2010 chMar 49 Number 1,ies Ser

Design and Operation of

the National Home Health

Aide Survey: 2007–2008
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Bercovitz A, Moss AJ, et al. Design and operation of the National Home Health

Aide Survey: 2007–2008. National Center for Health Statistics. Vital Health Stat

1(49). 2010.

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Series 1, Number 49

Design and Operation of

the National Home Health Aide

Survey: 2007–2008

Program and Collection Procedures

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

March 2010

DHHS Publication No. (PHS) 2010–1325
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate Director for Science

Division of Health Care Statistics

Jane E. Sisk, Ph.D., Director for Health Care Statistics
Contents
 

Acknowledgments ......................................................................................... iii 
 

Abstract ................................................................................................. 1 
 

Introduction .............................................................................................. 1 
 

Design Process............................................................................................ 2 
 

Initial Modifications to National Nursing Assistant Survey (NNAS)............................................... 2 
 

Pilot Test .............................................................................................. 3 
 

Pretest................................................................................................. 4 
 

Modifications between Pretest and National Survey ............................................................ 5 
 

National Survey Methods ................................................................................... 6 
 

Sample Design and Selection .............................................................................. 6 
 

Data Collection Procedures................................................................................ 7 
 

Survey Instrument ......................................................................................... 9 
 

Data Processing ........................................................................................... 9 
 

Response Rates ........................................................................................... 11 
 

Overall National Home Health Aide Survey (NHHAS) Response Rate............................................. 11 
 

Agency Response Rate ................................................................................... 11 
 

Home Health Aide Response Rate .......................................................................... 11 
 

Nonresponse............................................................................................ 11 
 

Public-Use File Data Set.................................................................................... 12 
 

Estimation Procedures...................................................................................... 12 
 

Standard Errors ......................................................................................... 12 
 

Survey Weights ......................................................................................... 12 
 

Reliability of Survey Estimates .............................................................................. 13 
 

Confidentiality ............................................................................................ 13 
 

Data Dissemination ........................................................................................ 13 
 

References ............................................................................................... 13 
 

Appendix I............................................................................................... 14 
 

List of Acronyms and Terms Used in This Report ............................................................. 14 
 

Appendix II .............................................................................................. 15 
 

Sampling Form ......................................................................................... 15 
 

Appendix III ............................................................................................. 16 
 

Flow Chart of Data Collection Procedures ................................................................... 16 
 

Appendix IV ............................................................................................. 17 
 

Contact Materials........................................................................................ 17 
 

iii
Appendix V .............................................................................................. 28 
 

DVD Storyboard ........................................................................................ 28 
 

Appendix VI ............................................................................................. 59 
 

Introductory Contact Script ............................................................................... 59 
 

Appendix VII............................................................................................. 61 
 

Text of Informed Consent ................................................................................. 61 
 

Appendix VIII ............................................................................................ 62 
 

Follow-up Scripts ....................................................................................... 62 
 

Appendix IX ............................................................................................. 69 
 

2007 National Home Health Aide Survey Questionnaire (NHHAS) ............................................... 69 
 

Text Figure

1. Number of calls per completed interview, 2007 National Home Health Aide Survey .............................. 8 
 

Text Table

A. Key subject areas on the 2007 National Home Health Aide Survey questionnaire................................. 10 
 

iv
Acknowledgments
 

The National Home Health Aide

Survey (NHHAS) was sponsored by the

Office of the Assistant Secretary for

Planning and Evaluation (ASPE). The

survey was conducted by the Centers for

Disease Control and Prevention’s

National Center for Health Statistics

(NCHS). The ASPE Federal Project

Officer was Marie Squillace. The NCHS

Federal Project Officers were Lauren

Harris-Kojetin and Robin Remsburg.

Design, production, and analysis

assistance for this project was provided

by: Emily Rosenoff, Anita Bercovitz,

Abigail Moss, Frederic Decker, Sarah

Gousen, Adrienne Jones, Iris Shimizu,

Arlene Siller, Genevieve Strahan,

Roberto Valverde, Lisa Dwyer, and

William Pearson.

The questionnaire was developed

with the assistance of Mathematica

Policy Research, Inc. All interviews for

this project were conducted by Westat.

We are indebted to our national

advisory group members who were most

giving of their time and expertise: Mark

Heaney, Chris Murtaugh, Mary St.

Pierre, Vera Salter, Jean Scott, Peter

Kemper, D.E.B. Potter, Edward

Salsberg, Michael Sinclair, Robyn Stone,

and Kenneth Wessel.

Most importantly, we gratefully

acknowledge the home health and

hospice aides who were willing to

participate in the interviews.

v
Design and Operation of the

National Home Health Aide

Survey: 2007–2008

By Anita Bercovitz, M.P.H., Ph.D.; Abigail J. Moss; Manisha

Sengupta, Ph.D.; and Lauren D. Harris-Kojetin, Ph.D., National

Center for Health Statistics; Marie R. Squillace, Ph.D.; and Emily

Rosenoff, M.P.A., Office of the Assistant Secretary for Planning and

Evaluation; and Laura Branden, Westat

Objectives

This report provides an overview of

the National Home Health Aide Survey

(NHHAS), the first national probability

survey of home health aides. NHHAS

was designed to provide national

estimates of home health aides who

provided assistance in activities of daily

living (ADLs) and were directly employed

by agencies that provide home health

and/or hospice care.

This report discusses the need for and

objectives of the survey, the design

process, the survey methods, and data

availability.

Methods

NHHAS, a multistage probability

sample survey, was conducted as a

supplement to the 2007 National Home

and Hospice Care Survey (NHHCS).

Agencies providing home health and/or

hospice care were sampled, and then

aides employed by these agencies were

sampled and interviewed by telephone.

Survey topics included recruitment,

training, job history, family life, client

relations, work-related injuries, and

demographics. NHHAS was virtually

identical to the 2004 National Nursing

Assistant Survey of certified nursing

assistants employed in sampled nursing

homes with minor changes to account for

differences in workplace environment and

responsibilities.

Results

From September 2007 to April 2008,

interviews were completed with 3,416

aides. A public-use data file that contains

the interview responses, sampling

weights, and design variables is

available. The NHHAS overall response

rate weighted by the inverse of the

probability of selection was 41 percent.

This rate is the product of the weighted

first-stage agency response rate of

57 percent (i.e., weighted response rate

of 59 percent for agency participation in

NHHCS times the weighted response

rate of 97 percent for agencies

participating in NHHCS that also

participated in NHHAS) and the weighted

second-stage aide response rate of

72 percent to NHHAS.

Keywords: National Home Health

Aide Survey c home health aide c

hospice aide c direct care worker

Introduction
 

By 2050 an estimated 27 million

persons will need some type of

long-term care (1). Of those, the

majority will receive long-term care in

the community rather than in

institutions. Some of the focus on homeand community-based care is the result

of the Olmstead decision, which

encouraged provision of communitybased care when desired and

possible (1). In 1999, the United States

Supreme Court ruled in Olmstead v. LC

that the unnecessary segregation of

individuals with disabilities in

institutions may constitute

discrimination based on disability. The

court ruled that the Americans with

Disabilities Act may require states to

provide community-based services rather

than institutional placements for

individuals with disabilities.

Demographic changes are a major

driving force in the need and demand

for home- and community-based formal

long-term care. The number of people

aged 65 and older has increased

dramatically from 3.1 million in 1900 to

37 million in 2006. As the first baby

boomers reach age 65 in 2011, the

growth of the older population is

expected to boom, almost doubling from

37 million to over 70 million in

2030 (2). With increased life expectancy,

a relative decrease in the younger

population, and aging of the baby

boomers, older Americans will

increasingly comprise a larger

proportion of the population: from

12.4 percent in 2006 to about 20 percent

in 2030. Although the health of older

Americans has improved through the

decades and many of them live longer

in good health, the surge in the older

population has generally meant an

increased need for medical and

long-term care. Many older Americans

experience one or more chronic

conditions as well as geriatric

syndromes that can lead to debilitating

disabilities and depression. In

2005–2006, about 50 percent of the

older population reported having

hypertension and arthritis, over

30 percent had heart conditions, and

about 20 percent had cancer or diabetes.

Both institutionalized as well as

community-dwelling elders experienced

activity limitations, at varying levels of

severity. In 2005, over 80 percent of

those living in long-term care facilities,

45 percent of those living in community

housing with services, and over

25 percent of those living in the

community experienced limitations with

at least one ADL (3). (Appendix I lists

this and other acronyms used in this

report.) Chronic conditions and

functional limitations have increased the

collective need for care and

management of diseases and provision

of long-term services and supports.

Currently, the majority of homeand community-based long-term care is

provided informally—by unpaid

caregivers, such as family members,

neighbors, or friends. While informal

care provision is expected to remain as

Page 1
Page 2 [ Series 1, No. 49

the primary source of community-based

long-term care, the demand for

formal (paid) caregivers is expected to

increase as the population needing care

increases (1). The bulk of formal

long-term care is provided by direct care

workers, such as nursing assistants,

home health aides, and personal aides.

Direct care workers provide basic care

and essential help with daily activities,

enabling younger and older people with

functional and activity limitations to live

independently in their homes. A major

challenge in the long-term care industry

is the retention of direct care workers. A

low pay structure, lack of or limited

fringe benefits, a heavy workload, poor

working conditions, lack of appropriate

training, little opportunity for

professional advancement, and a lack of

respect from management are some of

the reasons cited for high turnover and

vacancy rates (4–7). As a result of

multiple factors, including aging of the

baby boomers, shrinking of the pool of

informal caregivers due to the

decreasing size of families, the

geographic mobility of adult children,

and increased participation of women in

the labor market, the dependence on the

direct care workforce is likely to grow.

In 2006, about 3 million people were

employed in the direct care industry,

including nursing, psychiatric, and home

health aides. Direct care jobs are

projected to be among the fastest

growing occupations in the near future,

with the greatest increases among home

health aides. Projected employment of

home health aides is expected to

increase 49 percent from 2006 to

2016–from 787,000 to 1,171,000 (8).

National data on direct care workers

are limited, as most of the few existing

studies are restricted to smaller

geographic areas. The Bureau of Labor

Statistics (BLS) provides estimates of

employment in the home health aide

industry to monitor labor force

participation. However, no nationally

representative data are collected from

home health aides that could provide

their perspectives on what motivates

individuals to choose careers as home

health aides and what contributes to the

likelihood that they will continue in

these positions based on their job

satisfaction, work environment, training

and advancement opportunities. Given

high turnover and vacancy rates, these

data could help policy makers

understand the needs of and challenges

faced by home health aides and identify

strategies that may improve the quality

and stability of the workforce.

Recognizing the need to fill the

gap in data about factors related to

recruitment and retention of home

health aides, the Office of the

Assistant Secretary for Planning and

Evaluation (ASPE) sponsored the first

NHHAS. The NHHAS was conducted

as a partnership between ASPE and the

National Center for Health Statistics

(NCHS). ASPE led a national advisory

committee to inform the survey design

process. Under contract with NCHS,

Westat conducted the pilot, pretest, and

national surveys.

One objective of the NHHAS was

to provide a baseline of nationally

representative information about home

health aides who work in home health

and/or hospice settings, their training,

motivations, job environment, job

limitations, relationship with

management, job satisfaction, and

intention to stay in the job. Another

objective was to collect data that would

be comparable to the data collected in

the 2004 National Nursing Assistant

Survey (NNAS) (9) so that information

about direct care workers could be

compared across settings.

Design Process

The design of the NHHAS

interview and data collection procedures

involved four steps:

1.	 Initial modification of NNAS to

reflect differences in work

environment and responsibilities

between home health and/or hospice

aides and certified nursing

assistants (CNAs) working in

nursing homes

2.	 A pilot test

3.	 A pretest to test and refine the

survey protocol

4.	 Modifications to the survey as a

result of findings from the pretest

Initial Modifications to

National Nursing Assistant

Survey (NNAS)

Because one of the objectives of the

NHHAS was to obtain information

comparable to NNAS, the NHHAS

instrument was modeled very closely on

the NNAS (9). Differences between the

NNAS and the NHHAS instruments

reflect differences in the work

environment and training requirements

between home health aides and CNAs

working in nursing homes. Changes

were based on recommendations from a

national advisory committee. The

advisory committee included

representatives from home health

organizations and agencies and

government analysts with expertise in

home health care. The suggested

modifications were made and tested by

Mathematica Policy Research (MPR),

under contract with ASPE (10).

The major changes included

modifying questions on work settings,

workload, and travel. The pattern of

work for home health aides is different

from CNAs, since home health aides

may work in multiple settings, including

both homes and institutions. Thus,

questions were added to the NHHAS on

where the home health aides worked.

The advisory committee also noted that

an important issue to home health aides

is whether they are assigned the number

of hours of work that they want. These

questions were already in the NNAS,

but additional questions on frequency

of staying past the shift worked were

added to the NHHAS. Since many

home health aides work in private

homes and have to travel to various

work sites, questions on the extent of

travel and reimbursement for time

and travel were also added to the

NHHAS.

There were further changes in

the NHHAS instrument in response

to results from the pilot and

pretest (11).
Series 1, No. 49 [ Page 3

Pilot Test

A pilot test of the NHHAS was

conducted in May and June of 2006 as

part of the pilot test for the NHHCS (12).

The primary objective of the pilot test

was to test the procedures for selecting

the sample and contacting home health

aides. Specifically, the objectives of the

pilot test were to:

+	 Gain experience in requesting home

health and/or hospice agencies to

provide a list of their currently

employed home health aides to be

used as a sampling frame for

NHHAS.

+	 Test acquiring and cleaning the lists

of home health aides.

+	 Test procedures for collecting

contact information for the home

health aides.

