AHEAD Exit Proxy Questionnaire, Wave 2

02/01/1996

This instrument was developed for the Asset and Health Dynamics Among the Oldest Old. This project was conducted by the University of Michigan under contract for the Department of Health and Human Services, Office of Social Services Policy (now DALTCP). For additional information about this project, 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, S.W., Washington, D.C. 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The 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.

 

AHEAD 2

ASSET and HEALTH DYNAMICS AMONG THE OLDEST OLD

The University of Michigan
Survey Research Center
Institute for Social Research
Ann Arbor, MI 48106
EXIT PROXY
Questionnaire
February 1996

AHEAD Exit Proxy Questionnaire, Wave 2

February 1996

 

HOUSEHOLD/FAMILY COMPOSITION

Project: Ahead Exit (Dead) Proxy Job:AHD2X

TEXT FOR QUESTIONS Q1 THROUGH Q520 IS LOCATED IN THE APPENDIX

START OF IW TIME

SCREEN 0

IWER: YOU SHOULD BE INTERVIEWING A PROXY FOR THE LATE (R NAME).

IF YOU HAVE THE WRONG R OR R IS ALIVE THEN SUSPEND THIS CASE AMAND RESELECT THE CORRECT LINE.

INAP . . . . . 0
CORRECT R, IS DECEASED - GO ON . . . . . 1

if: CORRECT R(DK *OR* RF *OR* OUT OF RANGE)
YOU MUST ANSWER THIS
BACK to: SCREEN 0

CS1. IWER: IS (he/she) LIVING?

INAP . . . . . 0 CS1
YES -- GO BACK TO CSMS AND CHOOSE "NON-DECEASED R" IW . . . . . 1 CS1
NO . . . . . 5

CS1a. IWER: CHOOSE TYPE OF INTERVIEW:

INAP . . . . . 0 CS1a
PROXY IS SURVIVING SPOUSE . . . . . 2
PROXY IS NON-SPOUSE . . . . . 3

if: q99 (1)
SKIP to: CS1c

CS1b. WAVE1 PROXY WAS W1 PROXY NAME, W1 PROXY RELATIONSHIP TO R.

WAVE 2 PROXY IS:

INAP . . . . . 0
SAME PERSON AS IN WAVE 1 . . . . . 1
DIFFERENT/NEW PERSON . . . . . 2

CS1c. IWER: DESIGNATE INSTRUMENT

PROXY -- ENGLISH . . . . . 0
PROXY -- SPANISH . . . . . 1

if: CS1c(DK *OR* RF *OR* OUT OF RANGE)
YOU MUST ANSWER THIS QUESTION
BACK to: CS1c

CS2 INTRO.

This study is interested in learning about important aspects of people's lives such as their health, financial and family situations.

This interview is completely confidential and voluntary. If we should come to any question you don't want to answer, just let me know and we will go on to the next question.

CS2ax. What was the date on which R NAME died?

MONTH:
DAY:
YEAR:

CS2cx. At the time of death, was (he/she) in a hospital, in a nursing home, at home, in a hospice, or what?

INAP . . . . . 0
IN HOSPITAL . . . . . 1
IN NURSING HOME . . . . . 2
AT HOME . . . . . 3
IN HOSPICE . . . . . 4
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

CS2dx. In what state and county did (he/she) die?

STATE:
COUNTY:

CS2fx. In what state and county was (his/her) death certificate filed?

STATE:
COUNTY:

CS2hx. Please tell me about (R Name)'s death

IWER: ENCOURAGE THE PROXY TO DESCRIBE THE CIRCUMSTANCES SURROUNDING THE DEATH, IN WHATEVER ORDER THEY WISH TO SPEAK; RECORD AS MUCH AS YOU CAN OF WHAT THE PROXY SAYS HERE WITHOUT INTERFERING WITH WHAT IS BEING SAID. ALLOW THE RESPONDENT TO SAY WHAT THEY WANT IN THE WAY THEY WISH.

CS2jx. (Was the death expected at about the time it occurred, or was it unexpected?)

INAP . . . . . 0
EXPECTED . . . . . 1
UNEXPECTED . . . . . 2
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

CS2kx. (What was the major illness that led to (his/her) death?)

CS2mx. (About how long was it between the start of the final illness and the death: was it one or two hours, less than a day, less than a week, less than a month, less than a year, or was it more than a year?)

INAP . . . . . 0
ONE OR TWO HOURS (OR NO WARNING) . . . . . 1
LESS THAN A DAY . . . . . 2
LESS THAN A WEEK . . . . . 3
LESS THAN A MONTH . . . . . 4
LESS THAN A YEAR . . . . . 5
MORE THAN A YEAR . . . . . 6
DK . . . . . 8
RF . . . . . 9

CS2nx. Did (he/she) have any other major illnesses
"IF RE-INTERVIEW since the time of our interview in W1 IW MONTH W1 IW YEAR?
"ELSE NEW RESPONDENT in the two years preceding (his/her) death?
"END

INAP . . . . . 0 CS3
YES . . . . . 1
NO . . . . . 5 CS3
DK . . . . . 8 CS3
RF . . . . . 9 CS3

CS2px. What illness was that?

if: Q220 (*NOT* 1)
SKIP to:CS11

CS3. As of W1 IW MONTH W1 IW YEAR, our records show that
"IF MARRIED OR MARRIED, SPOUSE ABSENT (he/she), was married.
"ELSE R LIVING WITH PARTNER (he/she), was living with a partner as if married.
"ELSE 1st HOUSEHOLD (he/she, was not married or living with a partner.
"END

if: Q204(*NOT* 1 *TO* 3)
SKIP to:CS9x

CS4x. (Was (he/she)/Were you) still (his/her) (husband/wife/partner) at the time (he/she) died?

INAP . . . . . 0
YES, AND SPOUSE/PARTNER WAS LIVING THEN . . . . . 1 CS11
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

CS5x. IWER: IF PROXY IS THE FORMER SPOUSE DO NOT READ; JUST MARK "YES." (Was (he/she) still alive at that time?)

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:CS5x(DK *OR* RF *OR* OUT OF RANGE)
YOU MUST ANSWER THIS
BACK to:CS5X

CS6x. "IF SPOUSE/PARTNER ALIVE In what month and year did (you/they) stop living together?
"ELSE In what month and year did (she/he) die?
"END

MONTH:
YEAR:

CS7x. At the time (he/she) died, was (he/she) married?

INAP . . . . . 0
YES . . . . . 1 CS11
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

CS8x. At the time (he/she) died, did (he/she) have a partner (he/she) lived with as if married?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: Q204 (1 *TO* 3)
SKIP to:CS11

CS9x. At the time (he/she) died, was (he/she) married?

INAP . . . . . 0
YES . . . . . 1 CS11
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

CS10x. At the time (he/she) died, did (he/she) have a partner (he/she) lived with as if married?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

CS11. Was (he/she) a resident of a nursing home or other health care facility at the time (he/she) died?

DEF: A NURSING HOME OR OTHER HEALTH FACILITY PROVIDES ALL OF THE FOLLOWING SERVICES FOR ITS RESIDENTS: DISPENSING OF MEDICATION, 24-HOUR NURSING ASSISTANCE AND SUPERVISION, PERSONAL ASSISTANCE, AND ROOM & MEALS.

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:(220)(*NOT* 1) *OR* CS4x(5 *OR* DK *OR* RF) *AND* CS7x(5 *OR* DK *OR* RF) *AND* CS8x(5 *OR* DK *OR* RF) *OR* CS9x(5 *OR* DK *OR* RF) *AND* CS10x (5 *OR* DK *OR* RF)
SKIP to: CS16

CS12. "IF SPOUSE/PARTNER ALIVE At the time of (his/her) death were you living
"ELSE At the time of (his/her) death was (he/she) and (his/her) (new) (husband/wife/partner) living
"END
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH in the same (nursing home/health care facility)?
"ELSE together in a house or apartment?
"END

IWER: THIS QUESTION IS TO TELL WHETHER R'S SPOUSE/PARTNER WAS ALSO LIVING IN THE DWELLING OR INSTITUTION WHERE R LIVED.

INAP . . . . . 0
YES . . . . . 1 CS15
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

CS14. In what month and year did (you/they) stop living together?

MONTH:
YEAR:

CS13. At the time of (his/her) death (were you/was (his/her) (new) (husband/wife/partner) living in a nursing home or other health care facility?

DEF: A NURSING HOME PROVIDES ALL OF THE FOLLOWING SERVICES FOR ITS RESIDENTS: DISPENSING OF MEDICATION, 24-HOUR NURSING ASSISTANCE AND SUPERVISION, PERSONAL ASSISTANCE, AND ROOM & MEALS.

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:CS12(*NOT* YES) *OR* (CS7x(*NOT* YES) *AND* CS9x(*NOT* YES) *AND* CS8x(*NOT* YES) *AND* CS10x(*NOT* YES))
SKIP to: CS16

CS15. "IF PROXY IS SURVIVING SPOUSE in what month and year did you start living together?
"ELSE In what month and year did (he/she) and (his/her) (new) (husband/sife/partner) start living together?
"END

MONTH:
YEAR:

CS16. R ROSTER.

  A. ID#     B. FIRST NAME     C. LAST NAME     D. SEX     E. YEAR BORN     F. REL TO R     G. LIVING     H. HH #  

INTERVIEWER: VERIFY SPELLING OF FIRST AND LAST NAME AND SEX. IF NECESSARY, USE "YEAR BORN" TO CLARIFY IDENTITY OF R AND SPOUSE/PARTNER. PLEASE CHECK THAT RELATION TO R AND WHETHER LIVING AT THE TIME OF R'S DEATH ARE CORRECT.

"IF MARRIED OR LIVING WITH A PARTNER IF R HAD A NEW SP/PARTNER, FILL IN HIS/HER NAME IN THE GRID AFTER ASKING: What is (your name/the name of (his/her) new (husband/ife/partner))?
"END

WHEN FINISHED, PRESS F10 TO SELECT CONTINUE/GRID INCORRECT

INAP . . . . . 0
CONTINUE . . . . . 1
GRID INCORRECT . . . . . 5 CS1

CS17 R ROSTER CONFIRM.

IWER: PRESS 1 TO CONFIRM R GRID IS FINISHED. YOU WILL NOT BE ABLE TO AMEND IT AFTER THIS POINT.

INAP . . . . . 0
RESPONDENT GRID COMPLETED . . . . . 1
RESPONDENT GRID NOT COMPLETED . . . . . 5 CS16

R ROSTER

IWER: THE R ROSTER HAS BEEN RECORDED, YOU CANNOT GO BACK TO IT. PRESS ENTER TO CONTINUE.

NEW SP W1 INTERVIEW

NEW SP . . . . . 0
REINTERVIEW . . . . . 1
REFUSED SP . . . . . 5

OLD SP SEX

INAP . . . . . 0
MALE . . . . . 1
FEMALE . . . . . 2

OLD SP MARITAL STAT

INAP . . . . . 0
MARRIED . . . . . 1
MARRIED SP ABSENT . . . . . 2
LIVING WITH PARTNER . . . . . 3
DIVORCED/SEPARATED . . . . . 4
WIDOWED . . . . . 5
NEVER MARRIED . . . . . 6
DIED . . . . . 7

NEW SP FAM/NON V105

INAP . . . . . 0
FAMILY . . . . . 1
NON-FAMILY . . . . . 2
ONLY R . . . . . 3

OLD SP FIN/NON V106

INAP . . . . . 0
FINANCIAL R . . . . . 2
NON FINANCIAL R . . . . . 3

OLD SP WHICH HH

INAP . . . . . 0
HOUSEHOLD 1 . . . . . 1
HOUSEHOLD 2 . . . . . 2

OLD SP WHICH IW

INAP . . . . . 0
FIRST IW . . . . . 1
SECOND IW . . . . . 2

if: Q203(1)
SKIP to: R ROSTER END TIME

CS18. R ROSTER.

  A. ID#     B. FIRST NAME     C. LAST NAME     D. SEX     E. YEAR BORN     F. REL TO R     G. LIVING     H. HH #  

INTERVIEWER: VERIFY SPELLING OF FIRST AND LAST NAME AND SEX. IF NECESSARY, USE "YEAR BORN" TO CLARIFY IDENTITY OF R AND SPOUSE/PARTNER. PLEASE CHECK THAT RELATION TO R AND WHETHER LIVING AT THE TIME OF R'S DEATH ARE CORRECT.

"IF MARRIED OR LIVING WITH A PARTNER IF R HAD A NEW SP/PARTNER, FILL IN HIS/HER NAME IN THE GRID AFTER ASKING: What is (your name/the name of (his/her) new (husband/ife/partner))?
"END

WHEN FINISHED, PRESS F10 TO CONTINUE

INAP . . . . . 0
CONTINUE . . . . . 1
RE-ASK COVERSHEET QUESTIONS . . . . . 5 CS1

CS19 R ROSTER CONFIRM.

IWER: PRESS 1 TO CONFIRM R GRID IS FINISHED. YOU WILL NOT BE ABLE TO AMEND IT AFTER THIS POINT.

INAP . . . . . 0
RESPONDENT GRID COMPLETED . . . . . 1
RESPONDENT GRID NOT COMPLETED . . . . . 5 CS18

R ROSTER

IWER: THE R ROSTER HAS BEEN RECORDED, YOU CANNOT GO BACK TO IT.

PRESS ENTER TO CONTINUE.

R ROSTER END TIME

W1 INTERV

NEW SP . . . . . 0
REINTERVIEW . . . . . 1
REFUSED SP . . . . . 5

R SEX

INAP . . . . . 0
MALE . . . . . 1
FEMALE . . . . . 2

R MARITAL STAT

INAP . . . . . 0
MARRIED . . . . . 1
MARRIED SP ABSENT . . . . . 2
LIVING WITH PARTNER . . . . . 3
DIVORCED/SEPARATED . . . . . 4
WIDOWED . . . . . 5
NEVER MARRIED . . . . . 6
DIED . . . . . 7

R FAM/NON V105

INAP . . . . . 0
FAMILY . . . . . 1
NON-FAMILY . . . . . 2
ONLY R . . . . . 3

R FIN/NON V106

INAP . . . . . 0
FINANCIAL R . . . . . 2
NON FINANCIAL R . . . . . 3

Rs ORIGINAL SP LIVING

NO SPOUSE . . . . . 0
SPOUSE LIVING . . . . . 1
SPOUSE DEAD . . . . . 5

R SPOUSE NAME

IDFM OR IDNFM FLAG

CS CUR DAY TEXT

SUN . . . . . 1
MON . . . . . 2
TUE . . . . . 3
WED . . . . . 4
THU . . . . . 5
FRI . . . . . 6
SAT . . . . . 7

CUR MONTH TEXT - USE 1/12

if: TIME YEAR(> = R BIRTH YEAR)
97-373:
SKIP to:CS25

R'S CURRENT AGE

if: Q203(2) *AND* WHICH IW 1ST(*NOT* 1) *AND* CS11(*NOT* YES) *AND* HOLD 20(*NOT*1)
SKIP to:CS35a

CS25. In what month and year did (he/she) move to the (nursing home/health care facility) where (he/she) was a resident just before (his/her) death?

MONTH:
YEAR:

CS25b. In what city and state was the (nursing home/health care facility) where (he/she) was living?

if: Q203(2) *AND* Q220 (*NOT* 1)
SKIP to:CS35a

CS26. Did (he/she) still own or rent a house or apartment outside the facility where (he/she) was living?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: CS26(NO *OR* DK *OR* RF)
SKIP to:CS35a

CS27. Our records show that when we talked with (him/her) in W1 IW MONTH W1 IW YEAR, (his/her house or apartment / one of his/her houses or apartments) was in (City), State).

At the time (he/she) died, did (he/she) still own or rent that same house or apartment in (City)?

INAP . . . . . 0
YES . . . . . 1 CS30
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

CS 28. Was (his/her) house or apartment in or around (City)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: CS28(*NOT* NO)
SKIP to:CS30

CS29. How many years did (he/she) live around (City)?

IF LESS THAN ONE YEAR, USE 1

if: Q203(1) *AND* HH1 HAS 2ND(*NOT* HAS 1 OTHER RESIDENCE)
SKIP to:CS33

CS30. Our records also show that in W1 IW MONTH W1 IW YEAR (he/she) had another house or apartment, one in (2nd Residence City) (2nd Residence State).

At the time (he/she) died did (he/she) still own or rent that same house or apartment in (2nd Residence City)?

INAP . . . . . 0
YES . . . . . 1 CS33
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

CS31. Was (his/her) house or apartment in or around (2nd Residence City)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: CS31(*NOT* NO)
SKIP to:CS33

CS32. How many years did (he/she) live around (2nd Residence City)?

IF LESS THAN ONE YEAR, USE 1

CS33. At the time (he/she) died, in what city and state was (his/her) house or apartment located?

CS34. Did (he/she) have any other house or apartment where (he/she) had lived for 2 or more months of the year?

IF R REPORTS MORE THAN ONE ADDITIONAL RESIDENCE, ASK ABOUT THE ONE THEY USE MOST.

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: CS34(*NOT* YES)
SKIP to:CS35a

CS35. In what city and state was (his/her) other residence located?

CS35a. ASSIGN 1 OR 2 RESIDENCE

ONE RESIDENCE . . . . . 1
TWO RESIDENCE . . . . . 2

if: CS35a(ONE RESIDENCE)
SKIP to:CS36

CS36. Which was (his/her) main residence, (his/her) home in
"IF SAME RESIDENCE #1 AT TIME OF DEATH OR RESIDENCE IN SAME AREA AS W1 (City)
"ELSE SAME RESIDENCE #2 AT TIME OF DEATH OR RESIDENCE IN SAME AREA AS W1 (2nd Residence City)
"ELSE City
"END

or the one in
"IF (SAME RESIDENCE #2 AT TIME OF DEATH OR RESIDENCE IN SAME AREA AS W1) AND (SAME RESIDENCE #1 AT TIME OF DEATH OR RESIDENCE IN SAME AREA AS W1) (2nd Residence City)
"ELSE City
"END

DEF: MAIN RESIDENCE, ONE WHERE R SPENT THE MOST TIME (MTY)

INAP . . . . . 0
HOME IN W1 CITY, STATE 1ST RES . . . . . 1
HOME IN W2 CITY, STATE 1ND RES . . . . . 2 CS36B
HOME IN W1 CITY, STATE 2ND RES . . . . . 3
HOME IN W2 CITY, STATE 2ND RES . . . . . 4 CS36B
DK . . . . . 8
RF . . . . . 9

if: CS26(NO *OR* DK *OR* RF)
SKIP to:CS36b

CS36. ASSIGN MAIN RESIDENCE

if: CS26(NO *OR* DK *OR* RF)
:NO 2ND RESIDENCE:
SKIP to:CS36c

CS36b. ASSIGN 2ND RESIDENCE

CS36c. R MOVED MAIN RESIDENCE

YES, MOVED . . . . . 1
NO, DID NOT MOVE . . . . . 5

CS37 TIME STAMP

CS HAVE 2ND RESIDENCE

if: Q220 (*NOT* 1)
SKIP to:CS39

if: Q220 (*NOT* 1)
SKIP to: ROSTERS END

if: Q203(2)
SKIP to:CS40-2 TIME

CS39. Now some questions about (your and his/your and her/his/her/their) children
"IF IN NURSING HOME AT TIME OF DEATH (NOT YES) and TWO RESIDENCE and whether they were living with (him/her) in (his/her) home in (City, State) just before (he/she) died.
"ELSE RESIDENT IN NURSING HOME AT TIME OF DEATH and whether they were living with (him/her) in (his/her) home in (City, State) just before (he/she) moved into a nursing home.
"ELSE and whether they were living with (him/her) in (his/her) home just before (he/she) died.
"END

HH1 CHILD TIME STAMP

if: Q388(*NOT* 1)
SKIP to:CS40

HH1 CHILDREN

if: HH1 ROSTER DONE
SKIP to:CS40-2 TIME

CS40. VERIFY AND UPDATE INFORMATION ON CHILDREN & THEIR SPOUSES. PROMPT QUESTIONS FOR NEW CHILDREN ARE IN Q X Qs.

  R HH     REL TO R     SEX     NAME     LAST     MARI STAT     SP R HH     SPOUSE NAME     SP CHG  

"IF FAMILY R: Did (he/she) (or his/her) (husband/wife/partner) have any (other) children, step-children, or sons- or daughters-in-law?

USE DOWN ARROW TO CHECK FOR MORE PERSONS ON THE GRID. WHEN YOU ARE FINISHED, PRESS F10 TO CONTINUE

INAP . . . . . 0
CONTINUE . . . . . 1

CS40-2 TIMESTAMP

if: Q203(1)
SKIP to:CS43

CS40-2. Now some questions about (your and his/your and her/his/her/their) children
"IF IN NURSING HOME AT TIME OF DEATH (NOT YES) and TWO RESIDENCE and whether they were living with (him/her) in (his/her) home in (City, State) just before (he/she) died.
"ELSE RESIDENT IN NURSING HOME AT TIME OF DEATH and wether they were living with (him/her) in (his/her) home in (City, State) just before (he/she) moved into a nursing home.
"ELSE and whether they were living with (him/her) in (his/her) home jsut before (he/she) died.
"END

if: Q388(1)
SKIP to:CS42

HH2 CHILDREN

CS42. VERIFY AND UPDATE INFORMATION ON CHILDREN & THEIR SPOUSES. PROMPT QUESTIONS FOR NEW CHILDREN ARE IN Q X Qs.

  R HH     REL TO R     SEX     NAME     LAST     MARI STAT     SP R HH     SPOUSE NAME     SP CHG  

"IF FAMILY R: Did (he/she) (or his/her) (husband/wife/partner) have any (other) children, step-children, or sons- or daughters-in-law?

USE DOWN ARROW TO CHECK FOR MORE PERSONS ON THE GRID. WHEN YOU ARE FINISHED, PRESS F10 TO CONTINUE

if: Q203(2)
SKIP to:CS45

CS43. I also need to update information about (other) people who lived with R FIST NAME
"IF IN NURSING HOME AT TIME OF DEATH (NOT YES) and TWO RESIDENCE in (your and his/your and her/his/her/their) home in CITY OF MAIN RESIDENCE just before (he/she) died.
"ELSE RESIDENT IN NURSING HOME AT TIME OF DEATH and whether they were living with (him/her) just before (he/she) moved into the nursing home.
"ELSE and whether they were living with (him/her) in (your and his/your and her/his/her/their) home just before (he/she) died.
"END

HH1 NR KID TIME STAMP

if: Q388(1)
SKIP to:CS44

HH1 NON-KID RES

CS44. VERIFY AND UPDATE INFORMATION ON NON-CHILDREN RESIDENTS: PROMPT QUESTIONS FOR NEW RESIDENTS ARE IN Q X Qs

  R HH     REL TO R     SEX     NAME     LAST     MARI STAT     SP R HH     SPOUSE NAME     SP CHG  

"IF FAMILY R:
"IF IN NURSING HOME AT TIME OF DEATH (NOT YES) and TWO RESIDENCES Was there anyone else living in (your and his/your and her/his/her/their) home in (City, State)?
"ELSE IN NURSING HOME AT TIME OF DEATH (NOT YET) Was there anyone else living in (your and his/your and her/his/her/their) home?
"END

USE DOWN ARROW TO CHECK FOR MORE PERSONS ON THE GRID. WHEN YOU ARE FINISHED, PRESS F10 TO CONTINUE

CS44a. IWER: PRESS 1 TO CONFIRM HH GRIDS ARE FINISHED. YOU WILL NOT BE ABLE TO AMEND THEM AFTER THIS POINT.

INAP . . . . . 0
CHILD/NON-CHILDREN GRIDS COMPLETED . . . . . 1
CHILD/NON-CHILDREN GRIDS NOT COMPLETED . . . . . 5 CS44

ROSTERS.

IWER: THE ROSTERS HAVE BEEN RECORDED, YOU CANNOT GO BACK TO THEM.

PRESS ENTER TO CONTINUE.

if: Q203(1)
SKIP to:CS52 CKPT

CS45. I also need to update information about (other) people who lived with R FIRST NAME
"IF IN NURSING HOME AT TIME OF EATH (NOT YES) and TWO RESIDENCE in (your and his/your and her/his/her/their) home in (City, State) just before (he/she) died.
"ELSE RESIDENT IN NURSING HOME AT TIME OF DEATH and whether they were living with (him/her) just before (he/she) moved into the nursing home.
"ELSE and whether they were living with (him/her) in (your and his/your and her/his/her/their) home just before (he/she) died.
"END

if: Q388(*NOT* 1)
SKIP to:CS46

HH2 NON-KID RES

CS46. VERIFY AND UPDATE INFORMATION ON NON-CHILDREN RESIDENTS: PROMPT QUESTIONS FOR NEW RESIDENTS ARE IN Q X Qs

  R HH     REL TO R     SEX     NAME     LAST     MARI STAT     SP R HH     SPOUSE NAME     SP CHG  

"IF IN NURSING HOME AT TIME OF DEATH (NOT YES) and TWO RESIDENCE Was there anyone else living in (your and his/your and her/his/her/their) home in (City, State)?
"ELSE IN NURSING HOME AT TIME OF DEATH (NOT YET) Was there anyone else living in (your and his/your and her/his/her/their) home?
"END

USE DOWN ARROW TO CHECK FOR MORE PERSONS ON THE GRID. WHEN YOU ARE FINISHED, PRESS F10 TO CONTINUE

CS47. IWER: PRESS 1 TO CONFIRM HH GRIDS ARE FINISHED. YOU WILL NOT BE ABLE TO AMEND THEM AFTER THIS POINT.

INAP . . . . . 0
CHILD/NON-CHILDREN GRIDS COMPLETED . . . . . 1
CHILD/NON-CHILDREN GRIDS NOT COMPLETED . . . . . 5 CS46

ROSTERS.

IWER: THE ROSTERS HAVE BEEN RECORDED, YOU CANNOT GO BACK TO THEM.

