Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX III: Survey Domains for the National Survey of Residential Care Facilities

11/01/2011

Survey Domains: Facility Level Data
Domain   Source  
of
Data
  Proposed  
Survey
Domains
Final
Survey
  Domains  
Background and Demographics of Administrator
Position held   Facility Staff   X X
Length of time on job Facility Staff X X
Experience and training Facility Staff X X
Race of administrator Facility Staff X X
Gender of administrator Facility Staff X X
Age of administrator Facility Staff X X
Education of administrator Facility Staff X X
Facility Characteristics
How facility licensed Facility Staff X X
Ownership (for profit/not for profit) Facility Staff X X
Affiliation (chain or independent) Facility Staff X X
Multi-level campus Facility Staff X X
Length of time in operation Facility Staff X X
Number of beds/residents Facility Staff X X
Alzheimer’s Special Care Unit Facility Staff X X
Type of accommodations (e.g., private rooms, bathrooms) Facility Staff X X
Charges and reimbursement rates (amount and what it covers)   Facility Staff X X
Participation in Medicaid Facility Staff X X
Waiting lists Facility Staff X X
Occupancy rates Facility Staff X X
Resident turnover: admissions/discharges Facility Staff X X
Type of staff (e.g., RNs, LPNs) Facility Staff X X
Staffing levels Facility Staff X X
Level of staff training Facility Staff X X
Staff turnover Facility Staff X X
Record keeping (types of data maintained) Facility Staff X X
Age of residents served Facility Staff X X
Facility Staff estimates of cognitive, functional and health status of residents   Facility Staff X X
Facility Policies/Services
Types of services provided on site Facility Staff X X
Types of services provided by outside staff Facility Staff X X
Medication administration Facility Staff X X
Use of restraints Facility Staff X X
Admission policy (who admitted/excluded) Facility Staff X X
Discharge policy (reasons for discharge) Facility Staff X X
Linkage to health care system Facility Staff X  
Greatest problem Facility Staff X  

 

Survey Domains: Resident Level Data
Domain Source of Data   Proposed  
Survey
Domains
Final
Survey
  Domains  
  Resident     Family     Staff1  
Demographics
Age or date of birth X X X X X
Race/ethnicity X X X X X
Gender X X X X X
Education X X   X X
Marital Status X X X X X
Income X X   X  
Family/Social ties X X   X  
Previous occupation X X   X  
Resident Characteristics
Prior Living Arrangements X X   X X
Length of time in facility/date of admission X X X X X
Reason for moving to a facility X X   X  
Reason for choosing a residential care facility X X   X  
Rate paid X X X X X
Payment source(s) (private sources/Medicaid)   X X X X X
Insurance Status X X   X  
Health Status and Physical Functioning
Physical health/health conditions X X X X X
Cognitive status X X X X X
Health status X X X X X
Hospital stays X X X X X
Number of ER visits X X X X X
Vaccinations (flu/pneumonia) X     X X
Physical functioning (ADL/IADL status) X X X X X
Psycho-social well-being X X X X X
Mental health status   X X X X
Behavioral problems   X X X X
Types of services used (on-site staff) X   X X X
Types of services used (off-site staff) X   X X  
Autonomy and Choice
Living arrangement (lives in private room; has a roommate, shared or private bath)   X X X X X
Activity involvement X   X X X
Satisfaction
Satisfaction with accommodations X X   X  
Satisfaction with staff X X   X  
Satisfaction with services received X X   X  
  1. Staff may need to consult facility records for some of the information in this list.

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