Adult Carer Support Plan

Adult Carer Support Plan

Supporting Carers in Dumfries & Galloway
It has been identified that it would be useful for you to have an Adult Carers Support Plan.

This provides the opportunity to express your feelings and needs as a Carer. The aim is to find out what impact your caring responsibilities have on your life and helps to put a plan in place to support you in your caring role.

The Carer Support Plan does not have the intention of judging your ability to care or the way in which you carry out your caring role. We just want to ensure your own needs are being taken into account. It can also help to access the support you need.

This support plan looks at areas of your life: your caring role, how you are feeling, time for yourself, your health, how you manage at home, your finances and your work situation. This plan can be completed by yourself before you discuss things with your Support Worker or together with them.

If you have any questions prior to your appointment please contact the Carers Centre

You can call us on: 01387 248600 Email us at: info@dgalcarers.org

Visit our website at: www.dgalcarers.co.uk

Our postal address is: Dumfries & Galloway Carers Centre, 2-6 Nith Street, Dumfries DG1 2PW

PLEASE READ

DOES THE FORM STILL HAVE UNCOMPLETED SECTIONS? If the form is not complete, you can SAVE & return back to it at a later time. If you have completed all you can, and it still requires the Carers Centre staff to complete their section, please click SAVE and email the document link to your support worker or info@dgalcarers.org

HAS THE FORM BEEN FULLY COMPLETED? If Yes, please click SUBMIT.

** Only click SUBMIT once the form is fully completed **

Section 1: Personal Details

Please complete as much as this form as you can.
1.1 Your Details
Name

First NameLast Name
Prefer to be known as
Current Age
Date of Birth

DayMonthYear
Date
Ethnicity
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Gender

Other
1.2 Details of the person you care for

If you care for more than one person please include their details in relevant box below.
Name

First NameLast Name
Current Age
Date of Birth

DayMonthYear
Date
Gender

Other
Do they live with you?
Details of diagnosis / condition
Please include details of anyone else you care for here
1.3 Your Home
Does anyone else live with you that you want to tell us about?

Section 2: Letting us know about your caring situation

Outcome Area ~ Feeling Valued
Who recommended that you have an Adult Carers Support Plan?
2.1 Your Caring Role
Can you tell us about your caring situation?
Do you have any support with your caring role?
How does the caring situation impact on your relationship with the person you care for? Does this concern you and why?
Do you feel valued in your caring role? This relates to the person you care for, by your wider family and / or by other support agencies.
Please explain
Are you willing and able to continue your caring role at this time?
If ‘NO’ what would need to change to enable you to continue if that is what is wanted?

Sections 3: How does caring affect you?

Outcome Areas ~Feeling Well / Feeling Supported
3.1 How are you feeling?
How is your own health and wellbeing? How does your caring role affect this?
Think about your physical health and your wellbeing / mental health. How do you really feel?
Are you awaiting or receiving treatment or support for any of your own health issues?
Are you able to prioritise and attend your own health appointments? How does your caring role affect this?
Are you aware of the free health screening options that are available to you? eg; breast, bowel, cervical, prostate etc.
3.2 How do you manage to get time for you?
How do you manage a life outside/alongside your caring role? Who helps you to get a break?
Family/friends/support agencies/daycentres? Can you stay active/attend appointments for you etc?
What does ‘time for you’ look like? What would you like it to look like? What do you like to do? What makes you happy?
Is there something new that you would like to be able to do that is being limited by your caring role? Is there something that you used to do that you are unable to do now?
What is needed to make this happen?
3.3 Managing at Home
How do you manage within the home?
Do you have equipment / adaptations / technology that helps? Are there any safety issues? Has a fire safety check been considered?
How do you manage household tasks?
Is gardening / cleaning / cooking difficult?
Do you drive?
If No, do you have any difficulties around transport?

Section 4: Finances and Future Planning

Outcome Area ~Feeling In Control
4.1 Finances
Are finances a worry for you and in what way?How has caring impacted on your financia lsituation?
Do you have the correct benefits in place? Are there problems with debt or cost of living increases? Do you know about the council tax discounts you may be entitled to?
What help or information would you like about finances and benefits?
4.2 Employment / training
Please tell us about any paid employment /voluntary roles or training / education you do? Do you feel supported by the employer or provider?
How does you caring role impact on this?
Would you like to return to work, training or education? If so what would be needed to make this happen?
4.3 Future Planning
Do you have a Power of Attorney (POA) or Guardianship in place for the person you care for? Would you like further information about this?
What worries or concerns do you have around your caring role and future plans?
Do you have plans in place in case an emergency arises? If so what are they?
Would you like information about how to create your own Emergency Plan?
There are things that may help with this and please ask your support worker about this when this plan is discussed: Carers Emergency card, Anticipatory Care Plan, Herbert Protocol (for dementia Carers), This is me and health passport documents.
4.4 In control
What would help you feel more in control of all these areas of your life?
Does your GP Practice know about your caring role?
If No, would you like the Carers Centre to let them know?
By ticking Yes, you are consenting for a letter to be sent to your GP Practice letting them know of your caring responsibilities.
What GP Practice are you registered with?
4.5 Moving Forward
What is it you would like to change or improve as a result of this Adult Carers Support Plan?
What support would you like from the Carers Centre?