PRESS ENTER TO CONTINUE.

if: Q203(2) *AND* Q47 (2 *OR* 4)
SKIP to:CS52LOOP

CS52 CKPT

CS48. In what month and year did
"IF 1st HOURSHOLD
"IF CHILD/NON-CHILD NAME DECEASED, CHILD/NON-CHILD NAME die?
"ELSE CHILD/NON-CHILD NAME BECAME RESIDENT, R FIRST NAME and CHILD/NON-CHILD NAME start living together?
"ELSE CHILD/NON-CHILD NAME BECAME RESIDENT, R FIRST NAME and CHILD/NON-CHILD NAME stop living together?
"ELSE CHILD/NON-CHILD NAME stop living in (your and R name's/ R name's) home?
"END

MONTH:
YEAR:

CS48bx. Was the move intended to be temporary or was it thought of as permanent?

INAP . . . . . 0
TEMPORARY . . . . . 1
PERMANENT . . . . . 2
DK . . . . . 8
RF . . . . . 9

END of case

ROSTERS END TIME STAMP

if:CS1a(PROXY IS SURVIVING SPOUSE)
SKIP to: CS50x

CS49. CHOOSE THE RELATIONSHIP OF THE PROXY TO R FIRST NAME.

INAP . . . . . 00
DAUGHTER/STEPDAUGHTER . . . . . 02
SON/STEPSON . . . . . 03
DAUGHTER-IN-LAW . . . . . 04
SON-IN-LAW . . . . . 05
GRANDDAUGHTER . . . . . 06
GRANDSON . . . . . 07
SISTER . . . . . 08
BROTHER . . . . . 09
OTHER RELATIVE . . . . . 10
FRIEND . . . . . 11
PAID HELPER . . . . . 12
PROFESSIONAL (SPECIFY) . . . . . 13

CHILD DEAD SP

CS50x. We are interested in any temporary moves made by R FIRST NAME or by other people that were intended to help R FIRST NAME and that were made
"IF REINTERVIEW and IN NURSING HOME AT TIME OF DEATH (NOT YES) between the time of our interview in W1 IW MONTH W1 IW YEAR and when R FIRST NAME died. Since W1 IW MONTH W1 IW YEAR,
"ELSE REINTERVIEW and RESIDENT IN NURSING HOME AT TIME OF DEATH between the time of our interview in W1 IW MONTH W1 IW YEAR and when R FIRST NAME went into the (nursing home/health care facility). Since W1 IW MONTH W1 IW YEAR,
"ELSE in the two years preceding (his/her) death. During that period,
"END did anyone move into the house or apartment where R FIRST NAME was living to help (him/her) but then moved out before
"IF REINTERVIEW and RESIDENT IN NURSING HOME AT TIME OF DEATH R FIRST NAME went into the (nursing home/health care facility)?
"ELSE R FIRST NAME died?
"END

INAP . . . . . 0 CS52x
YES . . . . . 1
NO . . . . . 5 CS52x
DK . . . . . 8 CS52x
RF . . . . . 9 CS52x

CS51x. Who moved in: was it (a child of R FIRST NAME's,) a grandchild, another relative, or someone else? CHOOSE ALL THAT APPLY

INAP . . . . . 0, CS51cx
CHILD . . . . . 2,
GRANDCHILD . . . . . 4, CS51cx
RELATIVE-OTHER . . . . . 5, CS51cx
OTHER INDIVIDUAL . . . . . 6, CS51cx
DK . . . . . 8, CS51cx
RF . . . . . 9, CS51cx

CS51ax. Which children? CHOOSE ALL THAT APPLY

if:( < 2) *and* q203(1)
SKIP to: CS51CS

CS51bx. Which child stayed the longest? CHOOSE ALL THAT APPLY

CS51cx.About how many weeks or months did that
"IF CHILD MOVED IN WITH R child stay?
"ELSE person stay?
"END

Please tell me the longest stay if there was more than one person who stayed with R FIRST NAME. TIME:

INAP . . . . . 0
WEEKS . . . . . 1
MONTHS . . . . . 2
DK . . . . . 8
RF . . . . . 9

CS52x.
"IF REINTERVIEW and IN NURSING HOME AT TIME OF DEATH (NOT YES) Between the time of our interview in W1 IW MONTH W1 IW YEAR and R FIRST NAME'S death
"ELSE REINTERVIEW and RESIDENT IN NURSING HOME AT TIME OF DEATH Between the time our interview in W1 IW MONTH W1 IW YEAR and when R FIRST NAME went into the (nursing home/health care facility)
"ELSE In the two years preceding (his/her) death
"END did R FIRST NAME move into and then out of someone else's house or apartment?

INAP . . . . . 0 CS54x
YES . . . . . 1
NO . . . . . 5 CS54x
DK . . . . . 8 CS54x
RF . . . . . 9 CS54x

CS53x. With whom did (he/she) move in: was it (a child of R FIRST NAME'S,) a grandchild, another relative, or someone else? CHOOSE ALL THAT APPLY

INAP . . . . . 0, CS53cx
CHILD . . . . . 2,
GRANDCHILD . . . . . 4, CS53cx
RELATIVE-OTHER . . . . . 5, CS53cx
OTHER INDIVIDUAL . . . . . 6, CS53cx
DK . . . . . 8, CS53cx
RF . . . . . 9, CS53cx

CS53ax. Which children? CHOOSE ALL THAT APPLY

if: < 2 CHILDREN *AND* Q203(1)
SKIP to:CS53cx

CS51bx. Which child stayed the longest? CHOOSE ALL THAT APPLY

CS53cx. About how many weeks or months did R FIRST NAME stay
"IF R MOVED IN WITH CHILD with that child?
"ELSE with that person?
"END

Please tell me the longest stay if there was more than one person R FIRST NAME stayed with. TIME:

INAP . . . . . 0
WEEKS . . . . . 1
MONTHS . . . . . 2
DK . . . . . 8
RF . . . . . 9

if: Q513 (0)
SKIP to:CS49

CS54x.
"IF REINTERVIEW and IN NURSING HOME AT TIME OF DEATH (NOT YES) Between the time of our interview in W1 IW MONTH W1 IW YEAR and when R FIRST NAME died
"ELSE REINTERVIEW and RESIDENT IN NURSING HOME AT TIME OR DEATH Between the time of our interview in W1 IW MONTH W1 YEAR and when R FIRST NAME went into the (nursing home/health care facilty)
"ELSE in the two years preceding (his/her) death
"END did (he/she) and any of (his/her) children move in order to be closer to each other but not living in the same house or apartment?

INAP . . . . . 0 CS49
YES . . . . . 1
NO . . . . . 5 CS49
DK . . . . . 8 CS49
RF . . . . . 9 CS49

CS54ax. Which child was that? CHOOSE ALL THAT APPLY

CS54bx. Did CHILD/NON-CHILD NAME move or did R FIRST NAME move?

INAP . . . . . 0
CHILD MOVED . . . . . 1
R MOVED . . . . . 2
BOTH . . . . . 4
DK . . . . . 8
RF . . . . . 9

CS54cx. Was the move intended to be temporary or was it thought of as permanent?

INAP . . . . . 0
PERMANENT MOVE . . . . . 1
TEMPORARY MOVE . . . . . 5
DK . . . . . 8
RF . . . . . 9

END of case

if: Q256 (4 *OR* 5 *OR* 6)
SKIP to:CS49

CS49. What was the relationship of (name) to R FIRST NAME'S (husband/wife/partner)? CHILD NAME / RELATIONSHIP

INAP . . . . . 0
CONTINUE . . . . . 1

 

SECTION A - DEMOGRAPHICS

A1 TIME STAMP

A0. Because people can move from time to time, and their families can change, I have some questions about the places R FIRST NAME lived and changes in (his/her) family structure.

if: REINTERVIEW
SKIP to:A9

A1. First, I have some questions about (his/her) background. In what month, day, and year was (he/she) born?

MONTH:
DAY:
YEAR:

A2. Was (he/she) born in the United States?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 A28
DK . . . . . 8
RF . . . . . 9

if:A2(DK *OR* RF)
SKIP to:A3

A2a. In what state was (he/she) born?

if:A2(YES)
SKIP to:A3

A2b. In what country was (he/she) born?

A2c. In about what year did (he/she) come to the United States?

YEAR:
     OR
YEARS AGO:
     OR
AT AGE:

INAP . . . . . 0
CONTINUE . . . . . 1

A3. What is the highest grade of school or year of college (he/she) completed?

0     FOR NO FORMAL EDUCATION
1-11     GRADES
12     HIGH SCHOOL
13-15     SOME COLLEGE
16     COLLEGE GRAD
17     POST COLLEGE (17+ YEARS)
97     OTHER

if:A3(13 *TO* 17)
SKIP to:A3b

A3b. (Did (he/she) get a college degree?)

INAP . . . . . 0 A4
YES . . . . . 1
NO . . . . . 5 A4
DK . . . . . 8 A4
RF . . . . . 9 A4

A3c. (What is the highest degree (he/she) have earned)?

INAP . . . . . 0
LESS THAN BACHELORS . . . . . 1
BACHELORS . . . . . 2
MASTERS\MBA . . . . . 3
LAW . . . . . 4
PHD . . . . . 5
MD . . . . . 6
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

A4. Did (his/her) mother attend 8 years or more of school?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

A5. Did (his/her) father attend 8 years or more of school?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

A7. Did (he/she) consider (him/her)self Hispanic or Latino?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 A8
DK . . . . . 8
RF . . . . . 9

A7a. Would you say (he/she) was Mexican American, Puerto Rican, Cuban American or something else? CHOOSE ALL THAT APPLY

INAP . . . . . 0,
MEXICAN AMERICAN/CHICANO . . . . . 1,
PUERTO RICAN . . . . . 2,
CUBAN AMERICAN . . . . . 3,
OTHER (SPECIFY) . . . . . 7,
DK . . . . . 8,
RF . . . . . 9,

A8. Did (he/she) consider (him/her)self primarily white or Caucasian, Black or African American, American Indian, or Asian, or something else?

INAP . . . . . 0
WHITE/CAUCASIAN . . . . . ,
BLACK/AFRICAN AMERICAN . . . . . 2
AMERICAN INDIAN OR ALASKAN NATIVE . . . . . 3
ASIAN OR PACIFIC ISLANDER . . . . . 4
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

A9.
"IF REINTERVIEW I need to clarify some aspects of family history.
"END

How many children had (he ever fathered/she given birth to)? Please don't count miscarriages or still-births, or adopted or step-children for this question.

if:A9(0 *OR* DK *OR* RF)
SKIP to:A10

A9a.
"IF # CHILDREN EVER (1) Is that child alive today?

IWER: IF R RESPONDS YET TYPE 1 AND PRESS ENTER
TYPE 0 IF R RESPONDS NO

"ELSE How many of them are still living?
"END

if: Q370 (*NOT* 0 *AND* *NOT* 5)
SKIP to:A12

A10. Did (he/she) ever serve in the active military of the United States?

INAP . . . . . 0 A21
YES . . . . . 1
NO . . . . . 5 A21
DK . . . . . 8 A21
RF . . . . . 9 A21

A10a. During what years was (he/she) in active service?

FROM:
TO:

A10c. Did (he/she) have a disability connected with military service?

INAP . . . . . 0 CS3
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

A21.R MARITAL

MARRIED, SPOUSE PRESENT . . . . . 1
MARRIED, SPOUSE ABSENT FROM HH . . . . . 2
LIVING WITH SOMEONE . . . . . 3
DIVORCED/SEPARATED . . . . . 4
WIDOWED . . . . . 5
NEVER MARRIED . . . . . 6
MARRIED, SPOUSE ABSENT (NOT INSTITUTION) . . . . . 7

A21A TIME STAMP

if: Q370 (*NOT* 0 *AND* *NOT* 5)
SKIP to:A25

if:A21(MARRIED, SPOUSE PRESENT *OR* MARRIED, SPOUSE ABSENT FROM HH)
SKIP to:A21a

A21. Was (he/she) ever married?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 A25
DK . . . . . 8
RF . . . . . 9

A21a. Altogether, how many times had (he/she) been married (including current marriage)?

INAP . . . . . 0
ONCE . . . . . 1
TWICE . . . . . 2
THREE TIMES . . . . . 3
FOUR OR MORE . . . . . 4
DK . . . . . 8
RF . . . . . 9

A2. In what year did (he/she) (first) marry?

if:A22( < = 1992)
SKIP to:A22b

A22a. In what month was that?

if:A21a(ONCE) *AND* A21(MARRIED, SPOUSE PRESENT *OR* MARRIED, SPOUSE ABSENT FROM HH)
SKIP to:A25

A22b. Did that marriage end in divorce or was (he/she) widowed?

INAP . . . . . 0
DIVORCED . . . . . 4
WIDOWED . . . . . 5
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

A22c. About how many years did that marriage last?

if:A21a(ONCE)
SKIP to:A25

A23. In what year did (he/she) marry most recently?

if:A23( < = 1992)
SKIP to:A23b

A23a. In what month was that?

if:A21(MARRIED, SPOUSE PRESENT *OR* MARRIED, SPOUSE ABSENT FROM HH)
SKIP to:A25

A23b. Did that marriage end in divorce or was (he/she) widowed?

INAP . . . . . 0
DIVORCED . . . . . 4
WIDOWED . . . . . 5
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

A23c. About how many years did that marriage last?

if:CS36c(NO, DID NOT MORE) *OR* (CS11(YES) *AND* CS26( *NOT* YES))
SKIP to:A26

A25. In what month and year did (he/she) move to (his/her) home in (City, State)?

MONTH:
YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

if:CS35a(ONE RESIDENCE) *AND* CS28(YES)
SKIP to:A26

A25b. Did (he/she) ever live in or around (City, State) before moving there?

INAP . . . . . 0 CS3
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:A25b(NO) *AND* A25a( > 0)
SKIP to:A27

A26.
"IF R SAME SPOUSE/PARTNER AT TIME OF DEALTH and STILL OWN/RENT HOME WHILE IN NURSING HOME (NOT YES) Altogether, about how many years did (he/she) live in or around (City)?
"ELSE Altogether, about how many years did (he/she) live in or around (City, State)?
"END

96     ALWAYS LIVED AROUND HERE/THERE
YEARS:

if:A26(96)
SKIP to:A28

A27. In what state or country did (he/she) live most of the time (he/she) was (in grade school/in high school/about age 10)?

if:(W1 INTERV(REINTERVIEW) *AND* W1 R EDUCAT(0)) *OR* (W1 INTERV( *NOT* REINTERVIEW) *AND* A3(0))
SKIP to:A36

A28. Was (he/she) living in a rural area most of the time when (he/she) was (in grade school/in high school/about age 10)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

A36 TIME STAMP

if: Q370 (*NOT* 0 *AND* *NOT* 5)
SKIP to:A36B

A36. What was (his/her) religious preference; Was it Protestant, Catholic, Jewish, some other religion, or did (he/she) have no preference?

INAP . . . . . 0 A36B
PROTESTANT . . . . . 1
CATHOLIC . . . . . 2 A36B
JEWISH . . . . . 3 A36B
NO PREFERENCE . . . . . 4 A36B
OTHER . . . . . 7 A36B
DK . . . . . 8 A36B
RF . . . . . 9 A36B

A36a.DENOMINATION

A36c. About how often did (he/she) attend religious services during (his/her) last year?

PROBE IF NECESSARY: (Would you say more than once a week, once a week, two or three times a month, one or more times a year, or not at all?)

INAP . . . . . 0
MORE THAN ONCE A WEEK . . . . . 1
ONCE A WEEK . . . . . 2
TWO OR THREE TIMES A MONTH . . . . . 3
ONE OR MORE TIMES A YEAR . . . . . 4
NOT AT ALL . . . . . 5
DK . . . . . 8
RF . . . . . 9

A37. Was English the language (he/she) usually spoke at home?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:(CS4x(NO) *AND* CS5x(NO) *AND* PRELOAD MAR(1 *OR* 2))
SKIP to:A42

if: Q220 (2)
SKIP to:A END

A40. I have a few additional questions about marital changes that may sound repetitive. Because marriages end or begin frequently these days and because such changes are important, the study is trying not to miss any marital changes.

Did (he/she) have a marriage start after W1 IW MONTH W1 IW YEAR?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:A40( *NOT* YES)
SKIP to:A41

A40a. In what month and year was that?

MONTH:
YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

if:A40A(1)
SKIP to:A END

A41. Did (he/she) divorce or become widowed since W1 IW MONTH W1 IW YEAR?

YES, DIVORCED/ANNULLED . . . . . 1
YES, WIDOWED . . . . . 2
NO . . . . . 5 A42
DK . . . . . 8
RF . . . . . 9

A41a. In what month and year did that happen?

MONTH:
YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

A END TIME STAMP

 

SECTION B - HEALTH CONDITIONS

B1 TIME STAMP

B0x. Next I would like to ask you some questions about R FIRST NAME'S
"IF REINTERVIEW health since W1 IW MONTH W1 IW YEAR.
"ELSE health during the last two years.
"END

B5.
"IF REINTERVIEW WAVE 1: W1 CANCER V Site: W1 CANCER S
"END
"IF W1 INTERVIEW (NOT REINTERVIEW) Did a doctor ever say that (he/she) had cancer or a malignant tumor, excluding minor skin cancers?
"ELSE W1 CANCER Our records from (his/her) last interview in W1 IW MONTH W1 IW YEAR show that (he/she) had had cancer.

IWER: PRESS 1 THEN PRESS ENTER UNLESS R VOLUNTARILY DISPUTES W1 RECORD.

"ELSE Since we talked to (him/her) in W1 IW MONTH W1 IW YEAR, did a doctor say that (he/she) had a cancer or malignant tumor, excluding minor skin cancer?
"END

INAP . . . . . 0 B6
YES . . . . . 1
[VOL] DISPUTES W1 RECORD . . . . . 3 B6
NO . . . . . 5 B6
DK . . . . . 8 B6
RF . . . . . 9 B6

B5b. Did (he/she) receive treatment for cancer
"IF REINTERVIEW since W1 IW MONTH W1 IW YEAR
"ELSE in the two years preceding (his/her) death?
"END

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:B5b(NO) *AND* W1 CANCER V(YES)
SKIP to:B6

if:B5b( *NOT* YES) *AND* W1 CANCER V(YES)
SKIP to:B5g

if:B5b( *NOT* YES) *AND* W1 CANCER V( *NOT* YES)
SKIP to:B5g

B5c.
"IF W1 INTERVIEW (NOT REINTERVIEW) During the last two years,
"ELSE Since W1 IW MONTH W1 IW YEAR,
"END what sort of treatments did (he/she) receive for cancer?

CHOOSE ALL THAT APPLY

INAP . . . . . 0,
CHEMOTHERAPY OR MEDICATION . . . . . 1,
SURGERY OR BIOPSY . . . . . 2,
RADIATION/X-RAY . . . . . 3,
MEDICATIONS/TREATMENT FOR SYMPTOMS (PAIN, NAUSEA, RASHES) . . . . . 4,
NONE . . . . . 5,
OTHER, SPECIFY . . . . . 7,
DK . . . . . 8,
RF . . . . . 9,

if: W1 CANCER (YES)
SKIP to:B5h

B5g. In which organ or part of (his/her) body did (his/her) cancer(s) start?

RECORD FOR ALL CANCERS.

B5j. In what month and year was (his/her) (most recent) cancer diagnosed?

MONTH:
YEAR:

B6.
"IF REINTERVIEW WAVE 1: W1 LUNG V23
"END
"IF W1 INTERVIEW (NOT REINTERVIEW) Not including asthma, did a doctor ever say that (he/she) had chronic lung disease such as chronic bronchitis or emphysema?

DO NOT INCLUDE ASTHMA

"ELSE W1 LUNG Our records from (his/her) last interview in W1 IW MONTH W1 IW YEAR show that (he/she) had a chronic lung disease, such as chronic bronchitis or emphysema.

IWER: PRESS 1 THEN PRESS ENTER UNLESS R VOLUNTARILY DISPUTES W1 RECORD.

"ELSE Not including asthma, did a doctor say since we talked to (him/her) that (he/she) had a chronic lung disease, such as chronic bronchitis or emphysema?

DO NOT INCLUDE ASTHMA

"END

INAP . . . . . 0
YES . . . . . 1
[VOL] DISPUTES W1 RECORD . . . . . 3 B7
NO . . . . . 5 B7
DK . . . . . 8
RF . . . . . 9

B6c.Was (he/she) receiving oxygen for (his/her) lung condition?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B7.
"IF REINTERVIEW WAVE 1: W1 HEART V2
"END
"IF W1 INTERVIEW (NOT REINTERVIEW) Did a doctor ever say that (he/she) had a heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems?
"ELSE W1 HEART Our records from (his/her) interview in W1 IW MONTH W1 IW YEAR show that (he/she) had a heart problem.

IWER: PRESS 1 THEN PRESS ENTER UNLESS R VOLUNTARILY DISPUTES W1 RECORD.

"ELSE Since (his/her) interview in W1 IW MONTH W1 IW YEAR did a doctor say that (he/she) had a heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems?
"END

INAP . . . . . 0
YES . . . . . 1
[VOL] DISPUTES W1 RECORD . . . . . 3 B9
NO . . . . . 5 B9
DK . . . . . 8
RF . . . . . 9

B7d. Had (he/she) had a heart attack or myocardial infarction
"IF REINTERVIEW since W1 IW MONTH W1 IW YEAR?
"ELSE in the past two years?
"END

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:B7d(NO *OR* DK *OR* RF)
SKIP to:B7y

B7g. In what month and year was (his/her) (most recent) heart attack?

MONTH:
YEAR:

B7k.
"IF W1 HEART Since we talked to (him/her) in W1 IW MONTH W1 IW YEAR, did a doctor say that
"ELSE W1 INTERVIEW (NOT REINTERVIEW) In the last two years did a doctor say that
"ELSE Did a doctor ever say that
"END (he/she) had congestive heart failure?

INAP . . . . . 0 B7q
YES . . . . . 1
NO . . . . . 5 B7q
DK . . . . . 8 B7q
RF . . . . . 9 B7q

B7p.
"IF REINTERVIEW Since W1 IW MONTH W1 IW YEAR
"ELSE In the past two years
"END did (he/she) have a special test or treatment of (his/her) heart where tubes were inserted into (his/her) veins or arteries (cardiac catheterization, coronary angiogram or angioplasty)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B7q.
"IF REINTERVIEW Since W1 IW MONTH W1 IW YEAR
"ELSE In the past two years
"END did (he/she) have surgery on (his/her) heart?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B9.
"IF REINTERVIEW WAVE 1: W1 STROKE V
"END
"IF W1 INTERVIEW (NOT REINTERVIEW) Did a doctor ever say that (he/she) had a stroke?
"ELSE W1 HEART Our records from (his/her) interview in W1 IW MONTH W1 IW YEAR show that (he/she) had a stroke.

IWER: PRESS 1 THEN PRESS ENTER UNLESS R VOLUNTARILY DISPUTES W1 RECORD.

"ELSE Since (his/her) interview in W1 IW MONTH W1 IW YEAR did a doctor say that (he/she) had a stroke?
"END

INAP . . . . . 0
YES . . . . . 1
[VOL] POSSIBLE OR TIA . . . . . 2
[VOL] DISPUTES W1 RECORD . . . . . 3 B12
NO . . . . . 5 B12
DK . . . . . 8
RF . . . . . 9

if:W1 STROKE V( *not* YES)
SKIP to:B9M

B9j. Since W1 IW MONTH W1 IW YEAR, did a doctor say that (he/she) had another stroke?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:B9j(NO *OR* DK *OR* B9([VOL] POSSIBLE OR TIA)
SKIP to: B12

B9m. In what month and year was (his/her) (most recent) stroke?

MONTH:
YEAR:

B12. Did (he/she) fall down
"IF REINTERVIEW since W1 IW MONTH W1 IW YEAR?
"ELSE in the last two years?
"END

INAP . . . . . 0 B13
YES . . . . . 1
NO . . . . . 5 B13
DK . . . . . 8 B13
RF . . . . . 9 B13

B12a. How many times did (he/she) fall
"IF REINTERVIEW since W1 IW MONTH W1 IW YEAR?
"ELSE in the last two years?
"END

# TIMES:

B12b. In (any of these falls/that fall), did (he/she) injure (him/her)self seriously enough to need medical treatment?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B13.
"IF W1 INTERVIEW (NOT REINTERVIEW) Did (he/she) ever fracture (his/her) hip?
"ELSE WAVE 1: W1 BROKEN H Did (he/she) fracture (his/her) hip since we talked in W1 IW MONTH W1 IW YEAR?
"END

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B15 TIMESTAMP

B18.Was (he/she) often troubled with pain between W1 IW MONTH W1 IW YEAR and when (he/she) died?

INAP . . . . . 0 B19
YES . . . . . 1
NO . . . . . 5 B19
DK . . . . . 8 B19
RF . . . . . 9 B19

B18a. When the pain was at its worst, was it mild, moderate or severe?

INAP . . . . . 0
MILD . . . . . 1 B19
MODERATE . . . . . 2
SEVERE . . . . . 3
DK . . . . . 8
RF . . . . . 9

B18b. How bad was the pain most of the time: mild, moderate or severe?

INAP . . . . . 0
MILD . . . . . 1
MODERATE . . . . . 2
SEVERE . . . . . 3
DK . . . . . 8
RF . . . . . 9

B19. Did (he/she) have any other major health problems which you haven't told me about? IF YES, SPECIFY ON NEXT SCREEN

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B19A TIMESTAMP

B19a. What was that?

B20. Did (he/she) smoke cigarettes in the last two years of (his/her) life?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 B21
DK . . . . . 8
RF . . . . . 9

B20a. About how many cigarettes or packs did (he/she) usually smoke in a day? PROBE A RANGE

CIGARETTES/DAY:
PACKS/DAY:

INAP . . . . . 0
CONTINUE . . . . . 1

B21. Did (he/she) ever drink any alcoholic beverages such as beer, wine, or liquor in the last two years of (his/her) life?

