FAMILY CARER SURVEY         

Please indicate your age

under 25 years
25 - 65 years
over 65 years

Which State/Territory do you live in?

Optional Name
Email address

Who are you caring for?

my spouse/partner
my daughter/son
my sister/brother
my mother/father
other (please describe your relationship to the person being cared for)

What is the age of the person being cared for?

under 18 years
18 - 65 years
65+ years

If the person being cared for lives with you, please describe your accommodation arrangements.

sharing accommodation with spouse/partner
sole parent
sole parent sharing accommodation with other adults
living with (both) parents
living with one parent
living with one parent and other adults
other (please describe your circumstances)

What is the reason for care being needed?

frailty due to age
age dementia
physical disability due to trauma
disability due to brain injury
multiple disabilities
physical/neurological impairment from birth
intellectual impairment from birth
mental illness
(other) chronic or terminal illness
other (please describe the reason for care being needed)

Are you entitled to payments from Centrelink?

Yes 
No
I don't know

If you answered "Yes" to the question above, what type of payment do you receive?

Carer Respite Centres have been established to provide information on the options available for assistance to carers when they need to take a break. Have you had any contact with these Centres?

Yes
No

If you answered "Yes" to the above question, was the service provided appropriate to your needs?

Yes
No

Do you have any comments you would like to make on respite care?

Have you had any contact with other carer organisations?

Yes
No

If you answered "Yes" to the question above, what type of organisation did you contact?

What type of assistance did you seek?

Did the service provided fit your needs?

Yes
No

If you answered "No" to the above question, please tell us why.

Do you have any comments you would like to make on carer support services?

Can you describe an incident or give an example of how inadequate the current arrangements are?

Are you willing to have this incident or example used in publicity to present the case for carers?

Yes
No

If you answered "Yes" to the question above, do you want to be identified?

No
Yes (please write your details below)
Name
Email address (for confirmation)
Do you have any comments you would like to make about the use of the information?


What are the key issues we should take up in campaigning for carers?

                

© Centre for Civil Society 2007

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