Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XIX: NSRCF Resident Selection Questionnaire

11/01/2011

Question Number Resident Selection Question Item Code Categories Facility Asked Skip Pattern
P_CHECK INTERVIEWER: ENTER WHAT STAGE YOU HAVE REACHED IN INTERVIEWING THIS FACILITY. 1 STARTED/ COMPLETED FACILITY QUESTIONNAIRE --WROTE DOWN # OF BEDS
2 STARTED/ COMPLETED FACILITY QUESTIONNAIRE --DID NOT WRITE DOWN # OF BEDS
3 HAVE NOT STARTED THE FACILITY QUESTIONNAIRE
All facilities  
P_FA1 I will now re-ask a question I asked earlier. This is because the information is needed for this next part of the interview.
At this facility, what is the number of licensed, registered, or certified residential care beds? Include both occupied and unoccupied beds.
1-995
NUMBER OF BEDS
  IF P_CHECK = 2
  INTERVIEWER:
IF YOU WROTE DOWN THE NUMBER OF LICENSED, REGISTERED, OR CERTIFIED RESIDENTIAL CARE BEDS WHEN ADMINISTERING THE FACILITY QUESTIONNAIRE (F_A1), RECORD THE NUMBER OF BEDS HERE. YOU DO NOT NEED TO ASK THE QUESTION FOR P_FA1
1-995
NUMBER OF BEDS
  IF P_CHECK = 1
  At this facility, what is the number of licensed, registered, or certified residential care beds? Include both occupied and unoccupied beds. 1-995
NUMBER OF BEDS
  IF P_CHECK = 3
P_FA1a ASK ONLY IF P_FA1 = DK (CAN'T ANSWER IN BEDS BECAUSE FACILITY IS LICENSED BY THE NUMBER OF ROOMS /APARTMENTS)
Thank you. In that case, at this facility what is the number of licensed, registered or certified rooms or apartments where residents live? Exclude rooms within apartments.
1-995
NUMBER OF ROOMS/ APARTMENTS
  IFP_FA1 = DK
P_FA1_CONFIRM You reported that this facility has less than 4 beds. Is this correct?
[If NO, CORRECT P_FA1]
1 YES
2 NO
  If P_FA1<4
P_FA1_ABORT I am sorry but your facility is not eligible for this study. Thank you for your time.     If P_FA1_CONFIRM = 1
P_INTRO_A To help make a random selection of residents for our resident interviews, can you tell me the number of residents living in this residential care facility as of midnight yesterday?
A MINIMUM OF ONE (1) RESIDENT IS REQUIRED TO CONTINUE.
1-995
NUMBER OF RESIDENTS
  IF P_CHECK = 1
P_INTRO_B I will be able to complete the interviews about the residents now and come back to complete the facility information later. I'll need your help for a few more minutes right now.
What is the current number of residents living at this residential care facility as of midnight yesterday?
A MINIMUM OF ONE (1) RESIDENT IS REQUIRED TO CONTINUE.
1-995
NUMBER OF RESIDENTS
  IF P_CHECK = 2
P_INTRO_C In order to obtain national level data about the residents of residential care facilities such as this one, we are collecting information from a sample of current residents. I will be asking questions about the background, health status, and charges for each sampled resident. I will need your help for a few minutes right now.What is the current number of residents living at this residential care facility as of midnight yesterday?
A MINIMUM OF ONE (1) RESIDENT IS REQUIRED TO CONTINUE.
1-995
NUMBER OF RESIDENTS
  IF P_CHECK = 3
P_INTRO_OTHER The next process is sampling the residents. In order to protect the confidentiality of your residents, I will need to work with someone who can best assist with selecting the sample from a list and locating staff who are familiar with the sampled residents. Are you the best person to help WITH the resident sampling process?
INTERVIEWER:
ASK FOR A SUBSTITUTE IF ONE IS AVAILABLE, TO ANSWER THESE QUESTIONS.
1 YES
2 NO
