Under 55's Survey

Some Helpful Hints Before Starting

Please read each question carefully. In most cases you will only have to click on one option per question but  sometimes you will need to click on more than one or provide a written answer. Some sections of this survey are only intended to be completed by some respondents ( e..g. Over 55's, under 55's). Please read any instructions carefully to make sure you are completing the right section. Also, the survey will skip past any questions that are not relevant to you. Once you have finished please take a minute to check you have answered all the questions that you should have answered. If you have any queries about the questionnaire or what the information will be used for please do not hesitate to contact [insert name] on 01509 634705 or by e-mail at consultation@charnwood.gov.uk

Where do you live?

Q1	In which of the following areas do you currently live? Please choose one option only
		In Charnwood			Elsewhere in UK
		Leicestershire			Outside the UK
		East Midlands

Q2

Which area of Charnwood do you live in?                                     (Please include name of area and postcode)

How would you describe your home?

Q3	What sort of property do you currently live in? Please choose one option only
		Detached House		Semi-detatched House
		Terraced House		Bungalow
		Flat		Maisonette
		Mobile Home		Bedsit
		Other

Q4	How many bedrooms do you have in your home? Please choose one option only
		1		2		3		4		5 or more

Q5	Which of the following best applies to you Please choose one option only
		Own your home without a mortgage		Rent from the Council
		Own part of your home as shared owner		Rent from Housing Association
		Own your home with a mortgage		Live with family or friends.
		Rent from a Private landlord		Other (provide details below)

Q6	Which of the following best describes your household? Please include any person whose home is with you but they are away at college/university/armed forces. Please choose one option only
		Single person living alone		Couple
		Single person person with other adults		Couple with adults and children
		Single person with adults & children		Couple with with child/ren under 16
		Single person with child/ren under 16		Couple with other adults

Personal Information

Q7	Are you currently.... Please choose one option only
		Employed		Long Term sick / unable work
		Looking after home / family		Retired
		Unemployed		Other

Q8	Do you have any long-term illness, health problem or disability? Please choose one option only
		Yes			No

Q9	If yes, what is the nature of this illness, health problem or disability? Please choose one option only
		Physical disability (wheelchair user)		Visual impairment
		Physical disability (no wheelchair)		Hearing impairment
		Learning disability		Long term illness
		Mental health problem		Other (please write detail below

Q10	Do you or any other member of your household currently receive care or support in your home? Please choose one option only
		Yes		No

Q11

What is your nationality / country of birth?

Q12	Which of the following best describes your ethnicity? Please choose one option only
		Asian		Dual / Mixed Heritage
		Chinese		White
		Black or Black British		Other (ü and write in below)

Q13	What age group are you? Please choose one option only
		18 - 35			55 - 60
		35 - 55			60 +

Questions for under 55's

Q14	Do you expect to move within five years of your retirement? Please choose one option only
		Yes			Too early to say
		No

Q15	What do you think will be the reasons you will move? Please choose as many options as you wish.
		Needed more bedrooms		To be nearer relative/friend/carer
		Needed less bedrooms		Financial reasons
		Needed a bungalow		To be closer to shops / doctors
		Needed extra care housing		To be nearer places of worship
		To be in a better area		To be nearer own community
		Safety / security reasons		Health / care reasons
		Needed wheelchair adapted home		Other (please tick and write detail below)

Q16	What type of housing would you prefer? Please choose one option only
		Detatched House		Flat
		Semi-detatched House		Maisonette
		Terraced House		Mobile Home
		Bungalow		Bedsit

Q17	How many bedrooms would you want? Please choose one option only
		1		2		3		4		5 or more

Q18	Which of the following would you prefer... Please choose one option only
		Own your home without a mortgage
		Own your own home with a mortgage
		Own part of your home as a shared owner
		Rent from a private landlord
		Rent from the Council
		Rent from a Housing Association
		Live with family or friends

Q19	Would you want to move into housing for older people? Please choose one option only
		Yes			Too early to say
		No

Q20	If yes, what sort of housing would you expect to move into. Please choose one option only
		Sheltered Housing - if you live in sheltered housing you will normally have a warden or scheme manager)
		Extra Care Housing - extra care housing provides more assistance and support than sheltered housing and will often have a restaurant on site.
		Residential Care
		None of these

Q21	Are there any facilities that would encourage you to move to housing for older people?                                                                Please choose as many options as you wish.
		A spare room		Hairdresser facilities
		GP service		Warden Service
		Alternative therapy		Leisure activities
		24 hour emergency call		Internet facilities
		Library		Communcal Lounge
		Good storage space		Own garden
		Parking		Shops
		Proximity to other services		Other

Getting Housing Advise

Q22	How easy do you think it is to get advice help with housing and support services for older people?                                          Please choose one option only
	Very easy		Fairly Easy		Fairly Difficult		Very Difficult		Don't Know

Q23	Where would you go for advice or help with housing and support services for older people?

Any Other Comments

	If there is anything else you would like to say on this subject that you have not been able to say above please it write in the box below.

Thank you very much for taking part in this survey