting supervision, and specific responsibilities (appointee, financial/welfare guardian, named person, power of attorney), current services and other people who share caring responsibilities.

HEALTH AND WELL-BEING

Describe any concerns or issues that you may have about your health and well being. This may include if your health affects your ability to care or if your caring role affects your health and well being.

LIFE OF YOUR OWN

Describe any difficulties you have balancing caring with other aspects of your life. This may include employment, education, social and leisure activities, spiritual needs and your hopes and plans for the future.
Describe if your caring role has an impact on other relationships or if there are any relationship issues that impact on your caring role.

FINANCES

Are there any issues relating to finances? This may include the management and or level of finances / Yes/No
If yes, describe specific issues
Has an income maximisation assessment been offered?(this is a data item and must stay as it is) / Yes/No
If no, give reasons

THE FUTURE

Are there any potential changes in the future which may affect your caring role? / Yes/No
If yes, describe the changes
Describe your hopes and plans for the future?

EMERGENCY OR CRISIS PLANNING

Are there any measures in place for emergency or crisis planning? / Yes/No
If yes, describe
If no, what would need to be done if an emergency arose

This section to be completed in partnership with your Support Professional

Summary of support needs, actions and agreements

With the aim of supporting you in your caring role in an appropriate and acceptable way you are asked to consider the needs you have identified in the assessment and explore all options/opportunities available to support you, these options may relate to practical, emotional and or social support.

Summary of support needs identified during the assessment / Actions and agreements to meet support needs of the carer / When will this be done / Date actions completed / Intended outcomes
Pick list to be agreed
Detail any identified needs that cannot be met at the moment and possible consequences:

Draft V 3 May 2008 (following SSA Development Group)

Date Support Plan Agreed
Date copy of completed support plan sent to carer (within 2weeks)
Date referred on for service provision/intervention
Date for review: no later than six monthly
Will the review of the carer support plan be reviewed in conjunction with the review for the cared for person? / Yes/No
Has the carer been verbally informed/given written advice as to who is the single point of contact to coordinate the contributions to assessment and the delivery of support? If this question needs to be asked, it needs to be re-worded / Yes/No
If no, give reasons:
Provide details of point of contact if different from the professional on page **:
Date Support Plan ended
Reason Support Plan ended:

DECLARATION

Please tick

I have been involved in putting this support plan together
and feel it is an accurate reflection of my support needs.
I give permission for this completed form to be shared with
relevant service providers and or people who will support me
I have been given a copy of the ‘Single Shared Assessment
Sharing information and giving consent’ leaflet
Signature of Carer: / Date:
Signature of Support professional: / Date:
Print name and designation:

Note: Information recorded on this form will be held manually and on computer. Maintenance of the records and the information contained will be subject to the provision of the Data Protection Act 1998.

Draft V 3 May 2008 (following SSA Development Group)

This section to be completed in partnership with your Support Professional

Summary of support needs, actions and agreements

Draft V 3 May 2008 (following SSA Development Group)