Which hospital was the person you care for in? ^*

K&C QEQM WHH BHD

Which ward were they on? ^*

Month of admission

Does the person that you care for have any of the following pre-existing conditions?

Dementia Learning difficulties Neurological conditions Other

Did hospital staff ask you about the needs of the person you look after to help plan their care?

Yes No

Were you asked if you would like to be involved in the care of the person you care for?

Yes No

Did you feel that you were able to visit at appropriate times to support that care?

Yes Sometimes No

If you contacted the ward did you receive the communication you needed?

Yes No Not Applicable

Were you involved as much as you wanted to be in decisions about their care and treatment?

Yes No N/A

Did the staff explain to you the reason why the person you care for was transferred to another ward or department?

Yes No N/A

How many times was the person you care for moved between hospital wards.

1 2 3 4 5

When the person that you care for was in hospital where their dietary requirements met?

Yes Sometimes No

Did the staff do enough to control the pain of the person?

Yes Sometimes No N/A

Did staff give you enough information about agencies in your local area which might be able to help and support you as a Carer?

Yes No Not required

What else could be done to improve support for you as a Carer?