CARERS SUPPORT PLAN/REVIEW

The purpose of the Carers Support Plan is to give you as a carer the opportunity to identify the areas of your life that have been affected by your caring role; to examine how caring impacts on your ability to lead a healthy and balanced life; and to identify ways to improve your well-being and make plans for the future. The Carers Support Plan will help you to identify the information you need to be better supported in your caring role.

CARER’S DETAILS	TITLE:	FIRST NAME: 	SURNAME: 	
GENDER: 	DATE OF BIRTH: 	ETHNICITY: 	
ADDRESS:  	TOWN: 	POSTCODE: 	
TELEPHONE NO.
(Work/mobile)	TELEPHONE NO.
(Home)
	E-MAIL: 	
RELATIONSHIP TO CARED FOR PERSON: 	COMMUNICATION SUPPORT REQUIRED FOR CARER
(Please provide details)

For Office Use Only:	
LAS ID: 	CHI No. 	

About Me

Please provide some background information about you and your role as a carer that you wish to share with service providers. This is to help others understand what is important to you as an individual.

	Provided	Frequency	Comments	
Personal Care	
			
Help with bills/finance				
Practical Support	
			
Transport				

1	Quality of Life
Think about your health & wellbeing: having a life of your own; and having a good relationship with the person you care for.

What is working well for me?

	
What would a good quality of life look like for me?

	
I think my quality of life just now is:	

	

	

1	
2	
3	
4	
5	
6	

I have a very poor quality of life	

	
	
I have an excellent quality of life	

	
Actions required to improve the quality of my life:	Person Responsible for the action:	Action by date:	

			

			

			

2		Managing the Caring Role
Think about the extent you want to continue in your caring role?  Do you feel you are equipped, in terms of information, skills and equipment, to continue caring; satisfactions and stress of caring; being involved in decision-making by services; willingness to continue to provide care.

What is working well for me?

	
What I need to be able to manage my caring role better is…

	
I think my ability to manage my caring role just now is:

	

	

1	
2	
3	
4	
5	
6	

I am unable to manage my caring role	

	
	
I have no difficulties managing my caring role	

	
Actions required to assist me in managing the caring role:	Person Responsible for the action:	Action by date:	

			

			

			

3	How you are valued by Services.
Think about how your expertise on the needs of the cared for person are recognised: how your views are taken into account by services; how services recognise your needs as a carer; your access to services; having a positive relationship with staff.

What is working well for me?

	
What needs to improve for me to feel more valued by services?

	
I think the extent to which I am valued by services just now is:

	

	

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2	
3	
4	
5	
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Very low	

	
	
Very high	

	
Actions required to help me feel more valued by services:	Person Responsible for the action:	Action by date:

			

			

			

4	Planning for the Future
Think about the things you may need to do to plan for the future: plan for emergencies; accommodation (housing and adaptations); manage change (transitions); social care supports/services; anticipatory health planning with a GP for the person you care for; sustain employment/education; consult a solicitor about legal matters including Power of Attorney, or Guardianship (Welfare & Financial).
Do you have an Emergency Plan? Yes/No
Please recommend and include that carers carer completes the emergency plan and is included in their own personal action plan.

What planning have I done?

	
I need to improve planning for the future in the following areas…

	
I think where I am at with planning for the future is…

	

	

1	
2	
3	
4	
5	
6	

Very poor	

	
	
Excellent	

	
Actions required to improve planning for the future:	Person Responsible for the action:	Action by date:	

			

			

			

5	Finances and Benefits
Think about access to information about benefits entitlements and other financial advice.

What do I know about benefits and finances?

	
I need to find out more about finances and benefits in the following areas…

	
I think where I am at with action on finances and benefits is…

	

	

1	
2	
3	
4	
5	
6	

Very poor	

	
	
Excellent	

	
Actions required to access information about benefits and finances:	Person Responsible for the action:	Action by date:	

			

			

			

6	Emotional Wellbeing
Think about how life presents events that challenge you, and your ability to adapt to face these e.g., produce positive emotions, moods, thoughts, feelings.

What is working well for me? 

	
What I need to be able to manage/improve my emotional wellbeing…

	
I think my ability to manage my emotional wellbeing just now is…

	

	

1	
2	
3	
4	
5	
6	

Very poor	

	
	
Excellent	

	
Actions required to improve my emotional wellbeing:	Person Responsible for the action:	Action by date:	

			

			

			

7	Life Balance
Think about how you make time for the things you have to do (responsibilities) and the things you want to do (things that bring you pleasure, personal fulfilment, etc.).

What is working well for me? 

	
What I need to be able to manage/improve my emotional wellbeing…

	
Has a break from caring been considered to meet carers specific needs? Yes/No

How will you make this happen?

	
I think my ability to manage my emotional wellbeing just now is…

	

	

1	
2	
3	
4	
5	
6	

Very poor	

	
	
Excellent	

	
Actions required to improve my life balance:	Person Responsible for the action:	Action by date:	

			

			

			

8	Employment
Think about your aspirations and decisions around work e.g., juggling work and your caring role, undertaking retraining/further education etc.

What is working well for me?

	
What I need to be able to manage/improve my emotional wellbeing…

	
I think my ability to manage my life balance just now is…

	

	

1	
2	
3	
4	
5	
6	

Very poor	

	
	
Excellent	

	
Actions required:	Person Responsible for the action:	Action by date:	

			

			

			

9	Living Environment
Think about where you live and how this impacts on you.
What is working well for me?

	
What I need to be able to manage/improve my living environment…

	
I think my ability to manage my living environment just now is…

	

	

1	
2	
3	
4	
5	
6	

Very poor	

	
	
Excellent	

	
Actions required to manage/improve my living environment:	Person Responsible for the action:	Action by date:	

			

			

			

Your Caring Role
Do you feel able and willing to continue in your caring role? Yes/No

What is required to be done to support you?

Data Protection Act 1988
The information provided by you on this form will be held by Fife Council for the purpose of assisting you as a carer. As part of this process, the Council may share statistical returns with the Scottish Government for the purposes of research.
All use and storage of personal information will be in accordance with the Data Protection Act 1998. Further information is available on the Council’s website www.fifedirect.org.uk

If you have been supported by a professional worker to complete this form please provide their details:

Practitioner/Agency Details:
Name:				
Title/Designation:	
Contact details:	

I confirm that the information contained in this form is correct to the best of my knowledge.

Carer Agreed with Support Plan/Review: Yes/No

Carer’s Signature:    			

Date Support Plan/Review Completed: 		

Review
Review Scheduled: Yes/No

Next review: 		

Review Arrangements: 		

Support Links
The following provide information about support that are available for both the Carer and Cared for Person in Fife.
•	Fife Carer Centre, 157 Commercial Street, Kirkcaldy – 01592 205472 or centre@fifecarers.co.uk

•	On Your Doorstep – onyourdoorstepfife.org.uk

•	Fife Direct – fifedirect.org.uk

•	Health and Social Care (Contact Centre) – 03451 551503