INAP . . . . . 0
YES . . . . . 1
[VOL] NEVER HAVE USED ALCOHOL . . . . . 3
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B22a. Did R FIRST NAME gain or lose ten or more pounds in the last 12 months of (his/her) life?

INAP . . . . . 0
YES, GAINED . . . . . 1
YES, LOST . . . . . 2
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23ax. Was there a period of at least one month during the last year of (his/her) life when (he/she) had the following problems: Difficulty breathing?

INAP . . . . . 0
YES . . . . . 1
[VOL] ON RESPIRATOR . . . . . 3
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23bx. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Very little appetite or desire for food?

INAP . . . . . 0
YES . . . . . 1
[VOL] IV FLUIDS OR FEEDING TUBE . . . . . 3
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23cx. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Frequent vomiting?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23dx. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Difficulty controlling (his/her) arms and legs?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23ex. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Depression?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23fx. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Period confusion?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23m. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Severe fatigue or exhaustion?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23hx. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Difficulty being aroused or awakened, or loss of consciousness?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23n. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Persistent wheezing, cough, or bringing up phlegm?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23kx. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Uncontrolled outbursts of temper?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B23mx. (Was there a period of at least one month during the last year of (his/her) life when (he/she) had) Loss of control of bowel or bladder?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

B END TIMESTAMP

 

SECTION PC - COGNITION

PC1. Part of this study is concerned with people's memory, and ability to think about things. For the next few questions, I want you to think about R FIRST NAME as of one month before (his/her) death. First, how would you rate R FIRST NAME'S memory at that time? Would you say it was excellent, very good, good, fair or poor?

EXCELLENT . . . . . 1
VERY GOOD . . . . . 2
GOOD . . . . . 3
FAIR . . . . . 4
pOOR . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC3. How would you rate R FIRST NAME in making judgements and decisions? Would you say (he/she) was excellent, very good, good, fair or poor?

EXCELLENT . . . . . 1
VERY GOOD . . . . . 2
GOOD . . . . . 3
FAIR . . . . . 4
pOOR . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC5. How would you rate R FIRST NAME'S ability to organize (his/her) daily activities? (Would you say (he/she) was excellent, very good, good, fair or poor?)

EXCELLENT . . . . . 1
VERY GOOD . . . . . 2
GOOD . . . . . 3
FAIR . . . . . 4
pOOR . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC7. Now we want you to remember what R FIRST NAME was like
"IF REINTERVIEW When we interviewed (him/her) in W1 IW MONTH W1 IW YEAR
"ELSE two years before (his/her) death
"END and to compare it with what (he/she was like toward the end of (his/her) life, but leaving out the last month or so of (his/her) life.
I will read situations where R FIRST NAME had to use (his/her) memory or intelligence and we would like you to indicate whether this improved, stayed the same, or got worse in that situation over that time period.
Note the importance of comparing (his/her) performance toward the end of (his/her) life with
"IF REINTERVIEW when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR. So if in W1 IW MONTH W1 IW YEAR
"ELSE two years before (his/her) death. So if two years earlier
"END R FIRST NAME always forgot where (he/she) had left things, and (he/she) still did toward the end of (his/her) life, then this would be considered "not much change".

PC8.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,)
"END how was R FIRST NAME at: Remembering things about family and friends, such as occupations, birthdays, and addresses. Had this improved, not much changed, or gotten worse?

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC9
GOTTEN WORSE . . . . . 3 PC8b
DK . . . . . 8
RF . . . . . 9

PC8a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC8(IMPROVED)
SKIP to: PC9

PC8b. Was it much worse or a bit worse?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPROVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

PC9.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Remembering things that had happened recently. (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC10
GOTTEN WORSE . . . . . 3 PC9b
DK . . . . . 8
RF . . . . . 9

PC9a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC9(IMPROVED)
SKIP to: PC10

PC9b. Was it much worse or a bit worse?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPROVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

PC10.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Recalling conversations a few days later?. Had this improved, not much changed, or gotten worse?

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC11
GOTTEN WORSE . . . . . 3 PC10b
DK . . . . . 8
RF . . . . . 9

PC10a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC10(IMPROVED)
SKIP to: PC11

PC10b. Was it much worse or a bit worse?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPROVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

PC11.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Remembering (his/her) address and telephone number? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC12
GOTTEN WORSE . . . . . 3 PC11b
DK . . . . . 8
RF . . . . . 9

PC11a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC11(IMPROVED)
SKIP to: PC12

PC11b. Was it much worse or a bit worse?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPROVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

PC12.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Remembering what day and month it is? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC13
GOTTEN WORSE . . . . . 3 PC12b
DK . . . . . 8
RF . . . . . 9

PC12a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC12(IMPROVED)
SKIP to: PC13

PC12b. Was it much worse or a bit worse?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPROVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

PC13.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Remembering where things are usually kept? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC14
GOTTEN WORSE . . . . . 3 PC13b
DK . . . . . 8
RF . . . . . 9

PC13a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC13(IMPROVED)
SKIP to: PC14

PC13b. Was it much worse or a bit worse?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPROVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

PC14.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Remembering where to find things which have been put in a different place than usual? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC15
GOTTEN WORSE . . . . . 3 PC14b
DK . . . . . 8
RF . . . . . 9

PC14a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC14(IMPROVED)
SKIP to: PC15

PC14b. Was it much worse or a bit worse?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPROVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

PC15.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Knowing how to work familiar machines around the house?(Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC16
GOTTEN WORSE . . . . . 3 PC15b
DK . . . . . 8
RF . . . . . 9

PC15a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC15(IMPROVED)
SKIP to: PC16

PC15b. Was it much worse or a bit worse?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPROVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

PC16.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,)
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Learning to use a new gadget or machine around the house? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC17
GOTTEN WORSE . . . . . 3 PC16b
DK . . . . . 8
RF . . . . . 9

PC16a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC16(IMPROVED)
SKIP to: PC17

PC16b. Was it much worse or a bit worse?

INAP . . . . . 0
A BIT WORSE . . . . . 4
MUCH WORSE . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC17.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Learning new things in general? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC18
GOTTEN WORSE . . . . . 3 PC17b
DK . . . . . 8
RF . . . . . 9

PC17a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC17(IMPROVED)
SKIP to: PC18

PC17b. Was it much worse or a bit worse?

INAP . . . . . 0
A BIT WORSE . . . . . 4
MUCH WORSE . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC18.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Following a story in a book or on TV? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC19
GOTTEN WORSE . . . . . 3 PC18b
DK . . . . . 8
RF . . . . . 9

PC18a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC18(IMPROVED)
SKIP to: PC19

PC18b. Was it much worse or a bit worse?

INAP . . . . . 0
A BIT WORSE . . . . . 4
MUCH WORSE . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC19.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Making decisions on everyday matters? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC20
GOTTEN WORSE . . . . . 3 PC19b
DK . . . . . 8
RF . . . . . 9

PC19a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC19(IMPROVED)
SKIP to: PC20

PC19b. Was it much worse or a bit worse?

INAP . . . . . 0
A BIT WORSE . . . . . 4
MUCH WORSE . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC20.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Handling money for shopping? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC21
GOTTEN WORSE . . . . . 3 PC20b
DK . . . . . 8
RF . . . . . 9

PC20a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC20(IMPROVED)
SKIP to: PC21

PC20b. Was it much worse or a bit worse?

INAP . . . . . 0
A BIT WORSE . . . . . 4
MUCH WORSE . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC21.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Handling financial matters, that is, the pension or dealing with the bank? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC22
GOTTEN WORSE . . . . . 3 PC21b
DK . . . . . 8
RF . . . . . 9

PC21a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC21(IMPROVED)
SKIP to: PC22

PC21b. Was it much worse or a bit worse?

INAP . . . . . 0
A BIT WORSE . . . . . 4
MUCH WORSE . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC22.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Handling other everyday arithmetic problems, such as, knowing how much food to buy, knowing how long between visits from family or friends? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC23
GOTTEN WORSE . . . . . 3 PC22b
DK . . . . . 8
RF . . . . . 9

PC22a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC22(IMPROVED)
SKIP to: PC23

PC22b. Was it much worse or a bit worse?

INAP . . . . . 0
A BIT WORSE . . . . . 4
MUCH WORSE . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC23.
"IF REINTERVIEW (Compared with when we interviewed (him/her) in W1 IW MONTH W1 IW YEAR,
"ELSE (Compared with two years before (his/her) death,
"END how was R FIRST NAME at:) Using (his/her) intelligence to understand what's going on and to reason things through? (Had this improved, not much changed, or gotten worse?)

INAP . . . . . 0
IMPROVED . . . . . 1
NOT MUCH CHANGED . . . . . 2 PC24
GOTTEN WORSE . . . . . 3 PC23b
DK . . . . . 8
RF . . . . . 9

PC23a. Was it much improved or a bit improved?

INAP . . . . . 0
MUCH IMPROVED . . . . . 1
A BIT IMPORVED . . . . . 2
DK . . . . . 8
RF . . . . . 9

if:PC23(IMPROVED)
SKIP to: PC24

PC23b. Was it much worse or a bit worse?

INAP . . . . . 0
A BIT WORSE . . . . . 4
MUCH WORSE . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC24. Did R FIRST NAME ever get lost in a familiar environment?

YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC25. Did (he/she) ever wander off and not return by (himself/herself)?

YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC26. Could (he/she) be left alone for an hour or so?

YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC27. Did R FIRST NAME ever see or hear things that were not really there?

YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

PC28. During the last few months of (his/her) life, how often did R FIRST NAME show any of the following behaviors:

(During the last few months of (his/her) life) how often did (he/she) become angry or hostile without reason? Was it most of the time, some of the time, or never?

MOST OF TIME . . . . . 1
SOME OF TIME . . . . . 2
NEVER . . . . . 3
DK . . . . . 8
RF . . . . . 9

PC29. (During the last few months of (his/her) life) How often did (he/she) have difficulties falling asleep or waking frequently during the night?

MOST OF TIME . . . . . 1
SOME OF TIME . . . . . 2
NEVER . . . . . 3
DK . . . . . 8
RF . . . . . 9

PC30. (During the last few months of (his/her) life) How often did (he/she) do things that were dangerous to (himself/herself) or others?

MOST OF TIME . . . . . 1
SOME OF TIME . . . . . 2
NEVER . . . . . 3
DK . . . . . 8
RF . . . . . 9

PC31. (During the last few months of (his/her) life) How often did (he/she) pace around or make unexplained rocking movements while sitting?

MOST OF TIME . . . . . 1
SOME OF TIME . . . . . 2
NEVER . . . . . 3
DK . . . . . 8
RF . . . . . 9

PC32. (During the last few months of (his/her) life) How often did (he/she) mention that people were plotting against or trying to harm (him/her)?

MOST OF TIME . . . . . 1
SOME OF TIME . . . . . 2
NEVER . . . . . 3
DK . . . . . 8
RF . . . . . 9

PC33. (During the last few months of (his/her) life) How often did (he/she) drink too much alcohol?

MOST OF TIME . . . . . 1
SOME OF TIME . . . . . 2
NEVER . . . . . 3
DK . . . . . 8
RF . . . . . 9

PC END TIMESTAMP

SKIP to: C TIME STAMP

C TIME STAMP
C END TIME STAMP

 

SECTION D - FAMILIES

SECTION D REVIEW SCREEN

D0. Families and friends often help one another in different ways. Part of our research is finding out how they do that, so we have some questions about family.

D4x. Did R FIRST NAME (and his/her husband/wife/partner) have any grandchildren?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 D42
DK . . . . . 8
RF . . . . . 9

D40. How many grandchildren did R FIRST NAME (and his/her husband/wife/partner) have?

D42. Did R FIRST NAME (and his/her husband/wife/partner) have any great-grandchildren?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 D45
DK . . . . . 8
RF . . . . . 9

D42a. Altogether, how many great-grandchildren did R FIRST NAME (and his/her husband/wife/partner) have?

if:D40( > 0) *OR* D42(YES)
SKIP to:D46

D45. CKPOINT ANY "OFFSPRING" R/SP

if:D45(0) *AND* Q513(0)
SKIP to:D72

D46. The next questions are about help given or received since W1 IW MONTH W1 IW YEAR but before (he/she) died.

The financial help we ask about excludes shared housing and shared food, so don't count that type of help. It also excludes anything (he/she) left to others after (he/she) died. (Since Wave1 Month, Year/In the last two years), had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) given any of (his/her/their) (children) (or grandchildren) (or great-grandchildren) a deed to a house?

INAP . . . . . 0 D50 TIMESTAMP
YES . . . . . 1
NO . . . . . 5 D50 TIMESTAMP
DK . . . . . 8 D50 TIMESTAMP
RF . . . . . 9 D50 TIMESTAMP

D46a.
"IF Q513 (1) Did (he/she) give it to (his/her/their) child?
"ELSE Did (he/she) give it to any of (his/her/their) children?
"END

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D46a(NO *NO* DK *OR* RF) *OR* Q513(1)
SKIP to:D48

D47. White child was that? CHOOSE ALL THAT APPLY

if:D45(0) *OR* D46(1)
SKIP to:D50 TIMESTAMP

D48. Did (he/she) give a deed to any of (his/her/their) grandchildren (or great-grandchildren)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 D50 TIMESTAMP
DK . . . . . 8
RF . . . . . 9

D49. Which of (his/her/their) children is the parent of those grandchildren (or great-grandchildren)? CHOOSE ALL THAT APPLY

D50 TIMESTAMP

if:Q513 CHILDREN(0)
SKIP to:D55 TIME ST

D50. (Since Wave1 Month, Year/In the last two years) had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) given financial help or (other) gifts totaling $100 or more to
"IF Q513 (1) Did (his/her/their) child?
"ELSE any of (his/her/their) children?
"END

INAP . . . . . 0
YES . . . . . 1 D50
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D54(NO *OR* DK *OR* RF) *OR* D52(ALL CHILDREN) *OR* D52(ALL CHILDREN)
SKIP to:D55 TIME ST

if: Q513 (0)
SKIP to:D55 TIME ST

D52
"IF R HAS ONE CHILD To which child did (he/she) give the largest amount?
"ELSE To which child did (he/she) give the next largest amount?
"END

if: Q513 (0)
SKIP to:D55 TIME ST

D53.
"IF CHILD IS DECEASED About how much did that amount to for (his/her/their) deceased child
"ELSE NOT *ALL MY CHILDREN* About how much did that amount to for GRANDCHILD NAME
"ELSE About how much did that amount to for each child
"END (or family) (since Wave1 Month, Year/In the last two years)?

DO NOT PROBE DK/RF
AMOUNT:

if:Q513 (0)
SKIP to:D55 TIME ST

D53a. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D54(NO *OR* DK *OR* RF) *OR* D52(ALL CHILDREN) *OR* D52(ALL CHILDREN)
SKIP to:D55 TIME ST

D53b. Was it more than $20,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:Q513 (0)
SKIP to:D55 TIME ST

D53c. Was it more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D54(NO *OR* DK *OR* RF) *OR* D52(ALL CHILDREN) *OR* D52(ALL CHILDREN)
SKIP to:D55 TIME ST

D54. Had (he/she) (or your husband/wife/partner / or your late husband/wife partner) given financial help gifts totaling $100 or more to any other child (since Wave1 Month, Year/in the last two years)?

INAP . . . . . 0
YES . . . . . 1 D52
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D45(0)
SKIP to:D61

D55. (Since Wave1 Month, Year/In the last two years) had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) given financial help or gifts totaling $500 or more to any of (his/her/their) grandchildren (or great-grandchildren)? That would include financial help with education.

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D56 TIME STAMP

if:D58(NO *OR* DK *OR* RF)
SKIP to:D61

D56.
"IF R HAS ONE GRANDCHILD Which of (his/her/their) children is the parent of the grandchild (or great-grandchild) to whom (he/she) gave the largest amount?
"ELSE Which of (his/her/their) children is the parent of the grandchild (or great-grandchild) to whom (he/she) gave the next largest amount?
"END

INAP . . . . . 0
DECEASED CHILD . . . . . 10
ALL CHILDREN . . . . . 11

if:D55(NO *OR* DK *OR* RF)
SKIP to:D61 TIME ST

if:D58(NO *OR* DK *OR* RF)
SKIP to:D61

D57.
"IF GRANDCHILD IS DECEASED Thinking about what (he/she) gave to all of (his/her/their) deceased child's
"ELSE GRANDCHILD IS LIVING Thinking about what (he/she) gave to all of GRANDCHILD NAME
"ELSE Thinking about what (he/she) gave to all of HH2 GRANDCHILD NAME
"END offspring, about how much was that altogether during the period (since Wave1 Month, Year/in the last two years)?

DO NOT PROBE DK/RF
AMOUNT:

D57. TRANSFER TO OFFSPRING $

AMOUNT

if:D55(NO *OR* DK *OR* RF)
SKIP to:D61 TIME ST

D57a. Was it more than $5,000

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D57b. Was it more than $20,000

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D57c. Was it more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D55(NO *OR* DK *OR* RF)
SKIP to:D61 TIME ST

D58. Had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) given financial help or gifts totaling $500 or more (since Wave1 Month, Year/in the last two years) to any other grandchildren (or great-grandchildren)?

INAP . . . . . 0
YES . . . . . 1 D56
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D61 TIME STAMP

D59. (Other tahn what you have already told me about) had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) given any amount of financial help or gifts to any other grandchildren (or great-grandchildren)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 D61
DK . . . . . 8
RF . . . . . 9

D60. About how much did that financial help or gifts amount to altogether?

AMOUNT:

if: Q513 (0)
SKIP to:D65 TIME ST

D61. (Since Wave1 Month, Year/In the last two years) had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner)received financial help or gifts totaling $100
"IF Q513 (1) or more from (his/her/their) children?
"ELSE or more from any of (his/her/their) child?
"END

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D62.
"IF R HAS ONE CHILD Which child gave (him/her) the largest amount?
"ELSE Which child gave (him/her) the next largest amount?
"END

INAP . . . . . 0
DECEASED CHILD . . . . . 10
ALL CHILDREN . . . . . 11

D63.
"IF IF DECEASED CHILD About how much did that amount to from (his/her/their) deceased child?
"ELSE NOT *ALL MY CHILDREN* About how much did that amount to from 1ST CHILD NAME
"ELSE About how much did that amout to from each child
"END (since Wave1 Month, Year/in the last two years)?
DO NOT PROBE DK/RF

AMOUNT:

if:D64(NO *OR* DK *OR* RF) *OR* D62(ALL CHILDREN) *OR* D62(ALL CHILDREN)
SKIP to:D65 TIME ST

D63a. Wash it more than $1,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D63b. Wash it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D63c. Wash it more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D54(NO *OR* DK *OR* RF) *OR* D62(ALL CHILDREN) *OR* D62(ALL CHILDREN)
SKIP to:D65 TIME ST

D64.
"IF PROXY IS SURVIVING SPOUSE Have you or your (husband/wife/partner / late husband/wife/partner) received financial help
"ELSE Had (he/she) (or your husband/wife/partner / or your late husband/wife partner) received financial help
"END or gifts totaling $100 or more from any other child (since Wave1 Month, Year/in the last two years)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D45(0)
SKIP to:D72 TIMESTAMP

D65. (Since Wave1 Month, Year/In the last two years) had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) received financial help or gifts totaling $500 or more from any grandchild (or great-grandchild)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D66.
"IF R HAS ONE GRANDCHILD OR GREAT GRANDCHILD Which of (his/her/their) children is the parent of the grandchild (or great-grandchild) from whom (he/she) received the largest amount?
"ELSE Which of (his/her/their) children is the parent of the grandchild (or great-grandchild) from whom (he/she) received the next largest amount?
"END

INAP . . . . . 0
DECEASED CHILD . . . . . 10
ALL CHILDREN . . . . . 11

if:D67ex(NO *OR* DK *OR* RF)
SKIP to:D72 TIME ST

D67.
"IF D66 WAS ANSWERED Thinking about what (he/she) received from all of D66's
"ELSE Thinking about what (he/she) received from all of D66's
"END

"ELSE CHILD NOT DECEASED Thinking about what (he/she) received from all of D66's
"ELSE Thinking about what (he/she) received from all of D66's
"END offspring, about how much was that altogether during the period (since Wave1 Month, Year/in the last two years)?

DO NOT PROBE DK/RF
AMOUNT:

D67a. Was it more than $1,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D67b. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D67c. Was it more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D67ex(NO *OR* DK *OR* RF)
SKIP to:D72 TIME ST

D67ex. Had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) received financial help or gifts totaling $500 or more (since Wave1 Month, Year/in the last two years) from any other grandchildren (or great-grandchildren)?

INAP . . . . . 0
YES . . . . . 1 D66
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

D72 TIME STAMP

D68. (Other than what you have already told me about) had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) received smaller amounts of financial help or gifts from any other grandchildren (or great-grandchildren)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 D72 TIMESTAMP
DK . . . . . 8
RF . . . . . 9

D68b. About how much did that financial help or gifts amount to altogether?

AMOUNT:

D72 TIMESTAMP

D72. (Since Wave1 Month, Year/In the last two years) had R FIRST NAME (or your husband/wife/partner / or your late husband/wife partner) received financial help or gifts totaling $500 or more from any (other) relatives or friends?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 D76
DK . . . . . 8
RF . . . . . 9

D73. How many (other) relatives or friends provided that assistance?

D74. Altogether, about how much did the assistance from those (other) relatives and friends amout to (since Wave1 Month, Year/in the last two years)?

DO NOT PROBE DK/RF
AMOUNT:

if:D74 ( *NOT* DK *AND* *NOT* RF)
SKIP to:D74d

D74a. Was it more than $1,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 D74c
DK . . . . . 8
RF . . . . . 9

D74b. Was it more than $5,000?

INAP . . . . . 0 D74d
YES . . . . . 1 D74d
NO . . . . . 5 D74d
DK . . . . . 8 D74d
RF . . . . . 9 D74d

D74c. Was it more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:D45(0)
SKIP to: END D TIME STAMP

D76. (Since Wave1 Month, Year/In the last two years), had R FIRST NAME (or your husband/wife/partner or your late husband/wife partner) spent any time taking care of (his/her/their) grandchildren (or great-grandchildren)?

INAP . . . . . 0 END D TIMESTAMP
YES . . . . . 1
NO . . . . . 5 END D TIMESTAMP
DK . . . . . 8 END D TIMESTAMP
RF . . . . . 9 END D TIMESTAMP

D76a. Which of (his/her/their) children is the parent of those grandchildren (or great-grandchildren)?

CHOOSE ALL THAT APPLY

D77. Did (he/she), (him/her)self spend 100 or more hours in total (since Wave1 Month, Year/in health last two years) taking care of grandchildren (or great-grandchildren)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 D77b
DK . . . . . 8
RF . . . . . 9

D77a. About how many hours altogether did (he/she) spend?

D77b. Did R FIRST NAME's (husband/wife/partner / late husband/wife/partner), spend 100 or more hours in total (since Wave1 Month, Year/in the last two years) taking care of grandchildren (or great-grandchildren)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 END D TIMESTAMP
DK . . . . . 8
RF . . . . . 9

D77c. About how many hours altogether did (his/her) (husband/wife/partner / late husband/wife/partner) spend?

D END TIMESTAMP

 

SECTION E -- HEALTH CARE USE AND COSTS

SECTION E REVIEW SCREEN

if: CS2cx( *NOT* IN HOSPITAL)
SKIP to:E1

Ex1. Earlier you told me that R FIRST NAME died while in a hospital. How long had (he/she) been a patient in that hospital before (his/her) death?

Ex2. Why had (he/she) been admitted to the hospital? Was it to have surgery, receive other treatments, relieve (his/her) symptoms, or what? CHOOSE ALL THAT APPLY

INAP . . . . . 0,
SURGERY . . . . . 1,
OTHER TREATMENTS . . . . . 2,
RELIEVE SYMPTOMS . . . . . 3,
OTHER (SPECIFY) . . . . . 7,
DK . . . . . 8,
RF . . . . . 9,

E1 TIME STAMP

E1.
"IF PLACE OF DEATH (HOSPITAL) In addition to that hospital stay,
"END (Since Wave1 Month, Year / in the last two years before he/she died), had R FIRST NAME been a patient in a hospital overnight?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E4x
DK . . . . . 8
RF . . . . . 9

if: CS2cx(IN HOSPITAL) *AND* E1(NO *OR* DK *OR* RF)
SKIP to:E3

E2.
"IF PLACE OF DEATH (HOSPITAL) Including (his/her) final hospitalization,
"END How many different times was (he/she) a patient in a hospital overnight (since Wave1 Month, Year / in the last two years before he/she died)?

E3. (Altogether) How many nights was (he/she) a patient int he hospital (since Wave1 Month, Year / in the last two years before he/she died)?
"IF MORE THAN ONE OVERNIGHT HOSPITAL STAYS IN THE LAST TWO YEARS During any of those hospital stays
"ELSE During (his/her) hsopital stay
"END did R FIST NAME spend any time in an intensive care unit?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E3bx.
"IF MORE THAN ONE OVERNIGHT HOSPITAL STAYS IN TIME LAST TWO YEARS (During any of those hospital stays)
"ELSE (During (his/her) hospital stay)
"END did (he/she) was life support equipment, such as a respirator?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E3cx.
"IF MORE THAN ONE OVERNIGHT HOSPITAL STAYS IN THE LAST TWO YEARS (During any of those hospital stays)
"ELSE (During (his/her) hospital stay)
"END did (he/she) use kidney dialysis services?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E3dx.
"IF MORE THAN ONE OVERNIGHT HOSPITAL STAYS IN THE LAST TWO YEARS (During any of those hospital stays)
"ELSE (During (his/her) hospital stay)
"END did (he/she) receive antibiotics to treat pneumonia or other infection?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E4. Were the costs for (his/her) hospital stay(s) completely covered by
"IF BIRTH YEAR ON OR BEFORE 1931 Medicare, Medicaid, or other
"END health insurance, partly covered by insurance, or not covered at all by insurance?