  If SCREENER.S_17 = 2
P_INTRO_START We'll begin by selecting a sample of your residents. Because this is a statistical survey, I will need to follow procedures to do this. To start, I will ask you to provide a list of the current residents as of midnight yesterday. The sampling procedures do not require the full name of the residents. I will only record the initials of each resident. Each resident should be listed on a separate line.
Then, I will briefly review the list with you. Finally after I enter the total number of current residents, the computer program will randomly choose which residents we will include in the sample.
1 CONTINUE All eligible facilities  
P_CONFIRM INTERVIEWER:
WHEN YOU GET THE LIST FROM THE RESPONDENT, READ:
I just need to confirm that this is a complete list of all the residents as of midnight yesterday.
INTERVIEWER:
LOOK AT THE LIST TOGETHER WITH THE RESPONDENT.
Please take a moment to check for anyone on the list who was not a resident as of midnight yesterday or who is younger than 18 years old. Also check for new residents who might not be on the list but were admitted before midnight yesterday.
To the best of your knowledge, is this list complete and accurate?
INTERVIEWER:
IF NO, ASK THE RESPONDENT TO MAKE ANY ADJUSTMENTS NECESSARY TO THE LIST. YOU WILL NOT BE ABLE TO PROCEED UNTIL THE LIST IS CORRECT AND THE RESPONSE IS YES.
1 YES
2 NO
All eligible facilities  
P_ENUME RATE NUMBER THE RESIDENTS BEGINNING WITH 1. IF THERE ARE MULTIPLE PAGES OF RESIDENTS, THEN CONTINUE NUMBERING THE NEXT PAGE WHERE YOU LEFT OFF. THE PROGRAM WILL MAKE A RANDOM SELECTION WHICH WILL REFER TO YOUR PERSON-LEVEL NUMBERING. 1 CONTINUE All eligible facilities  
P_ASK_R I have counted {in line} on the list. Would you say that is an accurate number of residents?
INTERVIEWER:
IF THE RESPONSE IS NO THEN CORRECT AND RENUMBER THE LIST BEFORE ENTERING YES TO CONTINUE.
1 YES
2 NO
All eligible facilities  
P_NUM_R ENTER THE TOTAL NUMBER OF RESIDENTS ON THE CONFIRMED LIST.
IF THE TOTAL NUMBER OF RESIDENTS IS 0, BREAKOFF THE INTERVIEW.
1-995
NUMBER OF RESIDENTS
All eligible facilities  
P-End PRESS ‘‘1'' TO CONTINUE. 1 CONTINUE All eligible facilities  
S-Start PRESS ‘‘1'' TO SELECT RESIDENTS AT THIS FACILITY. 1 CONTINUE All eligible facilities  
S_CHOOSE_R INTERVIEWER:
THIS DISPLAY TELLS YOU WHICH ARE YOUR SELECTED CASES.
NOW SAY TO YOUR RESPONDENT:
The computer program has identified the following residents [READ RESIDENTS SELECTED]. To complete interviews about these selected residents, I would like to speak with a caregiver who knows about them. Our Resident Questionnaire asks about services provided to the resident and a little about his or her background. I can interview different caregivers for different residents. I would like your help arranging to speak with the caregiver in a private place or some place where we wont be disturbed. The Resident Questionnaire takes about 20 minutes for each selected resident.
It will also be helpful if the resident records for each of the residents selected could be retrieved before we begin these interviews.
1 CONTINUE All eligible facilities  
S_RESIDENT ID Here I will record a description of our selected residents.
INTERVIEWER:
ENTER THE FIRST AND LAST INITIALS OF THE SAMPLED RESIDENTS. NO OTHER INFORMATION ABOUT THE RESIDENTS SHOULD BE ENTERED HERE.
RESIDENT INITIALS All eligible facilities  
S_THANKU Thank you, now we can proceed with the Resident portion of the study.

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