Licensure Questionnaire

01/01/1992


This instrument was developed for the National Board and Care Survey project. This project was conducted by the Bureau of the Census under contract for the Department of Health and Human Services (HHS) Office of Disability, Aging and Long-Term Care Policy. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.


NOTE: This is a recreation of this form. See the PDF version for a scanned version of the actual form.

 

QUESTIONNAIRE 2
LICENSURE

FIFTY STATE SURVEY OF AGENCIES INVOLVED
IN THE REGULATION OF BOARD AND CARE HOMES

 

STATE: _________________________
AGENCY: _________________________
CONTACT: _________________________  
POSITION: _________________________
DATE: _________________________
INTERVIEWER: _________________________  

 

START TIME: _________________________    

PART I: REGULATIONS

1. Is the following an accurate definiton of how your state defines board and care, known in your state as _________________________?

DEFINITION: _________________________   If this is a correct definition, then summarize and input into data base.

 

_____Yes Y = Yes
N = No
D = Don't Know  
_____No     IF NO, PLEASE PROVIDE YOUR STATE'S DEFINITION.
_____Don't Know

2. Can board and care homes admit bedfast residents?

_____Yes     IF YES, SKIP TO QUESTION 4.   Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know

3. Can board and care homes retain residents who become bedfast after admittance?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know  

4. Can board and care homes admit chairfast residents?

_____Yes     IF YES, SKIP TO QUESTION 6.   Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know

5. Can board and care homes retain residents who become chairfast after admittance?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know  

6. How does your state classify board and care facilities? (SPECIFY CATEGORIES OF BOARD AND CARE HOMES AND CRITERIA FOR ESTABLISHING THESE CATEGORIES.)

CATEGORY CRITERIA
A. _________________________   a. _________________________  
b. _________________________
c. _________________________
B. _________________________ a. _________________________
b. _________________________
c. _________________________
C. _________________________ a. _________________________
b. _________________________
c. _________________________
D. _________________________ a. _________________________
b. _________________________
c. _________________________
E. _________________________ a. _________________________
b. _________________________
c. _________________________
Total Number of Categories _____  

7. Does board and care include what is known as assisted living that is a residential environment that provides supportive services to the semi-independent elderly who are functionally impaired and require some household services but who do not require nursing care or constant supervision?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know  

8. Do board and care regulations also apply to assited living programs?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know  

9. How is assisted living distinguished from board and care? _________________________

10. What is the total number of LICENSED board and care facilities in your state? (SPECIFY BY FACILITY CATEGORY.)

  CLASSIFICATIONS IN YOUR STATE:  
(Use categories from Question 6.)
Size Range
  # of Beds in Existing Homes  
  Total Homes     Total Beds   Total Current Residents
  (or Extimate Occupancy Rate)  
_________________________ _________________________ _____ _____ _____
_________________________ _________________________ _____ _____ _____
_________________________ _________________________ _____ _____ _____
_________________________ _________________________ _____ _____ _____
  TOTAL _____ _____ _____

11. Do you think that the number of licensed board and care facilities in your state is increasing in number since 1980?

_____No Y = Yes
N = No
D = Don't Know  
_____Yes     Why?_________________________  
_____Don't Know

 

PART II: MONITORING

12. Does your state inspect licensed homes on a regular basis?

_____No   Specify number of times in a calendar year.  
_____Yes   If yes, ask
How often does state inspect?
How often does a local agency inspect? _____ times per year  
(IF NO, SKIP TO QUESTION 14.)

13. Who inspects the licensed homes? (CIRCLE ALL THAT APPLY.)

  1. Social worker
  2. Nurse
  3. Fire marshall
  4. Health inspector
  5. Physician
  6. Welfare worker - not a social worker
  7. Building inspector
  8. Other (SPECIFY) _________________________

 

PART III: ENFORCEMENT

14. Are the following remedies or sanctions used in your state for addressing problems encountered in LICENSED board and care homes:

(IF USED BY THE STATE ENTER "Y" AND THEN ASK:

How often has the sanction been used during the last 12 months?