+	 Test the quality of the contact

information for the home health

aides.

Because the computer-assisted telephone

interviewing (CATI) questionnaire in

many ways resembled the one that was

used previously in the NNAS,

identifying issues of instrument length

and appropriateness of the questions

were of lesser importance.

A convenience sample of 47 home

health and/or hospice agencies in

selected geographic areas was compiled

from the lists maintained by the Centers

for Medicare & Medicaid Services

(CMS) and available on that website.

Interviews were to be scheduled with

nine agencies, representing home health

only, hospice only, and mixed

agencies (agencies that provide both

home health and hospice care), with the

goal of completing interviews in at least

six agencies, two of each type. Up to

eight home health aides were to be

sampled from each agency.

In-person interviews were scheduled

and conducted in eight agencies from

May 24 to June 5. A total of 36 aides

was sampled, averaging 4.5 aides per

agency. To fulfill the primary objective

of testing the procedures for selecting

the sample and contacting home health

aides, the subset of CATI questions to

establish eligibility for the survey was

administered to all of the sampled home

health aides. However, the complete

CATI interview was given to only one

home health aide from each of the pilot

test agencies.

After each NHHCS agency

appointment was scheduled, an

appointment confirmation package was

mailed to the agency director. Among its

contents were two documents pertaining

to the NHHAS:

+	 A flyer announcing the survey to be

posted at the agency for all home

health aides to see.

+	 Copies of the NHHAS announcement letter to be distributed by the

agency to every home health aide

employed by the agency in advance

of the NHHCS interview.

The protocol also called for all

sampled home health aides to receive a

package of promotional materials prior

to being contacted by telephone. The

advance package included:

+	 A welcome letter

+	 $5 bill clipped to the letter

+	 NHHAS fact sheet

+	 Postcard to indicate willingness to

participate

+	 Postage-paid return envelope to

return the postcard

+	 NHHAS gift pen

Interviewers mailed these packages

to the home health aides when contact

information for the sampled aides was

provided by the agency. All but one of

the agencies provided contact

information for the sampled aides. When

contact information was not provided by

the agency, the interviewer gave the

package directly to the agency

representative to distribute to the

sampled aides either in person or by

mail. Altogether, 33 aides were mailed

advance packages by the interviewer

and 3 aides received their advance

packages via their agencies.

Full CATI interviews were

completed with eight home health aides

from June 1 through 30, 2006 (one aide

per agency); interview length ranged

from 60 to 83 minutes, with an average

of 67 minutes. Screeners or full

interviews were completed for all but 5

of the 36 aides sampled (86 percent). On

average, it took three calls to reach the

aides to complete the screener or the

full interview, with a range of one to

nine calls. All aides were reached in the

evenings or on weekends. All but one of

the aides contacted were eligible for the

NHHAS, based on responses to the

screener questions. All but one of the

agencies provided contact information

for the sampled aides at the time of the

NHHCS interview. The contact

information provided by the sampled

agencies for the aides was generally

good.

There were three major findings

from the pilot study:

1.	 Both the percentage of agencies

providing contact information for

home health aides and the quality

of the contact information provided

far exceeded expectations.

2.	 The CATI questionnaire took longer

to administer than anticipated, well

over 1 hour on average to complete.

This exceeded the desired goal of

40 minutes per interview.

3.	 The CATI questionnaire included

several field-coded questions that

required interviewers to choose

from long lists of response

categories. (Field-coded items are

open-ended questions. The

interviewer codes each response

either into a predefined category, or,

if a response does not appear to fit

into a predefined category, the

interviewer enters the text verbatim,

and the text is coded by NCHS

staff during data processing. See the

section describing the data

processing for further description of

field-coded questions.)

These questions turned out to be

more problematic than expected for

telephone interviewers to record aides’

responses both accurately and in a

timely way.

These findings—as well as

recommendations for specific instrument

item changes based on input from

observers’ notes, CATI frequencies and

comments, and director debriefing

notes–provided guidance for necessary

changes that were subsequently made

for the pretest. Changes made between

the pilot study and the pretest included

the following:

+	 Improvements were made to the

NHHAS contact materials. A
Page 4 [ Series 1, No. 49

NHHAS video promoting the survey

was developed and included in the

NHHAS advance package. A

NHHAS pen and NHHAS letterhead

with the names of the four

endorsing national organizations

were produced. Modifications to the

welcome and advance letters were

also made.

+	 The process for distributing the

advance packages to sampled home

health aides was modified. In the

pilot study, the NHHCS field

interviewers were responsible for

customizing ‘‘generic’’ advance

packages for all sampled aides by

entering names and addresses on

welcome letters and envelopes, and

either mailing the packages

themselves or providing the advance

materials to agencies that did not

provide contact information for them

to disseminate. This approach was

adapted from procedures used for

the 2004 NNAS. However, in the

NHHCS pilot study, agencies

provided contact information for

92 percent of the aides sampled.

Because of this high cooperation

rate, instead of the field interviewers

distributing the packets, a

centralized distribution approach

was used by the contractor to

distribute the packets through the

contractor’s home office. This

approach provided more

standardization and control in

administration and greater time

efficiency for the interviewers while

at the agency.

+	 Changes to reduce interview length

and improve overall data quality

included shortening extensive lists

of response options and modifying

the patient relations questions to ask

specifically about the number of

patients and the number of patient

visits for the most recent week

worked instead of for an ‘‘average’’

week.

+	 The Education and Training sections

of the questionnaire turned out to be

the most time consuming to

administer and contained the most

difficult questions for respondents to

answer, since there is little

standardization in training

requirements for home health aides.

As a result, more than a dozen

questions were deleted and the

series of questions that asked aides

to rate their training was shortened.

Although the NNAS contained two

separate series of questions about

initial and continuing education,

these were combined in the NHHAS

and the questions referred to all

training the home health aides

received. Also, the series of

questions in the NNAS on what

topics the CNAs felt should have

been included in their initial and

continuing education was eliminated.

Several questions on the extent to

which home health aides ask for

help from other home health aides

and agency employees were deleted

from the questionnaire since these

were less relevant in the home

health setting than for CNAs

working in a nursing home.

Pretest

The primary goals of the NHHAS

pretest were to address specific

problems identified during the pilot

study with the procedures for contacting

home health aides and administering the

questionnaire and to conduct a dry run

for the national survey (13). In addition,

greater emphasis was placed on

reducing the interview length, refining

the protocol for contacting aides, and

focusing on the quality of the question

items themselves. Like the pilot study,

the pretest was not intended to evaluate

approaches for building response rates.

The pretest goal was to complete 25

NHHCS agency interviews. Pretest

agencies were obtained from an initial

sample of 60 home health and/or

hospice agencies located in selected

states, with an array of home health

only, hospice only, and mixed agencies

in each state. Aides were selected from

all of the agencies interviewed during

the NHHCS pretest. A total of 172

home health aides were sampled from

the 27 home health and/or hospice

agencies that actually participated in the

NHHCS pretest.

Each agency was notified in

advance of the NHHCS agency visit that

up to eight home health aides employed

directly by the agency would be selected

for the NHHAS. As with the pilot study,

the home health aides sampling was

completed during NHHCS agencies’

appointments by the field interviewers

using lists provided by the agencies.

Interviewers used the CAPI instrument

to select sampled aides and a hard copy

contact form to record sampled aides’

addresses and telephone information.

As with the pilot study, agencies

agreeing to participate in the NHHCS in

advance of the agency visit received

copies of the NHHAS announcement

letters to distribute to each of the

agencies’ home health aides and

NHHAS flyers for the agencies to post

in prominent locations.

Based on the pilot study experience,

the contractor’s home office staff mailed

the advance packages. These packages

were mailed to the home health aides in

late December 2006, approximately

1 month after the fielding of the

NHHCS pretest began. For the aides for

whom contact information was provided,

the advance packages were mailed to

the home addresses provided by the

agencies. For aides for whom the

agencies did not provide contact

information, the advance packages were

sent by FedEx directly to the agencies

for them to distribute to their sampled

aides. A follow-up package with

reminder letters was also sent to these

agencies 1 week after the initial mailing

of the advance packages.

The home health aide advance

package included the following items:

+	 Welcome letter

+	 $5 bill clipped to the letter

+	 Letter signed by the Director of

NCHS

+	 NHHAS fact sheet

+	 Postcard to indicate willingness to

participate

+	 Postage-paid envelope to return the

postcard

+	 NHHAS gift pen

+	 NHHAS DVD with a 5-minute

explanation of the survey and

importance of participation

In the advance packages, home

health aides were invited to call a

toll-free number or return a postcard to

participate in the survey. They were also

informed that they would receive an

additional $30 to compensate them for
Series 1, No. 49 [ Page 5

their time for participating in the

survey.

Seven telephone interviewers

received 16 hours of training. Two of

the interviewers had previous experience

with the 2004 NNAS. On the last day of

training, interviewers conducted ‘‘live’’

interviews with aides, followed by a

short debriefing session to discuss

problematic areas encountered. Problem

areas discussed included the long

response category lists and the recording

of travel times between patient visits,

the number of patient visits per week,

and the highest grade completed in

school.

Between January 11 and 28, 2007,

telephone interviewers contacted the

home health aides. Interviewers were

able to call cases whose contact

information was available from the

agency, from an aide’s returned

postcard, or from an aide’s call to the

toll-free number. The NHHAS postcards

also provided space for home health

aides to record the best times to contact

them. The shift that a home health aide

worked was also available to

interviewers if it was collected during

the agency visit. Interviewers used this

information to target the date and time

that a contact was attempted. With

respondents’ permission, most of the

telephone interviews were audio

recorded. This was done to allow review

and evaluation of the interviewer-coded

responses for the CATI instrument items

that contained more than 10 response

categories.

During the NHHAS pretest, a total

of 80 telephone interviews was

completed with sampled home health

aides. The median time to complete the

CATI questionnaire was about 45

minutes.

Of the 26 sampled agencies that

participated in the NHHCS and had at

least 1 employed home health aide,

22 (85 percent) provided contact

information for the sampled aides.

(One of the 27 sampled agencies that

participated in the NHHCS had no home

health aides employed.) Of the 172

aides sampled for the NHHAS, contact

information was collected for 148 aides

(86 percent). Among those aides with

contact information provided, five had

only a telephone number (3 percent).

Cell phone numbers were provided for

34 aides (23 percent).

Between December 27, 2006, and

January 22, 2007, 53 home health aides

returned the NHHAS postcards and 40

calls were received on the NHHAS

toll-free number. When unduplicated,

postcard responses or toll-free calls were

made by 31 percent of the sampled

home health aides. Five aides

(9 percent) who returned a postcard

indicated that they did not want to

participate in the survey. Only one home

health aide when reached by telephone

declined to participate. Eleven advance

packages (from nine agencies) were

returned by the U.S. Post Office,

although for two of these, an updated

address was provided.

An average of three calls was made

to complete a case in the NHHAS

pretest. No refusal conversion or

follow-up was attempted with the

agencies and limited follow-up or

tracing was conducted with home health

aides.

Modifications between

Pretest and National

Survey

A number of strategies and

activities were used to evaluate the

NHHAS pretest and provide guidance

for the national survey. These included

interviewer debriefings, monitoring of

telephone interviews, review of module

timings, item nonresponse analysis, data

review, interview audio recordings,

comments entered in CATI by

interviewers, and cognitive testing that

occurred following the pretest. The

purpose of cognitive testing is to

examine the ways in which people go

about answering survey questions.

Cognitive testing, or cognitive

interviewing, is a pretesting technique

used to ascertain whether or not a

question is working as intended and to

help identify problems in question

wording or response categories needing

revision.

The following concerns were

identified:

+	 Challenges with the interview

questions about workload as

measured by number of patient

visits made and number of patients

seen

+	 The number of response categories

for field-coded items

+	 Areas where more training for the

interviewers was needed

+	 The start of fielding of the NHHAS

in relation to the NHHCS

+	 Alteration in the home health aide

sample design in NHHCS facilities

to ensure an adequate number of

home health aides was sampled to

meet the analytic goals of the

NHHAS

+	 Strategies to obtain optimum

response rates among sampled home

health aides

With the exception of two

questions, telephone interviewers noted

few problems administering the CATI

instrument. The most problematic

questions pertained to workload. These

questions asked about the average

number of patients seen and the average

number of patient visits per week. As

scripted, they required interviewers to

probe extensively and perform

arithmetic to help respondents derive

accurate answers to the questions. To

address this problem, a hard copy

weekly grid was developed for

interviewers to record this information

for the final few pretest telephone

interviews that were conducted. As a

result of the early pretest results and

revisions, cognitive testing was

conducted with several of the pretest

home health aides to develop and refine

the patient visit data collection using the

grid.

Another recommendation that

affected a number of question items was

to limit the number of response

categories for field-coded items to fewer

than 10. Other suggestions made by

interviewers related to their training.

They would have liked more practice

breaking off the interview and restarting

partially completed interviews. They

also recommended having more practice

in field coding realistic responses for

open-ended questions.

A major outcome resulting from the

pretest was a change to the sampling

strategy to ensure sampling enough

aides for a target sample size of
Page 6 [ Series 1, No. 49

between 3,400 and 3,800 aides for the

national survey. The initial sampling

plan for the NHHAS was to sample up

to eight aides in a random subsample of

one-half of the agencies in the NHHCS.

Through the pretest, NCHS determined

that up to one-third of agencies had

fewer than eight aides employed. Thus,

in order to ensure an adequate sample

size, the sampling design was modified

to sample aides from all agencies

participating in the NHHCS, and to

avoid over-sampling, the number of

aides sampled per agency was decreased

to six. This was a departure from the

sampling strategy used in the NNAS,

which sampled nursing assistants from

approximately one-half of the nursing

homes participating in the National

Nursing Home Survey.

