First name
Last name
Email
Mobile
1.
What are you currently waiting for?
Please select
Aged care assessment
Home care package allocation
Increase to a higher level package
2.
2. How long have you been waiting?
Please select
Less than 3 months
3-6 months
6-12 months
More than a year
3.
How is the wait affecting you or your loved one? Select the option you feel is the most pressing in your life, or the life of your loved one.
Please select
Declining health or mobility
Increased stress or anxiety
Financial strain
Risk of injury or hospitalisation
Strain on family or carers
A loved one died while waiting
4.
In your own words, please tell us your story. (What challenges are you facing while waiting? How is it impacting your daily life?)
5.
While waiting, are you currently receiving any care through:
Please select
A lower-level home care package
The Commonwealth Home Support Program (CHSP)
Both
Neither
6.
If yes, does this support meet your needs?
Please select
Yes, fully
Yes, Partly
No, not at all
7.
If it’s applicable, please tell us more about any gaps between the care you are receiving on a lower-level package or through CHSP versus what you actually need.
8.
What changes would you like to see to improve the system?
9.
Would you be willing for us to contact you to learn more about your story?
Please select
Yes
No