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 63XXXX or by e-mail at XXX.XXX@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 choose one option only
		Anstey Ward		Barrow and Sileby West Ward
		Birstall Wanlip Ward		Birstall Watermead Way
		East Goscote Ward		Forest Bradgate Ward
		Loughborough Ashby Ward		Loughborough Dishley & Hathern Ward
		Loughborough Garendon Ward		Loughborough Hastings Ward
		Loughborough Lemyngton Ward		Lougborough Nanpantan Ward
		Loughborough Outwoods Ward		Loughborough Shelthorpe Ward
		Loughborough Southfields Ward		Loughborough Storer Rd
		Mountsorrel Ward		Queniborough Ward
		Quorn & Mountsorrel Castle Ward		Rothley & Thurcaston Ward
		Shepshed East Ward		Shepshed West Ward
		Sileby Ward		Syston East Ward
		Syston West Ward		The Wolds Ward
		Thurmaston Ward		Wreake Villages Ward

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		Other (ü and write in below)
		Black or Black British White

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

Questions for Over 55's only - Current Home

Q14	Do you live in housing built for older people? Please choose one option only
		Yes			No

Q15	If yes, is it... 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

Q16	Do you think your home is suitable for your needs? Please choose one option only
		Yes			No

Q17	If you have answered no, which of the following best explains why... Please choose as many options as you wish.
		Not enough space for storage		Not enough bedrooms
		It is in a poor state of repair		It needs adaptions
		The rent/mortgage is too expensive		It's too expensive to run (e.g. heating costs)
		It is too far from facilities like shops and doctors.		It is too far from public transport
		It too far from family & friends		For health reasons
		Other (please write below)

Q18	Do you feel isolated in your home? Please choose one option only
		Yes			No

Q19	If you have answered yes, which of the following would make you feel less isolated... Please choose as many options as you wish.
		Living nearer people of my age
		Better local amenities and community activities
		Living nearer people of different ages
		Regular visits from people providing professional help
		Living nearer family and friends

Q20	Do you have or would you use a pavement / mobility scooter? Please choose one option only
		Yes, I already have one		I will need one in future years
		I intend to get one soon		No, I wouldn't consider getting one.

Questions for Over 55's only - Previous Home

Q21	Have you moved in the last 5 years? Please choose one option only
		Yes			No

Q22	If yes, where did you moved from? Please choose one option only
		In Charnwood			Elsewhere in UK
		Leicestershire			Outside the UK
		East Midlands

Q23	Which area of Charnwood did you move from? Please choose one option only
		Anstey Ward		Barrow and Sileby West Ward
		Birstall Wanlip Ward		Birstall Watermead Way
		East Goscote Ward		Forest Bradgate Ward
		Loughborough Ashby Ward		Loughborough Dishley & Hathern Ward
		Loughborough Garendon Ward		Loughborough Hastings Ward
		Loughborough Lemyngton Ward		Lougborough Nanpantan Ward
		Loughborough Outwoods Ward		Loughborough Shelthorpe Ward
		Loughborough Southfields Ward		Loughborough Storer Rd
		Mountsorrel Ward		Queniborough Ward
		Quorn & Mountsorrel Castle Ward		Rothley & Thurcaston Ward
		Shepshed East Ward		Shepshed West Ward
		Sileby Ward		Syston East Ward
		Syston West Ward		The Wolds Ward
		Thurmaston Ward		Wreake Villages Ward

Q24	Which of the following best describes where you used to live? Please choose one option only
		Detatched House		Flat
		Semi-detatched House		Maisonette
		Terraced House		Mobile Home
		Bungalow		Bedsit

Q25	How many bedrooms did you have in your last home? Please choose one option only
		1		2		3		4		5 or more

Q26	In your previous home, did you... 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

Q27	Why did you 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)

Questions for Over 55's only - Future Move?

Q28	Do you intend to move in the next five years?
		Yes			No

Q29	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)

Q30	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

Q31	How many bedrooms would you want? Please choose one option only
		1		2		3		4		5 or more

Q32	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

Q33	Do you want to move into housing for older people? Please choose one option only
		Yes			No

Q34	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

Q35	Have you applied to the Council or a Housing Association for housing? Please choose one option only
		Yes		No
	Council
	Housing Association

Q36	Where do you expect to move to? Please choose one option only
		In Charnwood			Elsewhere in UK
		Leicestershire			Outside the UK
		East Midlands			Not decided

Q37	Which area of Charnwood would this most likely be? Please choose one option only
		Anstey Ward		Birstall Watermead Way
		Birstall Wanlip Ward		Forest Bradgate Ward
		East Goscote Ward		Loughborough Dishley & Hathern Ward
		Loughborough Ashby Ward		Loughborough Hastings Ward
		Loughborough Garendon Ward		Lougborough Nanpantan Ward
		Loughborough Lemyngton Ward		Loughborough Shelthorpe Ward
		Loughborough Outwoods Ward		Loughborough Storer Rd
		Loughborough Southfields Ward		Queniborough Ward
		Mountsorrel Ward		Rothley & Thurcaston Ward
		Quorn & Mountsorrel Castle Ward		Shepshed West Ward
		Shepshed East Ward		Syston East Ward
		Sileby Ward		The Wolds Ward
		Syston West Ward		Wreake Villages Ward
		Thurmaston Ward		Not decided
		Barrow and Sileby West Ward

Q38	Do you want to move to any of the following specialist housing scheme? 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

Questions for over 60's only

Q39	Are you over 60? Please choose one option only
		Yes			No

Q40	Which - if any - of the following changes does your home need? Please choose as many options as you wish.
		Wheelchair adaptions		Bathroom adaptions
		Kitchen adaptions		Handrails / grab rails
		Improvements to access		Downstairs shower and toilet
		Room for carer		Other (please tick and write detail below)
		Stair lift / vertical lift

Q41	Is there any of the following types of support that you or anyone in your family would like but doesn't currently receive? Please choose as many options as you wish.
		Bathing / dressing / feeding		24 hour supervision
		Cleaning		Gardening
		Shopping		Transport
		Meals on Wheels		Contact with other People

Q42	Are you a carer for anyone in your household?
		Yes, sole carer
		Yes, carer with help from relatives / friends
		Yes, carer with help from other agency
		No

Q43	Is the person you care for over 60? Please choose one option only
		Yes			No

Questions for under 55's

Q44	Do you intend to move within five years of your retirement? Please choose one option only
		Yes			No

Q45	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)

Q46	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

Q47	How many bedrooms would you want? Please choose one option only
		1		2		3		4		5 or more

Q48	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

Q49	Do you want to move into housing for older people? Please choose one option only
		Yes			No

Q50	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

Q51	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

Q52	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

Q53	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