National Survey

Methods

Sample Design and

Selection

The NHHAS is a linked

establishment and worker survey, similar

to the design of the NNAS. The

NHHAS is based on a two-stage

probability sample design, with the

agency sampled first and then, from

within each of the eligible participating

sampled agencies, selection of a random

sample of aides.

Linked establishment and worker

surveys have multiple advantages, with

the main advantage being that the

sample frame of workers is drawn from

the employees of the establishment,

obviating the need to construct a

separate sample frame for workers.

Using this built-in sample frame

facilitates reaching employees who may

otherwise be hard to identify. Costs are

reduced since efforts to identify and

obtain contact information for the aides

can be included in the process of

contacting and interviewing the

establishment. Linking the survey with

the establishment where the employee

works may provide additional legitimacy

for the aides about the employee survey.

In addition, linkage of the establishment

and worker surveys increases the

analytic potential of both the NHHCS

and the NHHAS. Linking information

on employer characteristics with

worker characteristics and perceptions

permits analysis of the interrelationships between these two types

of variables.

Agency sampling

At the first stage of sampling,

agencies providing home health and/or

hospice care were selected from a

sampling frame of over 15,000 agencies,

representing the universe of agencies

providing home health and/or hospice

care in the United States. These

agencies included free-standing agencies

as well as those affiliated with hospitals,

government entities, retirement centers,

or similar institutions where the

agencies maintained financial and

patient records separate from those of

the larger institution. For the purposes

of the NHHCS, an eligible home health

and/or hospice agency was one that:

+	 Provided home health, hospice, or

both types of services

+	 Provided more services than only

homemaker or housekeeping

services, or only durable medical

equipment and supplies

+	 For agencies providing only home

health care, had one or more current

patients

+	 For agencies providing only hospice

care, had one or more current

patients or had one or more hospice

discharges during the 3-month

period prior to the month of

interview

+	 For agencies providing both home

health and/or hospice care, had one

or more current home health and/or

hospice patients, or had one or more

hospice discharges during the

3-month period prior to the month

of interview

The sample frame was stratified by type

of services the agency provided (home

health only, hospice only, or mixed) and

metropolitan statistical area (MSA)

(metropolitan, micropolitan, other). Within

these primary strata, facilities were sorted

by census region, ownership, certification

status, state, county, and ZIP Code. A total

of 1,545 agencies was systematically

randomly selected with probability

proportional to size. Further information

on the NHHCS is available from:

http://www.cdc.gov/nchs/nhhcs.htm.

Home health aide sampling

In the second stage of sampling, a

random sample of aides was selected

from each agency eligible for and

participating in the NHHCS. Aides were

eligible for the survey if they were:

directly employed by the agency and

provided assistance with ADLs

including eating, toileting, bathing,

dressing, and transferring.

The rationale for including only

aides who were directly employed by

the sampled agency was so that an

aide’s responses to questions about

supervision and agency policies and

characteristics would refer to the

sampled agency. The rationale for

including only aides who provided

assistance with ADLs was to ensure the

work environment and responsibilities

among sampled aides were as similar as

possible. Some home health aides

provide only transportation,

companionship, or assistance with

shopping or medication management;

their work environment and experience

may be substantially different from

aides who provide assistance with

ADLs.

Up to six aides were chosen in all

participating agencies. An average of 4.3

aides was sampled per agency. Five

percent of the selected agencies had no

aides to sample.

The sampling procedure started with

the NHHCS in-person agency interview.

During the NHHCS in-person interview

with the agency respondent, the agency

was asked to provide a list of aides who

met eligibility criteria as of midnight of

the day before the interview. The

interviewer reviewed the list with the

agency representative to remove

duplicates and to ensure that the list

included only aides who were directly

employed by the agency and provided

assistance with ADLs. The interviewer

then numbered the list and entered the

total number of aides into the CAPI

system used for the NHHCS survey and

sampling. The CAPI program, through
Series 1, No. 49 [ Page 7

systematic randomization procedures,

selected up to six aides. The NHHCS

interviewer entered the names of the

aides into CAPI and on a hard copy

sampling form. For each sampled aide, a

unique nine-digit number was generated

by CAPI to serve as identification and

was used for all subsequent materials

for that aide. The NHHCS interviewer

obtained contact information for the

sampled aides and which shifts the aides

worked for the agency. This information

was then entered on the hard copy

sampling form (see Appendix II). These

hard copies were express mailed to the

contractor’s central office for

distribution of survey recruitment

materials as described in the next

section.

Data collection for the NHHAS

began September 19, 2007, and ended

April 1, 2008. The NHHAS data

collection began about 1 month after the

NHHCS to allow a sufficient sample

size to accrue so that the contractor

could efficiently conduct interviews.

Appendix III consists of a flow chart

summarizing the data collection process.

Data Collection Procedures

Contacting and recruiting aides

The initial step in data collection

for the NHHAS was to provide advance

packages to the sampled home health

aides. The mode of providing the

packages to the home health aides

depended on whether the agency

provided contact information for the

sampled home health aides. As

described in the sampling section, the

NHHCS field interviewers asked the

agency respondent for contact

information for the selected home health

aides. Ninety percent of agencies

participating in the NHHAS provided

some contact information, and

89 percent of the cases had contact

information. Not all of the contact

information included a mailing address;

for some home health aides only a

phone number was provided. If the

agency provided contact information, it

was entered on the hard copy sampling

form and in the CAPI system and

transmitted to the contractor. If address

information was provided for the aide,

the contractor mailed advance packages

to the home health aides. If no address

information was provided, the contractor

mailed advance packages to the agency

to be distributed to the sampled aides

(see Appendix IV, Exhibit A for the text

of the letter sent to the agency asking

the agency to distribute the advance

package to the sampled aides).

Advance package contents were

enclosed in a large envelope with the

NHHAS logo and labeled with the

NHHAS ID number. Each package

distributed by the agency was labeled

with the home health aide’s name or

other unique identifier. The package

contents included:

+	 Welcome letter (see Appendix IV,

Exhibit B)

+	 $5 bill clipped to the letter

+	 Letter signed by the Director of

NCHS (see Appendix IV, Exhibits

C1 and C2)

+	 NHHAS fact sheet (see Appendix

IV, Exhibit D)

+	 Postcard to indicate willingness to

participate, (see Appendix IV,

Exhibit E)

+	 Postage-paid envelope to return the

postcard

+	 NHHAS gift pen

+	 NHHAS DVD (see Appendix V for

a PDF of the DVD)

All of the information materials, except

the postcard, listed the toll-free number

the home health aides could call for

information or to indicate whether they

wanted to participate in the survey. The

letter from the Director of NCHS, the

pen, and the fact sheet also included

a link to the NHHCS website:

http://www.cdc.gov/nchs/nhhcs.htm.

Visitors to the site could get further

information on the NHHCS and the

NHHAS, which has its own website:

http://www.cdc.gov/nchs/nhhas.htm.

Visitors could also watch the NHHCS or

NHHAS information video or look at

the PDF file of the video.

One week after the advance

packages were distributed, a reminder

letter was distributed to all home health

aides. Sampled aides for whom agencies

provided home address information

were mailed the reminder letter directly

to their homes (see Appendix IV,

Exhibit F). Among sampled aides for

whom agencies did not provide home

address information, two reminder

letters were sent 1-week apart to the

agencies to distribute to each sampled

home health aide. (See Appendix IV,

Exhibit G for the reminder letter for the

agency to distribute to the home health

aides and Exhibit H for text of the letter

sent to the agency asking them to

distribute the reminder letters to the

selected aides.) Cases were made

available to the interviewers in the

contractor’s Telephone Research Center

about 1 week after the cases were

fielded to that center. Delayed release of

cases to the interviewers allowed

enough time for the home health aides

to receive their advance package

mailings before being contacted.

Data collection

Home health aides could indicate

interest in participating by returning the

postcard, calling the toll-free number

listed on the information materials, or

by agreeing to participate when an

interviewer contacted them. Similarly,

home health aides could indicate they

did not want to participate by checking

the box on the postcard labeled ‘‘NO, I

don’t want to be part of the NHHAS,’’

calling the toll-free number, or refusing

to participate when contacted or at any

point in the survey.

Calls to the toll-free number came

into the contractor’s Telephone Research

Center. If the callers asked to participate

in the survey, their calls were either sent

to an available interviewer for an

immediate interview, or an appointment

was set for a later interview.

Home health aides who sent in

postcards indicating they wished to

participate in the survey and home

health aides who did not reply either

through the toll-free number or postcard

were contacted by the contractor’s

telephone interviewers to arrange an

interview time. The interviewers used

the shift information provided in the

initial contact information and the best

times to call indicated by the home

health aide on the return postcard to

identify the best times to call for an

interview. Interviews started with an

initial (paper) contact script to ascertain
Page 8 [ Series 1, No. 49

whether the respondent was reached and

whether the respondent received the

advance package. The initial contact

script had multiple paths depending on

whether the respondent agreed to

participate (see Appendix VI).

If the home health aide agreed to

participate, the interviewer moved to the

interview. The telephone interviewers

read a consent statement prior to starting

the interview. The consent statement

was written at an eighth-grade reading

level (see Appendix VII for the text).

Home health aides had to respond

affirmatively before the interview could

continue. The consent statement was

reviewed and approved by the NCHS

Ethics Review Board (ERB) as part of

the ERB’s review and approval of the

NHHAS. Aides who participated in the

interview were sent a $30 check to

compensate them for their time in

participating in the survey.

Data collection was conducted using

CATI. The average number of calls per

completed eligible case was 4.7 (median

3); the average number of calls per

ineligible case that completed the CATI

screener was 6.6 (median 3). The range

of call attempts was 1 to 59 calls for

eligible completed cases and 1 to 40 for

ineligible cases. Figure 1 displays the

distribution of the number of calls per

completed interview. Although over

three-quarters of cases were completed

with five or fewer calls, 10 percent were

completed after more than 10 calls.

The average duration of the CATI

completed interviews, including

ineligibles, was 53 minutes, and 54

minutes for eligible aides working at the

NHHCS agency at the time of the

NHHAS interview. This time included

the interview as well as the introduction

script, informed consent, and contact

time. The average interview duration,

excluding introduction, consent, and

contact time, was 44 minutes including

ineligibles, and 45 minutes for eligible

aides working at the NHHCS agency at

the time of the NHHAS interview.

A total of 1,340 postcards was

completed and returned by the home

health aides. Of these, 97 percent

(1,300) were from home health aides for

whom the agency had provided contact

information. The average length of time

from NHHAS sampling to NHHAS

postcard receipt was 24 days. For

97 percent of the postcards returned, the

home health aide agreed to participate.

Follow-up

Two types of follow-up were

conducted depending on whether or not

the agency provided contact information

for the home health aides.

If the agency did not provide

contact information for the home health

aides and if there were no completed

cases or postcards received from

sampled aides at the agency 3 weeks

after the advance packages were mailed,

the contractor followed up with the

agency by telephone. The agency was

contacted using a structured script (see

Appendix VIII, Exhibit A). Thirteen

agencies fit these criteria. Of these,

there were nine agencies where no

contact information was provided for the

home health aides and no aides ever

participated, representing 1 percent of

agencies where home health aides

were sampled. At the remaining 4

agencies, 16 aides eventually were

interviewed.

If the agency did provide contact

information and the Telephone Research

Center staff could not locate the

sampled home health aide, the agency

was contacted to obtain additional

contact information (see Appendix VIII,

Exhibit B). If no additional information

was available, then Telephone Research

Center staff used telephone tracing

through the internet and directory

assistance. Of the 588 cases ever in

tracing, 383 (65 percent) were located

and 282 (48 percent) completed an

interview.

Letters were sent to difficult to

reach home health aides for whom there

was no tracing or address problem. After

eight or more telephone calls were

attempted, the letters were sent to the

610 home health aides for whom

addresses were available (see Appendix

VIII, Exhibit C for text of letter).

Home health aides who returned the

postcard indicating they did not want to

participate in the survey were not

contacted further. Home health aides who

were called by the interviewers to

schedule an interview and refused were

sent a refusal letter (see Appendix VIII,

Exhibit D), and received a follow-up

More than 10 calls 

10% 

8–10 calls 

6% 1 call 

30% 

6–7 calls 

8% 

4–5 calls 

15% 

2–3 calls 

31% 

SOURCE: CDC/NCHS, National Home Health Aide Survey. 

Figure 1. Number of calls per completed interview, 2007 National Home Health Aide Survey
Series 1, No. 49 [ Page 9

telephone call from an interviewer

experienced in refusal conversion. Of the

cases ever coded a refusal, 18 percent

ended up having a completed interview.

Telephone Research Center

interviewers and training

The NHHAS interviews were

conducted by experienced telephone

interviewers, who worked daytime,

evening, and weekend hours in order to

reach home health aides during

nonworking hours. Interviewers received

16 hours of training over a 3-day period.

The training included an overview of

the NHHAS; practice contacting home

health aides, responding to FAQs, and

setting appointments; practice

conducting interviews using the NHHAS

CATI questionnaire; and practice

completing call records and other

administrative procedures. Nineteen

interviewers attended and successfully

completed training; 14 interviewers

continued on the project until data

collection ended on April 1, 2008.