    USED BY STATE     TIMES USED IN LAST YEAR   For:
(1) "Used by State"  
Y = Yes
N = No
D = Don't Know

(2) "Times Used"
Enter a number, if respondent doesn't know number, enter "9's."

If unknown, enter "9's."

A. Corrective action plan with facility certifying action completed? _____ _____
B. Corrective action plan with On site inspection by state or local agency to verify action completed? _____ _____
C. Provisional License?

IF YES, SPECIFY:

Maximum time facility can have a provisional license _____ months

Maximum number of provisional licenses before other action taken _____

_____ _____
D. License revocation? _____ _____
E. Monetary fine?

IF YES, SPECIFY:

Range of $ amount:
   Minimum $_____
   Maximum $_____
Average amount of fines imposed last year $_____
# Homes fined last year _____
# Fines IMPOSED last year _____
# Fines COLLECTED last year _____

_____ _____ Enter amounts in dollars, no cents.

If unknown, enter "9's."

F. Ban on admissions? _____ _____  
G. Ban on referrals? _____ _____  
H. Other? (Specify) _____ _____  

15. What are the major obstacles to dealing with LICENSED homes? (LIST EACH OBSTACLES SEPARATELY)

A. _________________________ Input first obstacles listed. If there are more than 6 listed code yes for "other obstacles."
B. _________________________
C. _________________________
D. _________________________
E. _________________________
F. _________________________
G. _________________________
H. _________________________
(OTHER OBSTACLES? _________________________  

16. Is there a register or listing of licensed facilities in your state?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No (IF NO, SKIP TO QUESTIONS 19.)  
_____Don't Know

17. Is this register or listing available to the public upon request?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know  

18. Is this register or listing made available in other ways such as through libraries, hospitals or Area Agencies on Aging?

_____No Y = Yes
N = No
D = Don't Know  
_____Yes      Specify How_________________________  
_____Don't Know

19. Approximately how many of these registers were provided to the public in FY90?

Enter number: _____   If respondent doesn't know number, enter "9's."

 

PART IV: UNLICENSED HOMES

20. Is an effort made to identify UNLICENSED board and care homes in your state?

_____No (IF NO, SKIP TO QUESTION 23.) Y = Yes
N = No
D = Don't Know  
_____Yes     How?_________________________  
_____Don't Know

21. In your opinion how successful is your state in identifying unlicensed board and care homes?

_____ Very successful Very Successful = VS
Somewhat Successful = SS
Somewhat Unsuccessful = SU
Very Unsuccessful = VU
Don't Know = DK
_____ Somewhat successful
_____ Somewhat unsuccessful
_____ Very unsuccessful
_____ Don't Know

22. What are the major obstacles to LOCATING unlicensed board and care homes? (LIST EACH OBSTACLE SEPARATELY.)

A. _________________________ Input first 5 obstacles. If there are more than 5 listed obstacles, code "yes" for other obstacles."
B. _________________________
C. _________________________
D. _________________________
E. _________________________
F. _________________________
G. _________________________
H. _________________________
(Other Obstacles? _________________________)  

23. What is the total number of UNLICENSED board and care facilities in your state?

  Size Range in
  # of Beds of Existing Homes  
  Total Homes     Total Beds   Total Current Residents
  (or Estimate Occupancy Rate)  
If numbers unknown code "9's".
Lawfully Unlicensed*     __________     _____     _____     __________  
Illegal Unlicensed**   __________     _____     _____     __________  
* Lawfully unlicensed board and care homes are homes which do not require licensure according to state law.
** Illegal unlicensed board and care homes are homes which are required under state law to be licensed but which do not fulfill this requirement.

24. Do you think that the number of UNLICENSED board and care facilities in your state is increasing in number since 1980?