INAP . . . . . 0
FULLY COVERED . . . . . 1
PARTLY COVERED . . . . . 3
NOT COVERED AT ALL . . . . . 5
COSTS NOT SETTLED YET . . . . . 7
DK . . . . . 8
RF . . . . . 9

if: CS2cx( *NOT* IN NURSING HOME)
SKIP to:E5

E4x
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH Earlier you told me that R FIRST NAME died while in a nursing home.
"END How long had (he/she) been a patient in that nursing home before (his/her) death?

DAYS:
MONTHS:
DATE:

INAP . . . . . 0
CONTINUE . . . . . 1

E4ax. Why had (he/she) been admitted to the nursing home?

if: CS11(YES)
SKIP to:E6

E5.
"IF PLACE OF DEATH (NURSING HOME) In addition to that nursing home stay,
"END (Since Wave1 Month, Year / in the last two years before he/she died), had R FIRST NAME been a patient overnight in a nursing home, convalenscent home, or other long-term health care facility?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E10
DK . . . . . 8
RF . . . . . 9

if: CS2cx(IN NURSING HOME) *AND* E5(NO *OR* DK *OR* RF)
SKIP to:E8

E6.
"IF PLACE OF DEATH (NURSING HOME) Including (his/her) final stay,
"END Now many different times was (he/she) a patient in a nursing home or other long-term care facility (since Wave1 Month, Year / in the last two years before he/she died)?

E7. (Altogether) How many nights was (he/she) a patient in a nursing home(since Wave1 Month, Year / in the last two years before he/she died)?

USE 996 FOR CONTINUOUS SINCE ENTERED
NIGHTS:
     OR
MONTHS:

INAP . . . . . 0
CONTINUE . . . . . 1

E8. Were the costs for (his/her) nursing home stay(s) completely covered by
"IF BIRTH YEAR ON OR BEFORE 1931 Medicare, Medicad, or other
"END health insurance, partly covered by insurance, or not covered at all by insurance?

INAP . . . . . 0
FULLY COVERED . . . . . 1
PARTLY COVERED . . . . . 3
NOT COVERED AT ALL . . . . . 5
COSTS NOT SETTLED YET . . . . . 7
DK . . . . . 8
RF . . . . . 9

if: E8( *NOT* PARTLY COVERED *TO* COSTS NOT SETTLED YET) *AND* E4( *NOT* PARTLY COVERED *TO* COSTS NOT SETTLED YET)
SKIP to:Ex10f

E10. About how much did (he/she) ((or his/her husband/wife/partner)) pay out-of-pocket for (nursing home, hospital) bills (since Wave1 Month, Year / in the last two years before he/she died)?

DO NOT PROBE DK/RF
AMOUNT:

if: E10( *NOT* DK *AND* *NOT* RF)
SKIP to:Ex10f

E10a. Was it more than $10,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E10d
DK . . . . . 8
RF . . . . . 9

if: E10a(DK *OR* RF)
SKIP to:Ex10f

E10b. Was it more than $20,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 Ex10f
DK . . . . . 8
RF . . . . . 9

E10c. Was if more than $50,000?

INAP . . . . . 0 Ex10f
YES . . . . . 1 Ex10f
NO . . . . . 5 Ex10f
DK . . . . . 8 Ex10f
RF . . . . . 9 Ex10f

E10d. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 Ex10f
DK . . . . . 8
RF . . . . . 9

E10e. Was it more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: CS2cx( *NOT* IN HOSPICE)
SKIP to:Ex10g

Ex10f. Earlier you told me that R FIRST NAME died while in a hospice. How long had (he/she) been a patient in that hospice before (his/her) death?

DAYS:
MONTHS:
SINCE DATE:
(IWER: USE THE '/' TO MOVE BETWEEN MONTH/DAY/YEAR IN THE DATE FIELD ONLY.) IF PROXY DK DAY IN DATE FIELD, ENDER "15"

Ex10g.
"IF PLACE OF DEATH (HOSPICE) In addition to that hospice stay,
"END (Since Wave1 Month, Year / In the last two years before he/she died) had R FIRST NAME been a patient overnight in a hospice?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E11
DK . . . . . 8
RF . . . . . 9

if: CS2cx(IN HOSPICE) *AND* Ex10g(NO *OR* DK *OR* RF)
SKIP to:Ex10k

Ex10h.
"IF PLACE OF DEATH (HOSPICE) Including (his/her) final stay,
"END How many different times was (he/she) a patient in a hospice (since Wave1 Month, Year / in the last two years before he/she died)?

E10j. (Altogether) How many nights was (he/she) a patient in a hospice (since Wave1 Month, Year / in the last two years before he/she died)? Were the costs for (his/her) hospice stay(s) completely covered by
"IF BIRTH YEAR ON OR BEFORE 1931 Medicare, Medicaid, or other
"END health insurance, partly covered by insurance, or not covered at all by insurance?

INAP . . . . . 0
FULLY COVERED . . . . . 1 E11
PARTLY COVERED . . . . . 3
NOT COVERED AT ALL . . . . . 5
COSTS NOT SETTLED YET . . . . . 7
DK . . . . . 8
RF . . . . . 9

Ex10m. About how much did (he/she) ((or his/her husband/wife/partner)) pay out-of-pocket for hospice care (since Wave1 Month, Year / in the last two years before he/she died)?

DO NOT PROBE DK/RF
AMOUNT:

if: Ex10m( *NOT* DK *AND* *NOT* RF)
SKIP to:E11

Ex10n. Was it more than $10,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 Ex10r
DK . . . . . 8
RF . . . . . 9

if: Ex10n(DK *OR* RF)
SKIP to:E11

Ex10p. Was it more than $20,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E11
DK . . . . . 8
RF . . . . . 9

Ex10q. Was it more than $50,000?

INAP . . . . . 0 E11
YES . . . . . 1 E11
NO . . . . . 5 E11
DK . . . . . 8 E11
RF . . . . . 9 E11

Ex10r. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1 E11
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

Ex10s. Was it more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E11.
"IF R HAD BEEN OVERNIGHT PATIENT IN HOSPITAL SINCE W1 DATE Aside from any hospital stays,
"END How many times did R FIRST NAME see or talk to a medical doctor about (his/her) health, including emergency room or clinic visits (since Wave1 Month, Year / in the last two years before he/she died)?

USE ZERO FOR NONE

if: E11(0 *OR* DK *OR* RF)
SKIP to:E20

E13. Were the costs for (his/her) doctor visit(s) completely covered by
"IF BIRTH YEAR ON OR BEFORE 1931 Medicare, Medicaid, or other
"END health insurance, partly covered by insurance, or not covered at all by insurance?

INAP . . . . . 0
FULLY COVERED . . . . . 1
PARTLY COVERED . . . . . 3
NOT COVERED AT ALL . . . . . 5
COSTS NOT SETTLED YET . . . . . 7
DK . . . . . 8
RF . . . . . 9

if: E13( *NOT* PARTLY COVERED *TO* COSTS NOT SETTLED YET)
SKIP to:E20

About how much did (he/she) (or (his/her) (husband/wife/partner)) pay out-of-pocket for doctor bills (since Wave1 Month, Year / in the last two years before he/she died)? (Except any payments you told me about.)

DO NOT PROBE DK/RF
AMOUNT:

if: E18a( *NOT* DK *AND* *NOT* RF)
SKIP to:E20

E18b. Was it more than $1,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E18e
DK . . . . . 8
RF . . . . . 9

if: E18b(DK *OR* RF)
SKIP to:E20

E18c. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E20
DK . . . . . 8
RF . . . . . 9

E18d. Was it more than $20,000?

INAP . . . . . 0 E20
YES . . . . . 1 E20
NO . . . . . 5 E20
DK . . . . . 8 E20
RF . . . . . 9 E20

E18e. Was it more than $500?

INAP . . . . . 0
YES . . . . . 1 E20
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E18f. Was it more than $200?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E20. Did (he/she) regularly take prescription medications (since Wave1 Month, Year / in the last two years before he/she died)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: E20(NO *OR* DK *OR* RF)
SKIP to:E22

E21. Were the costs of (his/her) prescription medications completely covered by
"IF BIRTH YEAR ON OR BEFORE 1930 Medicare, Medicaid, or other
"END health insurance, partly covered by insurance, or not covered at all by health insurance?

INAP . . . . . 0
FULLY COVERED . . . . . 1 E22
PARTLY COVERED . . . . . 3
NOT COVERED AT ALL . . . . . 5
COSTS NOT SETTLED YET . . . . . 7
DK . . . . . 8
RF . . . . . 9

E21a. On the average, about how much did (he/she) ((or his/her husband/wife/partner)) pay out-of-pocket per month for these prescriptions (since Wave1 Month, Year / in the last two years before he/she died)?

DO NOT PROBE DK/RF
AMOUNT:

if: E21a( *NOT* DK *AND* *NOT* RF)
SKIP to:E22

E21b. Was it more than $20 per month?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E21e
DK . . . . . 8
RF . . . . . 9

if: E21b(DK *OR* RF)
SKIP to:E22

E21c. Was it more than $100 per month?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E22
DK . . . . . 8
RF . . . . . 9

E21d. Was it more than $500 per month?

INAP . . . . . 0 E22
YES . . . . . 1 E22
NO . . . . . 5 E22
DK . . . . . 8 E22
RF . . . . . 9 E22

E21e. Was it more than $10 per month?

INAP . . . . . 0
YES . . . . . 1 E22
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E21f. Was it more than $5 per month?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: CS11(YES)
SKIP to:E25x

E22. (Since Wave1 Month, Year / In the last two years before he/she died) did any medically-trained person come to (his/her) home to help (him/her)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: E22(NO *OR* DK *OR* RF)
SKIP to:E24

E23. Were the costs of (his/her) home medical care completely covered by
"IF BIRTH YEAR ON OR BEFORE 1931 Medicare, Medicaid, or other
"END health insurance, partly covered by insurance, or not covered at all by insurance?

INAP . . . . . 0
FULLY COVERED . . . . . 1
PARTLY COVERED . . . . . 3
NOT COVERED AT ALL . . . . . 5
[VOL] COSTS NOT SETTLED YET . . . . . 7
DK . . . . . 8
RF . . . . . 9

E24. READ SLOWLY (Since Wave1 Month, Year / in the last two years before he/she died), did (he/she) use any special facility or service which we haven't talked about, such as: an adult care center, a social worker, an outpatient rehabilitation program, or transportation or meals for the elderly or disabled?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: E23( *NOT* PARTLY COVERED *TO* [VOL] COSTS NOT SETTLED YET) *AND* E24(NO *OR* DK *OR* RF)
SKIP to:E25ax

E24a. About how much did (he/she) ((or his/her husband/wife/partner)) pay out-of-pocket for (in-home medical care, special facilities or services) (since Wave1 Month, Year / in the last two years before he/she died)?

DO NOT PROBE DK/RF
AMOUNT:

if: E24a( *NOT* DK *AND* *NOT* RF)
SKIP to:E25x

E24b. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E24e
DK . . . . . 8
RF . . . . . 9

if: E24b(DK *OR* RF)
SKIP to:E25x

E24c. Was it more than $10,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E25x
DK . . . . . 8
RF . . . . . 9

E24d. Was it more than $20,000?

INAP . . . . . 0 E25x
YES . . . . . 1 E25x
NO . . . . . 5 E25x
DK . . . . . 8 E25x
RF . . . . . 9 E25x

E24e. Was it more than $1,000?

INAP . . . . . 0
YES . . . . . 1 E25x
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E24f. Was it more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E25x. Aside from the medical expenses we already mentioned, did R FIRST NAME have any other out-of-pocket medical expenses, that is, expenses not covered by insurance, such as medications, special food, equipment such as a special bed or chair, visits by doctors or other health professionals, or other costs?

INAP . . . . . 0 E26x
YES . . . . . 1
NO . . . . . 5 E26x
DK . . . . . 8 E26x
RF . . . . . 9 E26x

E25ax. About how much did (he/she) ((or his/her husband/wife/partner)) pay out-of-pocket for those other expenses (since Wave1 Month, Year / in the last two years before he/she died)?

DO NOT PROBE DK/RF
AMOUNT:

if: E25ax( *NOT* DK *AND* *NOT* RF)
SKIP to:E26x

E25bx. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E25ex
DK . . . . . 8
RF . . . . . 9

if: E25bx(DK *OR* RF)
SKIP to:E26x

E25cx. Was it more than $10,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E26x
DK . . . . . 8
RF . . . . . 9

E25dx. Was it more than $20,000?

INAP . . . . . 0 E26x
YES . . . . . 1 E26x
NO . . . . . 5 E26x
DK . . . . . 8 E26x
RF . . . . . 9 E26x

E25ex. Was it more than $1,000?

INAP . . . . . 0
YES . . . . . 1 E26x
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E25fx. Was if more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: E1( *NOT* YES) *AND* E5( *NOT* YES) *AND* E11(0 *OR* DK *OR* RF) *AND* E20( *NOT* YES) *AND* E22( *NOT* YES) *AND* E24( *NOT* YES) *AND* CS11( *NOT* YES)
SKIP to:E31x

E26. I would like to get a rough idea of the total cost of (his/her)
"IF R HAD BEEN OVERNIGHT PATIENT IN HOSPITAL SINCE W1 DATE hospital stays
"END
"IF PATIENT IN NURSING HOME SINCE W1 OR IN NURSING HOME AT TIME OF DEATH nursing home stays
"END
"IF ONE OR MORE VISITS TO A MEDICAL DOCTOR OR CLINIC doctor and clinic visits
"END
"IF HAD OUTPATIENT SURGERY IN THE LAST TWO YEARS outpatient surgery
"END
"IF RECEIVED DENTAL CARE INTHE LAST TWO YEARS dental visits
"END
"IF TOOK PRESCRIPTION MEDICATIONS IN THE LAST TWO YEARS prescriptions
"END
"IF RECEIVED IN-HOME-MEDICAL CARE IN THE LAST TWO YEARS in-home-medical care
"END (and) all other medical costs for (him/her) (since Wave1 Month, Year / in the last two years before he/she died), including costs covered by
"IF BIRTH YEAR ON OR BEFORE 1931 Medicare, Medicaid, or other
"END health insurance. Do you think the total costs were more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E26b
DK . . . . . 8
RF . . . . . 9

if: E26x(DI *OR* RF *OR* OUT OF RANGE)
SKIP to:E26dx

E26a. Was it more than $1,000?

INAP . . . . . 0 E26dx
YES . . . . . 1 E26dx
NO . . . . . 5 E26dx
DK . . . . . 8 E26dx
RF . . . . . 9 E26dx

E26b. Was it more than $25,000?

INAP . . . . . 0 E26dx
YES . . . . . 1
NO . . . . . 5 E26dx
DK . . . . . 8 E26dx
RF . . . . . 9 E26dx

E26c. Was it more than $100,000?

INAP . . . . . 0 E26dx
YES . . . . . 1
NO . . . . . 5 E26dx
DK . . . . . 8 E26dx
RF . . . . . 9 E26dx

E26d. Was it more than $500,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E26dx. In addition to medical expenses, persons with serious illnesses often have non-medical expenses. Did R FIRST NAME have other out-of-pocket non-medical expenses such as modifying the house with ramps or lifts, hiring help for housekeeping or other household chores or for assisting with personal needs?

INAP . . . . . 0 E27
YES . . . . . 1
NO . . . . . 5 E27
DK . . . . . 8 E27
RF . . . . . 9 E27

E26dax. About how much did (he/she) ((or his/her husband/wife/partner)) pay out-of-pocket for non-medical expenses (since Wave1 Month, Year / in the last two years before he/she died)?

DO NOT PROBE DK/RF
AMOUNT:

E26dbx. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E26dex
DK . . . . . 8
RF . . . . . 9

E26dcx. Was it more than $10,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E27
DK . . . . . 8
RF . . . . . 9

E26ddx. Was it more than $20,000?

INAP . . . . . 0 E27
YES . . . . . 1 E27
NO . . . . . 5 E27
DK . . . . . 8 E27
RF . . . . . 9 E27

E26dex. Was it more than $1,000?

INAP . . . . . 0
YES . . . . . 1 E27
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E26dfx. Was if more than $500?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E27. Did anyone help (him/her) (and his/her husband/wife/partner) pay for (his/her) health care costs (since Wave1 Month, Year / in the last two years before he/she died)? DEF: APART FROM WHAT WAS COVERED BY INSURANCE.

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E31x
DK . . . . . 8
RF . . . . . 9

E28. Was that a (child or other) relative of R FIRST NAME (and his/her husband/wife/partner), or was that someone else?

INAP . . . . . 0 E30
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 1
OTHER RELATIVE . . . . . 2 E30
SOMEONE ELSE . . . . . 3 E30
DK . . . . . 8 E30
RF . . . . . 9 E30

E29. (Which child was that?) CHOOSE ALL THAT APPLY. ACCEPT MORE THAN 1 CHILD ONLY AFTER PROBE: Which child helped the most? IF GRANDCHILD: (Which of (his/her) children is the parent of that grandchild?)

E30. Altogether, about how much money did that help amount to?

AMOUNT:

E31. About how many days did R FIRST NAME stay in bed more than half the day because of illness or injury during the last three months before (his/her) death?

USE 93 FOR EVERY DAY

E59 TIMESTAMP

if: E31x( > 85)
SKIP to: E TIME STAMP

E72fx. The next questions are about help R FIST NAME received with various activities because of a physical, mental, emotional, or memory problem. Please tell me whether R FIRST NAME received any help doing each of the everyday activities that I read to you.

We want to know about help that (he/she) received during the last three months of (his/her) life.

Because of a health or memory problem did anyone help R FIRST NAME get across a room during the last three months of (his/her) life?

INAP . . . . . 0 E73fx
YES . . . . . 1
NO . . . . . 5 E73fx
COULDN'T DO . . . . . 6 E73fx
DIDN'T DO . . . . . 7 E73fx
DK . . . . . 8 E73fx
RF . . . . . 9 E73fx

E72gx. How long had (he/she) needed help with walking? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

E73fx. (Because of a health or memory problem) Did anyone help (him/her) dress in the last 3 months of (his/her) life?

INAP . . . . . 0 E74fx
YES . . . . . 1
NO . . . . . 5 E74fx
COULDN'T DO . . . . . 6 E74fx
DIDN'T DO . . . . . 7 E74fx
DK . . . . . 8 E74fx
RF . . . . . 9 E74fx

E73gx. How long had (he/she) needed help with dressing? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

E74fx. (Because of a health or memory problem) Did anyone help (him/her) with bathing or showering in the last 3 months of (his/her) life?

INAP . . . . . 0 E75fx
YES . . . . . 1
NO . . . . . 5 E75fx
COULDN'T DO . . . . . 6 E75fx
DIDN'T DO . . . . . 7 E75fx
DK . . . . . 8 E75fx
RF . . . . . 9 E75fx

E74gx. How long had (he/she) needed help with bathing? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

E75fx. (Because of a health or memory problem) Did anyone help (him/her) eat in the last 3 months of (his/her) life?

INAP . . . . . 0 E76fx
YES . . . . . 1
NO . . . . . 5 E76fx
COULDN'T DO . . . . . 6 E76fx
DIDN'T DO . . . . . 7 E76fx
DK . . . . . 8 E76fx
RF . . . . . 9 E76fx

E75gx. How long had (he/she) needed help with eating? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

E76fx. (Because of a health or memory problem) Did anyone help (him/her) get in or out of bed in the last 3 months of (his/her) life?

INAP . . . . . 0 E77fx
YES . . . . . 1
NO . . . . . 5 E77fx
COULDN'T DO . . . . . 6 E77fx
DIDN'T DO . . . . . 7 E77fx
DK . . . . . 8 E77fx
RF . . . . . 9 E77fx

E76gx. How long had (he/she) needed help with getting in or out of bed? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

E77fx. (Because of a health or memory problem) Did anyone help (him/her) use the toilet in the last 3 months of (his/her) life?

INAP . . . . . 0 E83
YES . . . . . 1
NO . . . . . 5 E83
COULDN'T DO . . . . . 6 E83
DIDN'T DO . . . . . 7 E83
DK . . . . . 8 E83
RF . . . . . 9 E83

E77gx. How long had (he/she) needed help with using the toilet? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

ADLHELP.CKPT IF ANY ADL HELPERS

E83 TIMESTAMP

E83. Who most often helped (him/her) with
"IF RECEIVED HELP GETTING ACROSS A ROOM IN THE LAST 3 MONTHS LIFE getting across a room,
"END
"IF RECEIVED HELP DRESSING IN THE LAST 3 MONTHS OF LIFE dressing,
"END
"IF RECEIVED HELP BATHING IN THE LAST 3 MONTHS OF LIFE bathing,
"END
"IF RECEIVED HELP EATING IN THE LAST 3 MONTHS OF LIFE eating,
"END
"IF RECEIVED HELP GETTING IN AND OUT OF BED IN LAST 3 MONTHS OF LIFE getting in and out of bed,
"END
"IF RECEIVED HELP USING THE TOILET IN THE LAST 3 MONTHS OF LIFE using the toilet
"END during the last three months of (his/her) life?

if: E83( *NOT* NOT ON LIST)
SKIP to:E83c

E83a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH AND NAME NOT ON LIST OF HELPERS or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E83c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E83b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E83c. Did anyone else help (him/her) with (this activity/these activities)?

INAP . . . . . 0 E92x
YES . . . . . 1
NO . . . . . 5 E92x
DK . . . . . 8 E92x
RF . . . . . 9 E92x

E84. Who was that?

E84a. What was the person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E84c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E84b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E84c. Did anyone else help (him/her) with (this activity/these activities)?

INAP . . . . . 0 E92x
YES . . . . . 1
NO . . . . . 5 E92x
DK . . . . . 8 E92x
RF . . . . . 9 E92x

E85. Who was that?

E85a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E85c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E85b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E85c. Did anyone else help (him/her) with (this activity/these activities)?

INAP . . . . . 0 E92x
YES . . . . . 1
NO . . . . . 5 E92x
DK . . . . . 8 E92x
RF . . . . . 9 E92x

E86. Who was that?

E86a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E86c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E86b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E86c. Did anyone else help (him/her) with (this activity/these activities)?

INAP . . . . . 0 E92x
YES . . . . . 1
NO . . . . . 5 E92x
DK . . . . . 8 E92x
RF . . . . . 9 E92x

E87. Who was that?

E87a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E87c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E87b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E87c. Did anyone else help (him/her) with (this activity/these activities)?

INAP . . . . . 0 E92x
YES . . . . . 1
NO . . . . . 5 E92x
DK . . . . . 8 E92x
RF . . . . . 9 E92x

E88. Who was that?

E88a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E88c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E88b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E88c. Did anyone else help (him/her) with (this activity/these activities)?

INAP . . . . . 0 E92x
YES . . . . . 1
NO . . . . . 5 E92x
DK . . . . . 8 E92x
RF . . . . . 9 E92x

E89. Who was that?

E89a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E92x
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E89b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E92x. Here are a few other activities which some people need help with because of a physical, mental, emotional, or memory problem.

Please tell me whether R FIRST NAME received any help with each activity I name. If (he/she) didn't do the activity at all, just tell me so.

We want to know about help that (he/she) received in the last three months of (his/her) life.

E95x. (Because of a health or memory problem) Did anyone help (him/her) prepare hot meals in the last 3 months of (his/her) life?

INAP . . . . . 0
YES . . . . . 1 E95GX
NO . . . . . 5 E96x
COULDN'T DO . . . . . 6
DIDN'T DO . . . . . 7
DK . . . . . 8
RF . . . . . 9

E95bx. Was that because of a health or memory problem?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E96x
DK . . . . . 8
RF . . . . . 9

E95gx. How long had (he/she) needed help with preparing hot meals? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

E96x. (Because of a health or memory problem) Did anyone help (him/her) shop for groceries in the last 3 months of (his/her) life?

INAP . . . . . 0
YES . . . . . 1 E96GX
NO . . . . . 5 E97x
COULDN'T DO . . . . . 6
DIDN'T DO . . . . . 7
DK . . . . . 8
RF . . . . . 9

E96bx. Was that because of a health or memory problem?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E97x
DK . . . . . 8
RF . . . . . 9

E96gx. How long had (he/she) needed help with shopping for groceries? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

E97x. (Because of a health or memory problem) Did anyone help (him/her) make telephone calls in the last 3 months of (his/her) life?

INAP . . . . . 0
YES . . . . . 1 E97GX
NO . . . . . 5 E98x
COULDN'T DO . . . . . 6
DIDN'T DO . . . . . 7
DK . . . . . 8
RF . . . . . 9

E97bx. Was that because of a health or memory problem?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E98x
DK . . . . . 8
RF . . . . . 9

E97gx. How long had (he/she) needed help making telephone calls? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

E98x. (Because of a health or memory problem) Did anyone help (him/her) with taking medication in the last 3 months of (his/her) life?

