Suitable / Accessible Homes in RBWM

1. About me (select all that apply) *

I have long-term health conditions / learning difficulties / disabilities
Family members in my household have long-term health conditions / learning difficulties or disabilities
Regular visitors to my home have long-term health conditions / learning difficulties or disabilities

2. Age of person(s) with long-term health conditions / learning difficulties / disabilities (select all that apply) *

3. The long-term health conditions, disabilities or learning difficulties are (select all that apply) *

4. Support equipment used or needed (select all that apply) *

5. How suitable my home is now *

It is suitable as we don't need any adaptations
We have all the adaptations we need
We have some adaptations but need more
We need adaptations now
We will need adaptations in the next few years
We will need adaptations in the longer term
My home cannot be adapted and so we need to move

Comments:

6. It is important that new accessible homes in the borough are / have (select all that apply)

Number of bedrooms I need

7. The council ward (or town / village) I live in is

8. My home is

9. My home is owned by *

10. Current or anticipated future problems with my home (select all that apply)

	Now	Future
Getting to the front door	Getting to the front door Now	Getting to the front door Future
Getting in the front door	Getting in the front door Now	Getting in the front door Future
Moving around inside my home	Moving around inside my home Now	Moving around inside my home Future
Getting into the garden	Getting into the garden Now	Getting into the garden Future
Keeping my home warm	Keeping my home warm Now	Keeping my home warm Future
Storing support equipment	Storing support equipment Now	Storing support equipment Future
Keeping my home safe and secure	Keeping my home safe and secure Now	Keeping my home safe and secure Future
Using light switches / plug sockets	Using light switches / plug sockets Now	Using light switches / plug sockets Future
No downstairs cloakroom	No downstairs cloakroom Now	No downstairs cloakroom Future
Using the existing downstairs cloakroom	Using the existing downstairs cloakroom Now	Using the existing downstairs cloakroom Future
Using the bathroom	Using the bathroom Now	Using the bathroom Future
Using the kitchen	Using the kitchen Now	Using the kitchen Future
Using the stairs	Using the stairs Now	Using the stairs Future
Getting into / out of bed	Getting into / out of bed Now	Getting into / out of bed Future
Hearing the door bell / smoke alarm	Hearing the door bell / smoke alarm Now	Hearing the door bell / smoke alarm Future
Getting out and about as much as I need / like	Getting out and about as much as I need / like Now	Getting out and about as much as I need / like Future
Property / garden maintenance	Property / garden maintenance Now	Property / garden maintenance Future

11. Adaptations to my home that have already been made, we need now or will need in future (select all that apply)

	Done	Need Now	Need in Future
Improving the path to the front door	Improving the path to the front door Done	Improving the path to the front door Need Now	Improving the path to the front door Need in Future
Modifying the entrance / widening the front door	Modifying the entrance / widening the front door Done	Modifying the entrance / widening the front door Need Now	Modifying the entrance / widening the front door Need in Future
Widening other doorways	Widening other doorways Done	Widening other doorways Need Now	Widening other doorways Need in Future
Removing internal obstacles (thresholds, flooring)	Removing internal obstacles (thresholds, flooring) Done	Removing internal obstacles (thresholds, flooring) Need Now	Removing internal obstacles (thresholds, flooring) Need in Future
Moving light switches / plug sockets	Moving light switches / plug sockets Done	Moving light switches / plug sockets Need Now	Moving light switches / plug sockets Need in Future
Adding grab rails	Adding grab rails Done	Adding grab rails Need Now	Adding grab rails Need in Future
Adding hoists	Adding hoists Done	Adding hoists Need Now	Adding hoists Need in Future
Storage for support equipment	Storage for support equipment Done	Storage for support equipment Need Now	Storage for support equipment Need in Future
Creating a downstairs cloakroom / WC	Creating a downstairs cloakroom / WC Done	Creating a downstairs cloakroom / WC Need Now	Creating a downstairs cloakroom / WC Need in Future
Modifying the kitchen	Modifying the kitchen Done	Modifying the kitchen Need Now	Modifying the kitchen Need in Future
Adding a stairlift / through floor lift	Adding a stairlift / through floor lift Done	Adding a stairlift / through floor lift Need Now	Adding a stairlift / through floor lift Need in Future
Other changes to the stairs	Other changes to the stairs Done	Other changes to the stairs Need Now	Other changes to the stairs Need in Future
Modifying the bathroom	Modifying the bathroom Done	Modifying the bathroom Need Now	Modifying the bathroom Need in Future
Creating a wet-room / roll-in shower	Creating a wet-room / roll-in shower Done	Creating a wet-room / roll-in shower Need Now	Creating a wet-room / roll-in shower Need in Future

Anything else ?

12. Who paid for the adaptations that have already been made ? (select all that apply)

Me / my family
RBWM Council
Disabled Facilities Grant
Other (please give details):

13. Problems outside my home. These may relate to where I live and how hard it is to get to important places (select all that apply)

14. I have asked RBWM council for help (select all that apply)

	Never	This year	Last few years	Longer ago
Advice on adapting my home	Advice on adapting my home Never	Advice on adapting my home This year	Advice on adapting my home Last few years	Advice on adapting my home Longer ago
Adapting my home	Adapting my home Never	Adapting my home This year	Adapting my home Last few years	Adapting my home Longer ago
A home that meets my needs	A home that meets my needs Never	A home that meets my needs This year	A home that meets my needs Last few years	A home that meets my needs Longer ago

15. RBWM council responded to my request

Yes and I got the help / advice I needed
Yes but I am still waiting for the help / advice
Yes but I didn't get the help / advice I needed
No they haven't responded

16. I would also like you to know...

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