This instrument was developed for the National Board and Care Survey project. This project was conducted by the Bureau of the Census under contract for the Department of Health and Human Services (HHS) Office of Disability, Aging and Long-Term Care Policy. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.
| NOTE: This is a recreation of this form. See the PDF version for a scanned version of the actual form. |
QUESTIONNAIRE 2
LICENSURE
FIFTY STATE SURVEY OF AGENCIES INVOLVED
IN THE REGULATION OF BOARD AND CARE HOMES
| STATE: _________________________ AGENCY: _________________________ CONTACT: _________________________ POSITION: _________________________ | DATE: _________________________ INTERVIEWER: _________________________ |
| START TIME: _________________________ |
PART I: REGULATIONS
1. Is the following an accurate definiton of how your state defines board and care, known in your state as _________________________?
DEFINITION: _________________________ If this is a correct definition, then summarize and input into data base.
_____Yes Y = Yes
N = No
D = Don't Know_____No IF NO, PLEASE PROVIDE YOUR STATE'S DEFINITION. _____Don't Know
2. Can board and care homes admit bedfast residents?
_____Yes IF YES, SKIP TO QUESTION 4. Y = Yes
N = No
D = Don't Know_____No _____Don't Know
3. Can board and care homes retain residents who become bedfast after admittance?
_____Yes Y = Yes
N = No
D = Don't Know_____No _____Don't Know
4. Can board and care homes admit chairfast residents?
_____Yes IF YES, SKIP TO QUESTION 6. Y = Yes
N = No
D = Don't Know_____No _____Don't Know
5. Can board and care homes retain residents who become chairfast after admittance?
_____Yes Y = Yes
N = No
D = Don't Know_____No _____Don't Know
6. How does your state classify board and care facilities? (SPECIFY CATEGORIES OF BOARD AND CARE HOMES AND CRITERIA FOR ESTABLISHING THESE CATEGORIES.)
CATEGORY CRITERIA A. _________________________ a. _________________________
b. _________________________
c. _________________________B. _________________________ a. _________________________
b. _________________________
c. _________________________C. _________________________ a. _________________________
b. _________________________
c. _________________________D. _________________________ a. _________________________
b. _________________________
c. _________________________E. _________________________ a. _________________________
b. _________________________
c. _________________________Total Number of Categories _____
7. Does board and care include what is known as assisted living that is a residential environment that provides supportive services to the semi-independent elderly who are functionally impaired and require some household services but who do not require nursing care or constant supervision?
_____Yes Y = Yes
N = No
D = Don't Know_____No _____Don't Know
8. Do board and care regulations also apply to assited living programs?
_____Yes Y = Yes
N = No
D = Don't Know_____No _____Don't Know
9. How is assisted living distinguished from board and care? _________________________
10. What is the total number of LICENSED board and care facilities in your state? (SPECIFY BY FACILITY CATEGORY.)
CLASSIFICATIONS IN YOUR STATE:
(Use categories from Question 6.)Size Range
# of Beds in Existing HomesTotal Homes Total Beds Total Current Residents
(or Extimate Occupancy Rate)_________________________ _________________________ _____ _____ _____ _________________________ _________________________ _____ _____ _____ _________________________ _________________________ _____ _____ _____ _________________________ _________________________ _____ _____ _____ TOTAL _____ _____ _____
11. Do you think that the number of licensed board and care facilities in your state is increasing in number since 1980?
_____No Y = Yes
N = No
D = Don't Know_____Yes Why?_________________________ _____Don't Know
PART II: MONITORING
12. Does your state inspect licensed homes on a regular basis?
_____No Specify number of times in a calendar year. _____Yes If yes, ask
How often does state inspect?
How often does a local agency inspect? _____ times per year
(IF NO, SKIP TO QUESTION 14.)
13. Who inspects the licensed homes? (CIRCLE ALL THAT APPLY.)
- Social worker
- Nurse
- Fire marshall
- Health inspector
- Physician
- Welfare worker - not a social worker
- Building inspector
- Other (SPECIFY) _________________________
PART III: ENFORCEMENT
14. Are the following remedies or sanctions used in your state for addressing problems encountered in LICENSED board and care homes:
(IF USED BY THE STATE ENTER "Y" AND THEN ASK:
How often has the sanction been used during the last 12 months?