Quality assurance

All of the NHHAS interviewers

were monitored by NHHAS-trained

Telephone Research Center team leaders

on an ongoing basis throughout the data

collection period. During monitoring,

team leaders followed a standard

protocol of listening to the call on a

silent monitor (blind to the interviewer)

and viewing the CATI instrument entries

as the interviewer conducted the

interview. The goal for monitoring was

10 percent of the air time for all

interviewers. Team leaders completed a

monitoring report documenting the

results of the monitoring session, and

discussed the results with interviewers

via instant messaging. If there were any

issues of concern observed during the

monitoring session, the team leader

spoke directly with the telephone

interviewer. The contractor and NCHS

project staff also monitored the NHHAS

interviews during the first month of data

collection. Areas of concern that were

frequently detected were clarified in

memos distributed to the telephone

interviewers and team leaders.

The rate of survey completions was

tracked through weekly reports and

weekly conference calls between the

contractor and NCHS staff. Weekly

reports summarized information for the

current week as well as cumulatively for

the field period. The reports summarized

receipt of postcards and the numbers of

home health aides who were eligible,

refused, in tracing, and had contact

information.

Survey Instrument

The survey instrument was based on

the NNAS, with modifications to reflect

differences in working conditions and

requirements between nursing assistants

working in nursing homes and home

health aides, as discussed in the Design

Process section mentioned previously (10).

The NHHAS questionnaire

contained 12 discrete sections of

question items, each focusing on a

specific topic. Table A shows the

sections of the questionnaire, the main

topic areas, and selected topics included

in the sections. Home health aides

sampled during the NHHCS interview

who no longer worked at the NHHCS

agency when contacted for the NHHAS

interview were asked only a subset of

NHHAS questions (Sections A, L, and

selected questions from Sections D and

K in Appendix IX). A complete set of

NHHAS questionnaire items is provided

in Appendix IX.

Data Processing

Data processing and editing

occurred both during data collection, as

a result of the CATI programming, and

after data collection, during post-CATI

editing. CATI included hard and soft

range checks, skip patterns, and hard

and soft consistency checks among

question items. Hard edits required the

interviewer to fix the discrepant data

before the interview could continue. Soft

edits resulted in a prompt for the

interviewer to either correct the data or

suppress the edit. Post-CATI editing

included coding of self-reported industry

and occupation, coding text strings from

open-ended questions or ‘‘other specify’’

responses, and reviewing responses for

logic and consistency.

The contractor coded home

health aides’ description of their

industry and occupation. Occupation

was coded according to the Bureau of

Labor Statistics (BLS) Standard

Occupational Classification, October

2000 ISBN 0–934213–77–1. (See

http://www.bls.gov/soc/home.htm for

further description.) Industry was coded

according to the North American

Industry Classification System, which

was developed and published by the

Bureau of Labor Statistics. (See

http://stats.bls.gov/bls/naics.htm for

further information.)

NCHS staff edited or recoded

responses to open-ended questions that

were entered verbatim when the

interviewers did not believe the home

health aide’s response fit one of the

preset categories. For some questions,

these verbatim responses were then

coded by NCHS staff into newly created

categories or back-coded into existing

categories. For other questions, the

responses were edited to protect

confidentiality and left as text. A similar

procedure was followed for coding of

text strings from ‘‘other specify’’

responses.

The files intended for public use

and posting on the website went

through extensive disclosure review

analysis. The purpose of this analysis

was to ensure that a home health aide

could not be identified. A few

variables from the NHHCS were

added to the NHHAS public-use file

to increase analytic capabilities. These

variables included agency type

(whether the agency provided home

health services only, hospice services

only, or both), whether the agency was

part of a chain, agency ownership

(for-profit, other), and MSA.
Page 10 [ Series 1, No. 49

Table A: Key subject areas on the 2007 National Home Health Aide Survey questionnaire

Section Main topic Contents

A Current employment Eligibility

Location (in-patient facility, home, or combination)

Single or multiple patients

Live with patient

B Recruitment Initial reasons for becoming a home health aide

How learned about becoming a home health aide

Tenure as a home health aide

Previous work

C Education and training Any initial or continuing education

Where training received

Adequacy of training in preparing for job as a home health aide

D Job history Number of jobs in past 2 and 5 years

Characteristics of current and previous jobs including salary

How learned about current job

Travel requirements and reimbursement

Benefits including health insurance

E Family life Travel time

Family composition

Family care requirements

Public benefits use

F Management and supervision Supervisor characteristics

G Patient relations Number of patients and patient visits per week

Adequacy of time to perform tasks

Supervisor and patient feedback

H Job satisfaction Overall satisfaction with job and specific aspects

Reason continue to work in current job

Attributes dislike about job

Commitment to field and agency

Current job search activity

Intent to leave and reasons

I Job rating Opinions about job

Perceived appreciation by supervisor, society, and agency

Self-perceived importance of work

Discrimination

J Work-related injuries Number and nature of injuries

How injuries occurred

Presence and use of safety devices

K Demographics Age

Sex

Hispanic ethnicity

Race

Marital status

Education

Income

Flu vaccination

Citizenship

Self-rated health

Languages spoken

L Agency leavers Why separated from agency

Current working arrangements

Commitment to being a home health aide

Commitment to agency

Discrimination
Series 1, No. 49 [ Page 11

Response Rates
 

Overall National Home

Health Aide Survey

(NHHAS) Response Rate

The overall unweighted NHHAS

response rate was 55 percent:

(71 percent unweighted response rate for

overall agency participation in the

NHHCS × 97 percent unweighted

response rate for agencies participating

in the NHHCS that also participated in

the NHHAS by providing lists of home

health aides employed by their agencies

× 80 percent unweighted response rate

for home health aides). The overall

NHHAS response rate weighted by the

inverse of the probability of selection

was 41 percent, using weighted rates of

the same components used to calculate

the unweighted response rate:

(59 percent × 97 percent × 72 percent).

Guideline 1.3.4 of Standard 1.3

Survey Response Rates in the Office of

Management and Budget’s Standards

and Guidelines for Statistical

Surveys (14) indicates that nonresponse

bias analysis be conducted if the unit

response rate is below 80 percent. The

OMB guidance notes that for a

multistage survey to focus the

nonresponse bias analysis on each

stage, with particular attention to the

‘‘problem’’ stages. NCHS plans to

evaluate potential nonresponse bias for

the NHHAS, with particular attention

to the agency-level nonresponse,

which has a 59 percent weighted

response rate. Results from this

nonresponse bias assessment will be

posted at NHHCS website in the future

(http://www.cdc.gov/nchs/nhhcs.htm).

For information on nonresponse bias

analyses at the NHHCS agency level,

see ‘‘The Redesign and Operation of the

National Home and Hospice Care

Survey: 2007.’’

Agency Response Rate

In the 2007 NHHCS, a total of

1,461 sampled agencies providing home

health and/or hospice care were eligible

for the survey. Of these, 1,036 agencies

participated in the NHHCS, for a

first-stage agency unweighted response

rate of 71 percent (1,036/1,461) and

response rate weighted by the inverse

of the probability of selection of

59 percent. (Further information on

the NHHCS is available from:

http://www.cdc.gov/nchs/nhhcs.htm.)

Of the 1,036 agencies that participated

in the NHHCS, 52 agencies had no

aides to sample, resulting in 984

agencies eligible to participate in the

NHHAS. Of these 984 agencies eligible

for the NHHAS, 22 refused to

participate, and no aides were sampled

at 7 additional agencies because the

interviewer ran out of time or was

otherwise unable to complete the aide

sampling. As a result, aides were

sampled from 955 of the 984 eligible

agencies for an unweighted response

rate of 97 percent and response rate

weighted by the inverse of the

probability of selection of 97 percent.

The unweighted NHHAS agency

response rate was 69 percent (71 percent

× 97 percent), and the NHHAS agency

response rate weighted by the inverse of

the probability of selection was

57 percent (59 percent × 97 percent).

Home Health Aide

Response Rate

Of the 4,416 home health aide cases

sampled from the 955 agencies and sent

to the contractor’s Telephone Research

Center for interviews, 137 (3 percent)

were ineligible: of these, 41 were not

employed on the sampling date, 31 did

not provide assistance with ADLs, 61

were contract employees, 3 were

unspecified errors in sample selection,

and 1 was identified as ineligible during

the aide interview because the

respondent did not know whether she

was an employee of the sampled agency.

A total of 4,279 of the sampled cases

were eligible and 3,416 aides completed

the NHHAS interview. The unweighted

response rate at the second sampling

stage was 80 percent (3,416/4,279). The

response rate at the second sampling

stage weighted by the inverse of the

probability of selection was 72 percent.

Nonresponse

The largest component of

nonresponse was the inability to reach

the aides. There were 233 aides

(5 percent of eligible aides) who were

unable to be located after multiple

efforts, which included asking the

NHHCS agency for additional contact

information for the aide and using the

internet and directory assistance. An

additional 240 cases (6 percent of

eligible aides) were coded as

‘‘maximum calls,’’ cases where the

telephone number was functional, but

the interviewer was not successful in

reaching the home health aide after

repeated attempts. An average of 30

calls was made prior to a case being

coded as a maximum call. A total of

166 cases (4 percent of eligible aides)

were classified as no-contact, meaning

no contact information was provided by

the agency and the home health aide did

not return a postcard or call the toll-free

number. Some agencies did not have

contact information and other agencies

chose not to provide this information. In

79 cases (2 percent of eligible aides) the

telephone number was functional, but

after repeated attempts (29 calls on

average), the interviewer reached only

an answering machine. In 10 cases (less

than 1 percent of eligible aides) the

telephone call always resulted in a ring

with no answer or a busy signal. Unlike

the questionnaire used for the NNAS,

the NHHAS questionnaire was not

translated into Spanish. However, only

14 NHHAS cases (less than 1 percent of

eligible aides) could not be completed

because of a language problem; all but

one spoke only Spanish. Four cases (less

than 1 percent of eligible aides) had

some other type of nonresponse.

The final unweighted refusal rate

was 3 percent (117 home health aides).

Of these, 84 refused when contacted by

interviewers, and 33 refused by

postcard. Eighteen percent of initial

refusals (119 aides) converted to

completed interviews (22 cases).
Page 12 [ Series 1, No. 49

Public-Use File Data

Set

Of the 3,416 completed NHHAS

interviews, 39 aides were no longer

working at the NHHCS agency from

which they had been sampled when

contacted for the NHHAS interview.

These 39 aides, considered ‘‘leavers,’’

were asked only a subset of the NHHAS

questions (see Section L of the NHHAS

survey in Appendix IX) that were asked

of the 3,377 aides who were still

employed at the NHHCS agency from

which they were sampled when

contacted for the NHHAS interview. To

minimize disclosure risk, these 39 cases

are excluded from the NHHAS

public-use file. The NHHAS public-use

file contains only the 3,377 aides who

were still employed at the NHHCS

agency from which they were sampled

when contacted for the NHHAS

interview. On the public-use file the

weights used for the 3,377 aides are

adjusted to incorporate the ‘‘leavers’’ for

national estimates.

Estimation Procedures

Standard Errors

Because the statistics from the

NHHAS are based on a sample, they

will differ somewhat from the data that

would have been obtained if a complete

census had been taken using the same

definitions, instructions, and procedures.

However, the probability design of the

NHHAS permits the calculation of

sampling errors. The standard error of a

statistic is primarily a measure of

sampling variability that occurs by

chance because only a sample, rather

than the entire population, is surveyed.

The standard error also reflects part of

the variation that arises in the

measurement process but does not

include any systematic bias that may be

in the data. The chances are about 95 in

100 that an estimate from the sample

differs from the value that would be

obtained from a complete census by less

than twice the standard error.

Standard errors can be calculated

for aide estimates using any statistical

software package as long as clustering

within agencies and other aspects of the

complex design are taken into account.

Software products such as SAS (15),

STATA (16), SPSS (17), and SUDAAN

(18) all have these capabilities. Statistics

presented in NCHS publications are

computed using software that produces

error estimates for statistics from

complex sample surveys. The software

employs a first-order Taylor Series

approximation of the deviation of

estimates from their expected values.

The NHHAS public-use file includes

design variables that designate each

record’s stratum marker and the

first-stage unit (or cluster) to which the

record belongs.

Survey Weights

Since the NHHAS was a sample

survey and is designed to produce

national estimates for home health aides,

data analyses must include sampling

weights to inflate the sample numbers to

national estimates. Each record on the

data file has a weight for this purpose.

By aggregating these weights, national

counts of home health aides can be

estimated. NHHAS estimators take into

account the selection procedures of the

complete survey design to develop the

final sample weight for each sample

agency and each sample aide.

An estimator X| for any given

population total X can be expressed as a

weighted sum over all sample units,

defined as:

X| = ∑u

x(u)W(u)

where u represents a sampled unit, x(u)

is the characteristics or response of

interest for unit u, and W(u) is the final

survey weight for sample unit u. The

final weight W(u) for each sampled unit

is the product of two components:

inverse of the probability of selection

and adjustment for nonresponse.

The first component of the weight

for each sampled unit is the inverse of

the unit’s selection probability. The

probability of selection of a home

health aide is a product of two

selection probabilities: the probability

of selecting an agency to the NHHCS

sample and the probability the home

health aide was selected within the

sample NHHCS agency. The inverse

of the product of these probabilities is

used for weighting. Further information

on the NHHCS is available from:

http://www.cdc.gov/nchs/nhhcs.htm.

The first component was modified

for sampled agencies found to have

multiple listings in the sampling frame

after the agency sample was selected.

For each agency found duplicated in the

sampling frame, the weights of all

sampled listings for the agency were

summed and divided by the total

number of times the agency was found

in the sampling frame. To the extent that

all listings of each sampled agency are

identified in the sampling frame, the

resulting weights produce unbiased

estimates (that is, estimates that would

be obtained if there were no duplicates

in the sampling frame).

The second component for

calculating the weight is adjustment for

nonresponse and omission of cases to

minimize disclosure risk. There are three

levels of these adjustments. The first

two are agency level and the third is

person level. At the first level,

adjustments were made when in-scope

agencies did not respond to the NHHCS.