INAP . . . . . 0
YES . . . . . 1 E98GX
NO . . . . . 5 E99
COULDN'T DO . . . . . 6
DIDN'T DO . . . . . 7
DK . . . . . 8
RF . . . . . 9

E98bx. Was that because of a health or memory problem?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E99
DK . . . . . 8
RF . . . . . 9

E98gx. How long had (he/she) needed help with taking medications? RECORD MONTHS OR YEARS, OR SINCE AGE, OR SINCE YEAR

MONTHS:
YEARS:
SINCE AGE:
SINCE YEAR:

if: E95x( *NOT* YES) *AND* E95bx( *NOT* YES) *AND* E96x( *NOT* YES) *AND* E96bx( *NOT* YES) *AND* E97x( *NOT* YES) *AND* E97bx( *NOT* YES) *AND* E98x( *NOT* YES) *AND* E98bx( *NOT* YES)
SKIP to:E106CX

E99. Who most often helped (him/her)
"IF R RECEIVED HELP WITH PREPARING MEALS OR DIDN'T DO BECAUSE OF HEALTH OR MEMORY PROBLEM prepare meals,
"END
"IF R RECEIVED HELP WITH SHOPPING FOR GROCERIES OR DIDN'T DO BECAUSE OF HEALTH OR MEMORY PROBLEM shop for groceries
"END
"IF R RECEIVED HELP MAKING TELEPHONE CALLS OR DIDN'T DO BECAUSE OF HEALTH OR MEMORY PROBLEM make telephone calls
"END
"IF R RECEIVED HELP TAKING MEDICATION OR DIDN'T DO BECAUSE OF HEALTH OR MEMORY PROBLEM take medications?
"END

E99a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E99c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E99b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E99c. Did anyone else help (him/her)
"IF NEED HELP, COULDN'T DO, DIDN'T DO BECAUSE OF HEALTH/MEMORY PROBLEM preapre meals,
"END
"IF NEED HELP, COULDN'T DO, DIDN'T DO BECAUSE OF HEALTH/MEMORY PROBLEM shop for groceries
"END
"IF NEED HELP, COULDN'T DO, DIDN'T DO BECAUSE OF HEALTH/MEMORY PROBLEM make telephone calls
"END
"IF NEED HELP, COULDN'T DO, DIDN'T DO BECAUSE OF HEALTH/MEMORY PROBLEM take medications?
"END

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: E99c( *NOT* YES)
SKIP to:E106cx

E100. Who else helped (him/her)?

E100a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E100c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E100b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E100c. Did anyone else help (him/her) with these activities?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: E100c( *NOT* YES)
SKIP to:E106cx

E101. Who else helped (him/her)?

E101a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they an employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E101c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E101b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E101c. Did anyone else help (him/her) with these activities?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: E101c( *NOT* YES)
SKIP to:E106CX

E102. Who else helped (him/her)?

E102a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they on employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E102C
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E102b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E102c. Did anyone else help (him/her) with these activities?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: E102c( *NOT* YES)
SKIP to:E106CX

E103. Who else helped (him/her)?

E103a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they on employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E103c
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E103b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E103c. Did anyone else help (him/her) with these activities?

INAP . . . . . 0 E106CX
YES . . . . . 1
NO . . . . . 5 E106CX
DK . . . . . 8 E106CX
RF . . . . . 9 E106CX

E104. Who else helped (him/her)?

E104a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they on employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E106CX
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E104b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E106cx. (Because of a health or memory problem) Did anyone help (him/her) mange (his/her) money in the last 3 months of (his/her) life?

INAP . . . . . 0
YES . . . . . 1 E107
NO . . . . . 5 E TIME STAMP
COULDN'T DO . . . . . 6
DIDN'T DO . . . . . 7
DK . . . . . 8
RF . . . . . 9

E106dx. Was that because of a health or memory problem?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 E TIME STAMP
DK . . . . . 8
RF . . . . . 9

E107. Who most often helped (him/her) manage (his/her) money?

E107a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they on employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E107c.
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

if: E107a(DK *OR* RF)
SKIP to:E107c

E107b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E107c. Did anyone else help (him/her) manage (his/her) money in the last 3 months of (his/her) life?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E108. Who was that?

E108a. What was that person's relationship to R FIRST NAME?
"IF RESIDENT IN NURSING HOME AT TIME OF DEATH and NOT ON LIST or were they on employee of the place (he/she) lived?
"END

INAP . . . . . 0
UNLISTED CHILD OR CHILD-IN-LAW . . . . . 2
EMPLOYEE OF "INSTITUTION" . . . . . 3 E TIME STAMP
GRANDCHILD . . . . . 4
RELATIVE-OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7
DK . . . . . 8
RF . . . . . 9

E108b.
"IF RELATIONSHIP OF HELPER WAS GRANDCHILD What is the first name of that grandchild?
"ELSE RELATIONSHIP OF HELPER WAS OTHER RELATIVE What is the name of that relative?
"ELSE RELATIONSHIP OF HELPER WAS OTHER INDIVIDUAL OR DON'T KNOW OR REFUSED What is the name of that individual?
"ELSE RELATIONSHIP OF HELPER WAS UNLISTED CHILD OR CHILD-IN-LAW What is the name of that child?
"ELSE What is the name of that organization?
"END

E TIME STAMP

E58. HELPER LIST

HELPER INTRO.

Let's think for a moment about the help R FIRST NAME received that we just talked about.

HELPER RELATIONSHIP

E158. AFFIRM SEX OF HELPER: (IS (NAME OF HELPER)) ASKED ONLY IF NECESSARY

INAP . . . . . 0
MALE . . . . . 1
FEMALE . . . . . 2
AGENCY/PROFESSIONAL/EMPLOYEE OF INSTITUTION . . . . . 3
DK . . . . . 8
RF . . . . . 9

E159. IF GRANDCHILD: (Which of (his/her) childen is the parent of that grandchild?)

E160. In a typical month, on about how many days did (NAME OF HELPER) help R FIRST NAME?

DAYS IN TYPICAL MONTH:
DAYS PER WEEK:

INAP . . . . . 0
EVERY DAY . . . . . 1

E161. On the days (NAME OF HELPER) helped (him/her), about how many hours per day was that? LESS THAN AN HOUR = 1

E162. Was (NAME OF HELPER) paid to help (him/her)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E163. Did Medicaid or insurance help pay (NAME OF HELPER)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E164. (Not counting expenses paid by Medicaid or insurance,) about how much did (he/she) (and his/her husband/wife/partner) end up paying (NAME OF HELPER) per month?

AMOUNT:
PER:

INAP . . . . . 0
MONTH . . . . . 1
WEEK . . . . . 2
DAY . . . . . 3
YEAR . . . . . 5
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

if: E164( *NOT* DK *AND* *NOT* RF)
SKIP to:E167

E166. Was it more than $100 for the month?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E167. Did any other person help R FIRST NAME (and his/her husband/wife/partner) pay this cost?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

E168. Was that a (child or other) relative of R FIRST NAME (and his/her husband/wife/partner), or was that someone else?

INAP . . . . . 0
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 1
OTHER RELATIVE . . . . . 2
SOMEONE ELSE . . . . . 3
DK . . . . . 8
RF . . . . . 9

E169. (Which child was that?) IF GRANDCHILD: (Which of (his/her) children is the parent of that grandchild?)

E169. (Which child was that?) IF GRANDCHILD: (Which of (his/her) children is the parent of that grandchild?)

END of case

CKPT

E TIME STAMP

F0 TIME STAMP

 

SECTION G -- WORK STATUS

if: Q185 ( *NOT* 2)
SKIP to:GC16

GC2. Now I'd like to ask you some questions about (his/her) employment situation since we last spoke to (him/her) before (his/her) death. According to our records, in W1 IW YEAR R FIRST NAME was self-employed. In what month and year did (he/she) stop working for (him/her)self? MONTHS ENTERED MUST BE BETWEEN W1 IW MONTH, W1 IW YEAR AND CUR MONTH T, CUR YEAR YY

MONTH:
YEAR:

INAP . . . . . 0
DENIES BEING SELF EMPLOYED AT WAVE I . . . . . 96 GC2z
DK . . . . . 98
RF . . . . . 99

if: HOURS WORKED PER YEAR( < = 520)
SKIP to:GC5

GC3. Was (he/she) paid a regular salary or wages?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 GC4
DK . . . . . 8
RF . . . . . 9

GC3a. How much was (he/she) paid before taxes and other deductions? IF PER HOUR BE SURE TO ADD .00 FOR CENTS IF THERE ARE NONE. PROBE IF NECESSARY: Was that per hour, week, month, or year?

AMOUNT:
PER:

INAP . . . . . 0
HOUR . . . . . 1
WEEK . . . . . 2
EVERY TO WEEKS/BI-WEEKLY . . . . . 3
MONTH . . . . . 4
TWICE A MONTH . . . . . 5
YEAR . . . . . 6
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

GC4. Did (he/she) receive some or all of the net earnings or profits?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 GC5
DK . . . . . 8
RF . . . . . 9

GC4a. (In addition to (his/her) regular salary,) How much did (he/she) receive from net earnings or profits? IF PROXY HAS TROUBLE GIVING DOLLAR FIGURE, ASK: What did (he/she) earn the last year (he/she) worked? IF PER HOUR BE SURE TO ADD .00 FOR CENTS IF THERE ARE NONE. PROBE IF NECESSARY: Wash that per hour, week, month, or year?

AMOUNT:
PER:

INAP . . . . . 0
HOUR . . . . . 1
WEEK . . . . . 2
EVERY TO WEEKS/BI-WEEKLY . . . . . 3
MONTH . . . . . 4
TWICE A MONTH . . . . . 5
YEAR . . . . . 6
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

GC5. Why did (he/she) stop working at that business? DO NOT PROBE BUT ENTER ALL THAT APPLY

INAP . . . . . 00,
BUSINESS CLOSED . . . . . 01,
LAID OFF/LET GO . . . . . 02,
POOR HEALTH/DISABLED . . . . . 03,
FAMILY CARE . . . . . 04,
BETTER JOB . . . . . 05,
QUIT . . . . . 06,
RETIRED . . . . . 07,
BUSINESS REQURIED TOO MUCH TIME . . . . . 08,
DIED . . . . . 09,
OTHER (SPECIFY) . . . . . 97,
DK . . . . . 98,
RF . . . . . 99,

GC6. Were there any months between W1 IW MONTH W1 IW YEAR and GC2 GC2a when (he/she) did not work?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 GC7
DK . . . . . 8
RF . . . . . 9

GC6a. Which months were those? ENTER ALL THAT APPLY. MONTHS ENTERED MUST BE BETWEEN W1 IW YEAR AND GC2, GC2a

INAP . . . . . 00,
ALL OF 1993 AFTER W1 IW . . . . . 36,
ALL OF 1994 . . . . . 37, E73fx
ALL OF 1995 TO DATE . . . . . 38,
ALL OF 1996 TO DATE . . . . . 39,
OTHER (SPECIFY) . . . . . 97,
DK . . . . . 98,
RF . . . . . 99,

if: HOURS WORKED PER YEAR ( < = 520)
SKIP to: N1x

GC7. Aside from IRA or Keogh plans, was (he/she) included in any pension or retirement plans, or any tax-deferred savings plans through (his/her) business?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N1x
DK . . . . . 8
RF . . . . . 9

GC8. I would like to know what type of plan that was. In some retirement plans, Type A, benefits are usually based on a formula involving age, years of service, and salary. In other plans, Type B, money is accumulated in an account. Was (his/her) plan Type A or Type B?

INAP . . . . . 0
TYPE A . . . . . 1
TYPE B . . . . . 2 E73fx
BOTH TYPES . . . . . 3
DK . . . . . 8
RF . . . . . 9

GC8a. How much money was left in (his/her) (Type B) account when (he/she) stopped working at that business?

AMOUNT:

GC9. When (he/she) died, was there a cash settlement, are survivors receiving benefits, were those benefits lost, or what? IWER: IF THERE WAS A CASH SETTLEMENT OR SURVIVORS BENEFITS, ENTER A COMMENT THAT INDICATE WHO RECEIVED THEM. DO NOT PROBE BUT ENTER ALL THAT APPLY.

INAP . . . . . 0, GC9e
EXPECT FUTURE BENEFITS . . . . . 1, GC9e
SURVIVOR RECEIVING BENEFITS NOW . . . . . 2,
RECEIVED CASH SETTLEMENT . . . . . 3, GC9e
ROLLED OVER INTO IRA . . . . . 4, GC9e
LOST BENEFITS . . . . . 5, GC9e
OTHER (SPECIFY) . . . . . 7, GC9e
DK . . . . . 8, GC9e
RF . . . . . 9, GC9e

GC9a. In what month and year did (he/she) start to receive these benefits? MONTHS ENTERED MUST BE BETWEEN W1 IW MONTH, W1 IWYEAR AND CUR MONTH T, CUR YEAR YY

MONTH:
YEAR:

GC9b. How much are the benefits per month or year? PROBE IF NECESSARY: Is that per month or year?

AMOUNT:
PER:

INAP . . . . . 0
HOUR . . . . . 1
WEEK . . . . . 2
EVERY TO WEEKS/BI-WEEKLY . . . . . 3
MONTH . . . . . 4
TWICE A MONTH . . . . . 5
YEAR . . . . . 6
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

GC9c. Are the benefits adjusted for changes in the cost of living?

INAP . . . . . 0
YES . . . . . 1 GC9e
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

GC9d. Have they ever been adjusted for changes in the cost of living?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: GC9( *NOT* RECEIVED CASH SETTLEMENT)
SKIP to:GC9G

GC9e. RECEIVED CASH SETTLEMENT How much did that amount to?

AMOUNT:

SKIP to:GC9G

GC9f. What did (he/she) do with the money?

INAP . . . . . 0,
BOUGHT DURABLES . . . . . 1,
SPENT IT . . . . . 2, E73fx
SAVED/INVESTED . . . . . 3,
PAID OFF DEBT . . . . . 4,
ROLLED INTO IRA . . . . . 5,
OTHER (SPECIFY) . . . . . 7,
DK . . . . . 8,
RF . . . . . 9,

if: GC9( *NOT* ROLLED OVER INTO IRA)
SKIP to:GC10

GC9g. ROLLED OVER INTO IRA How much did that amount to?

AMOUNT:

if: Q185 (2)
SKIP to: G/H TIME ST

GC16. Now I'd like to ask you some questions about (his/her) employment situation since we last spoke to (him/her) before (his/her) death.

According to our records, in W1 IW MONTH W1 IW YEAR (he/she) was working for pay. In what month and year did (he/she) stop working? MONTH ENTERED MUST BE BETWEEN W1 IW MONTH, W1 IW YEAR AND CUR MONTH T, CUR YEAR

MONTH:
YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

GC16b. What was (he/she) earning, before deductions, when (he/she) left that employer? IF PER HOUR BE SURE TO ADD .00 FOR CENTS IF THERE ARE NONE. PROBE IF NECESSARY: Was that per hour, week, month, or year?

AMOUNT:
PER:

INAP . . . . . 0
HOUR . . . . . 1
WEEK . . . . . 2
EVERY TO WEEKS/BI-WEEKLY . . . . . 3
MONTH . . . . . 4
TWICE A MONTH . . . . . 5
YEAR . . . . . 6
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

GC17. Why did (he/she) leave that employer? PROBE IF NECESSARY: Did the business close, was (he/she) laid off or let go, did (he/she) leave to take care of family members or what? DO NOT PROBE BUT ENTER ALL THAT APPLY:

INAP . . . . . 00,
BUSINESS CLOSED . . . . . 01, GC18
LAID OFF/LET GO . . . . . 02, GC18
POOR HEALTH/DISABLED . . . . . 03,
FAMILY CARE . . . . . 04,
BETTER JOB . . . . . 05,
QUIT . . . . . 06,
RETIRED . . . . . 07,
DIED . . . . . 08, GC18
OTHER (SPECIFY) . . . . . 97,
DK . . . . . 98,
RF . . . . . 99,

if: GC17(BUSINESS CLOSED *TO* RETIRED *OR* OTHER (SPECIFY) *AND* GC17(DK *OR* RF)
INVALID COMBINATION
BACK to:GC17

GC17a. Did (his/her) employment situation change in some way that encouraged (him/her) to leave?

INAP . . . . . 0 GC17c
YES . . . . . 1
NO . . . . . 5 GC17c
DK . . . . . 8 GC17c
RF . . . . . 9 GC17c

GC17b. How did it change? CHOOSE ALL THAT APPLY

INAP . . . . . 00,
SUPERVISOR ENCOURAGED DEPARTURE . . . . . 01,
COWORKER ENCOURAGED DEPARTURE . . . . . 02,
WAGES REDUCED (OR ABOUT TO BE REDUCED) . . . . . 03,
HOURS REDUCED (OR ABOUT TO BE REDUCED) . . . . . 04, GC18
WOULD HAVE BEEN LAID OFF . . . . . 05,
NEW JOB DUTIES . . . . . 06,
NEW JOB LOCATION . . . . . 07,
BECAME ELIGIBLE FOR PENSION . . . . . 08,
EMPLOYER CHANGED HEALTH INSURANCE . . . . . 09,
SPECIAL EARLY RETIREMENT INCENTIVE OFFER . . . . . 10,
OTHER (SPECIFY) . . . . . 97,
DK . . . . . 98,
RF . . . . . 99,

GC17c. If (his/her) employer had allowed (him/her) to work fewer hours with correspondingly less pay, would (he/she) have continued working there?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: GC16(DK *OR* RF) *OR* GC16a(DK *OR* RF) *OR* GC16MY|(364( < 2)
SKIP to:GC19

GC18. Between W1 IW MONTH W1 IW YEAR when we last talked with (him/her), and GC16 GC16a when (he/she) stopped working for someone else, were there any months when (he/she) was not working?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 GC19
DK . . . . . 8
RF . . . . . 9

GC18a. Which months were those? ENTER ALL THAT APPLY. MONTHS ENTERED MUST BE BETWEEN W1 IW MONTH, W1 IW YEAR AND GC16, GC16a

INAP . . . . . 00,
ALL OF 1993 AFTER W1 IW . . . . . 36,
ALL OF 1994 . . . . . 37,
ALL OF 1995 TO DATE . . . . . 38,
ALL OF 1996 TO DATE . . . . . 39,
OTHER (SPECIFY) . . . . . 97,
DK . . . . . 98,
RF . . . . . 99,

if: HOURS WORKED PER YEAR ( < = 520)
SKIP to:G/H TIME ST

GC19. Was (he/she) included in a pension or retirement plan, or in any tax deferred savings plan, when (he/she) worked for that employer?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 G/H TIME ST
DK . . . . . 8
RF . . . . . 9

GC20. I would like to know what type of plan this was. In some retirement plans, Type A, benefits are usually based on a formula involving age, years of service, and salary. In other plans, Type B, money is accumulated in an account. Was (his/her) plan Type A or Type B?

INAP . . . . . 0
TYPE A . . . . . 1 GC21
TYPE B . . . . . 2
BOTH TYPES . . . . . 3
DK . . . . . 8
RF . . . . . 9

GC20a. How much money was in (his/her) (Type B) account when (he/she) left that employer?

AMOUNT:

if: GC20(TYPE B)
SKIP to:G/H TIME ST

GC21. When (he/she) died, was there a cash settlement, are survivors receiving benefits, were those benefits lost, or what? IWER: IF THERE WAS A CASH SETTLEMENT OR SURVIVORS BENEFITS, ENTER A COMMENT THAT INDICATES WHO RECEIVED THEM. DO NOT PROBE BUT ENTER ALL THAT APPLY.

INAP . . . . . 0, GC21g
EXPECT FUTURE BENEFITS . . . . . 1, GC21g
SURVIVOR RECEIVING BENEFITS NOW . . . . . 2,
RECEIVED CASH SETTLEMENT . . . . . 3, GC21g
ROLLED OVER INTO IRA . . . . . 4, GC21g
LOST BENEFITS . . . . . 5, GC21g
OTHER (SPECIFY) . . . . . 7, GC21g
DK . . . . . 8, GC21g
RF . . . . . 9, GC21g

GC21a. In what month and year did (he/she) start to receive these benefits? MONTHS ENTERED MUST BE BETWEEN W1 IW MONTH, W1 IW YEAR AND CUR MONTH T, CUR YEAR YY

MONTH:
YEAR:

GC21c. How much are the benefits per month or year? PROBE IF NECESSARY: Is that per month or year?

AMOUNT:
PER:

INAP . . . . . 0
HOUR . . . . . 1
WEEK . . . . . 2
EVERY TO WEEKS/BI-WEEKLY . . . . . 3
MONTH . . . . . 4
TWICE A MONTH . . . . . 5
YEAR . . . . . 6
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

GC21e. Are the benefits adjusted for changes in the cost of living?

INAP . . . . . 0
YES . . . . . 1 GC21g
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

GC21f. Have they ever been adjusted for changes in the cost of living?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: GC21( *NOT* RECEIVED CASH SETTLEMENT)
SKIP to:GC21j

GC21g. How much did the cash settlement amount to?

AMOUNT:

if: GC21( *NOT* ROLLED OVER INTO IRA)
SKIP to: N1x

GC21j. How much did the rollover amount to?

AMOUNT:

G/H TIME STAMP

J END TIME STAMP

 

SECTION N -- CAPITAL GAINS

N TIME STAMP

if: W1 OWN RENT( *NOT* OWN)
SKIP to:N6x

N1x.
"IF SPOUSE ALIVE (NOT YEAS) and TYPE OF INTERVIEW (NOT PROXY IS SURVIVING SPOUSE) Our records show that R FIRST NAME owned a home
"ELSE SPOUSE ALIVE (NOT YES) and PROXY IS SURVIVING SPOUSE Our records show that you and R FIRST NAME owned a home
"ELSE SPOUSE ALIVE and TYPE OF INTERVIEW (NOT PROXY IS SURVIVING SPOUSE) Our records show that (he/she) and (his/her) (husband/wife/partner / late husband/wife/partner) owned a home
"ELSE Our records show that you and (he/she) owned a home
"END in (City) (State) in W1 IW MONTH W1 IW YEAR. Did R FIRST Name still own that home when (he/she) died?

INAP . . . . . 0 N6x
YES . . . . . 1 N3x
NO . . . . . 5
DK . . . . . 8 N6x
RF . . . . . 9 N6x

N1ax. What happened to that home -- did R FIRST NAME sell it, give it to someone, or what?

INAP . . . . . 0 N6x
GAVE TO SOMEONE . . . . . 1
SOLD . . . . . 2 N2
OTHER . . . . . 7 N6x
DK . . . . . 8 N6x
RF . . . . . 9 N6x

N1bx. To whom did (he/she) give the house, (that is, what was their relationship to R FIRST NAME)? CHOOSE ALL THAT APPLY

INAP . . . . . 0, N6x
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 2,
OTHER RELATIVE . . . . . 3, N6x
FRIEND . . . . . 4, N6x
CHARITY . . . . . 5, N6x
SOMEONE ELSE . . . . . 7, N6x
DK . . . . . 8, N6x
RF . . . . . 9, N6x

N1cx. (Which child is that?) CHOOSE ALL THAT APPLY. IF GRANDCHILD: Which child of R FIRST NAME (or his/her husband/wife/partner) is the parent of that grandchild?

if: N1ax(GAVE TO SOMEONE)
SKIP to:N6x

N2. What was the selling price? DO NOT PROBE DK

if: N2 ( *NOT* DK *AND* *NOT* RF)
SKIP to:N6x

N2a. Was it more than $50,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N2c
DK . . . . . 8
RF . . . . . 9

if: N2a(DK *OR* RF)
SKIP to:N6x

N2b. Was it more than $200,000?

INAP . . . . . 0 N6x
YES . . . . . 1 N6x
NO . . . . . 5 N6x
DK . . . . . 8 N6x
RF . . . . . 9 N6x

N2c. Was it more than $15,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N3x. What happened to that home after R FIRST NAME'S death:
"IF PROXY IS SURVIVING SPOUSE Do you own it now,
"ELSE SPOUSE ALIVE Does (his/her) (husband/wife/partner) own it now,
"END was it sold, was it inherited by someone else, has it not yet been disposed of, or what?

INAP . . . . . 0 N6x
SURVIVING SPOUSE STILL OWNS IT . . . . . 1 N6x
SOLD . . . . . 2 N4x
INHERITED . . . . . 3
NOT YET DISPOSED . . . . . 4 N5x
OTHER . . . . . 7 N6x
DK . . . . . 8 N6x
RF . . . . . 9 N6x

N3ax. Who inherited the house, (that is, what was their relationship to R FIRST NAME)? CHOOSE ALL THAT APPLY

INAP . . . . . 0, N6x
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 2,
OTHER RELATIVE . . . . . 3, N6x
FRIEND . . . . . 4, N6x
CHARITY . . . . . 5, N6x
SOMEONE ELSE . . . . . 7, N6x
DK . . . . . 8, N6x
RF . . . . . 9, N6x

N3bx. (Which child is that?) CHOOSE ALL THAT APPLY. IF GRANDCHILD: Which child of R FIRST NAME (or his/her husband/wife/partner) is the parent of that grandchild?

INAP . . . . . 00,

if: N3x(INHERITED)
SKIP to:N6x

N4x. What was the selling price? DO NOT PROBE DK

if: N4x( *NOT* DK *AND* *NOT* RF)
SKIP to:N5x

N4a. Was it more than $50,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N4c
DK . . . . . 8
RF . . . . . 9

if: N4a(DK *OR* RF)
SKIP to:N6x

N6b. Was it more than $200,000?

INAP . . . . . 0 N6x
YES . . . . . 1 N6x
NO . . . . . 5 N6x
DK . . . . . 8 N6x
RF . . . . . 9 N6x

N6c. Was it more than $15,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: N3x( *NOT* NOT YET DISPOSED)
SKIP to:N6x

N5x. Is that home now vacant, or is someone living there?

INAP . . . . . 0 N6x
VACANT . . . . . 1 N6x
OCCUPIED . . . . . 2
INHERITED . . . . . 3 N6x
DK . . . . . 8 N6x
RF . . . . . 9 N6x

N5ax. Who lives in the house, (that is, what was their relationship to R FIRST NAME)? CHOOSE ALL THAT APPLY

INAP . . . . . 0, N6x
SPOUSE . . . . . 1, N6x
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 2,
OTHER RELATIVE . . . . . 3, N6x
FRIEND . . . . . 4, N6x
CHARITY . . . . . 5, N6x
SOMEONE ELSE . . . . . 7, N6x
DK . . . . . 8, N6x
RF . . . . . 9, N6x

N5bx. (Which child is that?) CHOOSE ALL THAT APPLY. IF GRANDCHILD: Which child of R FIRST NAME (or his/her husband/wife/partner) is the parent of that grandchild?

if: Q203(S) *AND* HH2 HAS 2ND( *NOT* HAS 1 OTHER RESIDENCE)
SKIP to:N62x.

N6x. Our records show that R FIRST NAME also had a home in (2nd Residence City) (2nd Residence State). Did (he/she) own that home when (he/she) died?