_____No Y = Yes
N = No
D = Don't Know  
_____Yes     Why?_________________________  
_____Don't Know

25. What remedies or sanctions exist for addressing an illegal UNLICENSED board and care home? (LIST EACH SEPARATELY AND SPECIFY HOW OFTEN USED IN LAST 12 MONTHS.)

    TIMES USED   Input first 5 sanctions. If If more than 5 sanctions, code "Y" for "other sanctions."

If number of times used is unknown code "9's."

A. _________________________ _____
B. _________________________ _____
C. _________________________ _____
D. _________________________ _____
E. _________________________ _____
F. _________________________ _____
G. _________________________ _____
H. _________________________ _____
(Other Sanctions? _________________________)   _____

26. What are the major obstacles to dealing with illegal UNLICENSED homes? (LIST EACH OBSTACLE SEPARATELY.)

A. _________________________ Input first 5 obstacles listed. If more than 5 obstacles, code "Y" for "other obstacles."
B. _________________________
C. _________________________
D. _________________________
E. _________________________
F. _________________________
G. _________________________
H. _________________________
(Other Obstacles? _________________________  

27. Why do you think that illegal homes remain unlicensed? _________________________

 

PART V: EFFECT OF STATE REGULATIONS

28. Is the trend in your state to have more stringent requirements for board and care homes?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know  

29. Within the past five years, has any legislation been passed that was directed toward changing the board and care program in your state?

_____No     IF NO, SKIP TO QUESTION 33 Y = Yes
N = No
D = Don't Know  
_____Yes     Describe Legislation _________________________  
_____Don't Know

30. Did this affect the NUMBER of licensed homes in your state? Of unlicensed homes?

_____Yes, Affected Number of Licensed Homes
     How? _________________________  
If checked code "Y;" if not checked code "N."
_____Yes, Affected Number of Unlicensed Homes
     How? _________________________  
_____Don't Know

31. Were the following other items affected by this legislation? (CHECK ALL THAT APPLY.)

_____ A. Residential care payment rate If checked, Code "Y." If not checked, Code "N."
_____ B. Residential care payment procedures
_____ C. Client eligiblity criteria
_____ D. Content and distribution of services to residents
_____ E. Inspection and licensure of facilities
_____ F. Other (SPECIFY)_________________________  

32. Did the regulations affect different sizes or types of facilities in different ways? (CHECK ALL THAT APPLY.)

_____ A. Only affect small homes If checked, Code "Y." If not checked, Code "N."
_____ B. Only affect large homes
_____ C. Affect all sizes of homes
_____ D. Only affect homes with one type of client (SPECIFY) _________________________  
_____ E. Only affect homes with several types of client
_____ F. Affect homes with all types of clients
_____ G. Other (SPECIFY) _________________________  
(DESCRIBE THE NATURE OF THE CHANGES) _________________________

33. How often are board and care regulations reviewed? _________________________ Specify in terms of years.

34. When was the last time board and care regulations were reviewed? _________________________, 19_____ Specify month and year.

 

PART VI: FUNDING

35. Are there any sources of funding in the state for loans or grants to facilities for improvements to meet the standards?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No (IF "NO", SKIP TO QUESTION 40.)
_____Don't Know

36. How many facilities received these funds in FY90?

Enter number of facilities: _____   If unknown, enter "9's."

37. How many facilities applied for these funds in FY90?

Enter number of facilities: _____   If unknown, enter "9's."

38. How much can a facility borrow? $__________.00 per _________________________

39. At what payback rate? _________________________

40. Are there any funds available for improvements which are not linked to meeting regulations, for example automatic sprinkler systems, home adaptations, home modifications to insure resident privacy?

_____No (IF NO, SKIP TO QUESTION 43.) Y = Yes
N = No
D = Don't Know  
_____Yes     Describe _________________________  
_____Don't Know

41. How many facilities received these funds in FY90?

Enter number of facilities: _____   If unknown, enter "9's."