At the second level, adjustments were

made when an in-scope agency did not

permit survey of its home health aides.

At the third level, adjustments were

made when a sampled home health aide

failed to respond or a home health aide

was purposefully omitted from the

public-use file to minimize disclosure

risk (i.e., for the 39 aides no longer

employed by their NHHCS-sampled

agency when contacted for the NHHAS

interview).

The weights as described

previously were smoothed within

groups defined by region and agency

type, if there were outlier sample units

whose survey weights were somewhat

larger than those for the remaining

sample in the same group. In

smoothing, total estimates for each

group were preserved.
Reliability of Survey

Estimates

Generally, NCHS decides which

estimates to publish based on the

relative standard error (RSE, or the

coefficient of variation) of the estimate

and the number of sample records on

which the estimate is based. The RSE is

a measure of variability and is

calculated by dividing the standard error

(SE) of an estimate by the estimate

itself. The result is then converted into a

percent by multiplying it by 100.

Guidelines used by NCHS to determine

if estimates should be presented are:

+	 If the estimate is based on fewer

than 30 sample cases, then the value

of the estimate is not reported.

This is usually indicated with an

asterisk (*).

+	 If the estimate is based on a sample

of 30 to 59 cases regardless of RSE

value, or on 60 or more cases and

the RSE is 30 percent or more, then

the estimate is reported but should

not be assumed reliable. This is

usually indicated with an asterisk (*)

preceding the figure in the tables.

+	 If the estimate is based on 60 or

more sample cases and the RSE is

less than 30 percent, then the

estimate is reported and is

considered reliable.

Confidentiality

Participation in surveys conducted

by NCHS is voluntary, and information

collected on individuals or agencies is

confidential. Strict procedures are

utilized to prevent disclosure of

confidential data in survey operations

and data dissemination. In accordance

with NCHS’s confidentiality mandate

(Section 308(d) of the Public Health

Service Act (42 USC 242m)), no

information collected in the NHHAS

may be used for any purpose other than

the purpose for which it was collected.

Such information may not be published

or released in any form if the individual

or establishment is identifiable unless

the individual or establishment has

consented to such release. The

information provided by home health

aides is used solely for statistical

research and reporting purposes.

Data Dissemination

Data from the NHHAS are

available through public-use

files on the NHHCS website.

(http://www.cdc.gov/nchs/nhhcs.htm).

The files contain information from the

NHHAS edited to ensure protection of

confidentiality, and include some

variables on the agencies for which the

aides worked. Additional information

available through the website includes a

data dictionary and summary

descriptions of the NHHAS and

NHHCS.

Researchers who wish to link data

from the NHHAS to the agency or

patient questionnaires of the 2007

NHHCS will need to work through the

NCHS Research Data Center (RDC).

RDC allows researchers under RDC

supervision to access confidential

statistical microdata files. Researchers

must submit a proposal for review and

approval prior to using the RDC.

Additional information on the NCHS

RDC and procedures for access to

linked data files is available from:

http://www.cdc.gov/rdc/.

References

1.	 Department of Health and Human

Services and Department of Labor. The

future supply of long-term care workers

in relation to the aging baby boom

generation: Report to Congress.

Washington, D.C.: Office of Disability,

Aging and Long-Term Care Policy

(DALTCP). 2003. Retrieved on May 1,

2009 Available from: http://

aspe.hhs.gov/daltcp/reports/ltcwork.htm.

2.	 He W, Sengupta M, Velkoff VA,

DeBarros KA. 65+ in the United

States: 2005. Washington DC: U.S.

Government Printing Office. 2005.

3.	 Federal Interagency Forum on Aging

Related Statistics. Older americans

2008: Key indicators of well-being.

2008.

Series 1, No. 49 [ Page 13

4.	 Institute of Medicine. Retooling for an

aging America: Building the health care

workforce. Washington DC: National

Academies Press. 2008.

5.	 Newcomer R, Scherzer T. Who counts?

On (not) counting occupational injuries

in homecare. Presented at: Annual

Meeting of the American Public Health

Association: Boston, MA. 2006.

6.	 Stone RI. The direct care worker: The

third rail of home care policy. Annual

Rev Public Health 25:521–37. 2004.

7.	 Castle NG, Engberg J, Anderson R,

Men A. Job satisfaction of nurse aides

in nursing homes: Intent to leave and

turnover. Gerontologist 47(2):193–204.

2007.

8.	 Bureau of Labor Statistics. Fastest

growing occupations, 2006–16:

November 2007 Monthly Employment

Review. Washington DC. 2007.

9.	 Squillace MR, Remsburg RE, Bercovitz

A, Rosenoff E, Branden L. An

introduction to the National Nursing

Assistant Survey. Vital Health Stat

1(44):1–54. 2007.

10.	 Mathematica Policy Research.

Summary of Technical Assistance

Group Recommendations and

Comments on Questionnaire Design.

2006.

11.	 Branden L, Dulaney R, Edwards B,

Novik J, Vincent C. 2007 National

Home and Hospice Care Survey

(NHHCS): Final report. Westat. 2008.

12.	 Westat. National Home and Hospice

Care Survey: Pilot test report. 2006.

13.	 Branden L, Edwards B, Hall A, Harper

T, Jones R, Novik J. National Home

Health Aide Survey (NHHAS): Pretest

evaluation report. Westat. 2007.

14.	 Office of Management and Budget.

Standards and guidelines for statistical

surveys. Washington, DC. 2006.

Accessed on June 22, 2009 at:

http://www.whitehouse.gov/omb/assets/

omb/inforeg/statpolicy/standards_stat_

surveys.pdf.

15.	 SAS Institute. SAS/STAT Software:

Release 9.1.3. Cary, NC: SAS Institute.

2003.

16.	 StataCorp. Stata Statistical Software:

Release 9. College Station, TX:

StataCorp LP. 2005.

17.	 SPSS for Windows, Release 15.0.

Chicago: SPSS Inc. 2006.

18.	 SUDAAN (Release 10.1). Research

Triangle Institute: Research Triangle

Park, NC. 2008.
Page 14 [ Series 1, No. 49

Appendix I: List of Acronyms and Terms Used in This Report

ADL Activities of Daily Living

ASPE Office of the Assistant Secretary for Planning and Evaluation, United States

Department of Health and Human Services

CAPI Computer Assisted Personal Interviewing

CATI Computer Assisted Telephone Interviewing

CMS Centers for Medicare & Medicaid Services

CNA Certified Nursing Assistant

ERB Ethics Review Board

FAQ Frequently Asked Questions

HHA Home Health Aide

MSA Metropolitan Statistical Area

NCHS National Center for Health Statistics

NHHAS 2007 National Home Health Aide Survey

NHHCS 2007 National Home and Hospice Care Survey

NNAS 2004 National Nursing Assistant Survey

NNHS 2004 National Nursing Home Survey
Series 1, No. 49 [ Page 15

Appendix II: Sampling Form

Agency Name:

Agency Address:

INT NAME: _______________________________________________________________________________ INT ID: _____________________

INTERVIEW DATE: ________/________/___________

NHHAS ID NUMBER HOME HEALTH AIDES, HOME ADDRESSES, PHONE NUMBERS, SHIFT

001 FIRST NAME: ___________________________________________ LAST NAME: ___________________________________________

ADDRESS: ______________________________________________________________________________________________________

CITY: ________________________________________________________________ STATE: _____________ ZIP: _______________

PHONE Home: ________–________–____________ Cell: ________–________–____________ SHIFT: _________________________

002 FIRST NAME: ___________________________________________ LAST NAME: ___________________________________________

ADDRESS: ______________________________________________________________________________________________________

CITY: ________________________________________________________________ STATE: _____________ ZIP: _______________

PHONE Home: ________–________–____________ Cell: ________–________–____________ SHIFT: _________________________

003 FIRST NAME: ___________________________________________ LAST NAME: ___________________________________________

ADDRESS: ______________________________________________________________________________________________________

CITY: ________________________________________________________________ STATE: _____________ ZIP: _______________

PHONE Home: ________–________–____________ Cell: ________–________–____________ SHIFT: _________________________

004 FIRST NAME: ___________________________________________ LAST NAME: ___________________________________________

ADDRESS: ______________________________________________________________________________________________________

CITY: ________________________________________________________________ STATE: _____________ ZIP: _______________

PHONE Home: ________–________–____________ Cell: ________–________–____________ SHIFT: _________________________

005 FIRST NAME: ___________________________________________ LAST NAME: ___________________________________________

ADDRESS: ______________________________________________________________________________________________________

CITY: ________________________________________________________________ STATE: _____________ ZIP: _______________

PHONE Home: ________–________–____________ Cell: ________–________–____________ SHIFT: _________________________

006 FIRST NAME: ___________________________________________ LAST NAME: ___________________________________________

ADDRESS: ______________________________________________________________________________________________________

CITY: ________________________________________________________________ STATE: _____________ ZIP: _______________

PHONE Home: ________–________–____________ Cell: ________–________–____________ SHIFT: _________________________
Page 16 [ Series 1, No. 49

Appendix III: Flow Chart of Data Collection Procedures

No further action taken Aides sampled in agency? 

Contact information provided by agency? 

Contact information recorded on contact form 

and entered into CAPI 

Transmitted to Westat 

Data extracted for mailings and fielding to the 

Telephone Research Center (TRC) 

Data reviewed and 

updated as needed 

Case identified as ineligible after sampling? 

Telephone Research 

Center notified to code 

case as ineligible 

Address information 

available? 

Advance package mailed 

to Home Health Aide’s 

(HHA) home address 

Reminder letter mailed to 

HHA home address 1 

week after advance 

package 

Advance package mailed 

to agency for distribution 

Reminder letters mailed 

to agency for distribution 

1 & 2 weeks after 

advance package 

Cases fielded to TRC 

Post card received? 

Postcard date stamped, receipted, 

and sent to TRC 

Toll-free call received? 

Call transferred to TRC interviewer 

or appointment made 

No completed cases or postcards received 3 weeks after advance mailing 

Follow up with agency 

contact if no contact 

information received 

Refusal letter sent NHHAS respondent refuses interview when called 

Locating 

letter sent 

Unless postcard or call indicated refusal, case contacted until interview completed, end of 

data collection or assignment of final disposition code 

Contact information, or 

refusal abstracted from 

postcard or call 

No 

Yes 

Yes 

Yes 

No 

Yes 

Yes 

NHHAS respondent not reached after 8 call attempts & address is available 

No 

START
Series 1, No. 49 [ Page 17

Appendix IV. Contact Materials

Exhibit A: Text of letter sent to agency to request agency to distribute the information packets

<<Address Line 1>>
 

<<Address Line 2>>
 

<<City>>, <<State>> <<ZIP>>
 

Dear <<NHHASNAME>>:

We would like to thank you for your recent participation in the National Home and Hospice Care

Survey (NHHCS).

During our visit for the NHHCS, we selected up to six home health aides from your agency to be

part of the National Home Health Aide Survey (NHHAS). We are enclosing the advance packets

for you to distribute to the selected home health aides about the NHHAS.

We appreciate your help in distributing the enclosed advance packages to the home health aides

selected in your agency for the NHHAS so that they may contact us directly to participate in the

survey. Each advance packet is personalized for the home health aides selected for the NHHAS and

includes a $5 bill. Please make sure the advance packets get to them as soon as possible. We have

provided postage so that the packets may be mailed to the selected aides if you choose to address

and mail the packages.

Thank you again for your support and help in this important survey.

If you have any questions about this, please call me at 1-800-937-8281, extension 3552, or email me

at laurabranden@westat.com.

Sincerely,

/Laura Branden/

Laura Branden

Westat Associate Project Director

Enclosures OVER
Page 18 [ Series 1, No. 49

Below is a list of home health aides sampled for the National Home Health Aide Survey (NHHAS)

from <<AGENCYNAME>> on <<DT>>.

Please distribute the enclosed advance packages to each of the home health aides listed below

selected for the National Home Health Aide Survey (NHHAS). Each advance package is

personalized.

Thank you, again, for distributing these advance packages.

<<FullName1>>

<<FullName2>>

<<FullName3>>

<<FullName4>>

<<FullName5>>

<<FullName6>>
Series 1, No. 49 [ Page 19

Exhibit B. Welcome letter

90002001

Mary Jones

15 Elm Street

Stuckeyville, MD 15432

Dear Mary Jones:

Welcome to the National Home Health Aide Survey (NHHAS). You are one of

about 6,000 home health aides selected to participate in this important new survey.

NHHAS is the first national survey of home health aides working in home health

and hospice agencies, and your participation is vital to the success of this survey.

You were selected because your agency is part of the National Home and Hospice

Care Survey conducted by the U.S. Department of Health and Human Services

(DHHS) Centers for Disease Control and Prevention’s National Center for Health

Statistics.

The purpose of this survey is to hear – directly from you – ways that can help us

learn about your field of work. Because you were chosen as part of a small group

of home health aides for this survey, everyone that participates will make the

information more accurate. Help us include your experiences in this important

project.

We need your help to make this survey a success. Please return the enclosed

postcard today or call 1-888-290-1125 to schedule a convenient time to do the

telephone interview. You will receive $30 as a token of appreciation for participating in the NHHAS.

Thank you, in advance, for your help in this important survey.

