Supported Accommodation Application Form

ISSUED BY OFFICE Housing for Older People Application form FOR OFFICE USE ONLY Application for Housing Reference Number Applicant has expressed interest in the following areas: 1 2 3 4 5 Has a Health and Disability Assessment application been submitted? YES: NO: 2 Housing for Older People: Application for Assessment Guidance Notes Please ensure you read and understand the following information before completing the Housing for Older People application. What you should do: • Complete all questions on the application form, giving as much detail as possible. Failure to do so could result in the application being returned. • Please remember that you must submit a recent ‘Assessment of Need and a Care Plan’ from the Care Manager from the Health & Social Care Partnership • If further assistance is required to complete this application please contact your local housing office. • Sign and date the form • Return the form in person to your local housing office or by post to East Ayrshire Council who will deal with your application on behalf of the SEARCH partners: East Ayrshire Council Housing Register Team Housing Service P.O. Box 13 John Dickie Street Kilmarnock KA1 1HW What happens next? • The information you provide will be used to make an assessment of your housing need by the Housing Occupational Therapist •The Housing Occupational Therapist may contact or visit you at home in order to gain a better understanding of your needs. • Following the assessment we will write to you when a decision regarding your application has been made. Housing for Older People: Application for Assessment 3 Please be aware Housing for Older People is subject to additional support charges. Please see attached leaflet Information ‘Charging for Council funded or provided Support Services’. What is housing for Older People? How do I Apply for Housing for Housing for Older People are small, easy to manage Older People? properties grouped together in a community designated for people over the age of 60. They are aimed at enabling You need to complete this Housing for Older People people over the age of 60 with care needs to remain living Application. You will need to provide details of your current with in their community for as long as possible in a safe circumstances and return the form to your local housing environment. office for assessment. It is very important that you complete all the questions on the application and give us as much Type of Accommodation information as possible; this will help us to carry out an accurate assessment of your circumstances. All the properties across East Ayrshire are designed to be easily accessible, with all properties either being bedsits, flats You are not required to complete a Health and Disability or bungalows. All properties are self-contained providing Application if you are only interested in Housing for Older tenants with their own private living space and front door. People. Each of the communities are designated either low or high needs units depending on the facilities and services available. Who will assess my Housing for Please see Section 7 for list of available Housing for Older Older People Application? People communities in East Ayrshire. The assessment will be completed by the Housing Services available within Housing Occupational Therapist. The Housing Occupational Therapist will contact you or your representative to discuss your for Older People Accommodation circumstances in more detail. This may be carried out by Each property is installed with a community alarm and linked telephone, home visit or office appointment. On completion in smoke detector providing a 24 Hour response service. A of the assessment the Housing Occupational Therapist will few of our communities also have communal areas for the make recommendations in relation to your house type opportunity for social interaction with other tenants and requirements as well as awarding a priority level. Housing for people living in the local community. The social activities are Older People are not allocated on a point’s system and as organised by the Well-Being Development Officers who are such no points will be awarded to your application following linked to all our Housing for Older People communities. The this assessment. Following the assessment we will write to Well-Being and Development Officers are generally available you when a decision regarding your application has been Monday to Friday 9am-5pm. made. Please be aware the Well-Being Development Officers do If interested in applying for Housing for Older People owned not provide a warden service. by one of the Registered Social Landlords (Bield, Hanover Housing, Trust or West of Scotland) this form is also If you are interested in Applying for our Housing for Older applicable as request nominations for East Ayrshire Council. People please read the following criteria. However we recommend you register an application form with them directly. Criteria Housing for Older People is applicable to people over the age of 60 and who are experiencing functional difficulties around their home and social isolation as a result of their health condition or disability. 4 Housing for Older People: Application for Assessment Application for Housing for Older People All information provided will be treated in the strictest confidence Please answer all the questions as fully as possible to help us consider this application. If this form is not fully completed we will not be able to carry out an assessment. This form should be completed by you, or someone who cares for you. If you require assistance to fill in the form, contact the address on the back and someone will call to your home and help. Your Application for Housing for Older People will not be considered until this form has been completed and returned to the Council. Housing for Older People: Application for Assessment 5 Section 1: Information about the household member(s) applying for supported accommodation Name of main applicant Date of birth Current address Telephone number(s) Name of GP Address of GP Telephone number of GP Please detail any health conditions or disabilities including physical and mental health Are you a wheeelchair user? YES: NO: If YES, where do you use it? Indoors: Outdoors: Both: 6 Housing for Older People: Application for Assessment Name of joint applicant Date of birth Current address Telephone number(s) Name of GP Address of GP Telephone number of GP Please detail any health conditions or disabilities including physical and mental health Are you a wheeelchair user? YES: NO: If YES, where do you use it? Indoors: Outdoors: Both: Housing for Older People: Application for Assessment 7 Section 2: Existing Support Services Do you, or your partner, receive help from a Social Worker or YES: NO: Health Professional? If yes, please advise who provides your service and how often? Do you, or your partner, receive help from Community Nursing Staff? YES: NO: If yes, please advise what help is received and how often? 8 Housing for Older People: Application for Assessment Please tell us if the person has any difficulty with any of the following daily tasks I can manage Yes I receive If yes, who How often do indpendently help helps you? they help you? Washing self Dressing self Cleaning and maintaining my home Preparing meals Taking prescribed medication Going out shopping Attending social groups/clubs Keeping in touch with family and friends Managing my money, paying bills Managing mail and correspondence Housing for Older People: Application for Assessment 9 Section 3: Information about the person’s current accommodation Current accommodation type (please tick all that apply) Sheltered Housing/Housing for Maisonette (Ground floor) Older People Amenity Housing Maisonette (Upper floor) Flat (ground floor) House (three-storey) Flat (upper floor) House (end-terrace) Multi-storey flat House (mid-terrace) Basement flat House (semi-detached) Attic flat House (detached) Bedsit upper Bungalow Bedsit lower Other (please give details) Four in a Block (Ground floor) Four in a Block (upper floor) How many bedrooms does your current accommodation have? (If you have a separate dining room you should count this as a bedroom) Layout of current accommodation (please tick all that apply) Bathroom upstairs Bedroom upstairs Bathroom downstairs Bedroom downstairs Toilet upstairs Curved internal stairs Toilet downstairs Straight internal stairs Number of external steps: Front door Number of external steps: Back door 10 Housing for Older People: Application for Assessment What does the person’s current home have? (please tick all that apply) Level access entrance Stair lift Ramped entrance Tracking hoist fixed to the ceiling Door entry system Handrails inside over stairs (not a communal one) Handrail(s) outside over steps Adapted kitchen (e.g. lowered worktops, special sink etc) External lift Adaptation(s) for people with a hearing impairment Community Alarm/Telecare Adaptation(s) for people with a visual impairment Walk-in shower Other (please give details) (wet floor area or level shower base) Step-in shower Over-bath shower Specialist toilet/bath Wider doors for wheelchair access Specialist Equipment: Please detail any medical equipment, for example hospital bed, mobile hoist, ventilator, oxygen etc and/or other specialist equipment, for example, bathing, showering or toileting equipment, special seating, walking aid, that is currently used in the accommodation. Housing for Older People: Application for Assessment 11 Please tell us if the person has any difficulty within their current property with any of the following (please tick all that apply) Climbing outside steps Getting into rooms due to the width of the doors or hallways Getting in/out bath or shower Climbing the stairs inside the accommodation Getting on/off toilet Other (please give details below) 12 Housing for Older People: Application for Assessment Please tell us why you wish to be considered for supported accommodation.

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