42. How many facilities applied for these in FY90?

Enter number of facilities: _____   If unknown, enter "9's."

 

PART VII: ZONING REGULATIONS

43. Is there a state-wide zoning waiver for approved board and care facilities?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No (IF "NO",SKIP TO QUESTIONS 45.)
_____Don't Know

44. What must a prospective operator do to qualify for a zoning waiver? _________________________

45. Has there been community resistance to opening board and care homes?

_____No Y = Yes
N = No
D = Don't Know  
_____Yes     Describe _________________________  
_____Don't Know

46. Are zoning laws an issue in including or excluding facilities from becoming approved as board and care facilities?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No
_____Don't Know  

 

PART VII: STAFF/RESIDENT RATIO

47. Are there established staff/client ratios required in board and care facilities?

_____Yes Y = Yes
N = No
D = Don't Know  
_____No (IF NO, SKIP TO NEXT SECTION.)  
_____Don't Know

48. What is the staff/client ratio for each different type of facility? (LIST FACILITY TYPE AND THEN STAFF/CLIENT RATIO.)

  FACILITY TYPE     STAFF CLASSIFICATION     RATIO  
1. _________________________ _________________________ _____
2. _________________________ _________________________ _____
3. _________________________ _________________________ _____
4. _________________________ _________________________ _____
5. _________________________ _________________________ _____
6. _________________________ _________________________ _____

49. How is this ratio enforced? _________________________

 

PART VII: RESIDENT'S BILL OF RIGHTS

50. Is there a bill of rights for board and care residents in your state?

_____Yes   Y = Yes  
N = No
_____No

51. Are residents formally made aware of their rights?

_____No  
_____Yes     How? _________________________    

52. Are operators formally made aware of the rights of their residents? How?

_____No  
_____Yes     How? _________________________    

53. What procedures are available for enforcing the resident's bill of rights? (LIST EACH SEPARATELY)

A. _________________________  
B. _________________________  
C. _________________________  
D. _________________________  
E. _________________________  
F. _________________________  
G. _________________________  
OTHER OBSTACLES? _________________________    

54. Are you satisfied with the current state and local division of responsibility for board and care within your state?

_____No Y = Yes
N = No
D = Don't Know  
_____Yes     Why not? _________________________  
_____Don't Know

 

ENDING TIME: _________________________    

NATIONAL BOARD AND CARE SURVEY DESIGN REPORTS AVAILABLE

Searching for a Needle in a Haystack: Creative Use of the Decennial Census Dress Rehearsal Data to Find Board and Care Places in Central Missouri

Executive Summary   http://aspe.hhs.gov/daltcp/reports/1992/haystkes.htm

HTML   http://aspe.hhs.gov/daltcp/reports/1992/haystk.htm

PDF   http://aspe.hhs.gov/daltcp/reports/1992/haystk.pdf

INSTRUMENTS AVAILABLE

All Respondents Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/AllResp.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/AllResp.pdf

Interagency Councils Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/IntCoun.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/IntCoun.pdf

Licensure Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/Licensure.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/Licensure.pdf

Local Agency Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/LocalAg.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/LocalAg.pdf

Local Ombudsman Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/LocalOm.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/LocalOm.pdf

Payment/Eligibility Questionnaire

HTML   http://aspe.hhs.gov/daltcp/instruments/PayElig.htm

PDF   http://aspe.hhs.gov/daltcp/instruments/PayElig.pdf


To obtain a printed copy of this report, send the full report title and your mailing information to:

U.S. Department of Health and Human Services
Office of Disability, Aging and Long-Term Care Policy
Room 424E, H.H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
FAX:  202-401-7733
Email:  webmaster.DALTCP@hhs.gov


Preview
Download

"Licensure_0.pdf" (pdf, 2.29Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®