INAP . . . . . 0 N62x.
YES . . . . . 1 N8x
NO . . . . . 5
DK . . . . . 8 N62x.
RF . . . . . 9 N62x.

N6ax. Did R FIRST NAME ever own it?

INAP . . . . . 0 N62x.
YES . . . . . 1
NO . . . . . 5 N62x.
DK . . . . . 8 N62x.
RF . . . . . 9 N62x.

N6bx. What happened to that home -- did R FIRST NAME sell it, give it to someone, or what?

INAP . . . . . 0
GAVE TO SOMEONE . . . . . 1
SOLD . . . . . 2
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

if: N6bx( *NOT* GAVE TO SOMEONE *AND* *NOT* SOLD)
SKIP to:N62x.

if: N6bx(SOLD)
SKIP to:N6a

N6cx. To whom did (he/she) give the house, (that is, what was their relationship to R FIRST NAME)? CHOOSE ALL THAT APPLY

INAP . . . . . 0, N62x.
SPOUSE . . . . . 1, N62x.
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 2,
OTHER RELATIVE . . . . . 3, N62x.
FRIEND . . . . . 4, N62x.
CHARITY . . . . . 5, N62x.
SOMEONE ELSE . . . . . 7, N62x.
DK . . . . . 8, N62x.
RF . . . . . 9, N62x.

N6dx. (Which child is that?) CHOOSE ALL THAT APPLY. IF GRANDCHILD: Which child of R FIRST NAME (or his/her husband/wife/partner) is the parent of that grandchild?

INAP . . . . . 00,
DECEASED CHILD . . . . . 10,
ALL CHILDREN . . . . . 11,

if: N6bx(GAVE TO SOMEONE)
SKIP to:N62x.

N6. What was the selling price? DO NOT PROBE DK

if: N6( *NOT* DK *AND* *NOT* RF)
SKIP to:N62x.

N6a. Was it more than $50,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N6c
DK . . . . . 8
RF . . . . . 9

if: N6a(DK *OR* RF)
SKIP to:N62x.

N6b. Was it more than $200,000?

INAP . . . . . 0 N62x.
YES . . . . . 1 N62x.
NO . . . . . 5 N62x.
DK . . . . . 8 N62x.
RF . . . . . 9 N62x.

N6c. Was it more than $15,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N8x. What happened to that home after R FIRST NAME'S death: was it sold, was it inherited by someone else, has it not yet been disposed of, or what?

INAP . . . . . 0 N62x.
INHERITED . . . . . 1
SOLD . . . . . 2 N9x
NOT YET DISPOSED . . . . . 3 N10x
OTHER . . . . . 7 N62x.
DK . . . . . 8 N62x.
RF . . . . . 9 N62x.

N8ax. Who inherited the house, (that is, what was their relationship to R FIRST NAME)? CHOOSE ALL THAT APPLY

INAP . . . . . 0, N62x.
SPOUSE . . . . . 1, N62x.
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 2,
OTHER RELATIVE . . . . . 3, N62x.
FRIEND . . . . . 4, N62x.
CHARITY . . . . . 5, N62x.
SOMEONE ELSE . . . . . 7, N62x.
DK . . . . . 8, N62x.
RF . . . . . 9, N62x.

N8bx. (Which child is that?) CHOOSE ALL THAT APPLY. IF GRANDCHILD: Which child of R FIRST NAME (or his/her husband/wife/partner) is the parent of that grandchild?

if: N8x(INHERITED)
SKIP to:N10x

N9x. What was the selling price? DO NOT PROBE DK

N9ax. Was if more than $50,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N9cx
DK . . . . . 8
RF . . . . . 9

N9bx. Was it more than $200,000?

INAP . . . . . 0 N62x.
YES . . . . . 1 N62x.
NO . . . . . 5 N62x.
DK . . . . . 8 N62x.
RF . . . . . 9 N62x.

N9cx. Was it more than $15,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: N8x( *NOT* NOT YET DISPOSED)
SKIP to:N62x.

N10x. Is that home now vacant, or is someone living there?

INAP . . . . . 0 N62x.
VACANT . . . . . 1 N62x.
OCCUPIED . . . . . 2
DK . . . . . 8 N62x.
RF . . . . . 9 N62x.

N10ax. Who lives in the house, (that is, what was their relationship to R FIRST NAME)? CHOOSE ALL THAT APPLY

INAP . . . . . 0, N62x.
SPOUSE . . . . . 1, N62x.
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 2,
OTHER RELATIVE . . . . . 3, N62x.
FRIEND . . . . . 4, N62x.
CHARITY . . . . . 5, N62x.
SOMEONE ELSE . . . . . 7, N62x.
DK . . . . . 8, N62x.
RF . . . . . 9, N62x.

N10bx. (Which child is that?) CHOOSE ALL THAT APPLY. IF GRANDCHILD: Which child of R FIRST NAME (or his/her husband/wife/partner) is the parent of that grandchild?

N50 TIME STAMP

N62x. I asked you earlier about expenses incurred for the health care that R FIRST NAME received. How I want to know about expenses associated with (his/her) death, for funeral expenses, legal fees, and so on.

What were the total expenses associated with the death for things of that type? DO NOT PROBE DK. ALT-O NOT SETTLED YET

AMOUNT:

if: N62x(OUT OF RANGE)
SKIP to:N62ex

if: N62x( *NOT* DK *AND* *NOT* RF)
SKIP to:N62ex

N62ax. Was it more than $5,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N62dx
DK . . . . . 8
RF . . . . . 9

if: N62ax(DK *OR* RF)
SKIP to:N62ex

N62bx. Was it more than $25,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N62ex
DK . . . . . 8
RF . . . . . 9

N62cx. Was it more that $100,000?

INAP . . . . . 0 N62ex
YES . . . . . 1 N62ex
NO . . . . . 5 N62ex
DK . . . . . 8 N62ex
RF . . . . . 9 N62ex

N62dx. Was it more than $1,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N62ex. Were any of these costs covered by insurance?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N71x
DK . . . . . 8
RF . . . . . 9

N62fx. How much did insurance pay?

AMOUNT:
     OR
PERCENT:

CONTINUE . . . . . 1

N71x. Sometimes people make provision to leave things to specific family members if something happens to them, others do not. Because we are trying to get a complete picture of family situations, I have a few questions about inheritance.

Before (his/her) death, had R FIRST NAME put any of (his/her) assets into a trust?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N72x.
"IF PUT ASSETS INTO TRUST In addition to the trust,
"END Did R FIRST NAME have a will that was written and witnessed?

INAP . . . . . 0 N72cx
YES . . . . . 1
NO . . . . . 5 N72cx
DK . . . . . 8 N72cx
RF . . . . . 9 N72cx

N72ax. Has (his/her) will been probated?

INAP . . . . . 0 N72cx
YES . . . . . 1
NO . . . . . 5 N72cx
DK . . . . . 8 N72cx
RF . . . . . 9 N72cx

N72bx. IWER: ASK FOR COUNTY AS WELL AS STATE. In what state was it probated?

COUNTY:

if: N71x(YES) *OR* N72x(YES)
SKIP to:N74x

N73x. What happened to (his/her) assets and possessions: have they been divided among the heirs, have they not yet been distributed, was there nothing of much value to distribute, or what?

INAP . . . . . 0 N6x
DIVIDED AMONG THE HEIRS . . . . . 1
NOT YET DISTRIBUTED . . . . . 2
NOTHING MUCH OF VALUE . . . . . 3
OTHER (SPECIFY) . . . . . 7
DK . . . . . 8
RF . . . . . 9

if: A21( *NOT* MARRIED, SPOUSE PRESENT *T* LIVING WITH SOMEONE)
SKIP to:N75x

N74x
"IF PUT ASSETS INTO TRUST and WILL Did (he/she) make provisions in either the trust or the will for
"ELSE PUT ASSETS INTO TRUST Did (he/she) make provisions in the trust for
"ELSE WRITTEN AND WITNESSED WILL Did (he/she) make provisions in the will for
"ELSE Were any of (his/her) possessions or assets left to
"END
"IF PROXY IS SURVIVING SPOUSE you?
"ELSE (his/her) (husband/wife/partner)?
"END

INAP . . . . . 0 N75x
YES . . . . . 1
NO . . . . . 5 N75x
DK . . . . . 8 N75x
RF . . . . . 9 N75x

N74ax. How much did (you/(his/her) (husband/wife/partner) receive from (his/her) estate? ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N74bx. Was it more than half of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N74ex
DK . . . . . 8
RF . . . . . 9

if: N74bx(DK *OR* RF)
SKIP to:N75x

N74cx. Was it more than 75 percent of (his/her) total estate?

INAP . . . . . 0 N75x
YES . . . . . 1
NO . . . . . 5 N75x
DK . . . . . 8 N75x
RF . . . . . 9 N75x

N74dx. Was it more than 90 percent of (his/her) total estate?

INAP . . . . . 0 N75x
YES . . . . . 1 N75x
NO . . . . . 5 N75x
DK . . . . . 8 N75x
RF . . . . . 9 N75x

N74ex. Was it more than 25 percent of (his/her) total estate?

INAP . . . . . 0 N75x
YES . . . . . 1 N75x
NO . . . . . 5
DK . . . . . 8 N75x
RF . . . . . 9 N75x

N74fx. Was it more than 10 percent of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: Q513 *AND* D40(0 *OR* DK *OR* RF)
SKIP to:N77x

N75x.
"IF PUT ASSETS INTO TRUST and WRITTEN AND WITNESSED WILL Did (he/she) make provisions in either the trust or the will for any of (his/her)
"ELSE PUT ASSETS INTO TRUST Did (he/she) make provisions in the trust for any of (his/her)
"ELSE WRITTEN AND WITNESSED WILL Did (he/she) make provisions in the will for any of (his/her)
"ELSE Were any of (his/her) (possessions) left to any of (his/her)
"END
"IF Q513 (NOT 0) and # OF GRANDCHILDREN DDFM (GREATER THAN 0) children or grandchildren (or great-grandchildren)?
"ELSE Q513 (NOT 0) children?
"ELSE grandchildren (or great-grandchildren)?
"END IWER: PLEASE RECORD ANY INFORMATION ABOUT ULTIMATE BENEFICIARIES IN F2 COMMENTS.

INAP . . . . . 0 N77x
YES . . . . . 1
NO . . . . . 5 N77x
DK . . . . . 8 N77x
RF . . . . . 9 N77x

if: Q513(1)
SKIP to:N75bx

N75ax. Did (he/she) leave the same amount to each of (his/her) children and their families?

INAP . . . . . 0
YES . . . . . 1 N75bx
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if: D4x( *NOT* YES)
SKIP to:N76x

N75aax. Did (he/she) leave the same amount to each of (his/her) grandchildren?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N76x
DK . . . . . 8
RF . . . . . 9

N75bx. Altogether, how much did (he/she) leave for (his/her)
"IF Q513 (1) child (grandchild)?
"ELSE children (grandchildren)?
"END ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N75cx. Was it more than half of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N75fx
DK . . . . . 8
RF . . . . . 9

if: N75cx(DK *OR* RF)
SKIP to:N77x

N75dx. Was it more than 75 percent of (his/her) total estate?

INAP . . . . . 0 N77x
YES . . . . . 1
NO . . . . . 5 N77x
DK . . . . . 8 N77x
RF . . . . . 9 N77x

N75ex. Was it more than 90 percent of (his/her) total estate?

INAP . . . . . 0 N77x
YES . . . . . 1 N77x
NO . . . . . 5 N77x
DK . . . . . 8 N77x
RF . . . . . 9 N77x

N75fx. Was it more than 25 percent of (his/her) total estate?

INAP . . . . . 0 N77x
YES . . . . . 1 N77x
NO . . . . . 5
DK . . . . . 8 N77x
RF . . . . . 9 N77x

N75gx. Was it more than 10 percent of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N76ax. How much did (he/she) leave for CHILD'S NAME and (his/her) family?
ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N76bx. Was it more than half of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N76ex
DK . . . . . 8
RF . . . . . 9

N76cx. Was it more than 75 percent of (his/her) total estate?

INAP . . . . . 0 N76x
YES . . . . . 1
NO . . . . . 5 N76x
DK . . . . . 8 N76x
RF . . . . . 9 N76x

N76dx. Was it more than 90 percent of (his/her) total estate?

INAP . . . . . 0 N76x
YES . . . . . 1 N76x
NO . . . . . 5 N76x
DK . . . . . 8 N76x
RF . . . . . 9 N76x

N76ex. Was it more than 25 percent of (his/her) total estate?

INAP . . . . . 0 N76x
YES . . . . . 1 N76x
NO . . . . . 5
DK . . . . . 8 N76x
RF . . . . . 9 N76x

N76fx. Was it more than 10 percent of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

END of case

N77x.
"IF PUT ASSETS INTO TRUST and WRITTEN AND WITNESSED WILL Did (he/she) make provisions in either the trust or the will for
"ELSE PUT ASSETS INTO TRUST Did (he/she) make provisions in the trust for
"ELSE WRITTEN AND WITNESSED WILL Did (he/she) make provisions in the will for
"ELSE Were any of (his/her) (possessions) left to
"END charities?

INAP . . . . . 0 N78x
YES . . . . . 1
NO . . . . . 5 N78x
DK . . . . . 8 N78x
RF . . . . . 9 N78x

N77ax. How much did charities receive from (his/her) estate? ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N77bx. Was it more than half of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N77ex
DK . . . . . 8
RF . . . . . 9

N77cx. Was it more than 75 percent of (his/her) total estate?

INAP . . . . . 0 N78x
YES . . . . . 1
NO . . . . . 5 N78x
DK . . . . . 8 N78x
RF . . . . . 9 N78x

N77dx. Was it more than 90 percent of (his/her) total estate?

INAP . . . . . 0 N78x
YES . . . . . 1 N78x
NO . . . . . 5 N78x
DK . . . . . 8 N78x
RF . . . . . 9 N78x

N77ex. Was it more than 25 percent of (his/her) total estate?

INAP . . . . . 0 N78x
YES . . . . . 1 N78x
NO . . . . . 5
DK . . . . . 8 N78x
RF . . . . . 9 N78x

N77f. Was it more than 10 percent of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N78x.
"IF PUT ASSETS INTO TRUST and WRITTEN AND WITNESSED WILL Did (he/she) make provisions in either the trust or the will for
"ELSE PUT ASSETS INTO TRUST Did (he/she) make provisions in the trust for
"ELSE WRITTEN AND WITNESSED WILL Did (he/she) make provisions in the will for
"ELSE Were any of (his/her) (possessions) left to
"END any of (his/her) brothers or sisters?

INAP . . . . . 0 N79x
YES . . . . . 1
NO . . . . . 5 N79x
DK . . . . . 8 N79x
RF . . . . . 9 N79x

N78ax. Altogether, how much did (his/her) brothers and sisters receive from (his/her) estate? ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N78bx. Was it more than half of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N78ex
DK . . . . . 8
RF . . . . . 9

N78cx. Was it more than 75 percent of (his/her) total estate?

INAP . . . . . 0 N79x
YES . . . . . 1
NO . . . . . 5 N79x
DK . . . . . 8 N79x
RF . . . . . 9 N79x

N78dx. Was it more than 90 percent of (his/her) total estate?

INAP . . . . . 0 N79x
YES . . . . . 1 N79x
NO . . . . . 5 N79x
DK . . . . . 8 N79x
RF . . . . . 9 N79x

N78ex. Was it more than 25 percent of (his/her) total estate?

INAP . . . . . 0 N79x
YES . . . . . 1 N79x
NO . . . . . 5
DK . . . . . 8 N79x
RF . . . . . 9 N79x

N78fx. Was it more than 10 percent of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N79x.
"IF PUT ASSETS INTO TRUST and WRITTEN AND WITNESSED WILL Did (he/she) make provisions in either the trust or the will for
"ELSE PUT ASSETS INTO TRUST Did (he/she) make provisions in the trust for
"ELSE WRITTEN AND WITNESSED WILL Did (he/she) make provisions in the will for
"ELSE Were any of (his/her) (possessions) left to
"END any other of (his/her) relatives?

INAP . . . . . 0 N80X
YES . . . . . 1
NO . . . . . 5 N80X
DK . . . . . 8 N80X
RF . . . . . 9 N80X

N79ax. Altogether, how much did these other relatives receive from (his/her) estate? ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N79bx. Was it more than half of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N79ex
DK . . . . . 8
RF . . . . . 9

N79cx. Was it more than 75 percent of (his/her) total estate?

INAP . . . . . 0 N80X
YES . . . . . 1
NO . . . . . 5 N80X
DK . . . . . 8 N80X
RF . . . . . 9 N80X

N79dx. Was it more than 90 percent of (his/her) total estate?

INAP . . . . . 0 N80X
YES . . . . . 1 N80X
NO . . . . . 5 N80X
DK . . . . . 8 N80X
RF . . . . . 9 N80X

N79ex. Was it more than 25 percent of (his/her) total estate?

INAP . . . . . 0 N80X
YES . . . . . 1 N80X
NO . . . . . 5
DK . . . . . 8 N80X
RF . . . . . 9 N80X

N79fx. Was it more than 10 percent of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N80x.
"IF PUT ASSETS INTO TRUST and WRITTEN AND WITNESSED WILL Did (he/she) make provisions in either the trust or the will for
"ELSE PUT ASSETS INTO TRUST Did (he/she) make provisions in the trust for
"ELSE WRITTEN AND WITNESSED WILL Did (he/she) make provisions in the will for
"ELSE Were any of (his/her) (possessions) left to
"END any of (his/her) friends?

INAP . . . . . 0 N81X
YES . . . . . 1
NO . . . . . 5 N81X
DK . . . . . 8 N81X
RF . . . . . 9 N81X

N80ax. Altogether, how much did (his/her) friends receive from (his/her) estate? ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N80bx. Was it more than half of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N80ex
DK . . . . . 8
RF . . . . . 9

N80cx. Was it more than 75 percent of (his/her) total estate?

INAP . . . . . 0 N81X
YES . . . . . 1
NO . . . . . 5 N81X
DK . . . . . 8 N81X
RF . . . . . 9 N81X

N80dx. Was it more than 90 percent of (his/her) total estate?

INAP . . . . . 0 N81X
YES . . . . . 1 N81X
NO . . . . . 5 N81X
DK . . . . . 8 N81X
RF . . . . . 9 N81X

N80ex. Was it more than 25 percent of (his/her) total estate?

INAP . . . . . 0 N81X
YES . . . . . 1 N81X
NO . . . . . 5
DK . . . . . 8 N81X
RF . . . . . 9 N81X

N80fx. Was it more than 10 percent of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N81x.
"IF PUT ASSETS INTO TRUST and WRITTEN AND WITNESSED WILL Did (he/she) make provisions in either the trust or the will for
"ELSE PUT ASSETS INTO TRUST Did (he/she) make provisions in the trust for
"ELSE WRITTEN AND WITNESSED WILL Did (he/she) make provisions in the will for
"ELSE Were any of (his/her) (possessions) left to
"END anyone else or anything else that we have not yet listed?

INAP . . . . . 0 N82x
YES . . . . . 1
NO . . . . . 5 N82x
DK . . . . . 8 N82x
RF . . . . . 9 N82x

N81ax.Altogether, how much did those others receive from (his/her) estate? ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N81bx. Was it more than half of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N81ex
DK . . . . . 8
RF . . . . . 9

N81cx. Was it more than 75 percent of (his/her) total estate?

INAP . . . . . 0 N82x
YES . . . . . 1
NO . . . . . 5 N82x
DK . . . . . 8 N82x
RF . . . . . 9 N82x

N81dx. Was it more than 90 percent of (his/her) total estate?

INAP . . . . . 0 N82x
YES . . . . . 1 N82x
NO . . . . . 5 N82x
DK . . . . . 8 N82x
RF . . . . . 9 N82x

N81ex. Was it more than 25 percent of (his/her) total estate?

INAP . . . . . 0 N82x
YES . . . . . 1 N82x
NO . . . . . 5
DK . . . . . 8 N82x
RF . . . . . 9 N82x

N81fx. Was it more than 10 percent of (his/her) total estate?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N82x.Altogether, what was the value of (his/her) estate?

IWER: DO NOT PROBE DK

N82bx. Was it more than $100,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N82ex
DK . . . . . 8
RF . . . . . 9

N82cx. Was it more than $500,000?

INAP . . . . . 0 N82gx
YES . . . . . 1
NO . . . . . 5 N82gx
DK . . . . . 8 N82gx
RF . . . . . 9 N82gx

N82dx. Was it more than $2,000,000?

INAP . . . . . 0 N82gx
YES . . . . . 1 N82gx
NO . . . . . 5 N82gx
DK . . . . . 8 N82gx
RF . . . . . 9 N82gx

N82ex. Was it more than $25,000?

INAP . . . . . 0 N82gx
YES . . . . . 1 N82gx
NO . . . . . 5
DK . . . . . 8 N82gx
RF . . . . . 9 N82gx

N82fx. Was it more than $10,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N82gx.
"IF PUT ASSETS INTO TRUST Is any part of (his/her) estate still held in any type of a trust?
"ELSE Was any part of (his/her) estate put into a trust after (he/she) died?
"END

INAP . . . . . 0 N83x
YES . . . . . 1
NO . . . . . 5 N83x
DK . . . . . 8 N83x
RF . . . . . 9 N83x

N82hx. Who is currently the trustee of this trust? CHOOSE ALL THAT APPLY

INAP . . . . . 0, N83x
SPOUSE . . . . . 1, N83x
CHILD . . . . . 2,
OTHER RELATIVE . . . . . 3, N83x
ATTORNEY . . . . . 4, N83x
BANK OFFICER/TRUST DEPARTMENT AT A BANK . . . . . 5, N83x
OTHER (SPECIFY) . . . . . 7, N83x
DK . . . . . 8, N83x
RF . . . . . 9, N83x

N82jx. (Which child is that?) CHOOSE ALL THAT APPLY

Q
"IF PUT ASSETS INTO TRUST and WRITTEN AND WITNESSED WILL or ESTATE DIVIDED AMONG THE HEIRS In addition to what you have just told me about (his/her) estate
"END Did anyone receive a settlement from life insurance?

INAP . . . . . 0 R
YES . . . . . 1
NO . . . . . 5 R
DK . . . . . 8 R
RF . . . . . 9 R

N83ax. Who were the beneficiaries of that life insurance? CHOOSE ALL THAT APPLY

INAP . . . . . 0, N85gx
SPOUSE/PARTNER . . . . . 1, N85gx
CHILD(REN) . . . . . 2,
GRANDCHILD(REN) OR GREAT-GRANDCHILD(REN) . . . . . 3,
OTHER RELATIVE(S) . . . . . 4, N85gx
OTHER (SPECIFY) . . . . . 7, N85gx
DK . . . . . 8, N85gx
RF . . . . . 9, N85gx

if: Q513 (1)
SKIP to:N85x

N84x. Did each of (his/her) children and their families receive the same amount from life insurance?

INAP . . . . . 0 N85x
YES . . . . . 1
NO . . . . . 5 N85x
DK . . . . . 8 N85x
RF . . . . . 9 N85x

N84ax.Altogether, how much did (his/her) children receive from (his/her) life insurance? ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N84bx. Was it more than half of the life insurance settlement?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N84ex
DK . . . . . 8
RF . . . . . 9

if: N84bx(DK *OR* RF)
SKIP to:N85x

N84cx. Was it more than 75 percent of the life insurance settlement?

INAP . . . . . 0 N85x
YES . . . . . 1
NO . . . . . 5 N85x
DK . . . . . 8 N85x
RF . . . . . 9 N85x

N84dx. Was it more than 90 percent of the life insurance settlement?

INAP . . . . . 0 N85x
YES . . . . . 1 N85x
NO . . . . . 5 N85x
DK . . . . . 8 N85x
RF . . . . . 9 N85x

N84ex. Was it more than 25 percent of the life insurance settlement?

INAP . . . . . 0 N85x
YES . . . . . 1 N85x
NO . . . . . 5
DK . . . . . 8 N85x
RF . . . . . 9 N85x

N84fx. Was it more than 10 percent of the life insurance settlement?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

N85ax. How much did (CHILD) and (his/her) family receive from life insurance? ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N85bx. Was it more than half of the life insurance settlement?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N85ex
DK . . . . . 8
RF . . . . . 9

N85cx. Was it more than 75 percent of the life insurance settlement?

INAP . . . . . 0 N85x
YES . . . . . 1
NO . . . . . 5 N85x
DK . . . . . 8 N85x
RF . . . . . 9 N85x

N85dx. Was it more than 90 percent of the life insurance settlement?

INAP . . . . . 0 N85x
YES . . . . . 1 N85x
NO . . . . . 5 N85x
DK . . . . . 8 N85x
RF . . . . . 9 N85x

N85ex. Was it more than 25 percent of the life insurance settlement?

INAP . . . . . 0 N85x
YES . . . . . 1 N85x
NO . . . . . 5
DK . . . . . 8 N85x
RF . . . . . 9 N85x

N85fx. Was it more than 10 percent of the life insurance settlement?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

END of case

if: N83ax(SPOUSE/PARTNER)
CONTINUE elseSKIP to: N85hx

N85gx.
"IF PROXY IS SURVIVING SPOUSE Altogether, how much did you
"ELSE Altogether, how much did (his/her) (husband/wife/partner)
"END receive from (his/her) life insurance?
ACCEPT EITHER A DOLLAR AMOUNT ON A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

if: N83ax(OTHER RELATIVE(S))
CONTINUE elseSKIP to: N85jx

N85hx. Altogether, how much did (his/her) other relatives receive from (his/her) life insurance?
ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

if: N83ax(OTHER (SPECIFY))
CONTINUE elseSKIP to:N86x

N85jx. Altogether, how much did other non-relatives receive from (his/her) life insurance?
ACCEPT EITHER A DOLLAR AMOUNT OR A PERCENTAGE

AMOUNT:
PERCENT:

INAP . . . . . 0
CONTINUE . . . . . 1

N86x. Altogether, what was the value of the life insurance settlement?