USED BY STATE TIMES USED IN LAST YEAR For:
(1) "Used by State"
Y = Yes
N = No
D = Don't Know(2) "Times Used"
Enter a number, if respondent doesn't know number, enter "9's."If unknown, enter "9's."
A. Corrective action plan with facility certifying action completed? _____ _____ B. Corrective action plan with On site inspection by state or local agency to verify action completed? _____ _____ C. Provisional License? IF YES, SPECIFY:
Maximum time facility can have a provisional license _____ months
Maximum number of provisional licenses before other action taken _____
_____ _____ D. License revocation? _____ _____ E. Monetary fine? IF YES, SPECIFY:
Range of $ amount:
Minimum $_____
Maximum $_____
Average amount of fines imposed last year $_____
# Homes fined last year _____
# Fines IMPOSED last year _____
# Fines COLLECTED last year __________ _____ Enter amounts in dollars, no cents. If unknown, enter "9's."
F. Ban on admissions? _____ _____ G. Ban on referrals? _____ _____ H. Other? (Specify) _____ _____
15. What are the major obstacles to dealing with LICENSED homes? (LIST EACH OBSTACLES SEPARATELY)
A. _________________________ Input first obstacles listed. If there are more than 6 listed code yes for "other obstacles." B. _________________________ C. _________________________ D. _________________________ E. _________________________ F. _________________________ G. _________________________ H. _________________________ (OTHER OBSTACLES? _________________________
16. Is there a register or listing of licensed facilities in your state?
_____Yes Y = Yes
N = No
D = Don't Know_____No (IF NO, SKIP TO QUESTIONS 19.) _____Don't Know
17. Is this register or listing available to the public upon request?
_____Yes Y = Yes
N = No
D = Don't Know_____No _____Don't Know
18. Is this register or listing made available in other ways such as through libraries, hospitals or Area Agencies on Aging?
_____No Y = Yes
N = No
D = Don't Know_____Yes Specify How_________________________ _____Don't Know
19. Approximately how many of these registers were provided to the public in FY90?
Enter number: _____ If respondent doesn't know number, enter "9's."
PART IV: UNLICENSED HOMES
20. Is an effort made to identify UNLICENSED board and care homes in your state?
_____No (IF NO, SKIP TO QUESTION 23.) Y = Yes
N = No
D = Don't Know_____Yes How?_________________________ _____Don't Know
21. In your opinion how successful is your state in identifying unlicensed board and care homes?
_____ Very successful Very Successful = VS
Somewhat Successful = SS
Somewhat Unsuccessful = SU
Very Unsuccessful = VU
Don't Know = DK_____ Somewhat successful _____ Somewhat unsuccessful _____ Very unsuccessful _____ Don't Know
22. What are the major obstacles to LOCATING unlicensed board and care homes? (LIST EACH OBSTACLE SEPARATELY.)
A. _________________________ Input first 5 obstacles. If there are more than 5 listed obstacles, code "yes" for other obstacles." B. _________________________ C. _________________________ D. _________________________ E. _________________________ F. _________________________ G. _________________________ H. _________________________ (Other Obstacles? _________________________)
23. What is the total number of UNLICENSED board and care facilities in your state?
Size Range in
# of Beds of Existing HomesTotal Homes Total Beds Total Current Residents
(or Estimate Occupancy Rate)If numbers unknown code "9's". Lawfully Unlicensed* __________ _____ _____ __________ Illegal Unlicensed** __________ _____ _____ __________ * Lawfully unlicensed board and care homes are homes which do not require licensure according to state law.
** Illegal unlicensed board and care homes are homes which are required under state law to be licensed but which do not fulfill this requirement.
24. Do you think that the number of UNLICENSED board and care facilities in your state is increasing in number since 1980?
_____No Y = Yes
N = No
D = Don't Know_____Yes Why?_________________________ _____Don't Know
25. What remedies or sanctions exist for addressing an illegal UNLICENSED board and care home? (LIST EACH SEPARATELY AND SPECIFY HOW OFTEN USED IN LAST 12 MONTHS.)