Sincerely,

/Lauren Harris-Kojetin/

Lauren Harris-Kojetin

Chief, Long-term Care Statistics Branch,

Division of Health Care Statistics

National Center for Health Statistics

3311 Toledo Road, Room 3431

Hyattsville, Maryland 20782

Be part of the National Home Health Aide Survey!
Page 20 [ Series 1, No. 49

Exhibit C1. Letter signed by National Center for Health Statistics Director

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, Maryland 20782

90002001

Dear Mary Jones:

The need for home health aides is growing. Many home health and hospice agencies have a

hard time filling these important positions. I am writing to ask for your help with an important new

survey, The National Home Health Aide Survey (NHHAS). Please share your experiences and ideas

so we can learn how to keep qualified people like you working in this important field. This research

is authorized by the U.S. Public Health Service Act, Volume 42 of the United States Code, Section

242k. This survey is sponsored by the Department of Health and Human Services. It is part of the

National Home and Hospice Care Survey that is being conducted by the National Center for Health

Statistics all across the country.

You have been selected from a list of home health aides at your agency to take part in this

survey along with thousands of home health aides working in home health and hospice care

agencies throughout the United States. Westat, a social science research firm, has been hired to

collect the data in the survey. Included with this letter is $5, and you will receive $30 as a token

of appreciation for participating in the NHHAS. Your participation in this survey is voluntary.

You may take part in the survey or not, but we want your experiences included so public leaders

can learn what it is like to be a home health aide. No penalties or loss of benefits will come from

refusing to participate. You may choose not to answer any question and can stop at any time. The

survey will take about 40 minutes, but the amount of time is likely to vary from person to person.

The confidentiality of your responses is assured by Section 308(d) of the Public health Service

Act [42 United States Code 242m(d)] and the Confidential Information and Statistical Efficiency

Act (PL 107–347). Everything you tell us will be kept strictly private. Nothing about you personally

will be reported, including your name and the agency where you work. Nothing you tell us will be

given to your agency or supervisor. Taking part will not affect your job in any way. Your name will

not be given to any other organization outside of those collaborating on this survey. Your data will

be combined with data from other home health aides and used for statistical research and reporting

purposes only. Unless you agree, Federal law does not allow us to release information that could

identify you or the agency where you work.

Please help us by agreeing to participate when you are called or by filling out and returning

the enclosed postcard in the postage-paid return envelope or calling the toll free number listed

below. You can call us to conduct the interview now or to set up an appointment for a later time.

The survey is done over the phone with a trained interviewer. Please ask us any questions you have

about the survey. The toll-free number at Westat is 1-888-290-1125. Please refer to the NHHAS

ID number on the postcard when you call the toll-free number.

Sincerely,
 

/Edward J. Sondik/
 

Edward J. Sondik, Ph.D.
 

Director, National Center for Health Statistics
 

If you would like to take part in this survey, return the enclosed postcard or call 1-888-290-1125.

You may want to ask about your rights as a participant in this survey. If so, please call the office set up to

oversee research, toll-free, at 1-800-223-8118. Please leave a brief message with your name and phone number.

Say you are calling about Protocol # 2006-05. Your call will be returned promptly. You can learn more about the

National Home Health Aide Survey at our website: www.cdc.gov/nchs/nhhcs.htm
Series 1, No. 49 [ Page 21

Exhibit C2. Back of letter from National Center for Health Statistics Director

National Home Health Aide Survey

Frequently Asked Questions

WHY ARE YOU DOING THIS SURVEY?

The Department of Health and Human Services is doing this survey to help us learn more about your field of work.

Every home health aide that takes part in the survey will make the information more accurate. Help us include your

experiences in this important project.

DO I HAVE TO TAKE THE SURVEY?

No. Taking the survey is up to you and will not affect your job in any way. But this research is an important way

for people to understand what being a home health aide is like. We want your experiences to be included and will

provide a total of $35 to thank you for your help.

WHAT KINDS OF QUESTIONS WILL YOU ASK?

We will ask you about different topics like your past schooling, your career path, jobs you have had, training and

the management and supervision at your agency.

WILL THE DATA BE CONFIDENTIAL?

Your name and the agency where you work will be kept private. None of your answers will be reported in any way

that identifies you personally.

The NHHAS is authorized by Congress in Section 306 of the Public Health Service Act (42 United States Code

242K). All information collected in this survey will be held in strict confidence according to law [Section 308 (d) of

the Public Health Service Act (42 United States Code 242m(d) and the Confidential Information Protection and

Statistical Efficiency Act (PL 107–347)]. Aside from NCHS employees, the only parties that can receive your

personal information are Westat, our data collection contractor, and our collaborators. These persons have worked as

our full partners from the earliest stages of this survey. These parties who will use your information for statistical

research only and to carry out this survey, are bound by strong restrictions designed to guarantee your privacy. In

assisting us, the information collected is handled with strict NCHS requirements to protect your confidentiality. We

remove names and agency locations and never reveal other facts that could directly identify you. By law we cannot

release information that could identify you to anyone else without your consent. If any federal employee or

contractor gives out confidential information not authorized by law, he or she can be fired and fined and/or

imprisoned.

WILL MY ANSWERS BE SHARED WITH MY EMPLOYER?
 

WILL THIS AFFECT MY JOB?
 

No. Your answers will not be given to your employer or anyone else at the agency. Whether or not you decide to

take part in the survey will not affect your employment in any way.

WHY CAN’T YOU CALL SOMEONE ELSE? I DON’T HAVE TIME TO DO THIS.

We can only speak with a small number of home health aides at different types of home health and hospice

agencies. Since you were selected for this survey, it is important that we speak with you to make sure the

experiences at your type of agency are represented. We understand your time is important. We can do the survey in

more than one call if we need to. We can begin and do as much as we can. Then, if you need to stop, we can call

you back at another time to finish.

I’M NOT A HOME HEALTH AIDE ANYMORE. I’M NOT WORKING RIGHT NOW.

We are speaking with current and former home health aides. It is important that our research include everyone’s

experiences, including people who are no longer working as home health aides.

WHEN WILL I GET MY CHECK?

After the interview your name will be given to our Accounting Department. You should receive your check in about

2 weeks.
Page 22 [ Series 1, No. 49
 

Exhibit D. NHHAS fact sheet
Series 1, No. 49 [ Page 23

Exhibit E. Postcard to indicate willingness to participate and provide contact information
Page 24 [ Series 1, No. 49

Exhibit F. Reminder letter

{CASE ID}

{NHHAS RESPONDENT}

{STREET ADDRESS}

{CITY}, {ST} {ZIP}

Dear HHA {FIRST NAME} {LAST NAME}:

We recently visited the home health or hospice agency where you work and sent a packet for you

about the National Home Health Aide Survey (NHHAS).

The survey is the first of its kind to ask a group of home health aides across the United States

about their work. You were chosen as part of a small group of home health aides at your agency to

take part in this important survey. You have a chance to help us learn about what it is like to be a

home health aide. Every home health aide taking part in this survey—and that includes you—will

make the study more accurate.

To take part in this important project, you can contact us by returning the postcard from the

information packet you received or you can call our contractor, Westat, toll free at 1-888-290-1125.

There is no charge for calling this phone number. Trained interviewers are available to speak with

you 7 days a week during the day and evening. Our interviewers will be happy to answer any

questions you have about this survey.

If you complete the survey, you will receive a check for $30 to thank you for being part of the

survey.

I hope you’ll help public health leaders and home health agencies and hospices learn how to keep

experience people like you working in this important field by taking part in this survey.

Please let us hear what you have to say by taking part in this important survey.

If you have already sent in the postcard, thank you very much. We really appreciate your help.

We look forward to hearing from you soon.

Sincerely,

/Lauren Harris-Kojetin/

Lauren Harris-Kojetin

Chief, Long-term Care Statistics Branch,

Division of Health Care Statistics

PLEASE SEND IN YOUR POSTCARD OR CALL 1-888-290-1125 AND ASK FOR
 

THE NATIONAL HOME HEALTH AIDE SURVEY.
 

YOU WILL RECEIVE $30 FOR TAKING PART IN THE SURVEY.
 
Series 1, No. 49 [ Page 25

Exhibit G. Second reminder letter to be distributed by agency to home health aides for whom no contact information was

provided

Shirley Jones

Dear HHA Shirley Jones:

We recently visited the home health or hospice agency where you work and sent a packet to the

agency for you about the National Home Health Aide Survey (NHHAS).

If you have already sent in the postcard or called the toll-free number, thank you very much. We

really appreciate your time and your help.

If not, we want you to know how important it is for you to take part in this survey. You were chosen

for this survey along with a small group of home health aides at your agency. You are one of only

6,000 home health aides in the U.S. who has a chance to help us learn about what it is like to be a

home health aide. Your participation will make this survey more accurate.

You will receive a check for $30 to thank you for being a part of the survey.

Please contact us today to be part of this survey. You can call our contractor, Westat, toll free at

1-888-290-1125. There is no charge for calling this phone number. Trained interviewers are available

to speak with you 7 days a week during the day and evening. Our interviewers will be happy to

answer any questions you have about this survey. If you prefer, you can contact us by returning the

postcard from the information packet you received.

We need your help for public health leaders and home health agencies and hospices to learn how to

keep experienced people like you working in this important, growing field.

Please let us hear what you have to say by taking part in this important survey.

If you have any questions about this survey, please call 1-888-290-1125. We look forward to hearing

from you soon.

Sincerely,

/Lauren Harris-Kojetin/

Lauren Harris-Kojetin

Chief, Long-term Care Statistics Branch,

Division of Health Care Statistics

National Center for Health Statistics

3311 Toledo Road, Room 3431

Hyattsville, Maryland 20782
Page 26 [ Series 1, No. 49

Exhibit H. Letter sent to agency to request agency to distribute the reminder letter

<<NHHASNAME>>

<<NHHASTITLE>>

<<AGENCYNAME>>

<<ADDRESSLINE1>>

<<ADDRESSLINE2>>

<<CITY>>, <<STATE>> <<ZIP>>

Dear <<NHHASNAME>>;

We would like to thank you for your recent participation in the National Home and Hospice Care

Survey (NHHCS).

During our visit for the NHHCS, we selected up to six home health aides from your agency to be

part of the National Home Health Aide Survey (NHHAS). We recently sent the advance packets for

you to distribute to the selected home health aides about the NHHAS.

We would appreciate your help in distributing the enclosed reminder letters to the home health aides

selected in your agency for the NHHAS. Each letter is personalized for the home for the home health

aides selected for the NHHAS. Research has shown that people are more likely to responde by mail

if they receive a reminder shortly after the request. So, please make sure the letter gets to them as

soon as possible—it’s important.

Thank you again for your support and help in this important survey.

If you have any questions about this, please call me at 1-800-937-8281, extension 3552, or email me

at laurabranden@westat.com.

Sincerely,

/Laura Branden/

Laura Branden

Westat Associate Project Director

OVER

Enclosures
Series 1, No. 49 [ Page 27

Exhibit H. Continuance of letter sent to agency to request agency to distribute the reminder letter

Below is a list of home health aides sampled for the National Home Health Aide Survey (NHHAS)

from <<AGENCYNAME>> on <<DT>>.

Please distribute the enclosed letters to each of the home health aides listed below selected for the

National Home Health Aide Survey (NHHAS). Each letter is personalized.

Thank you, again, for distributing these letters.

<<FullName1>>
 

<<FullName2>>
 

<<FullName3>>
 

<<FullName4>>
 

<<FullName5>>
 

<<FullName6>>
 
Page 28 [ Series 1, No. 49

Appendix V. DVD Storyboard

This appendix includes the pictures and text of the voiceover in the DVD about the National Home and Hospice Health Aide

Survey. The DVD was included in the advance package to the aides and available on the National Home and Hospice Health

Aide Survey website.

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Series 1, No. 49 [ Page 59

Appendix VI. Introductory Contact Script

NATIONAL HOME HEALTH AIDE SURVEY (NHHAS)
 

INTRODUCTORY CONTACT SCRIPT
 

Q1. May I please speak to [NHHAS RESPONDENT]? 

Hello, my name is [YOUR NAME] and I’m calling for the U.S. Department of Health and 

Human Services (HHS). 

AVAILABLE SPEAKING................... 1 (GO TO Q5)
 

NOT AVAILABLE/NOT HOME.......... 2 (GO TO Q2)
 

DOES NOT LIVE HERE ................... 3 (GO TO Q3)
 

OTHER (SPECIFY) .......................... 4 (RECORD RESULT)
 

BOX 1
 

IF YOU HAVE NOT DIALED THE CORRECT NUMBER, END INTERVIEW.
 

Q2.	 What day and time would be best for me to call back so that I can speak to [NHHAS 

RESPONDENT]? 

BEST DAY_____________________ BEST TIME_______________ AM/PM (END INTERVIEW) 

LOCATING
 

Q3. Do you have a new phone number or address for (NHHAS RESPONDENT)?
 

YES .................................................... 1o (RECORD CONTACT INFO AND
 

END CALL) 

NO ........................................................ 2 (GO TO Q4) 

DON’T KNOW ................................. d (GO TOQ4)

 ADDRESS:

 PHONE: ______________________________________________________ 

Q4. Do you know anybody else I could call that may know how to reach (him/her)? 

YES ................................................. 1o (RECORD CONTACT INFO AND END 

CALL) 

NO .................................................. 2 (END INTERVIEW)

 NAME: _____________________________________________________

 ADDRESS:

 PHONE: ______________________________________________________ 
 

 

 

 

 

 

 

 

 

___________________________________________________________________________ 

___________________________________________________________________________ 

 

 

 

 

 

 

 

 

 

 

 

Page 60 [ Series 1, No. 49

Q5. The Department of Health and Human Services is conducting a survey of home health aides. 

You should have received a letter recently that explained the study. The letter said we would 

call you as part of the National Home and Hospice Care Survey. You will receive $30 as a 

thank you after the interview. 

Since the demand for home health aides is growing, we hope to learn why people become 

home health aides and stay working in the field. 

