Do you have any problems seeing or hearing? Do you wear glasses or a hearing aid?

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1 Do you have any problems seeing or hearing? Do you wear glasses or a hearing aid? When were your eyes and ears last tested? Have you had an eye test in the last 2 years? What things do you do to make sure your eyes and ears are healthy? What help do you need to look after your eyes and ears? To help you to think about your hearing & vision use the Seeing & Hearing Checklist or visit Do you smoke? How many cigarettes do you smoke a day? Do you know why you smoke? Do you want to stop smoking? Do you need any support to help you stop smoking? Do you drink alcohol? How much do you drink? If you regularly take medication, do you know if it is safe to drink alcohol? Do you want to cut down on how much alcohol you drink? 1

2 Do you know how tall you are? Do you know what you weigh? Do you weigh the right amount for your height and age? Have you lost or gained weight recently? What things do you do to make sure you stay the right weight? Do you need any support to help you to loose weight? What sort of food do you eat? Are you eating well a healthy balanced diet? Do you eat 5 pieces of fruit and vegetables a day? Do you grill or steam your food instead of frying? How much fluid do you drink each day, such as water or sugar free juice or squash? What are you going to do to make sure you eat healthy food and drink the right amounts of fluid? Do you have problems with eating or swallowing? Do you have a safe eating and drinking plan? What help do you need during mealtimes? If you have problems with eating & drinking, you can contact the Learning Disability Service, who will assess your needs.. 2

3 What sort of exercise do you like to do? Do you do 30 minutes of exercise or physical activity each day? Do you want to do more exercise? For improved health, activity should be increased gradually to 30 minutes of moderate intensity for 5-7 days of the week. The 30 minutes can be broken down into minute sessions per day. Do you have difficulty moving parts of your body? Do you need things to help you move around like a walking stick, frame or a wheel chair? What help do you need to move around? Do you have help from a physiotherapist? Are you able to move around on your own? Do you use specialist seating? Do you need specialist positioning at night? Do you use a sleep system? What help do you need to make sure you are in a comfortable position 24 hours a day? 3

4 Do you have any special health needs that you already know about like epilepsy, asthma, diabetes or high blood pressure? Do you take any medication for your special health need? What do you do to look after your medication and your special health needs? Do you want to know more about your special health needs and the medication that you take? Has your doctor told you about the side effects of the medication that you take? What help do you need to look after your special health needs and to take your medication? Would you like to be more independent in taking your medication and looking after your special health need? Have you had a recent check up at your doctors for your special health need and your medication? Are there things that often make you feel sad, scared, worried or angry? Has anything changed the way you feel i.e. someone dying or moving house? What things do you do to stay happy and well? What things upset you? What support do you need to stay happy and well? Are you on Care Programme Approach? Your health action plan can be part of your CPA.

5 How do you look after your teeth and gums? What problems do you have with your teeth and gums? What help do you need to look after your teeth and gums? Have you changed your toothbrush in the last 3 months? Have you had your teeth and gums checked by a dentist in the last 6-12 months? Do you have any problems with your skin such as rashes or itchy skin? Do you suffer from pressure sores? Do you have any moles? Do you know what your moles look like? How do you look after your skin and keep it healthy? What do you do to protect your skin when it is sunny? Do you have any problems with your feet or toenails such as fungal infections? What things do you do to look after your feet and toenails? What help do you need to look after your feet or toe nails? Do you get any pain in your feet? What things do you do to reduce the pain in your feet? Residential home staff can only file toenails following training from a chiropodist. Contact your community hospital chiropody department to arrange training. 5

6 Do you know how to check your breasts for lumps or changes? Have you had your breasts screened in the last 3 years (If you are between years old)? Do you want to know more about checking your breasts? Do you want to know more about breast screening? Have you had a smear test in the last 3 years (If you are aged between years old)? Do you want to know more about having a cervical screen (smear test)? Do you have regular periods? Do you need any help when you are on your period? How do you keep yourself clean and tidy? Do you have any close relationships? Do you understand about safe sex? Do you check your testicles (balls) for lumps or changes? Do you want to know more about checking your own testicles (balls)? How do you keep yourself clean and tidy? Do you have any close relationships? Do you understand about safe sex? 6

7 Do you have problems going to the toilet? Do you suffer from any pain or any other problems when going to the toilet? What help do you need to go to the toilet? If you are aged have you received a Bowel Cancer Screening Kit? Did you use it and send it back? Do you need to know more about bowel screening? How do the people that support you know if you are in pain or not? How do you tell people when you are in pain? How do you tell people if you feel unwell? Do you sleep well at night? What helps you to sleep well at night? Do you sleep during the day? Would you like to talk to someone about death and dying? 7