Health Services, Formal

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XXII: Refusal Conversion Letters

Exhibit A . Having trouble reaching you letter Exhibit B . No time letter Exhibit C . Not interested/not if voluntary letter Exhibit D . Cancelled appointment letter Exhibit A. Having Trouble Reaching You Letter

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XXI: Interviewer Debriefing Questionnaire

DID THE ADMINISTRATOR HAVE THE PRE-INTERVIEW WORKSHEET FILLED OUT? YES NO (please explain) DID RESPONDENT(S) HAVE ANY SPECIFIC DIFFICULTIES ANSWERING ANY QUESTIONS? YES NO (please explain) DO YOU FEEL RESPONDENTS WERE ACCURATE IN THEIR ANSWERS? YES NO (please explain)

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

Question Number Question Item Code Categories Resident Asked Skip Pattern R_A_INTRO1

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

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

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XVIII: NSRCF Facility Questionnaire

Question Number Facility Question Item Code Categories Facility Asked Skip Pattern F_A1_Intro1 This survey is about the characteristics of residential care facilities and the individuals who live in them.

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XVII: NCHS Thank You Letter

Department of Health & Human Services Public Health Service Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road Hyattsville, Maryland 20782 Thank You

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XVI: Appointment Reschedule Call Script

RESCHEDULE CALL OPEN FACESHEET . GO TO FACILITY & DIRECTOR TAB AND REVIEW DATA. GO TO APPOINTMENT TAB AND REVIEW DATA. PLACE CALL TO PRIMARY PERSON TO REMIND. SPEAKING TO RECEPTIONIST

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XV: Interviewer Reminder Call Script

REMINDER CALL OPEN FACESHEET . GO TO FACILITY & DIRECTOR TAB AND REVIEW DATA. GO TO APPOINTMENT TAB AND REVIEW DATA. PLACE CALL TO PRIMARY PERSON TO REMIND. SPEAKING TO RECEPTIONIST Hello, this is FIRST AND LAST NAME OF INTERVIEWER. May I please speak with ____________________? Could you transfer me to his/her voicema

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XIV: Pre-Interview Worksheet

OMB No. 0920-0780 Exp. Date 12/31/2012 2010 National Survey of Residential Care Facilities Pre-Interview Worksheet Dear {NAME OF DIRECTOR} at {NAME OF FACILITY} Thank you for agreeing to participate in the 2010 National Survey of Residential Care Facilities. The date and time of your interview and your interviewer's name are: {

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XIII: NSRCF Screener Questionnaire

Question Number Screener Question Item Code Categories Facility Asked Skip Pattern S_I_STATEMENT_A I would like to verify some information we have about [ SAMPLED FACILITY ]. The questions I have right now should take just a few minutes.

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XII: Frequently Asked Questions

WHO SPONSORS THIS STUDY? This is a federally-sponsored statistical survey. The government agency sponsors include the Centers for Disease Control and Prevention, the Assistant Secretary for Planning and Evaluation, and the Department of Veterans Affairs. I work for RTI International, a not-for-profit research institute located in Nort

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XI: Set an Appointment Call Script

OPEN FACESHEET TO FACILITY & DIRECTOR AND REVIEW DATA. PLACE CALL. SPEAKING TO RECEPTIONIST:

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX X: Advance Package to Facilities

The advance package to facilities is the same as the NSRCF package to chains except that it included the NCHS letter to facilities with FAQs on the back, instead of the NCHS letter to chains.

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX IX: Advance Package Call Script

ADVANCE PACKAGE CALL: OPEN FACESHEET. GO TO ORIGINAL PRELOADS TAB AND REVIEW DATA. GO TO FACILITY & DIRECTOR. PLACE CALL. VERIFY INFORMATION:

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX VIII: NSRCF Chain Package

Exhibit A . NSRCF Pocket Folder Exhibit B . NCHS Letter to Chains Exhibit C . NCHS ERB Letter Exhibit D . NSRCF Brochure (available from: http://www.cdc.gov/nchs/data/nsrcf/nsrcf_brochure.pdf )

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX VII: Provider Organization Newsletter Articles on NSRCF

Data Collection For Federal Health Center Assisted Living Study Begins In April The National Survey of Residential Care Facilities, a national study of assisted living and residential care communities, is scheduled to start the data collection phase in April 2010. The National Center for Health Statistics (NCHS), within the Centers for Disea

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX VI: Provider Organizations That Supported NSRCF

CEAL Board of Directors and their organizations Karen Love, President David Kyllo, National Center for Assisted Living (NCAL) Stephen Maag, American Association for Homes and Services for the Aging (AAHSA) Rachelle Bernstecker, American Seniors Housing Association (ASHA) Maribeth Bersani, Assisted Living Federation of America (ALFA)

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX V: NSRCF Letter of Support

The National Survey of Residential Care Facilities (NSRCF) is the first ever federal study of residential care/assisted living communities designed to provide national information about these communities and their residents. In-person interviews will be conducted with directors and caregivers to provide information about services, staffing, and pr

Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX IV: Facesheet

NOTE : This is a recreation of this form. See the PDF version for a scanned version of the actual form. CASE ID: Facility Name: Facility City: _ X _Original Preloads ___Facility & Director ___Chain ___Completed Mailouts ___Appointment Proceed to form NSRCF FACESHEET Original Preloads CASEID:

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

Survey Domains: Facility Level Data Domain Source of Data Proposed Survey Domains Final Survey Domains Background and Demographics of Administrator Position held Facility Staff

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