I would like to go over information about the survey so you can decide if you would like to take 

part. Is now a convenient time? 

YES.................................................. 1 (GO TO CATI) 

NO.................................................... 2 (GO TO Q7) 

DID NOT RECEIVE ADVANCE LETTER 3 (GO TO Q6) 

REFUSED ........................................ r 

IF RESPONDENT REFUSES TO PARTICIPATE, CHECK BOX � 

AND SAY: 

I hope you will change your mind after you have had additional time to think about the 

survey. May I leave a number that you can call if you later decide to participate? 

YES.................................................. 1 (GIVE R # - 888-290-1125) 

NO.................................................... 2 

May I ask why you don’t want to participate? 

END INTERVIEW 

NO ADVANCE LETTER 

Q6. The letter explained who we are and that we would be calling to do a survey of home health 

aides. It also explained that your participation in this survey is voluntary. A $5 bill was 

clipped to the letter and enclosed in a large white envelope. The envelope also included a 

fact sheet and a gift pen. Did you receive any of the contents of the envelope? 

YES ................................................ 1 (GO TO CATI) 

NO .................................................. 2 

DON’T KNOW................................. d 

Q6a. Shall I go over the information about the survey with you now or would you prefer that I call

you back after you have received the letter? (I’ll re-send it to you today.) 

DESCRIBE SURVEY ........................................... 1 (GO TO CATI) 

RE-SEND LETTER............................................... 2 (CONFIRM NAME AND

ADDRESS. MAKE 

CORRECTIONS ON THE RIS) 

Q7. What time and day would be best for me to call you back (next week)? 

BEST DAY_____________________ BEST TIME_______________ AM/PM (END INTERVIEW) 
Series 1, No. 49 [ Page 61

Appendix VII: Text of Informed Consent

Before we get to questions about home health aides, I’d like you to know that your answers will be kept strictly

private, as authorized by the Public Health Service Act. Your participation in this research is voluntary. You may

choose not to answer any question you don’t want to answer or stop at any time without penalty. Whether or not you

decide to take part in the survey will not affect your employment in any way.

The answers you provide will be combined with answers from other home health aides and used for statistical

research and reporting purposes only. Although the estimated time to complete the survey is about 40 minutes, time

varies from person to person. You should have received $5 cash already and a check for $30 will be mailed to you as

a token of appreciation after you participate in the survey.

If you have any questions about the survey, you can contact Brad Edwards, the project director at Westat for this

survey, at 1-800-937-8281. I’d like to continue now unless you have any questions.
Page 62 [ Series 1, No. 49

Appendix VIII: Follow-up Scripts

Exhibit A. Contact script for follow up with agencies where no contact information was provided and therefore agencies

were requested to distribute the information packets, but no completed interviews or postcards were received in the 3

weeks since mailing of information packets to agency.

NHHAS Agency Contact Followup Script

Hello, (Mr./Ms.) [AGENCY CONTACT FOR NHHAS].

This is [YOUR NAME] from Westat in Rockville, Maryland.

Recently [AGENCY NAME] participated in the National Home and Hospice Care Survey

for the Centers for Disease Control and Prevention’s National Center for Health Statistics.

One of our field representatives met with you to select home health aides from [AGENCY

NAME] to take part in the National Home Health Aide Survey. Again, let me thank you for

your help.

I am calling today about the consent packets that were sent to your agency after [DATE

OF NHHCS INTERVIEW] for the home health aides selected for the survey. So far, we

have not received a response from any of the home health aides selected for the survey.

Q1.	 Do you know if the NHHAS advance packets were distributed to the home health

aides?

YES, DISTRIBUTED ..................................... 1 (Q2)
 

NO, NOT DISTRIBUTED ................................. 2 (Q6)
 

SOMEONE ELSE DISTRIBUTED PACKETS ............... 3 (Q8)
 

DOESN’T REMEMBER THE VISIT OR
 

DOESN’T KNOW IF THE PACKETS WERE LEFT
 

OR THE PACKETS WERE DISTRIBUTED ................. 4 (Q8)
 

Q2.	 Do you know when the advance packets were distributed?

Yes .................................................... 1 (Q3)
 

No ..................................................... 2 (Q4)
 

Q3.	 When was that?

PROBE: Your best estimate about when the packets were distributed is fine.

Day	 Date
Series 1, No. 49 [ Page 63

Q4.	 Can you think of any reason why none of the selected home health aides would

participated in the National Home Health Aide Survey?

Yes .................................................... 1 (Q5)
 

No ................................................... 2 (Q10)
 

Q5.	 What are those reasons?

GO TO Q10.

Q6. Do you know why they weren’t distributed?

Yes .................................................. 1 (Q6a)

No ................................................... 2 (Q6b)

Q6a. Why weren’t they distributed?

6b.	 The advance packets contained information for the home health aides about the

survey along with a postcard to return to indicate whether they wanted to participate

in the survey, a gift pen, and a $5 bill for the home health aides. Can you arrange

to have the packets distributed to the selected home health aides?

Yes .................................................... 1 (Q7)
 

No ..................................................... 2 (Q8)
 
Page 64 [ Series 1, No. 49

So we will know about when we might expect to hear from the home

health aides from your agency, can you tell me about when the

NHHAS advance packets will be distributed?

PROBE: Your best estimate about when the packets will be

distributed is fine.

Day	 Date

GO TO Q10.

Q8.	 Can you give me the name, title, and phone number of another person at [AGENCY

NAME] who I can contact about the NHHAS advance packets.

RECORD PERSON TO CONTACT ABOUT THE NHHAS ADVANCE PACKETS:

NAME

TITLE

PHONE - ­

EXTENSION
 

Q9.	 Do you know the best time to call [CONTACT NAME GIVEN IN Q8]?

BEST CALL BACK TIME: : AM/PM

DAY DATE TIME

RECORD THE NAME OF THE NEW AGENCY NHHAS CONTACT ON THE CALL

RECORD AND CALL BACK DATE AND TIME.

___ CHECK IF RESPONDENT INDICATES THAT NHHAS ADVANCE PACKETS

NEED TO BE REMAILED

CONFIRM AGENCY NAME AND MAILING ADDRESS AND RECORD CHANGES

ON THE AGENCY SHEET.

Q10.	 Thank you very much for your time and your support of the National Home Health

Aide Survey.
Series 1, No. 49 [ Page 65

RECORD OTHER COMMENTS:
Page 66 [ Series 1, No. 49

Exhibit B. Contact script to obtain better contact information for home health aides

NHHAS Agency Followup Script for Tracing Home Health Aides

Agency ID

Hello, (Mr./Ms.) [NHHAS AGENCY CONTACT]. This is [YOUR NAME] from Westat in

Rockville, Maryland.

Recently [AGENCY NAME] participated in the National Home and Hospice Care Survey [for the

Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics

(NHCS)]. One of our field representatives [FI NAME] met with you on [AGENCY INTERVIEW

DATE] to select home health aides from [AGENCY NAME] to take part in the National Home

Health Aide Survey. Again, let me thank you for your help.

I am calling today about the address and telephone number that we have for [NAME/NAMES]

who (was/were) selected to participate in this survey.

We have been unable to contact (her/him/them) and would like to see if you would have a more

recent phone number or address for us to reach (her/him/them).

DETERMINE IF THIS IS A GOOD TIME TO COLELCT THIS ADDITIONAL INFORMATION.

IF NOT, SCHEDULE A TIME TO CALL BACK.

RECORD AGENCY CONTACT:

NAME

TITLE

PHONE

CALL BACK: : AM/PM

DAY DATE TIME

REVIEW CONTACT INFORMATION CURRENTLY AVAILABLE. RECORD THE NEW

CONTACT INFORMATION FOR EACH HOME HEALTH AIDE ON A CONTACTING FORM.

RECORD CONTACT INFORMATION AND CALL RESULT ON CALL RECORD.

PROBE FOR:

Á New phone number

Á New address

Á Emergency contact name, address, phone number

Á Next of kin

Á Co-Worker

Á New or other employer

IF NO ADDITIONAL CONTACT INFORMATION AVAILABLE, REQUEST NHHAS

CONTACT TO GIVE THE NHHAS TOLLFREE NUMBER (888-290-1125) TO HOME HEALTH

AIDE TO CALL ABOUT PARTICIPATING IN THE SURVEY. IF POSSIBLE, REQUEST

NHHAS CONTACT TO GET UPDATED CONTACT INFORMATION DIRECTLY FROM

HOME HEALTH AIDE.

IF AGENCY WANTS TO FAX THE INFO, FAX TO LAURA BRANDEN, FAX # 301-294-2038,

Office # 800-937-8281, EXT 3552. IF EMAIL RESPONSE REQUESTED, EMAIL

LAURABRANDEN@WESTAT.COM.
Exhibit C. Letter sent to hard to reach home health aides

Series 1, No. 49 [ Page 67

9990012001

Mary Jones

15 Elm Street

Stuckeyville, MD 15432

Dear Mary Jones:

We have been trying to reach you so that you can take part in the National Home Health Aide

Survey (NHHAS). You will receive $30 as a token of appreciation for participating in the

NHHAS.

Here are a few important things we’d like you to know.

Á The telephone survey takes about 40 minutes to complete.

Á The survey is confidential. Your name and agency where you work will be kept private. None

of your answers will be reported in any way that identifies you personally.

Á The survey is voluntary. Whether or not you decide to take part will not affect your job in

any way.

Á The survey is sponsored by the U.S. Department of Health and Human Services (DHHS).

Á Westat, a research firm located in Rockville, MD, is doing the survey.

You were chosen as part of a small group of home health aides to help us learn more about your

field of work. Every home health aide that takes part in the survey will make the information

more accurate. Help us include your experiences in this important project.

Trained interviewers are available to speak with you 7 days a week during the day and evening.

Call our contractor, Westat, toll free at 1-888-290-1125. There is no charge for calling this

phone number. Our interviewers will be happy to answer any questions you have about this

survey. We respect your right to not answer any part of the survey that makes you uncomfortable.

I hope you’ll help public health leaders and home health and hospice agencies learn how to keep

qualified people like you working in this important field by taking part in this survey.

We look forward to hearing from you soon.

Sincerely,

/Lauren Harris-Kojetin/

Lauren Harris-Kojetin

Chief, Long-term Care Statistics Branch,

Division of Health Care Statistics

National Center for Health Statistics

3311 Toledo Road, Room 3431

Hyattsville, Maryland 20782

PLEASE CALL 1-888-290-1125 AND ASK FOR THE NATIONAL HOME HEALTH AIDE SURVEY.

YOU WILL RECEIVE $30 FOR TAKING PART IN THE SURVEY.
Page 68 [ Series 1, No. 49

Exhibit D: Letter sent to home health aides who refused to participate in the NHHAS

9990012001

Mary Jones
 

15 Elm Street
 

Stuckeyville, MD 15432
 

Dear Mary Jones:

We called you a few weeks ago about the National Home Health Aide Survey (NHHAS). You

expressed some concerns about doing the survey. Here are a few important things we’d like you to

know.

Á	 The telephone survey takes about 40 minutes.

Á	 You will receive $30 as a token of appreciation for participating in the NHHAS in addition to

the $5 cash given to you previously.

Á	 The survey is confidential. Your name and the agency where you work will be kept private.

None of your answers will be reported in any way that identifies you personally.

Á	 The survey is voluntary. Whether or not you decide to take part will not affect your job in any

way.

Á	 The survey is sponsored by the U.S. Department of Health and Human Services (DHHS).

You were chosen as a part of a small group of home health aides to help us learn more about your

field of work. Every home health aide that takes part in the survey will make the information

more accurate. Help us include your experiences in this important survey.

Trained interviewers are available to speak with you 7 days a week during the day and evening.

Call our contractor, Westat, toll free at 1-888-290-1125. There is no charge for calling this

phone number. Our interviewers would be happy to answer any questions you have about survey.

We respect your right to not answer any part of the survey that makes you uncomfortable.

I hope you’ll help public health leaders and home health and hospice agencies learn how to keep

qualified people like you working in this important field by taking part in this survey.

We look forward to hearing from you soon.

Sincerely,

/Lauren Harris-Kojetin/

Lauren Harris-Kojetin

Chief, Long-term Care Statistics Branch,

Division of Health Care Statistics

National Center for Health Statistics

3311 Toledo Road, Room 3431

Hyattsville, Maryland 20782

PLEASE CALL 1-888-290-1125 AND ASK FOR THE NATIONAL HOME HEALTH AIDE SURVEY.

YOU WILL RECEIVE $30 FOR TAKING PART IN THE SURVEY.
7 National Home Health Aide Survey Questionnaire (NHHAS)

ssociated with the NHHAS included the following statements

Form Approved OMB No. 0920–0298 Exp. Date 07/31/2009

en of this collection of information is estimated to average 40 minutes per response, including the time for reviewing instructions, searching

nd maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and

d to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or

of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS E-11,

(0920–0298).

All information which would permit identification of an individual, a practice, or an establishment will be held confidential, will be used only by

urpose of the survey and will not be disclosed or released to other persons or used for any other purpose without the consent of the individual or

with section 308(d) of the Public Health Service Act (42 USC 242m).

Question item Code categories

Home Health Aides

asked and skip patterns Notes

loyed by {AGENCY}? 1 Yes

2 No

All HHAs

re or available for work on {SAMPLE DATE}?

ou were not scheduled to work that day, we

her or not you were employed at this agency

1 Yes2 No

If A1=2 HHAs who responded ‘‘No’’ to this

question were ineligible for the

NHHAS.

ng as . . .

EN RESPONDENT ANSWERS.

ndant, a CNA, or something else?