TIMES USED Input first 5 sanctions. If If more than 5 sanctions, code "Y" for "other sanctions." If number of times used is unknown code "9's."
A. _________________________ _____ B. _________________________ _____ C. _________________________ _____ D. _________________________ _____ E. _________________________ _____ F. _________________________ _____ G. _________________________ _____ H. _________________________ _____ (Other Sanctions? _________________________) _____
26. What are the major obstacles to dealing with illegal UNLICENSED homes? (LIST EACH OBSTACLE SEPARATELY.)
A. _________________________ Input first 5 obstacles listed. If more than 5 obstacles, code "Y" for "other obstacles." B. _________________________ C. _________________________ D. _________________________ E. _________________________ F. _________________________ G. _________________________ H. _________________________ (Other Obstacles? _________________________
27. Why do you think that illegal homes remain unlicensed? _________________________
PART V: EFFECT OF STATE REGULATIONS
28. Is the trend in your state to have more stringent requirements for board and care homes?
_____Yes Y = Yes
N = No
D = Don't Know_____No _____Don't Know
29. Within the past five years, has any legislation been passed that was directed toward changing the board and care program in your state?
_____No IF NO, SKIP TO QUESTION 33 Y = Yes
N = No
D = Don't Know_____Yes Describe Legislation _________________________ _____Don't Know
30. Did this affect the NUMBER of licensed homes in your state? Of unlicensed homes?
_____Yes, Affected Number of Licensed Homes
How? _________________________If checked code "Y;" if not checked code "N." _____Yes, Affected Number of Unlicensed Homes
How? ______________________________Don't Know
31. Were the following other items affected by this legislation? (CHECK ALL THAT APPLY.)
_____ A. Residential care payment rate If checked, Code "Y." If not checked, Code "N." _____ B. Residential care payment procedures _____ C. Client eligiblity criteria _____ D. Content and distribution of services to residents _____ E. Inspection and licensure of facilities _____ F. Other (SPECIFY)_________________________
32. Did the regulations affect different sizes or types of facilities in different ways? (CHECK ALL THAT APPLY.)
_____ A. Only affect small homes If checked, Code "Y." If not checked, Code "N." _____ B. Only affect large homes _____ C. Affect all sizes of homes _____ D. Only affect homes with one type of client (SPECIFY) _________________________ _____ E. Only affect homes with several types of client _____ F. Affect homes with all types of clients _____ G. Other (SPECIFY) _________________________ (DESCRIBE THE NATURE OF THE CHANGES) _________________________
33. How often are board and care regulations reviewed? _________________________ Specify in terms of years.
34. When was the last time board and care regulations were reviewed? _________________________, 19_____ Specify month and year.
PART VI: FUNDING
35. Are there any sources of funding in the state for loans or grants to facilities for improvements to meet the standards?
_____Yes Y = Yes
N = No
D = Don't Know_____No (IF "NO", SKIP TO QUESTION 40.) _____Don't Know
36. How many facilities received these funds in FY90?
Enter number of facilities: _____ If unknown, enter "9's."
37. How many facilities applied for these funds in FY90?
Enter number of facilities: _____ If unknown, enter "9's."
38. How much can a facility borrow? $__________.00 per _________________________
39. At what payback rate? _________________________
40. Are there any funds available for improvements which are not linked to meeting regulations, for example automatic sprinkler systems, home adaptations, home modifications to insure resident privacy?
_____No (IF NO, SKIP TO QUESTION 43.) Y = Yes
N = No
D = Don't Know_____Yes Describe _________________________ _____Don't Know
41. How many facilities received these funds in FY90?
Enter number of facilities: _____ If unknown, enter "9's."
42. How many facilities applied for these in FY90?
Enter number of facilities: _____ If unknown, enter "9's."
