Self-Assessmentfor Adult Social Care Needs

Self-assessmentfor adult social care needs

This is for private use and will only be read by County Council staff if you choose to submit it.

At this stage, this self-assessment is not about money – it has been designed to help you think about your personal circumstances before looking for care and support. The WSCC booklet “Your life,your choice” can provide more information about social care.

You can save the form and use it when you are thinking for yourself about finding support to meet your care needs. Or you can submit the form to the County Council for a fullerassessment of your needs, and for information and advice.It can be completed online or printed to complete in writing.

When completing the self-assessment it can be helpful to think about how things are working for you now before you think about what needs to change. Often small changes, like a piece of equipment or help to find and join a local group, can make a big difference to people’s quality of life. When thinking about your situation and completing the form you may wish to use our West Sussex Connect to Support website to help you find out more about your options:

It should not take you more than about 20 minutes to complete the form but this will depend on how much information you choose to include.

Please briefly describewhat is important to you in your everyday life. For example, the people who are important to youand the things you like to do.

Please brieflydescribe your health, any disabilities and medication you are taking.

Your strengths

What is working well in your life? Describe the things you can do well for yourself and also where someone is helping you.

Your difficulties

What difficulties are you facing in your everyday life and what would you like to change?

Your goals

What are the goals or outcomes you would like to achieve in your everyday life?

Your ability to enjoy life – the way you feel about yourself(please circle all yes or no)

Does your situation affect your enjoyment of life and the way you feel about yourself in the following things?

Being treated with respect and dignity Y/N

Your physical and mental health, including whether you feel generally

happy with your life Y/N

Keeping yourself safe from abuse or neglect Y/N

Being able to make choices and decisions in your everyday life Y/N

Being able to work or take part in education, training andleisure interests Y/N

Managing your money Y/N

Your family and personal relationships Y/N

The suitability of your home Y/N

Being able to take part in, or help with activities in your community Y/N

The questions below are divided into ten areas of daily living(please tick the statement that applies to you for each question).

1: Your personal care- such aswashing