Cheltenham Borough Homes (CBH) is exploring the possibility of developing Community Based

Older People’s Independent Living Services

Please help us by contributing to the development of this service

February 2014

Dear Sir / Madam

Cheltenham Borough Homes is looking to the future and would like to know how it can meet the needs of older people living in Cheltenham. If you are over 50 years old you can help by telling us your views.

By sparing a few minutes completing and returning this survey you will help to build this potential new service.

If you live with a partner or relative, please bear in mind their circumstances and potential needs jointly with yours, when completing this survey.

You can hear about the results of this survey at our Senior Community Voice Conference at The Thistle, Cheltenham, on Friday 28th March 2014, from 11am to 2pm. If you would like to attend the conference, or if you have any questions or would like some help to complete the survey, please call 0800 408 0000 and ask for the Community Involvement team or email .

Please return your survey in the envelope enclosed by Wednesday 12th March. All completed surveys received will be entered into a prize draw, to win afternoon tea for two at the Queens Hotel, Cheltenham.

Finally, please remember this survey is completely confidential.

Yours faithfully

Caroline Walker Bernie McBride (CBH Tenant)

Community Services Manager Senior Community Voice

CBH, Hesters Way Community Resource Centre, Cassin Drive, Cheltenham, GL51 7SU

SECTION A - YOUR CURRENT SITUATION
1. Your home
Which area of Cheltenham do you live in?
Town Centre and St Pauls / ¨ / Hatherley, The Reddings & Warden Hill / ¨
Arle, including Arle Farm & Alstone / ¨ / St Peters & The Moors / ¨
Charlton Kings & Leckhampton / ¨ / Prestbury, Whaddon, Lynworth
& Priors Farm / ¨
St Marks/ Monks Croft & Rowanfield / ¨ / Hesters Way / ¨
Do you live in a:
House / ¨ / Bungalow / ¨ / Flat / ¨ / Bedsit / ¨ / Maisonette / ¨
Do you:
Own your home / ¨ / Rent your home from a social landlord (e.g. CBH) / ¨ / Rent privately / ¨
If you rent from a social landlord, who is your landlord?
2. Suitability of your home now and in the future
§  How well is your home located for local amenities? e.g. Shops, Post Office, GP Surgery, Bank etc. / Very Well Located / Fairly Well Located / Badly Located
¨ / ¨ / ¨
Yes / No
§  Do you feel your home is well located for public transport / ¨ / ¨
§  Do you feel your home meets your needs now in terms of facilities? e.g. managing stairs and steps, garden, suitability of bathroom etc. / ¨ / ¨
§  Do you feel your home will meet your needs in the future in terms of facilities? e.g. managing stairs steps, garden etc. / ¨ / ¨
§  Do you feel your home has enough space so that you can use mobility aids? e.g. enough room to turn a wheel chair or install a stair lift / ¨ / ¨
§  Do you feel isolated where you currently live? / ¨ / ¨
3. Do you currently receive any of the following services: / Yes / No
§  A community alarm (e.g. Tunstall Pull Cord or pendant alarm) / ¨ / ¨
§  A visiting Support Service (e.g. Support Officer) / ¨ / ¨
§  A Care Package provided by Social Services or other agency / ¨ / ¨
§  Meals on wheels, e.g. Wiltshire Farm Foods or Oakhouse Foods / ¨ / ¨

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SECTION B Additional support services
As you age you may want additional support services. Support services help to maintain independence for people in their own home and help to avoid moving e.g. into residential care or other supported living.
a.  Which of the following support services could you benefit from
now and / or in the future? / Now / In the future
/ Value to older people / Would you be prepared to pay for this service?
Yes / No / Yes / No / High / Low / Yes / No
§  Well-being checks via a regular telephone call or other contact means / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Regular contact with someone who knows you and cares about your well-being / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Assistance to access welfare entitlements / benefits / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Help with skills to manage your finances, such as paying bills or budgeting / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Help with filling in forms and dealing with correspondence / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Advice about housing options and planning for the future / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Referrals to community organisations, leisure activities, transport / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Links to local services / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Help with household tasks, e.g. cleaning or shopping / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Advice on accessing a handyperson service (e.g. to get help with putting up a shelf; hang curtains; change light bulbs) / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Advice on accessing improvements and adaptations to your home / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  A garden maintenance service / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  An emergency response service for people prone to falls / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Introductions to local clubs, services, community organisations, leisure activities or transport providers / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Rehabilitation service, following a bout of illness, including collecting prescriptions / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Support to access health and well-being services / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Access to a community alarm service
This is a service with a dedicated telephone and mobile push button pendant. You can call for help at any time day or night. The call response operator will either alert your family or friends, or contact an emergency service as necessary. / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Access to a telecare service
A service which helps remind people to turn off the gas, take medication, lock the front door, monitor blood sugar levels, etc / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Emergency response service (linked to a community alarm)
This is a service for people who do not have family or friends nearby. The service provider can hold a key and provide assistance day or night / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
§  Access to a Community Hub
A local facility where you can enjoy social activities, access information and receive health and well-being services / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨ / ¨
b. Please state any other services you think might be valuable to older people
c. How would be the best way for older people to hear about these services?
Leaflets in GP surgeries / ¨ / Advertising on local radio ¨ / On the internet / ¨
Libraries / ¨ / Advice centres ¨ / Other (please state)

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SECTION C – About you
By responding to this section you will be helping us to develop a service that helps meet the needs of our communities. However, if you feel uneasy answering any question please leave it blank.
a.  Are you… / Male / ¨ / Female / ¨
b.  How old are you? / 50-59 / 60-69 / 70-79 / 80-89 / 90 plus
¨ / ¨ / ¨ / ¨ / ¨
c.  How would you describe your ethnic origin?
d.  Is English your first language? / Yes / ¨ / No / ¨ / If no please state which is:
e.  Does anyone else live in your home? / Yes / ¨ / No / ¨
f.  If yes, tick all the boxes that are appropriate to your situation:
I live with a partner / ¨ / I live with my children / ¨
An elderly relative(s) lives with me / ¨ / Other (e.g. a lodger/ friend) / ¨
g.  If you live alone, do you have regular contact with friends or family? / Yes / No
¨ / ¨
h.  Do you feel you have good social connections within the community? / ¨ / ¨
i.  How would you describe: / Good / Average / Poor
§  Your mobility / ¨ / ¨ / ¨
§  Your general health / ¨ / ¨ / ¨
j. / Yes / No
§  Do you have a physical disability? / ¨ / ¨
§  Do you have a sensory disability? / ¨ / ¨
§  Do you suffer from memory loss, dementia or Alzheimer's? / ¨ / ¨
§  Do you suffer from clinical depression? / ¨ / ¨
§  Do you receive formal personal care from a care agency on a regular basis? / ¨ / ¨
§  Do you receive informal personal care from family/friends on a regular basis? / ¨ / ¨
§  Have you ever applied for services provided by social services and been refused them? / ¨ / ¨
§  Do you receive a State Pension? / ¨ / ¨
§  Do you receive any other State Benefits? / ¨ / ¨
§  Do you currently receive Attendance Allowance / Disability Living Allowance? / ¨ / ¨
To enter the prize draw please complete your name and address:
Name:______
Address:______
______
Contact details:______
¨ I would like to attend the Senior Community Voice Conference
Thank you very much for spending time completing this survey.

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