planning conversations | adult

Planning Conversations - Adult C1 | v.1119icareTM | Insurance and Care NSW. 1 of 3

Planning conversations | AdultC1. Current living arrangementsDate icare reference number

Person’s name Planning facilitator Contact details (enter with no spaces)

1. Has there been a change in where you live?

No (move to Question 2)

Yes(provide details of your new address)

Street address

Suburb State Postcode

Is this move likely to impact on your rehabilitation or plan?

No Yes

What type of dwelling is your home?

Apartment Free-standing house Townhouse Farm Caravan Other

Do you own your new home, or do you rent?

Own home Rented home (specific e.g. Private rental, Housing NSW, through a relative or a friend)

Residential facility (e.g. nursing home)

Supported accommodation (e.g. group home, hostel, retirement village)

Have there been any modifications to this home because of your injury? Are these working well for you?

No Yes If yes, provide details


2. Living arrangementsHas there been any change to the people you live with?

No (move to next Question)

Yes(provide details below)

Name Relationship Name Relationship



3. Potential problems (risks) with your homeDo you think there might be problems in the future with your current home? (e.g. Your home is a private rental and modifications are needed, or you think the owner wants to sell the home)


In the future, do you think there might be changes to who you live with? (e.g. Your sister is due to move back into the home with her new baby. How would you feel about that if it happened?)


CommentsPerson’s comments Family comments

Planning facilitator comments


Additional information and comments

Once completed please e-mail this form to:

Lifetime [email protected]

Workers [email protected]


Planning conversations | AdultC2. Thinking about youDate icare reference number


What is most important to you at the moment?

What are your main concerns right now?DRAFT

icareTM | Insurance and Care NSW. 2 of 2




Other relevant information

What are your strengths?

DRAFT

Planning Conversations - Adult C2 | v.1119


Planning conversations | AdultC3. Activities and participationDate icare reference number


Support to complete activities and participateIncludes informal and formal supports, such as a family member helping you prepare a meal (not paid), the after school program providing child care (paid) or icare funded support workers helping you complete tasks (paid). Typically, people receive support from a mixture of informal support persons and formal support from support workers.

You need to think about the range of support you need to complete activities and participate as you develop your plan.

Assistive technologyWe use the term assistive technology to include ‘any piece of equipment, or product, whether it is acquired commercially, modified or customised, that is used to increase, maintain or improve your ability to function. It includes equipment such as disposable continence products, medications, eating aids, walking and mobility aids, orthoses, wheelchairs, information and communication technology, mobile phones and environmental controls’.

The support I need to complete activities and participateSelect no if you, your family and your planning facilitator agree that you do not need any support to complete or participate.

Select yes if you, your family or your planning facilitator think you need support - even if this support is only occasional.

Do you need support to communicate with people?

No Yes. If yes, complete Section 1: Communication

Do you need support to stand, sit, move around or use your arms?

No Yes. If yes, complete Section 2: Moving around

Do you need support to complete self-care activities?

No Yes. If yes, complete Section 3: Self-care activities

Do you need support to get along with people?

No Yes. If yes, complete Section 4: Relationships

Do you need support to learn and remember your day to day routine?

NoYes. If yes, complete Section 5: How you learn, knowing and remembering your day to day routine

Do you need support to manage your responsibilities at home?

NoYes. If yes, complete Section 6: Responsibilities at home

Do you need support to participate in major areas of your life? (e.g. education, employment and recreation) Do you need support to do things for yourself that need to get done (energy and drive)?

NoYes. If yes, complete Section 7: Major areas of your life

DRAFT


Section 1: Communication1. Do you need support to communicate when talking to people? Understand other people? Make peopleunderstand you? (In your preferred language)

No. Go to next question. Yes. Continue.

How often? Person Family member Planning facilitator

Always

Frequently

Sometimes

Periodically

Needs no support

Additional questionsDo you have any problems with your voice or speech (e.g. finding the words you want to say)?

Do you need support to use the telephone? Or other communication like email, phone apps or social media?

Comments on communication

Would additional assistive technology help with communication?

No Yes Unsure

Comments

DRAFT



Section 2: Moving around1. Do you need support to change positions and keep your body in a position, like sitting on a stool withouta back support? Change your position to be more comfortable?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

2. Do you need support to transfer such as getting in/out of bed, or a chair or the toilet?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

3. Do you need support to handle/hold objects with your hands, carry them and move around with them?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

DRAFT



4. Do you need support to move around your home?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

5. Do you need support to move around in the community? (e.g. using stairs, in a car, using public transport orcrossing the road)



Always

Frequently

Sometimes

Periodically

Needs no support

Would additional assistive technology help with moving around?

No Yes Unsure

Comments

Section 3: Self-care activities1. Do you need support to have a shower/bath and wash yourself? Dry yourself? Wash your hair or cleanyour teeth?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

DRAFT



2. Do you need support to go to the toilet?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

3. Do you need support to choose your own clothes and get dressed?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

4. Do you need support to eat and drink?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

DRAFT



5. Do you need support to manage your diet?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

Would additional assistive technology help with self-care activities?

No Yes Unsure

Comments

DRAFT



Section 4: Relationships1. Do you need support to get along with people? (e.g. Making and keeping friends, having intimaterelationships, behaving within accepted limits, coping with feelings and emotions)



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

Additional questionsDo you know and understand why, if someone gets upset with what you have done?

