Is there anyone who regularly depends on you for help or support?
By that I mean that you do things they couldn’t manage for
themselves because of illness, disability, old age or some other reason? Please don’t include any childcare you have just told me about

What relationship do they have to you?

What do you help with?

How many hours do you spend helping them in
an average week?

Does this person live in the same household as
you?

What relationship do they have to you?
(**if couple add 10 to code**)
spouse ……………………………….. 1
parent ………………………………… 2
parent in law ……………………… 3
brother/sister ………………………. 4
brother in law/sister in law …. 5
own child …………………………… 6
child (step, adopted etc.) …. 7
friend ………………………………….. 8
other (specify) ……………………. 9

What do you help with?
(code in order mentioned)
personal care …………………….. 1
(bathing, taking medicine etc.)
mobility round house …………. 2
household chores ………………. 3
(cleaning cooking etc.)
transportation outside ……….. 4
(take shopping etc.)
dealing with officials,
financial affairs etc. ………….. 5
companionship ………………….. 6
‘everything’ ………………………… 7
other (specify) ……………………. 8

How many hours do you spend helping them in
an average week?
(code hours per week)
col 6 How much of a strain is it?
a great strain ……………………… 1
quite a strain ……………………… 2
a moderate strain ……………… 3
not much of strain ……………… 4
no strain at all …………………….. 5

Does this person live in the same household as
you?
Resident in same household 1
Lives in another household … 2
Lives in an institution ………….. 3