IWER: DO NOT PROBE DK

N86bx. Was it more than $100,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 N83ex
DK . . . . . 8
RF . . . . . 9

N86cx. Was it more than $500,000?

INAP . . . . . 0 R
YES . . . . . 1
NO . . . . . 5 R
DK . . . . . 8 R
RF . . . . . 9 R

N86dx. Was it more than $2,000,000?

INAP . . . . . 0 R
YES . . . . . 1 R
NO . . . . . 5 R
DK . . . . . 8 R
RF . . . . . 9 R

N86ex. Was it more than $25,000?

INAP . . . . . 0 R
YES . . . . . 1 R
NO . . . . . 5
DK . . . . . 8 R
RF . . . . . 9 R

N86fx. Was it more than $10,000?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

 

SECTION R -- HEALTH INSURANCE

R0 TIME STAMP

R0. Health and health insurance are important areas of our study.
"IF MEDICARE COVERED We know that R FIRST NAME was covered by Medicare, but there are many kinds of insurance that people use.
"ELSE There are many kinds of health insurance that people use.
"END

if:W1 MEDICARE(YES)
SKIP to:R2

R1. For people 65 and over, Medicare is the most common type of health insurance. Was R FIRST NAME covered at any time (since Wave1 Month, Year/in the last two years)?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 R2
DK . . . . . 8
RF . . . . . 9

R1a. Part A of Medicare covers most hospital expenses. Part B covers many doctors expenses. The premium for Part B may have been deducted from (his/her) Social Security. Was R FIRST NAME covered by Medicare (since Wave1 Month, Year/in the last two years)?

YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

R1b. We would like to understand how people's medical history affects their use of health care. To do that, we need to obtain information about health care costs and diagnoses for for statistical purposes. The best place to get this information about R FIRST NAME without taking up a lot more of your time is in the Medicare files. Would you be able to read me the number from (his/her) Medicare card?

R MAY NEED TO LOOK UP THE MEDICARE CARE AT THIS POINT. BE SURE TO USE f1(QxQ-S) IF R NEEDS MORE PERSUASION.

R1c/f. NUMBER AVAILABLE:

INAP . . . . . 0
GOT NUMBER . . . . . 1
NOT GET NUMBER . . . . . 5 R1z
DK . . . . . 8
RF . . . . . 9

COPY MEDICARE NUMBER:

Thank you.

R2. "Medicaid" is a state program for people with low income or who are on public assistance. Sometimes people with very large medical bills are also covered by "Medicaid". Was R FIRST NAME's health care covered by "Medicaid" anytime (since Wave1 Month, Year/in the last two years)?

INAP . . . . . 0 R4
YES . . . . . 1
NO . . . . . 5 R4
DK . . . . . 8 R4
RF . . . . . 9 R4

R3. Would you be able to give or read me the number from (his/her) "Medicaid" card? NUMBER AVAILABLE:

INAP . . . . . 0
R GAVE NUMBER . . . . . 1
NOT GIVE NUMBER . . . . . 5
DK . . . . . 8
RF . . . . . 9

COPY MEDICAID NUMBER:

Thank you.

if:R2( *NOT* YES)
SKIP to:R5

R4. Was R FIRST NAME covered by "Medicaid" at the time of (his/her) death?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

if:E5(NO) *OR* R4(DK *OR* RF)
SKIP to:R5

NUMBER OF STAYS: E6

Was (he/she) eligible for "Medicaid" at the time (his/her) (first) nursing home stay started?

INAP . . . . . 0
YES . . . . . 1 R4c
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

Did (he/she) become eligible for "Medicaid" during (his/her) (first) nursing home stay?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

Did (he/she) lose (his/her) eligibility for "Medicaid" when (he/she) was discharged from (his/her) (first) nursing home stay?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

if:E6( < 2)
SKIP to:R5

R4d. NUMBER OF STAYS: E6

Was (he/she) eligible for "Medicaid" at the time (his/her) last nursing home stay started?

INAP . . . . . 0
YES . . . . . 1 R4f
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

Did (he/she) become eligible for "Medicaid" during (his/her) last nursing home stay?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

Did (he/she) lose (his/her) eligibility for "Medicaid" when (he/she) was discharged from (his/her) last nursing home stay?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

R5. AT the time R FIRST NAME died was (he/she) covered by any government health insurance program (besides Medicare), such as Railroad retirement, CHAMP-US, CHAMP-VA, or other military programs?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 R6
DK . . . . . 8
RF . . . . . 9

R5a. Which program was that?

INAP . . . . . 0
CHAMPVA/CHAMPUS . . . . . 3
RAILROAD RETIREMENT . . . . . 4
OTHER, SPECIFY . . . . . 7
DK . . . . . 8
RF . . . . . 9

R6. Now I'm going to ask you about how R FIRST NAME's health insurance worked.

if:R1( *NOT* YES) *AND* W1 MEDICARE( *NOT* YES) *AND* R5a( *NOT* RAILROAD RETIREMENT)
SKIP to:R8

R7. First, we are interested in how R FIRST NAME'S (Medicare/Railroad retirement) health insurance worked for routine care.

At the time (he/she) died, did R FIRST NAME receive (his/her) Medicare (and "Medicaid") benefits through an HMO, that is a Health Maintenance Organization?

DEF: With an HMO, the cost of the physician visit is typically covered in full or the participant pays only a small amount. All routine care must be provided by an HMO physician.

INAP . . . . . 0 R8
YES . . . . . 1
NO . . . . . 5 R8
DK . . . . . 8 R8
RF . . . . . 9 R8

R7a. About how long had R FIRST NAME been receiving (his/her) Medicare benefits through this HMO?

YEARS:
OR
MONTHS:

R7e. About how much were R FIRST NAME'S premiums for this plan?

AMOUNT:
PER:

INAP . . . . . 0
MONTH . . . . . 1
QUARTER (3 MONTHS) . . . . . 2
YEAR . . . . . 3
NO PREMIUM . . . . . 4
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

if;R4 ( *NOT* YES)
SKIP to:R9

if;R4(YES) *AND* R7(YES)
SKIP to:R9

R8. We are interested in how R FIRST NAME'S "Medicaid" worked for routine care.

At the time (he/she) died, did R FIRST NAME receive (his/her) "Medicaid" through an HMO (that is, a Health Maintenance Organization)?

DEF: With an HMO, the cost of the physician visit is typically covered in full or the participant pays only a small amount. All routine care must be provided by an HMO physician.

INAP . . . . . 0 R9
YES . . . . . 1
NO . . . . . 5 R9
DK . . . . . 8 R9
RF . . . . . 9 R9

R8a. About how long R FIRST NAME received (his/her) "Medicaid" through this HMO?

MONTHS:
YEARS:

R9. Not counting long-term care insurance
"IF MEDICARE COVERED.MEDICARE COVERED. MEDICAID NUMBER or Medicare,
"END
"IF CURRENTLY ON MEDICAID or "Medicaid",
"END
"IF R HAS GOVERNMENT INSURANCE (OTHER THAN MEDICARE OF MEDICAID) or (his/her) government health insurance,
"END at the time R FIRST NAME died, did (he/she) have any health insurance that paid any part of hospital or doctor bills? (Sometimes this is called a Medi-Gap policy).

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 R13
DK . . . . . 8
RF . . . . . 9

R9a. How many other health plans did R FIRST NAME have at the time (he/she) died?

R10d.
"IF MORE THAN ONE OTHER HEALTH INSURANCE Thinking about the first of these plans,
"END How did (he/she) obtain this type of health insurance coverage? Was it through (his/her) (or his/her husband's/wife's/partner's) employer or union, or through an organization or what? CHOOSE ALL THAT APPLY

INAP . . . . . 0,
R EMPLOYER/FORMER EMPLOYER . . . . . 1,
R UNION . . . . . 2,
SPOUSE/PARTNER EMPLOYER/FORMER EMPLOYER . . . . . 3,
SPOUSE/PARTNER UNION . . . . . 4,
OTHER ORGANIZATION . . . . . 5,
OTHER . . . . . 7

R10e. How was this coverage paid for--entirely by (him/her) (or his/her husband/wife/partner), entirely by (his/her) (husband's/wife's/partner's) (former) employer or union, or partly by a (former) employer or union, or what?

INAP . . . . . 0
ENTIRELY BY R OR SP/PARTNER . . . . . 1
ENTIRELY BY (FORMER) EMPLOYER OR UNION . . . . . 2
PARTLY BY (FORMER) EMPLOYER OR UNION . . . . . 3
OTHER . . . . . 7

if:R10e(ENTIRELY BY (FORMER) EMPLOER OR UNION)
SKIP to:R11d

R10f. About how much were (his/her) premiums for this plan?

AMOUNT:
PER:

INAP . . . . . 0
MONTH . . . . . 1
QUARTER (3 MONTHS) . . . . . 2
YEAR . . . . . 3
NO PREMIUM . . . . . 4
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

if:R9a(1)
SKIP to:R13

R11d. Thinking about (his/her) other health insurance plans, how did (he/she) obtain this type of health insurance coverage? Was it through (his/her) (or his/her husband's/wife's/partner's) employer or union, or through an organization or what? CHOOSE ALL THAT APPLY

INAP . . . . . 0,
R EMPLOYER/FORMER EMPLOYER . . . . . 1,
R UNION . . . . . 2,
SPOUSE/PARTNER EMPLOYER/FORMER EMPLOYER . . . . . 3,
SPOUSE/PARTNER UNION . . . . . 4,
OTHER ORGANIZATION . . . . . 5,
OTHER . . . . . 7

R11e. How was this coverage paid for--entirely by (him/her) (or his/her husband/wife/partner), entirely by (his/her) (husband's/wife's/partner's) (former) employer or union, or partly by a (former) employer or union, or what?

INAP . . . . . 0
ENTIRELY BY R OR SP/PARTNER . . . . . 1
ENTIRELY BY (FORMER) EMPLOYER OR UNION . . . . . 2 R13
PARTLY BY (FORMER) EMPLOYER OR UNION . . . . . 3
OTHER . . . . . 7

R11f. Thinking about R FIRST NAME'S other health insurance plan(s), about how much were (his/her) premiums for (that plan/those plans)?

AMOUNT:
PER:

INAP . . . . . 0
MONTH . . . . . 1
QUARTER (3 MONTHS) . . . . . 2
YEAR . . . . . 3
NO PREMIUM . . . . . 4
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

R13. Did any of R FIRST NAME'S health insurance plan(s) in effect at the time (he/she) died pay any part of the cost of (his/her) prescription medications?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

R13c. (Since Wave1 Month, Year / in the last two years) had R FIRST NAME withdrawn from an HMO?

INAP . . . . . 0 R14
YES . . . . . 1
NO . . . . . 5 R14
DK . . . . . 8 R14
RF . . . . . 9 R14

R13d. Did (he/she) voluntarily leave that HMO?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

R13e. Why did (he/she) leave that HMO? CHOOSE ALL THAT APPLY

INAP . . . . . 0,
HIS/HER OWN PHYSICIAN LEFT PLAN . . . . . 1,
HMO DIDN'T PROVIDE NEEDED SERVICES . . . . . 2,
HMO COSTS INCREASED . . . . . 3,
HMO ENCOURAGED HIM/HER TO LEAVE . . . . . 4,
MOVED OUT OF HMO SERVICE AREA . . . . . 5,
OTHER (SPECIFY). . . . . 7,
DK . . . . . 8,
RF . . . . . 9,

R13f. About how long was it before (he/she) was fully covered by (his/her) new health insurance plan? USE 96 FOR NEVER WITHOUT COVERAGE

MONTHS:

R14. (Since Wave1 Month, Year / In the last two years), did the type, cost, or coverage of R FIRST NAME'S health insurance change?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 R15
DK . . . . . 8
RF . . . . . 9

R14a. Did R FIRST NAME choose to change (his/her) health insurance or did (he/she) have no choice?

INAP . . . . . 0
R MADE CHANGE . . . . . 1
R HAD NO CHOICE . . . . . 5
DK . . . . . 8
RF . . . . . 9

R14b. What changed about (his/her) health insurance? CHOOSE ALL THAT APPLY

INAP . . . . . 00,
COST BECAME HIGHER . . . . . 01,
COST BECAME LOWER . . . . . 02,
FEWER SERVICES COVERED . . . . . 03,
MORE SERVICES COVERED . . . . . 04,
LESS CHOICE OF PHYSICIANS . . . . . 05,
MORE CHOICE OF PHYSICIANS . . . . . 06,
MORE CONVENIENT . . . . . 07,
LOST PLAN . . . . . 08,
OTHER . . . . . 97,
DK . . . . . 98,
RF . . . . . 99,

R14cx. About when did R FIRST NAME make this change?

# MONTHS BEFORE DEATH:
OR
MONTH:
YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

R15. Aside from the government programs, did R FIRST NAME have any insurance which specifically paid any part of long-term care, such as, personal or medical care in the home or in a nursing home?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 R END TIME
DK . . . . . 8
RF . . . . . 9

R15a. Did this plan cover care in a nursing home facility only, personal or long-term care at home, or both in-home and nursing home care?

INAP . . . . . 0
NURSING HOME CARE ONLY . . . . . 1
IN-HOME CARE ONLY . . . . . 2
BOTH NURSING HOME AND IN-HOME CARE . . . . . 3
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

R15b. Did R FIRST NAME ever receive benefits under this long-term care policy (since Wave1 Month, Year/in the last two years)?

INAP . . . . . 0 R15g
YES . . . . . 1
NO . . . . . 5 R15g
DK . . . . . 8 R15g
RF . . . . . 9 R15g

R15dx. Altogether how much did R FIRST NAME receive in benefits under this plan?

AMOUNT:

PER:

INAP . . . . . 0
MONTH . . . . . 1
QUARTER (3 MONTHS) . . . . . 2
YEAR . . . . . 3
NO PREMIUM . . . . . 4
OTHER . . . . . 7
DK . . . . . 8
RF . . . . . 9

FOR:

INAP . . . . . 0
MONTHS . . . . . 1
YEARS . . . . . 2
QUARTERS . . . . . 3
OTHER (SPECIFY). . . . . 7
DK . . . . . 8
RF . . . . . 9

INAP . . . . . 0
CONTINUE . . . . . 1

R15g. Had R FIRST NAME ever been covered by any long-term care insurance that (he/she) canceled or let lapse?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5 R END TIME
DK . . . . . 8
RF . . . . . 9

R15h. Did (his/her) coverage lapse because the premiums were too high, because (he/she) didn't think (he/she) needed to carry it any longer, or what?

INAP . . . . . 0,
PREMIUMS TOO HIGH . . . . . 1,
DIDN'T NEED IT . . . . . 2,
OTHER . . . . . 7,
DK . . . . . 8,
RF . . . . . 9,

R END TIME STAMP

 

SECTION M -- HEALTH CARE DIRECTIVES

if:CS5x( *NOT* NO) *AND* CS11( *NOT* YES) *AND* E5( *NOT* YES) *AND* CS9x( *NOT* YES) *AND* RTR SP( *NOT* 5 *TO* 7) *AND* B7d( *NOT* YES) *AND* B9( *NOT* YES) *AND* B9j( *NOT* YES) *AND* B5k( *NOT* ANSWERED ) *AND* CS36c( *NOT* YES, MOVED)
SKIP to: MX-0

EVC1. IWER: IF ONLY ONE EVENT DISPLAYED, DO NOT ASK QUESTION BUT CHOOSE THE NUMBER AND GO TO NEXT SCREEN.
"IF REINTERVIEW You mentioned the following events happened since W1 IW MONTH W1 IW YEAR.
"ELSE You mentioned the following events happened in the last two years.
"END Which of these happened first,...next,...next?

Death of spouse/partner . . . . . 1,
Nursing Home Stay . . . . . 2,
Married . . . . . 3,
Divorced . . . . . 4,
Heart Attack . . . . . 5,
Stroke . . . . . 6,
Cancer . . . . . 7,
Residential Move . . . . . 8,
NO EVENT . . . . . 9,

MODULE START TIME

if:CS2jx(UNEXPECTED) *AND* CS2mx(ONE OR TWO HOURS (OR NO WARNING) *OR* LESS THAN A DAY *OR* LESS THAN A WEEK)
SKIP to:MODULE END

if:CS1a( *NOT* PROXY IS SURVIVING SPOUSE) *AND* CS2-PROXY T( *NOT* 1 *TO* OTHER RELATIVE)
SKIP to:MODULE END

MX-0. Now we wish to ask some questions about healthcare decisions toward the end of R FIRST NAME's life.

MX-1. Did R FIRST NAME provide written instructions about the treatment or care (he/she) wanted to receive during the final days of (his/her) life?

IWER: EMPHASIZE THE PHRASE WRITTEN INSTRUCTIONS

INAP . . . . . 0 MX-2
YES . . . . . 1
NO . . . . . 5 MX-2
DK . . . . . 8 MX-2
RF . . . . . 9 MX-2

MX-1a. About when were these written instructions dated (approximately)?

MONTH:
YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

MX-1b1. Did these instructions express a desire to receive all care possible under any circumstances in order to prolong life?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-1b2. Did these instructions express a desire to limit care in certain situations?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-1b3. Did these instructions express a desire to have any treatment withheld?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-1b4. (Did these instructions express a desire to) keep (him/her) comfortable and pain free but to forego extensive measures to prolong life?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-1c. Were these instructions applicable to the actual situation?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-1d. Were you consulted about whether these instructions should be followed?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-1e. Were any (other) family memebers or other persons consulted?

INAP . . . . . 0 MX-1g
YES . . . . . 1
NO . . . . . 5 MX-1g
DK . . . . . 8 MX-1g
RF . . . . . 9 MX-1g

MX-1F. Who was this? CHECK ALL THAT APPLY.

Anyone else?

INAP . . . . . 00, MX-1j
DECEASED R . . . . . 01, MX-1j
NON-SPOUSE PROXY RESPONDENT . . . . . 02, MX-1j
SPOUSE . . . . . 03, MX-1j
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 04,
OTHER RELATIVE . . . . . 05, MX-1j
FRIEND . . . . . 06, MX-1j
PHYSICIAN/HEALTHCARE PROFESSIONAL . . . . . 07, MX-1j
MINISTER/RABBI/PRIEST/RELIGIOUS ADVISOR . . . . . 08, MX-1j
ATTORNEY . . . . . 09, MX-1j
SOCIAL WORKER . . . . . 10, MX-1j
OTHER (SPECIFY) . . . . . 11, MX-1j
DK . . . . . 98, MX-1j
RF . . . . . 99, MX-1j

MX-1g. Which child was that? CHOOSE ALL THAT APPLY

if:MX-1c( *NOT* YES)
SKIP to:MX-2

MX-1h. Did any problems come up in trying to follow these written instructions?

INAP . . . . . 0 MX-2
YES . . . . . 1
NO . . . . . 5 MX-2
DK . . . . . 8 MX-2
RF . . . . . 9 MX-2

MX-1j. Did the physician or any other health care worker have problems following the written instructions?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-2. Did R FIRST NAME (also) make any legal arrangements for a specific person or persons to make decisions about (his/her) care or medical treatment if (he/she) could not make those decisions (him/her)self? This is sometimes called a Durable Power of Attorney for Health Care.

INAP . . . . . 0 MX-3
YES . . . . . 1
NO . . . . . 5 MX-3
DK . . . . . 8 MX-3
RF . . . . . 9 MX-3

MX-2a. Who had that authority?

INAP . . . . . 00, MX-2c
DECEASED R . . . . . 01, MX-2c
NON-SPOUSE PROXY RESPONDENT . . . . . 02, MX-2c
SPOUSE . . . . . 03, MX-2c
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 04,
OTHER RELATIVE . . . . . 05, MX-2c
FRIEND . . . . . 06, MX-2c
PHYSICIAN/HEALTHCARE PROFESSIONAL . . . . . 07, MX-2c
MINISTER/RABBI/PRIEST/RELIGIOUS ADVISOR . . . . . 08, MX-2c
ATTORNEY . . . . . 09, MX-2c
SOCIAL WORKER . . . . . 10, MX-2c
OTHER (SPECIFY) . . . . . 11, MX-2c
DK . . . . . 98, MX-2c
RF . . . . . 99, MX-2c

MX-2b. Which child is that? CHECK ALL THAT APPLY

MX-2c. When was the Durable Power of Attorney for Health Care made (approximately)?

MONTH:
YEAR:

INAP . . . . . 0
CONTINUE . . . . . 1

MX-3. Did R FIRST NAME ever discuss with you or anyone else the treatment or care (he/she) wanted to receive in the final days of (his/her) life?

INAP . . . . . 0 MX-4
YES . . . . . 1
NO . . . . . 5 MX-4
DK . . . . . 8 MX-4
RF . . . . . 9 MX-4

MX-3a. Who was that?

INAP . . . . . 00, MX-4
DECEASED R . . . . . 01, MX-4
NON-SPOUSE PROXY RESPONDENT . . . . . 02, MX-4
SPOUSE . . . . . 03, MX-4
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 04,
OTHER RELATIVE . . . . . 05, MX-4
FRIEND . . . . . 06, MX-4
PHYSICIAN/HEALTHCARE PROFESSIONAL . . . . . 07, MX-4
MINISTER/RABBI/PRIEST/RELIGIOUS ADVISOR . . . . . 08, MX-4
ATTORNEY . . . . . 09, MX-4
SOCIAL WORKER . . . . . 10, MX-4
OTHER (SPECIFY) . . . . . 11, MX-4
DK . . . . . 98, MX-4
RF . . . . . 99, MX-4

MX-3b. Which child is that? CHECK ALL THAT APPLY

MX-4. Who was actually involved in making decision about the care and treatment of R FIRST NAME during the final days of (his/her) life? (Who else participated?)

INAP . . . . . 00, MX-4b
DECEASED R . . . . . 01, MX-5
NON-SPOUSE PROXY RESPONDENT . . . . . 02, MX-4b
SPOUSE . . . . . 03, MX-4b
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 04,
OTHER RELATIVE . . . . . 05, MX-4b
FRIEND . . . . . 06, MX-4b
PHYSICIAN/HEALTHCARE PROFESSIONAL . . . . . 07, MX-4b
MINISTER/RABBI/PRIEST/RELIGIOUS ADVISOR . . . . . 08, MX-4b
ATTORNEY . . . . . 09, MX-4b
SOCIAL WORKER . . . . . 10, MX-4b
OTHER (SPECIFY) . . . . . 11, MX-4b
DK . . . . . 98, MX-4b
RF . . . . . 99, MX-4b

MX-4a. Which child is that? CHECK ALL THAT APPLY

if:MX-4(DECEASED R)
SKIP to:MX-4c

Was R FIRST NAME able to participate in decisions about (his/her) medical care during the final days of (his/her) life?

INAP . . . . . 0 MX-5
YES . . . . . 1 MX-5
NO . . . . . 5
DK . . . . . 8 MX-5
RF . . . . . 9 MX-5

MX-4c. For about how long before R FIRST NAME died was (he/she) unable to participate in decisions about (his/her) medical care?

# MONTH:
# DAYS:
# YEARS:

INAP . . . . . 0
CONTINUE . . . . . 1

if: MX-4(1) *AND* MX-4b( *NOT* YES)
SKIP to:MX-6a

MX-5. Who was the main decision-maker?

INAP . . . . . 00, MX-6a
DECEASED R . . . . . 01, MX-6a
NON-SPOUSE PROXY RESPONDENT . . . . . 02, MX-6a
SPOUSE . . . . . 03, MX-6a
CHILD/CHILD-IN-LAW/GRANDCHILD . . . . . 04,
OTHER RELATIVE . . . . . 05, MX-6a
FRIEND . . . . . 06, MX-6a
PHYSICIAN/HEALTHCARE PROFESSIONAL . . . . . 07, MX-6a
MINISTER/RABBI/PRIEST/RELIGIOUS ADVISOR . . . . . 08, MX-6a
ATTORNEY . . . . . 09, MX-6a
SOCIAL WORKER . . . . . 10, MX-6a
OTHER (SPECIFY) . . . . . 11, MX-6a
DK . . . . . 98, MX-6a
RF . . . . . 99, MX-6a

Q. Which child is that? CHECK ALL THAT APPLY

if:CS2jx(UNEXPECTED)
SKIP to:MX-9

MX-6a. Did the final decision involve a desire to give all care possible unconditionally in order to prolong life?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-6b. Did the final decision involve limiting care in certain situations?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-6c. Did the final decision involve withholding any treatment?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-6d. Did the final decision rest largely on keeping R FIRST NAME comfortable and pain free without taking extensive measures to prolong life?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-7. Did any doctor(s) recommend any care or treatment that the family or other decision-maker(s) ultimately refused?

INAP . . . . . 0 MX-8
YES . . . . . 1
NO . . . . . 5 MX-8
DK . . . . . 8 MX-8
RF . . . . . 9 MX-8

MX-7a. Did R FIRST NAME receive this treatment anyway?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-8. Did cost enter into the decisions about what care or treatment (he/she) would receive in the final days of (his/her) life?

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
DK . . . . . 8
RF . . . . . 9

MX-9. In the course of R FIRST NAME's life, what would you say were (his/her) particular strengths?

MODULE END TIME

IWER: WHAT MODE IS INTERVIEW AT THIS POINT?

MODE IW

INAP . . . . . 0
PHONE . . . . . 1
F-T-F . . . . . 2

WHAT WAS THE RELATIONSHIP OF THE PERSON WHO ASSISTED R?

INAP . . . . . 0
SPOUSE . . . . . 1
CHILD/CHILD-IN-LAW . . . . . 2
OTHER RELATIVE . . . . . 3
OTHER INDIVIDUAL . . . . . 4
PROFESSIONAL . . . . . 5
OTHER (SPECIFY) . . . . . 7

FINAL TIME

THANK THE RESPONDENT FOR THE INTERVIEW

"IF RESIDENT IN NURSING HOME AT TIME OF DEATH
IWER: GET NAME AND ADDRESS OF INSTITUTION IN CSMS
"END
IWER: YOU ARE ABOUT TO EXIT THIS CASE AND COMPLETE IT.