What kinds of things can trigger a response from you?

Would additional assistive technology help?

No Yes Unsure

Comments

DRAFT



Section 5: How you learn, knowing and remembering your day to day routine1. Do you need support to learn something new?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

Additional questionsDo you have any difficulties with your memory? Are you able to remember things when you need to?

Are you able to concentrate on a task for the time you need to?

2. Do you need support to plan what you need to do for the day, or week? Make decisions? Solve problems?(provide an example appropriate to the participant)



Always

Frequently

Sometimes

Periodically

Needs no support

Additional questionDo you know when something is too risky - such as something which may cause harm to yourself or others?

Comments

DRAFT



3. Do you need support to carry out different tasks at the same time? Work out your priorities?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

Additional questionsCan you shift your focus between two or more things at the same time?

If something doesn’t work out as you planned or expected do you usually manage to work out a solution?

Would additional assistive technology help with learning, knowing and remembering your day to day routine?

No Yes Unsure

Comments

DRAFT



Section 6: Responsibilities at home1. Do you need support to prepare meals for yourself and others?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

2. Do you need support to do the jobs you are responsible for around the house? (e.g. Washing and dryingclothes, cleaning, home maintenance, gardening)



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

DRAFT



3. Do you need support to shop for the things you need? (e.g. Groceries, personal items)



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

Would additional assistive technology help with managing responsibilities at home?

No Yes Unsure

Comments

Section 7: Major areas of your life1. Do you need support with education (e.g. school, TAFE, University)?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

DRAFT



2. Do you need support with work and employment (including voluntary work)?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

3. Do you need support with recreational activities, hobbies, your spiritual life (e.g. church,/religious activities)or other activities?



Always

Frequently

Sometimes

Periodically

Needs no support

Comments

DRAFT



Comments


Always

Frequently

Sometimes

Periodically

Needs no support

4. Do you need support with doing things for yourself that you need to do, and moving towards what youwant to do? (energy and drive)


Additional questions

Do you think you get tired easily?

How is your sleeping?

Would additional assistive technology help with managing the major areas of your life?

No Yes Unsure

Comments




DRAFT



Planning conversations | AdultC4. Personal considerationsDate icare reference number


1. How do you think you are going with adjusting to your different circumstances?

Family comments Planning facilitator comments

2. How do you react to what is happening around you? Do you think you respond differently to howyou did before your injury?


DRAFT



4. Are you keen to try things in a different way, or try new activities?


3. How well do you manage when you feel under pressure or you are stressed? E.g. How well do youmanage when you need to respond to an emergency or call for assistance?


DRAFT






5. Do you look forward to the next day? Are you keen to try and do some of the things that youlike to do?


6. Do you think you or your family would benefit from additional emotional support (e.g.psychology, peer2peer support, carer support counselling or groups?)

Family comments Planning facilitator commentsDRAFT



Planning conversations | AdultC5. Formal and informal supportsDate icare reference number


1. Informal supports - not paidTell me about the support you receive from the people around you at home (not people paid to support you)?


Tell me about the support you receive from your friends or other family who do not live with you?


DRAFT



Tell me about the support you receive from people in the community (e.g. neighbours, your school or workplace, church, clubs etc.)


2. Formal supports paid for by other organisations or the familyTell me about other community supports and services that you use which are not paid for by icare? (e.g. After school care, private cleaner, taxi transport to access leisure activities, public transport) How are these going for you?


DRAFT



3. Formal supports paid for by icareTell me how things are going with your icare funded supports?


4. Attitudes of othersTell me about the attitudes of people around you since your accident? (e.g. your neighbours, people from your work, your brothers or sisters, your friends, your therapist)

Family comments Planning facilitator commentsDRAFT



5. Additional support needsWhat (if any) supports do you think you need, that you are not getting now?


6. Additional information (e.g. from family as appropriate)




DRAFT



Planning conversations | AdultC6. Wellbeing and quality of lifeDate icare reference number


1. WHOQoL ScoresThe WHOQol questionnaire is to be sent to icare as a separate attachment. Please use the WHOQoL calculator provided to calculate scores.

Insert below the scores from the completed WHOQoL.

Item 1 score (overall quality of life score) Item 2 score (overall wellbeing score)

Domain Raw score Transformed score*

Physical

Psychological

Social relationships

Environment

*Higher scores denote higher quality of life

2. Comments




DRAFT



Planning conversations | AdultC7. Planning for emergenciesDate icare reference number


Having plans and strategies in place to manage different emergency situations is recommended for everyone. Emergencies can arise from natural disasters, as well as personal health and safety issues, both in your home and in the community.There are a number of resources that can help you think through issues and what might be important for you:

At home and your community I’m OK http://imokay.org.au(Physical Disability Council of NSW, NRMA Insurance)

Disability inclusive (natural) disaster preparedness http://sydney.edu.au/health-sciences/cdrp/projects/disasterdisab.shtml(University of Sydney - Centre for Disability Research and Policy)

http://www.redcross.org.au/prepare.aspx(Australian Red Cross)

Risk management toolkit http://managingrisk.living-with-attendant-care.info/

1. What kinds of emergency events could happen that you might need to have a plan in place for?


DRAFT



2. Have you developed an action plan for each of these emergencies? Does your plan include thecontact details of the people or services you need to contact in case of an emergency?


3. Where is your emergency plan kept? Who is aware of your plan?Do they know how to access this?





DRAFT


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