PART VII: ZONING REGULATIONS
43. Is there a state-wide zoning waiver for approved board and care facilities?
_____Yes Y = Yes
N = No
D = Don't Know_____No (IF "NO",SKIP TO QUESTIONS 45.) _____Don't Know
44. What must a prospective operator do to qualify for a zoning waiver? _________________________
45. Has there been community resistance to opening board and care homes?
_____No Y = Yes
N = No
D = Don't Know_____Yes Describe _________________________ _____Don't Know
46. Are zoning laws an issue in including or excluding facilities from becoming approved as board and care facilities?
_____Yes Y = Yes
N = No
D = Don't Know_____No _____Don't Know
PART VII: STAFF/RESIDENT RATIO
47. Are there established staff/client ratios required in board and care facilities?
_____Yes Y = Yes
N = No
D = Don't Know_____No (IF NO, SKIP TO NEXT SECTION.) _____Don't Know
48. What is the staff/client ratio for each different type of facility? (LIST FACILITY TYPE AND THEN STAFF/CLIENT RATIO.)
FACILITY TYPE STAFF CLASSIFICATION RATIO 1. _________________________ _________________________ _____ 2. _________________________ _________________________ _____ 3. _________________________ _________________________ _____ 4. _________________________ _________________________ _____ 5. _________________________ _________________________ _____ 6. _________________________ _________________________ _____
49. How is this ratio enforced? _________________________
PART VII: RESIDENT'S BILL OF RIGHTS
50. Is there a bill of rights for board and care residents in your state?
_____Yes Y = Yes
N = No_____No
51. Are residents formally made aware of their rights?
_____No _____Yes How? _________________________
52. Are operators formally made aware of the rights of their residents? How?
_____No _____Yes How? _________________________
53. What procedures are available for enforcing the resident's bill of rights? (LIST EACH SEPARATELY)
A. _________________________ B. _________________________ C. _________________________ D. _________________________ E. _________________________ F. _________________________ G. _________________________ OTHER OBSTACLES? _________________________
54. Are you satisfied with the current state and local division of responsibility for board and care within your state?
_____No Y = Yes
N = No
D = Don't Know_____Yes Why not? _________________________ _____Don't Know
| ENDING TIME: _________________________ |
NATIONAL BOARD AND CARE SURVEY DESIGN REPORTS AVAILABLE
Searching for a Needle in a Haystack: Creative Use of the Decennial Census Dress Rehearsal Data to Find Board and Care Places in Central Missouri
Executive Summary http://aspe.hhs.gov/daltcp/reports/1992/haystkes.htm
HTML http://aspe.hhs.gov/daltcp/reports/1992/haystk.htm
PDF http://aspe.hhs.gov/daltcp/reports/1992/haystk.pdf
INSTRUMENTS AVAILABLE
All Respondents Questionnaire
HTML http://aspe.hhs.gov/daltcp/instruments/AllResp.htm
PDF http://aspe.hhs.gov/daltcp/instruments/AllResp.pdf
Interagency Councils Questionnaire
HTML http://aspe.hhs.gov/daltcp/instruments/IntCoun.htm
PDF http://aspe.hhs.gov/daltcp/instruments/IntCoun.pdf
Licensure Questionnaire
HTML http://aspe.hhs.gov/daltcp/instruments/Licensure.htm
PDF http://aspe.hhs.gov/daltcp/instruments/Licensure.pdf
Local Agency Questionnaire
HTML http://aspe.hhs.gov/daltcp/instruments/LocalAg.htm
PDF http://aspe.hhs.gov/daltcp/instruments/LocalAg.pdf
Local Ombudsman Questionnaire
HTML http://aspe.hhs.gov/daltcp/instruments/LocalOm.htm
PDF http://aspe.hhs.gov/daltcp/instruments/LocalOm.pdf
Payment/Eligibility Questionnaire
HTML http://aspe.hhs.gov/daltcp/instruments/PayElig.htm
PDF http://aspe.hhs.gov/daltcp/instruments/PayElig.pdf
To obtain a printed copy of this report, send the full report title and your mailing information to:
U.S. Department of Health and Human Services
Office of Disability, Aging and Long-Term Care Policy
Room 424E, H.H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
FAX: 202-401-7733
Email: webmaster.DALTCP@hhs.gov