Older people’s housing needs survey

Closes 19 Mar 2017

The questionnaire: About you

If you are completing the survey as a couple or a family, please provide details for both of you. Otherwise just leave the row for Respondent 2 blank.  

1. Please tick this box if you are completing the survey as a couple or family:

2. It’s really important that you tell us your post code, as we want to understand the different housing needs across the county.

3. Are you:

4. Which of these age groups do you belong to?

5. Do you currently get help with your daily activities?

For example, help to do things like get up/go to bed, dress/undress, get washed, use the toilet, prepare a meal, manage your medication or your home.   

If you said that you do get help with daily activities, who helps you?            Please tick all that apply. 

A family member or friend
A care worker paid for by Adult Social Care
A care worker who I pay for