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
Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX I: Acronyms Used in This Report
AAHSA
American Association of Homes and Services for the Aging
ADCF
Advance Data Collection Form
AHRQ
Agency for Healthcare Research and Quality
ALFA
Assisted Living Federation of America
ASHA
American Seniors Housing Association
ASPE
Office of the Assistant Secretary for Planning and Evaluation