Section 5: HOW YOU FEEL ACTION PLAN

This next section should be completed with a member of staff using the HOW YOU FEEL SUMMARY DOCUMENT which can be provided separately on request.
5.1 Feeling Valued
5.1A) How does your caring role impact on your relationships with the person you care for and / or other family members?
5.1A) Action Required (to the above)
5.1A) Outcome Level
5.1B) Do you feel valued by the wider health and social care team involved in your caring situation?
5.1B) Action Required (to the above)
5.1B) Outcome Level
5.2 Feeling Well
5.2A) How does your caring role affect your own health and wellbeing?
5.2A) Action Required (to the above)
5.2A) Outcome Level
5.3 Feeling Supported
5.3A) How does caring impact on your life alongside and outside of your caring role?
5.3A) Action Required (to the above)
5.3A) Outcome Level
5.4 Managing at Home
5.4A) Managing at home; is the caring role impacted by the home environment?
5.4A) Action Required (to the above)
5.4A) Outcome Level
5.4B) Does the caring role impact on household tasks like gardening / cleaning etc?
5.4B) Action Required (to the above)
5.4B) Outcome Level
5.5 Feeling in Control
5.5A) Is the caring role affecting work / education / training? There are two options for each level of impact on this question.
5.5A) Action Required (to the above)
5.5A) Outcome Level
5.5B) Does caring have an impact on your finances?
5.5B) Action Required (to the above)
5.5B) Outcome Level
5.5C) Do you have any worries or concerns around plans for the future?
5.5C) Action Required (to the above)
5.5C) Outcome Level

To section is to be completed by Care Centre Staff
Recommended resources required based on identified outcomes above.
Carers Support Workers Comments
REVIEW DATE: A check in & review date is set for...
Month set
Initial to confirm, added to review list
SHARING ACSP - PLEASE READ THIS PARAGRAPH TO CARER

I understand that completing this plan will lead to a computer record which will be treated confidentially. D&G Carers Centre and the Council will hold this information for the purpose of providing care services and to meet my needs (including emergency planning). To do this the information may be shared with NHS Agencies and other organisations. This will help to reduce the number of times I am asked for the same information. Information will not be passed on from the Carers Centre without my consent.
Does the Carer consent to the ACSP being shared with Social Work and NHS Agencies?
(this will need to be verbal consent supported by an email from the Carer if possible – if not please record details of verbal consent here)
Would the Carer like the plan to be shared with anyone else?
If Yes, please provide their details here
Date

DayMonthYear
Date
Carers Centre - Support Worker Name

First NameLast Name
PLEASE READ

HAS THE FORM BEEN FULLY COMPLETED? If Yes, please click SUBMIT.

DOES THE FORM STILL HAVE UNCOMPLETED SECTIONS? If the form is not complete, you can SAVE & return back to it at a later time. If you have completed all you can, and it still requires the Carers Centre staff to complete their section, please click SAVE and email the document link to your support worker: info@dgalcarers.org

** Only click SUBMIT once the form is fully completed **

PRIVACY STATEMENT

By Clicking SUBMIT you are agreeing that you are you happy for the Carers Centre to record your information. This is so that they can offer you support and advice in your caring role. They will not share your information with any other agencies unless they have your permission.
Should be Empty:

Adult Carer Support Plan

Section 1: Personal Details

1.1 Your Details

1.2 Details of the person you care for

1.3 Your Home

Section 2: Letting us know about your caring situation

2.1 Your Caring Role

Sections 3: How does caring affect you?

3.1 How are you feeling?

3.2 How do you manage to get time for you?

3.3 Managing at Home

Section 4: Finances and Future Planning

4.1 Finances

4.2 Employment / training

4.3 Future Planning

4.4 In control

4.5 Moving Forward

Section 5: HOW YOU FEEL ACTION PLAN

5.1 Feeling Valued

5.2 Feeling Well

5.3 Feeling Supported

5.4 Managing at Home

5.5 Feeling in Control

To section is to be completed by Care Centre Staff