TESTER END

INAP . . . . . 0
COMPLETE THE CASE . . . . . 1

FINAL IWER ID
FINAL VQ VERSION

 

APPENDICES

PRELOAD

Q1. HOUSEHOLD ID

Q2. HH1 FAM MEM LOOP

Q3. ROSTER WAVE 1 LIVE WITH RESPONDENT

RESIDENT . . . . . 1
NONRESIDENT . . . . . 5

Q4. ROSTER LINE P

Q5. ROSTER PIN

Q6. ROSTER WAVE 2 RESIDENT STATUS

RESIDENT . . . . . 1
AWAY/INST . . . . . 2
AWAY/OTHER . . . . . 3
DIED . . . . . 4
NONRESIDENT . . . . . 5

Q7. ROSTER FIRST NAME

Q8. ROSTER LAST NAME/INITIAL

Q9. ROSTER SEX

MALE . . . . . 1
FEMALE . . . . . 2

Q10. ROSTER RELATION TO WAVE 1 IDFM

CHILD . . . . . 1
STEP/PARTNER CHILD . . . . . 2
GRDKID . . . . . 3
OTH REL . . . . . 4
PROFESSIONAL . . . . . 5
CHILD-IN-LAW . . . . . 6
OTHER . . . . . 7

Q11. ROSTER RELATION TO WAVE 1 IDNM

CHILD . . . . . 1
STEP/PARTNER CHILD . . . . . 2
GRDKID . . . . . 3
OTH REL . . . . . 4
PROFESSIONAL . . . . . 5
CHILD-IN-LAW . . . . . 6
OTHER . . . . . 7

Q12. ROSTER MARITAL STATUS

MARRIED . . . . . 1
LIVING (WITH) . . . . . 3
DIV/SEP . . . . . 4
WIDOWED . . . . . 5
SINGLE . . . . . 6

Q13. ROSTER SPOUSE WAVE 2 RESIDENT STATUS

RESIDENT . . . . . 1
AWAY/INST . . . . . 2
AWAY/OTHER . . . . . 3
DIED . . . . . 4
NONRESIDENT . . . . . 5

Q14. ROSTER SPOUSE FIRST NAME

Q15. ROSTER SPOUSE CHANGED

YES . . . . . 2

Q16. ROSTER SPOUSE PIN

Q17. ROSTER WAVE 1 YEAR BORN

Q18. ROSTER WAVE 1 SPOUSE YEAR BORN

Q19. ROSTER WAVE 1 SPOUSE RESIDENT STATUS

RESIDENT . . . . . 1
NONRESIDENT . . . . . 5

Q20. HOLD 2

Q21. HH1 RESPONDENT INDEX

010 . . . . . 1
020 . . . . . 2
011 . . . . . 3
021 . . . . . 4

Q22. TYPE INTERVIEW WAVE 2

NEW SP . . . . . 0
REINTERVIEW . . . . . 1
REFUSED SP . . . . . 5

Q23. RESPONDENT FIRST NAME

Q24. RESPONDENT LAST NAME

Q25. RESPONDENT BIRTH YEAR

Q26. RESPONDENT SEX

MALE . . . . . 1
FEMALE . . . . . 2

Q27. RESPONDENT MARITAL STATUS WAVE 2

MARRIED . . . . . 1
MARRIED SP ABSENT . . . . . 2
LIV WITH PARTNER . . . . . 3
DIVORCED/SEPARATED . . . . . 4
WIDOWED . . . . . 5
NEVER MARRIED . . . . . 6
DIED . . . . . 7

Q28. RESPONDENT WAVE 1 FAMILY RESPONDENT

FAMILY R . . . . . 1
NON-FAMILY R . . . . . 2
FAMILY R . . . . . 3

Q29. RESPONDENT WAVE 2 FINANCIAL RESPONDENT

FINANCIAL R . . . . . 2
NON FINANCIAL R . . . . . 3

Q30. RESPONDENT SUB HOUSEHOLD NUMBER

HH 1 . . . . . 1
HH 2 . . . . . 2

Q31. 1ST/2ND IN HOUSEHOLD WAVE 2

1ST INTERVIEW . . . . . 1
2ND INTERVIEW . . . . . 2

Q32. HH1 RELATIONSHIP TO RESPONDENT

INAP . . . . . 00
SELF . . . . . 01
HUSBAND . . . . . 02
WIFE . . . . . 03
PARTNER . . . . . 04
EX-HUSBAND . . . . . 05
EX-WIFE . . . . . 06
EX-PARTNER . . . . . 07
LATE HUBAND . . . . . 08
LATE WIFE . . . . . 09
LATE PARTNER . . . . . 10

Q33. HH1 LIVING

YES . . . . . 1
NO . . . . . 5

Q34. HH1 1ST RESPONDENT IN NURS HOME

Q35. HH1 1ST ADDR CITY

Q36. HH1 1ST ADDR STATE

Q37. HH1 HAS 2ND RESIDENCE

HAS 1 OTHER RESIDENCE . . . . . 1
NO OTHER RESIDENCE . . . . . 5

Q38. HH1 2ND ADDR CITY

Q39. HH1 2ND ADDR STATE

Q40. HOLD 7

Q41. HOLD 8

Q42. HOLD 9

Q43. HH2 FAM MEM LOOP

Q44. ROSTER WAVE 1 LIVE WITH RESPONDENT

RESIDENT . . . . . 1
NONRESIDENT . . . . . 5

Q45. ROSTER LINEP

Q46. ROSTER PIN

Q47. ROSTER WAVE 2 RESIDENT STATUS

RESIDENT . . . . . 1
AWAY/INST . . . . . 2
AWAY/OTHER . . . . . 3
DIED . . . . . 4
NONRESIDENT . . . . . 5

Q48. ROSTER FIRST NAME

Q49. ROSTER LAST NAME/INITIAL

Q50. ROSTER SEX

MALE . . . . . 1
FEMALE . . . . . 2

Q51. ROSTER BELATION TO WAVE 1 IDFM

CHILD . . . . . 1
STEP/PARTNER CHILD . . . . . 2
GRDKID . . . . . 3
OTH REL . . . . . 4
PROFESSIONAL . . . . . 5
CHILD-IN-LAW . . . . . 6
OTHER . . . . . 7

Q52. ROSTER RELATION TO WAVE 1 IDNFM

CHILD . . . . . 1
STEP/PARTNER CHILD . . . . . 2
GRDKID . . . . . 3
OTH REL . . . . . 4
PROFESSIONAL . . . . . 5
CHILD-IN-LAW . . . . . 6
OTHER . . . . . 7

Q53. ROSTER MARITAL STATUS

MARRIED . . . . . 1
LIVING (WITH) . . . . . 3
DIV/SEP . . . . . 4
WIDOWED . . . . . 5
SINGLE . . . . . 6

Q54. ROSTER SPOUSE WAVE 2 RESIDENT STATUS

RESIDENT . . . . . 1
AWAY/INST . . . . . 2
AWAY/OTHER . . . . . 3
DIED . . . . . 4
NONRESIDENT . . . . . 5

Q55. ROSTER SPOUSE FIRST NAME

Q56. ROSTER SPOUSE CHANGED

YES . . . . . 2

Q57. ROSTER SPOUSE PIN

Q58. ROSTER WAVE 1 YEAR BORN

Q59. ROSTER WAVE 1 SPOUSE YEAR BORN

Q60. ROSTER WAVE 2 RESIDENT STATUS

RESIDENT . . . . . 1
NONRESIDENT . . . . . 5

Q61. HOLD 11

Q62. HH2 RESPONDENT INDEX

010 . . . . . 1
020 . . . . . 2
011 . . . . . 3
021 . . . . . 4

Q63. TYPE INTERVIEW WAVE 2

NEW SP . . . . . 0
REINTERVIEW . . . . . 1
REFUSED SP . . . . . 5

Q64. RESPONDENT FIRST NAME

Q65. REPONDENT LAST NAME

Q66. RESPONDENT BIRTH YEAR

Q67. SEX

MALE . . . . . 1
FEMALE . . . . . 2

Q68. RESPONDENT MARITAL STATUS WAVE 2

MARRIED . . . . . 1
MARRIED SP ABSENT . . . . . 2
LIV WITH PARTNER . . . . . 3
DIVORCED/SEPARATED . . . . . 4
WIDOWED . . . . . 5
NEVER MARRIED . . . . . 6
DIED . . . . . 7

Q69. RESPONDENT WAVE 1 FAMILY

FAMILY R . . . . . 1
NON-FAMILY R . . . . . 2
ONLY R . . . . . 3

Q70. RESPONDENT WAVE 2 FINANCIAL RESPONDENT

FINANCIAL R . . . . . 2
NON FINANCIAL R . . . . . 3

Q71. RESPONDENT SUB HOUSEHOLD NUMBER

HH 1 . . . . . 1
HH 2 . . . . . 2

Q72. 1ST/2ND IN HOUSEHOLD WAVE 2

1ST INTERVIEW . . . . . 1
2ND INTERVIEW . . . . . 2

Q73. HH2 RELATIONSHIP TO RESPONDENT

INAP . . . . . 00
SELF . . . . . 01
HUSBAND . . . . . 02
WIFE . . . . . 03
PARTNER . . . . . 04
EX-HUSBAND . . . . . 05
EX-WIFE . . . . . 06
EX-PARTNER . . . . . 07
LATE HUBAND . . . . . 08
LATE WIFE . . . . . 09
LATE PARTNER . . . . . 10

Q74. HH2 LIVING

YES . . . . . 1
NO . . . . . 5

Q75. HH2 1ST RESPONDENT IN NURS HOME

Q76. HH2 1ST ADDR CITY

Q77. HH2 1ST ADDR STATE

Q78. HH2 HAS 2ND RESIDENCE

HAS 1 OTHER RESIDENCE . . . . . 1
NO OTHER RESIDENCE . . . . . 5

Q79. HH2 SND ADDR CITY

Q80. HH2 2ND ADDR STATE

Q81. HOLD 16

Q82. HOLD 17

Q83. HOLD 18

Q84. HH1 ROSTER LISTING FLAG

HH1 ROSTER NOT DONE . . . . . 0
HH1 ROSTER DONE . . . . . 1

Q85. HH1 RESPONDENT LISTING FLAG

HH1 R NOT DONE . . . . . 0
HH1 R DONE . . . . . 1

Q86. HH2 ROSTER LISTING FLAG

HH2 ROSTER NOT DONE . . . . . 0
HH2 ROSTER DONE . . . . . 1

Q87. HH2 RESPONDENT LISTING FLAG

HH2 R NOT DONE . . . . . 0
HH2 R DONE . . . . . 1

Q88. HOLD 19

Q89. HOLD 20

Q90. HOLD 21

Q91. CONTROL 2 ID

Q92. WAVE 1 SAMPLE ID

Q93. WAVE 1 CASE ID

Q94. WAVE 1 IDFM

Q95. WAVE 1 INTERVIEW MONTH

INAP . . . . . 00
JAN . . . . . 01
FEB . . . . . 02
MAR . . . . . 03
APR . . . . . 04
MAY . . . . . 05
JUN . . . . . 06
JUL . . . . . 07
AUG . . . . . 08
SEP . . . . . 09
OCT . . . . . 10
NOV . . . . . 11
DEC . . . . . 12

Q96. WAVE 1 INTERVIEW YEAR

Q97. WAVE 1 MODULE #

Q98. WAVE 1 PROXY NAME

Q99. WAVE 1 INTERVIEW SELF/PROXY

INAP . . . . . 0
SELF . . . . . 1
PROXY . . . . . 2

Q100. WAVE 1 PROXY WHY

INAP . . . . . 0
REFUSED . . . . . 1
INCAPABLE . . . . . 2
LANGUAGE . . . . . 3

Q101. WAVE 1 PROXY RTR

NOT PROXY INTERVIEW . . . . . 00
SPOUSE . . . . . 01
DAUGHTER/STEPDAUGH . . . . . 02
SON/STEPSON . . . . . 03
DAUGHTER-IN-LAW . . . . . 04
SON-IN-LAW . . . . . 05
GRANDDAUGHTER . . . . . 06
GRANDSON . . . . . 07
SISTER . . . . . 08
BROTHER . . . . . 09
OTHER RELATIVE . . . . . 10
FRIEND . . . . . 11
PAID HELPER . . . . . 12
PROFESSIONAL (SPECIFY) . . . . . 13

Q102. WAIVER 1 SP INTERV

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5
NO SPOUSE . . . . . 6

Q103. WAVE 1 INTERVIEW COMPLETE

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q104. WAVE 1 NUM IN HOUSEHOLD

Q105. WAVE 1 NUM IN NONRES

Q106. WAVE 1 LANGUAGE

ENGLISH . . . . . 0
SPANISH . . . . . 1

Q107. WAVE 1 INTERVIEW START MODE

NOT IW . . . . . 0
PHONE . . . . . 1
F-T-F . . . . . 2

Q108. WAVE 1 RESPONDENT EDUCATION YEARS V125

Q109. WAVE 1 RESPONDENT HIGH BP V215

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q110. WAVE 1 DIABETES V219

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q111. WAVE 1 CANCER V225

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q112. WAVE 1 LUNG V235

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q113. WAVE 1 HEART V244/245/252

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q114. WAVE 1 STROKE V254

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q115. WAVE 1 PSYCHIATRIC V259

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q116. WAVE 1 ARTHRITIS V265

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q117. WAVE 1 FALL V275

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q118. WAVE 1 BROKEN HIP V277

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q119. WAVE 1 REPLACE JOINT V280

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q120. WAVE 1 INCONTINENCE V282

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q121. WAVE 1 CATARACT V289

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q122. WAVE 1 MOTHER LIVING V565

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q123. WAVE 1 FATHER LIVING V576

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q124. WAVE 1 HOSP V606

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q125. WAVE 1 NURS HOME V623

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q126. WAVE 1 MEDCARE COVER

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q127. WAVE 1 PART B MED

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q128. WAVE 1 GAVE MEDICARE NUMBER

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q129. WAVE 1 GAVE MEDICAID NUMBER

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q130. WAVE 1 HELP WALK V775

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q131. WAVE 1 RELATIONSHIP HELP WALK V776

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q132. WAVE 1 HELP DRESS V783

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q133. WAVE 1 RELATIONSHIP HELP DRESS V784

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q134. WAVE 1 HELP BATHE V779

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q135. WAVE 1 RELATIONSHIP HELP BATHE V780 (135)

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q136. WAVE 1 HELP EAT V795 (136)

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q137. WAVE 1 RELATIONSHIP HELP EAT V799 (137)

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q138. WAVE 1 HELP BED V804 (138)

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q139. WAVE 1 RELATIONSHIP HELP BED V805 (139)

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q140. WAVE 1 HELP TOILET V823)

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q141. WAVE 1 RELATIONSHIP HELP TOILET V824

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q142. WAVE 1 HELP IADL MEALS V903A1

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q143. WAVE 1 HELP IADL GROC V903A2

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q144. WAVE 1 HELP IADL PHONE V903A3

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q145. WAVE 1 HELP IADL MED V903A4 (145)

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q146. WAVE 1 IADL RELATE-1 (146)

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q147. WAVE 1 IADL RELATE-2

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q148. WAVE 1 HELP MONEY V950

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q149. WAVE 1 RELATIONSHIP HELP MONEY V951

INAP . . . . . 0
CHILD . . . . . 1
SPOUSE OF CHILD . . . . . 2
GRANDCHILD . . . . . 3
RELATIVE - OTHER . . . . . 5
OTHER INDIVIDUAL . . . . . 6
ORGANIZATION . . . . . 7

Q150. WAVE 1 CUR WORKING (150)

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q151. WAVE 1 RESPONDENT EARNED LCY

Q152. WAVE 1 RESPONDENT WAVE 1 GET SS

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q153. WAVE 1 SP WAVE 1 GET SS

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q154. WAVE 1 SP SS AMOUNT V1390

Q155. WAVE 1 SSI

Q156. WAVE 1 FOODSTAMP AMOUNT LCYR

Q157. WAVE 1 R/+SP INCOME VET BENEFITS

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q158. WAVE 1 R/+SP INCOME PENSIONS

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q159. WAVE 1 R/+SP INCOME ANNUITY

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q160. WAVE 1 R/+SP INCOME IRA

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q161. WAVE 1 R/+SP INCOME STOCKS & BONDS

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q162. WAVE 1 R/+SP INCOME SAVING/INVEST

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q163. WAVE 1 R/+SP OTHER REG INCOME

NO . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q164. WAVE 1 FAMILY INCOME V1648

Q165. WAVE 1 IMPUTE FAM INCOME V1648

NOT . . . . . 0
YES . . . . . 1

Q166. WAVE 1 OTHER HOUSEHOLD MEMBERS INCOME V1681

Q167. WAVE 1 IMPUTE OTHER HOUSEHOLD MEM INCOME V1681

NOT . . . . . 0
YES . . . . . 1

Q168. WAVE 1 NETWORTH

Q169. WAVE 1 REALESTATE V1721

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q170. WAVE 1 TRANSPORT V1725

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q171. WAVE 1 BUSINESS V1730

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q172. WAVE 1 IRA V1735

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q173. WAVE 1 STOCKS V1743

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q174. WAVE 1 CHECKINGS/SAVINGS V1750

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q175. WAVE 1 CD V1756

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q176. WAVE 1 BONDS V1782

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q177. WAVE 1 OTHER ASSETS

NONE . . . . . 0
LOW . . . . . 1
MEDIUM . . . . . 2
HIGH . . . . . 3
NOT ASCERTAINED . . . . . 7

Q178. WAVE 1 HOUSING TYPE

INAP . . . . . 0
SINGLE . . . . . 1
DUPLEX . . . . . 2
MOBILE . . . . . 3
APT/CONDO . . . . . 4
TOWNHOUSE . . . . . 5
OTHER . . . . . 7

Q179. WAVE 1 OWN RENT

INAP . . . . . 0
OWN . . . . . 1
RENT . . . . . 2
NEITHER OWN/RENT . . . . . 7

Q180. WAVE 1 VALUE HOME

Q181. WAVE 1 OWN MORT V1112

INAP . . . . . 0
YES . . . . . 1
OTHER PAYS . . . . . 3
NO . . . . . 5

Q182. WAVE 1 IWN #1W IN H# 1 OR 2

INAP . . . . . 0
FIRST IW . . . . . 1
SECOND IW . . . . . 2

Q183. TYPE RESPONDENT PRETEST 1

DO ALL . . . . . 0
TYPE 1 RESPONDENT . . . . . 1
TYPE 2 RESPONDENT . . . . . 2
TYPE 3 RESPONDENT . . . . . 3

Q184. LIVE ON FARM

INAP . . . . . 0
YES . . . . . 1
NO . . . . . 5

Q185. SELF/ELSE EMPLOYED)

INAP . . . . . 0
ELSE . . . . . 1
SELF . . . . . 2

Q186. WAVE 1 HRS WORKED PER WEEK

Q187. WAVE 1 HRS WORKED WKS/YEAR

Q188. WAVE 1 WEIGHT (LBS)

Q189. WAVE 1 CANCER SITE

INAP NO CANCER OR DK. . . . . 00
ABDOMEN . . . . . 01
ADRENAL GLAND . . . . . 02
ARM . . . . . 03
BACK . . . . . 04
BLADDER . . . . . 05
BLOOD . . . . . 06
BONE CARTILAGE . . . . . 07
BONE MARROW . . . . . 08
BRAIN . . . . . 09
BREAST . . . . . 10
LUNG/CHEST . . . . . 11
BOWEL/COLON . . . . . 12
CERVIX . . . . . 13
EAR . . . . . 14
UTERUS/WOMB . . . . . 15
ESOPHAGUS . . . . . 16
EXTREMITIES . . . . . 17
EYE . . . . . 18
FACE . . . . . 19
FEMALE ORGANS . . . . . 20
GALLBLADDER . . . . . 21
GASTROINTESTINAL . . . . . 22
HEAD . . . . . 23
HIP . . . . . 24
LYMPH NODES/GLANDS . . . . . 25
JAW . . . . . 26
KIDNEY . . . . . 27
LARYNX/VOCAL CORDS . . . . . 28
LEG . . . . . 29
LIP . . . . . 30
LIVER . . . . . 31
LYMPH NODES/GLANDS . . . . . 32
SKIN . . . . . 33
MOUTH/ORAL . . . . . 34
NECK . . . . . 35
NOSE/NASAL . . . . . 36
OVARY . . . . . 37
PANCREAS . . . . . 38
PELVIS . . . . . 39
PENIS . . . . . 40
PROSTATE . . . . . 41
SKIN . . . . . 42
SKIN . . . . . 43
SPINE . . . . . 44
SPLEEN . . . . . 45
STOMACH . . . . . 46
TESTICLES . . . . . 47
THROAT . . . . . 48
THYROID/GOITER . . . . . 49
TONGUE . . . . . 50
TRACHEA . . . . . 51
URETHRA/URETER . . . . . 52
VAGINA . . . . . 53
VULVA/LABIA . . . . . 54
METASTASIZED/ALL OVER . . . . . 95
OTHER . . . . . 97
DON'T KNOW . . . . . 98
REFUSED . . . . . 99

AHEAD WAVE 2 OTHER IMPORTANT VARIABLES

Q197. RESPONDENT INDEX Which RESPONDENT is being talked to, according to the last two digits of the Control 2 ID.

Q203. WHICH HOUSEHOLD

1ST HOUSEHOLD . . . . . 1
2ND HOUSEHOLD . . . . . 2

Q204. RESPONDENT WAVE 1 MARITAL STATUS

MARRIED . . . . . 1
MARRIED SPOUSE ABSENT . . . . . 2
LIV WITH PARTNER . . . . . 3
DIVORCED/SEPARATED . . . . . 4
WIDOWED . . . . . 5
NEVER MARRIED . . . . . 6
DIED . . . . . 7

Q210. RESPONDENT WAVE 1 SEX

MALE . . . . . 1
FEMALE . . . . . 2

Q212. RESPONDENT WAVE 1 FAM/FIN STATUS

FINANCIAL . . . . . 1
FAMILY . . . . . 2
FINANCIAL AND FAMILY . . . . . 3
NON-FINANCIAL AND NON-FAMILY . . . . . 4

Q213. SPOUSE WAVE 1 FAM/FIN STATUS

FINANCIAL . . . . . 1
FAMILY . . . . . 2
FINANCIAL AND FAMILY . . . . . 3
NON-FINANCIAL AND NON-FAMILY . . . . . 4

Q220. WHICH INTERVIEW

1ST INTERVIEW . . . . . 1
2ND INTERVIEW . . . . . 2

Q256. RESPONDENT WAVE 2 MARITAL STATUS

MARRIED . . . . . 1
MARRIED SPOUSE ABSENT . . . . . 2
LIV WITH PARTNER . . . . . 3
DIVORCED/SEPARATED . . . . . 4
WIDOWED . . . . . 5
NEVER MARRIED . . . . . 6
DIED . . . . . 7

Q258. WAVE 2 CURRENT SPOUSE

Q370. RESPONDENT WAVE 1 INTERVIEWED

NEW SPOUSE . . . . . 0
REINTERVIEW . . . . . 1
REFUSED SPOUSE . . . . . 5

Q371. RESPONDENT WAVE 2 FIRST NAME

Q372. RESPONDENT WAVE 2 LAST NAME

Q373 RESPONDENT WAVE 1 BIRTH YEAR

Q374. RESPONDENT WAVE 2 SEX

MALE . . . . . 1
FEMALE . . . . . 2

Q375. RESPONDENT WAVE 1 MARITAL STATUS

MARRIED . . . . . 1
MARRIED SPOUSE ABSENT . . . . . 2
LIV WITH PARTNER . . . . . 3
DIVORCED/SEPARATED . . . . . 4
WIDOWED . . . . . 5
NEVER MARRIED . . . . . 6
DIED . . . . . 7

Q376. RESPONDENT WAVE 2 FAMILY/NON

FINANCIAL . . . . . 1
FAMILY . . . . . 2
FINANCIAL AND FAMILY . . . . . 3
NON-FINANCIAL AND NON-FAMILY . . . . . 4

Q377. RESPONDENT WAVE 2 FINANCIAL/NON

FINANCIAL . . . . . 2
NON-FINANCIAL . . . . . 3

Q378. SPOUSE WAVE 2 NAME

Q388. IDFM/IDNFM FLAG

NOT IDFM . . . . . 0
IDFM . . . . . 1

Q391. CUR MONTH TEXT

Q435. WAVE 2 ONE OR TWO RESIDENCES

1 RESIDENCE . . . . . 1
2 RESIDENCES . . . . . 2

Q429. WAVE 2 MAIN RESIDENCE

Q440. WAVE 2 2ND RESIDENCE Assigned NO SECOND RESIDENCE if only 1 residence

Q441. WAVE 2 RESPONDENT MOVED MAIN RESIDENCE

MOVED MAIN RESIDENCE . . . . . 1
DID NOT MOVE . . . . . 5

Q503. LIST OF CHILDREN INDEX NUMBERS WHO ARE RESIDENTS

Q504. THE NUMBER OF RESIDENTS IN THE HOUSEHOLD

Q505. LIST OF CHILDREN INDEX NUMBERS WHO ARE RESIDENT CHILDREN

Q506. NUMBER OF RESIDEENT CHILDREN IN THE HOUSEHOLD

Q507. A LIST OF CHILDREN INDEX NUMBERS WHO ARE NOW RESIDENT CHILDREN

Q508. THE NUMBER OF NON RESIDENT CHILDREN IN THE HOUSEHOLD

Q510-Q512. A LIST OF CHILDREN INDEX NUMBERS WHO ARE CHILDREN

Q513. THE NUMBER OF CHILDREN IN THE HOUSEHOLD

Q515-Q516. A LIST OF CHILDREN INDEX NUMBERS WHO MOVED IN

Q517-Q519. A LIST OF CHILDREN INDEX NUMBERS WHO MOVED OUT

Q520. THE NUMBER OF PEOPLE WHO MOVED IN/OUT OF THE HOUSEHOLD

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