Holiday Lodge Application

If you have reliable help from family or friends that gives you the freedom to have the breaks that you need, answer ‘yes’.

If you need to be ‘in attendance’ of the person you care for because they need you to sit with them, or be in the vicinity, for more than 20 hours per week, answer ‘yes’ and / or the amount of time you spend undertaking caring tasks amounts to over 20 hours per week, answer ‘yes’?

If you and the person you care for live at the same address, or you and the person you care for stay together for more than 24 hours a day 8 days a month, answer ‘yes’.

If you do not need to be with the person you care for every day, because they are in another place for periods of 6 hours or more in a single day most weeks, answer ‘yes’.

If you have had a break away from home that has been by yourself, or with the person you care for, or a break at home because the person you care for has gone elsewhere in the last year, answer ‘yes’.

If you have been providing regular and substantial amounts of care to the person you care for, over 8 continuous years or more, answer ‘yes’, or if you have been caring for more than one person consecutively for more than 8 continuous years, answer ‘yes’.

If you have stopped meeting others and / or doing the things you like to do be- cause of your caring responsibilities, answer ‘yes’.

If you consider that most of the time your physical health is good enough to do all the things you want to do, including your caring responsibilities, answer ‘yes’.

If your caring role interferes with your sleep and / or in the last month you have been bothered by feeling down, depressed, or hopeless and / or you have little in- terest in doing things, answer ‘no’. If you have all of the feelings above and have not yet spoken to your GP about it, please contact your GP to discuss.

If you currently have a diagnosis of cancer, or you have a condition for which you have routine check-ups, e.g. asthma, diabetes, renal failure, heart disease, answer ‘yes’.

If, during your caring day you can regularly do other things without being pre-oc- cupied with your caring responsibilities, answer ‘yes’.

If you are 65 or above in the calendar year you complete this application, answer ‘yes’.

If you are in receipt of Guarantee Pension Credit, Income Support, or income-based Jobseekers Allowance, Income-related Employment Support Allowance, answer ‘yes’, and / or if you are in receipt of the highest rate of Attendance Allowance or Disability Living Allowance care component, or in receipt of the enhanced rate for daily living of the Personal Independence Payment, answer 'yes'.

If you are not able to switch off from caring, or your plans are frequently disrupted because you need to be available ‘just in case’, or there are few people that are able to manage the challenging behaviours of the person you care for, answer ‘yes’.