Care reform and funding Case Study Form

Have you or your relative had a positive or negative experience of care, either in a care home or care within their own home? Then we would like to hear from you.

We are looking for older people - or members of their families or carers – to share their experiences of the care system. Your story will support Age Concern’s campaign to ensure older people receive high quality care.

Required fields are marked with *

Name of person needing care
Age of person needing care
Address*
Person telling the story (if not patient please indicate your relationship to them)
Story* (please feel free to talk about your/relative’s experiences of care in later life, including specific examples of how certain things made you feel, what support/or lack of support was given to you and what your current situation is now)
Being able to share your story with the press could help Age Concern campaigning work. Please indicate if you would you be willing to speak to any of the following (please circle as appropriate)
Speak to broadcast journalists and be filmed if asked?*	Yes No
Have your story printed in campaign materials?*	Yes No
Have your photo taken if asked?*	Yes No
Age Concern would never put a journalist in touch with you or your family directly without your prior agreement. All calls are vetted by the media team and your first point of contact would always to a member of Age Concern staff.
Telephone number
Email*

We would like to keep you informed about Age Concern's charitable activities. Please tick the box if you DO NOT wish us to:
	tell you about our charitable activities
	pass your details to the trading companies of Age Concern England, Age Concern Scotland and Age Concern Cymru so that they can inform you about their products and services
	pass your details to other reputable organisations

Travel insurance over 65 - over 65 travel insurance‚ pre-existing medical conditions

Motor insurance - car insurance quotes for the over 50s‚ pensioners and the elderly

Will writing services - information and advice on legal wills

Gas and electricity – save on gas with E.On energy

Pension benefit advice - retirement and pension benefits and advice

Council tax benefit - help with paying your council tax

Care services for elderly people - easy information guide to sources of help

Elderly care home - make the right housing choices

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Care reform and funding Case Study Form

Care reform and funding Case Study Form

Care reform and funding Case Study Form