1 Home health aide2 Home care aide

3 Hospice aide4 A personal care attendant5 A CNA91 Something else

All HHAs

working as?] SPECIFY

_____________________

If A3=91

NCY}, {do/did} you provide assistance with

daily living? By ADLs, we mean eating,

sferring and toileting.

1 Yes2 No

All HHAs HHAs who responded ‘‘No’’ to this

question were ineligible for the

NHHAS.

ployee of {AGENCY} or {are/were} you a

1 Agency employee2 Contract worker

All HHAs HHAs who responded ‘‘Contract

worker’’ to this question wereineligible for the NHHAS.

an in-patient facility at your job with {AGENCY}

r patients in their homes?

TIENT FACILITY, PROBE: {Is/Was} it at one

ne facility?

1 One inpatient facility

2 Two or more inpatient facilities

3 Patient homes only

4 Both home and inpatient facility

All HHAs

you worked for {AGENCY}, did you work with

ultiple patients?

1 Single patient2 Multiple patients

If A4b=3

this patient? 1 Yes

2 No

If A5=1

Series 1, No. 49[ Page 69
Home Health Aides

Question item Code categories asked and skip patterns Notes

out why you initially decided to become a FOR EACH REASON (a–m): Current HHAs Questions in Section B were asked of

1 Yes home health aide who were still

please tell me whether this is a reason you 2 No employed at the sampled agency at

k. Was it because . . . the time of the National Home Health

as receiving care Aide Survey (NHHAS) (A1=1).

friend or relative

ve you time to interact with patients or the

etting to facility

riend was also a home health aide

health care

d secure

bs available

bs close to home

dule

become a nurse

reason you chose this type of work?

son you chose this type of work? SPECIFY REASON If B1m=1

Reason OS1_____________________Reason OS2_____________________

you gave mehealth aide?

was the most important reason MOST IMPORTANT REASON

1 Relative or friend was receiving care

If B1a-m=1 for 2+ reasons

2 Provided care to a friend or relative

3 Like helping people4 Would give you time to interact withpatients or elderly5 Prefer home care setting to facility6 Family member or friend was a home

health aide7 Wanted to work in health care8 Job was steady and secure

9 Home health aide jobs available

10 Home health aide jobs close to home

11 Work hours fit schedule

12 Want to become a nurse

13 Reason OS114 Reason OS2

out being a home health aide as a possible SELECT ALL THAT APPLY

1 Family member or friend was one,

Current HHAs Interviewer assigned home health

aide’s response(s) to one or more of

e? recommended it the pre-coded categories provided for

2 Providing care to a relative/friend and this question.became interested3 Relative/friend receiving care4 Worked in other health care setting, e.g.,nursing home5 Newspaper6 TV7 Radio8 School/job training program

9 Unemployment/employment agency91 Other (SPECIFY)

Page 70[ Series 1, No. 49
Question item Code categories

Home Health Aides

asked and skip patterns Notes

out being a home health aide as a possible

SPECIFY_____________________

If B3=91

e a home health aide, how long have you

f work, including the time at your current job?

between jobs or time spent on a leave of

IF NECESSARY

1 6 months or less2 > 6 months to lessthan 1 year3 1 to < 2 years4 2–5 years5 6–10 years6 11–20 years7 > 20 years

Current HHAs Interviewer assigned home health

aide’s response to one of the

pre-coded categories provided for this

question.

before you first became a home health aide?

d nursing assistant,

her type of job,

hildren,

ed, or

mething else?

1 Working as a certified nursing assistant

2 Working at some other type of job3 Going to school4 Staying home with children5 Unemployed91 Something else

Current HHAs

. .

h as a nursing home,

1 Long-term care2 Acute care3 Ambulatory care4 Home care

If B5=1

re you doing?

JOB, ASK:

nsider your main job?

SPECIFY_____________________

If B5=2

important activities or duties? SPECIFY If B5=2

_____________________

before you became a home health aide? SPECIFY If B5=91

_____________________

or industry did you work for?

y make, sell, or do?

SPECIFY_____________________

If B5=2

What kind of business was it?

whether to become a home health aide again,

ne,

ne,

e one, or

not become one?

1 Definitely become one2 Probably become one3 Probably not become one4 Definitely not become one

Current HHAs

Series 1, No. 49[ Page 71
Question item Code categories

Home Health Aides

asked and skip patterns Notes

ng

assroom or formal training to become a home

1 Yes2 No

Current HHAs Questions in Section C were asked of

home health aides who were still

employed at the sampled agency atthe time of the National Home HealthAide Survey (NHHAS) (A1=1).

e your training to become a home health aide?

CEIVED TRAINING IN ANOTHER COUNTRY,

ou receive training in the U.S. to become a

1 Agency where currently working

2 Agency other than where currently working

3 Nursing facility4 Community college, vocational, technical

school program5 Red Cross

If C1a=1 Interviewer assigned home health

aide’s response to one of the

pre-coded categories provided for this

question.

6 High school7 Not received in the U.S.91 Somewhere else

e training in the U.S. to become a home health

PLACE WHERE TRAINING WAS RECEIVED

SPECIFY

If C1b= 91

_____________________

me health aide training prepare you for what it

in a home health setting?

, or

1 Well prepared,2 Somewhat prepared

3 Not at all prepared

If C1a=1

h aide training . . .

or observing hands-on work with patients,

sroom study, or

n hands-on work and classroom study?

1 Mostly spent doing or observing hands-on

work with patients2 Mostly spent in classroom study3 Evenly split between hands-on work andclassroom study

If C1a=1

ink about all the home health aide training you

aining to become a home health aide and any

since you started working in the field.

tell me whether the training you received was

r poor.

d training in an area, just tell me.

uch as helping with eating, bathing, dressing,

s

care with patients’ families

rk tasks so that everything gets done on time

FOR EACH AREA (a–k):

1 Excellent2 Good3 Fair4 Poor5 Not received

Current HHAs

s that act out or are abusive

l injuries at work

s that don’t directly involve patients, such as

e of the home

d coping with grief

ssues

of different cultures or ethnicities, or with

efs

ome health continuing education classes,

aining, in the past two years?

1 Yes2 No

Current HHAs

Page 72[ Series 1, No. 49
Question item Code categories

Home Health Aides

asked and skip patterns Notes

have these home health aide continuing

n in helping you do your job?

r

1 Very useful,2 Somewhat useful

3 Not at all useful

If C5=1

me or part-time jobs have you had during the

urrent job and include military duty, self

wn business.

Y: Consider all private duty patients as one

1 One2 Two3 Three4 Four5 5–76 8–107 More than 10

All HHAs Interviewer assigned home health

aide’s response to one of the

pre-coded categories provided for this

question.

me or part-time jobs have you had during the

would be since (MONTH, YEAR TWO YEARS

W DATE).

urrent job.

NUMBER OF JOBSSPECIFY_____________________

If D1 ≠1

estions about the job(s) you have had during

b at {AGENCY}

orking for {AGENCY/EMPLOYER}?

orking there?

ENTER MONTH AND YEAR STARTED JOBSPECIFY_____________________ENTER MONTH AND YEAR ENDED JOB

{IF STILL AT JOB, ENTER 96.}SPECIFY

All HHAs

_____________________

worked since {MONTH/YEAR TWO YEARS

e and part-time work and any other current

JOB,COMPANY_____________________

HHAs with 2 to 5 jobs inpast 2 years; asked for

each job

orking for {AGENCY/EMPLOYER}? ENTER MONTH AND YEAR STARTED JOB

SPECIFY

For each job, 2 to 5

_____________________

orking there? ENTER MONTH AND YEAR ENDED JOB

{IF STILL AT JOB, ENTER 96.}SPECIFY

For each job, 2 to 5

_____________________

s are about your job at {AGENCY/

e/were} you doing there?

FOR JOBS 2–5SPECIFY_____________________

If D2 ≠1

IF RESPONDENT INDICATES HOMEHEALTH AIDE, CODE 999.

ing assistance with ADLs (Activities of Daily

1 Yes2 No

If D4a2=999

most important activities or duties? FOR JOBS 2–5

SPECIFY

If D4a4 ≠1

_____________________

Series 1, No. 49[ Page 73
Question item Code categories

Home Health Aides

asked and skip patterns Notes

or industry {is/was} this?

} (they/you) make, sell, or do?

FOR JOBS 2–5SPECIFY_____________________

If D2=2–5

RESPONDENT INDICATE JOB WAS AS AN

ME HEALTH OR HOSPICE AGENCY?

ested only in home health or hospice agency

oyment as a contract worker or private duty

1 Yes2 No

If D2=2–5

you working or available for work with

MPLE DATE}?

1 Yes2 No

Asked if D5a=1 and D4a4=1 and start

and stop dates for job span the date

of employment with the sampledagency.

f {EMPLOYER}? SPECIFY

_____________________

If D5b=1

did} you usually work in an average week for

R}?

timate is fine.

FOR EACH JOB ENTER NUMBER OF

HOURS PER WEEK. IF MORE THAN 99

HOURS PER WEEK, ENTER 99.

SPECIFY HOURS_____________________

This question is not asked if A6=1.

y the hour while working at {AGENCY/

FOR EACH JOB1 Yes2 NoIF GET DIFFERENTIAL CODE ‘NO’.

This question is not asked if A6=1.

urly rate of pay, {just before you left that job}

uctions?

FOR EACH JOBENTER HOURLY RATE$____________________

If D6a=1

u earn, before taxes and other deductions at

R} {just before you left that job}?

ommissions, and regular overtime pay.

FOR EACH JOBENTER DOLLARS$____________________ENTER UNIT1 Per day2 Per week3 Once every two weeks4 Twice a month

5 Per month6 Per year91 Other

If D6a=2 Also asked for Job 1 if A6=1.

ou earn, before taxes and other deductions at

R} {just before you left that job}?]

SPECIFY OTHER UNIT_____________________

If D6b2=91

king at {AGENCY/EMPLOYER}?

re you laid off, did you quit, or were you fired?

1 Laid off or job ended

2 Quit3 Fired4 Medical disability5 Retired

Asked about Job 1 if home health

aide no longer works at sampled

agency or for Jobs 2–5, if no longer

works there (i.e. D3b1 ≠ 96).

Interviewer assigned home healthaide’s response to one of the

pre-coded categories provided for this

question.

Page 74 Series 1, No. 49 [
Question item Code categories

Home Health Aides

asked and skip patterns Notes

this information.

you were working as a home health aide for

CIES CODED ‘‘YES’’ AT D5A+1 AND STILL

LE DATE} agency(ies).

1 Yes2 No

Asked if A1=1 AND if one or more

jobs with D4a4 and D5a=1 AND stopdate is no earlier than SAMPLE DATE

or still working.

me more questions about your current job.

current job at {AGENCY}?

hear about it? Anything else?

SELECT ALL THAT APPLY1 Family member or friend was one,

recommended it2 Relative or friend received care3 Prior home health or nursing assistant job

4 Newspaper ad, article5 TV6 Radio7 Home health or hospice agency8 School or job training program9 Recruiter10 Self-initiated job search11 Unemployment or employment agency

91 Other

Current HHAs All remaining questions in Section D

(i.e. D8–D32a) apply to home healthaides that were still employed at the

sampled agency at the time of theNational Home Health Aide Survey(NHHAS) (A1=1).Interviewer assigned home healthaide’s response to one or more of the

pre-coded categories provided for this

question.

r current job?] HOW FOUND JOB

SPECIFY_____________________

If D8=91

have you primarily been . . .

ferent locations for your assignments, or

n?

1 Traveling around to different locations2 Working at one location

Current HHAs

r your mileage or travel expenses or provided

1 Yes2 No91 Depends

Current HHAs

or your mileage or travel expenses?] SPECIFY

_____________________

If D11=91

travel time . . .

(first patient/agency) and from your (last

home?

ncy and) patients?

FOR EACH LOCATION (a–c):1 Yes2 No

Current HHAs

paid for your travel time]? SPECIFY

_____________________

If D12c=1

s specifically about health insurance.

nce coverage available to you at {AGENCY}?

clude insurance that is offered after a certain

the job.

use the benefit or not, is it available to you?

1 Yes2 No

Current HHAs

health insurance coverage for other family

1 Yes2 No

If D13=1

Series 1, No. 49[ Page 75
Question item Code categories

Home Health Aides

asked and skip patterns Notes

cipating in this health insurance plan?

CIPATING, FOR EXAMPLE, ONLY DENTAL

NO.’’

1 Yes2 No

If D13=1

this health insurance plan?

?

SELECT ALL THAT APPLY1 Self2 Spouse/partner3 Children91 Other (SPECIFY)

If D15=1 Interviewer assigned home health

aide’s response to one or more of the

pre-coded categories provided for this

question.

r this health insurance plan?] WHO ELSE COVERED

SPECIFY_____________________

If D15a=91

pating in the health insurance plan at your

SELECT ALL THAT APPLY1 Can’t afford it; too expensive

2 Already covered by another plan

3 Covered by Medicare, Medicaid

4 Not worked long enough to be eligible

5 Don’t need health insurance

6 Plan offered not a good value; not a goodplan7 Plan not offered to home health aides91 Other

If D15=2 Interviewer assigned home health

aide’s response to one or more of the

pre-coded categories provided for this

question.

ipating in the health insurance plan at your

REASON NOT COVERED

SPECIFY_____________________

If D16= 91

o you participate in any government programs

are such as Medicare or Medicaid {or STATE

NAME}?

a public-assistance program that pays for

1 Yes2 No

If D16 ≠ 3

pated in any government programs that pay for

Medicare or Medicaid {or STATE SPECIFIC

1 Yes2 No

If D18=2

alth insurance you get through {AGENCY}, do

e health insurance coverage either through

r’s job or employer, or (other) health insurance

sed on your own?

coverage on a parent’s plan.

1 Yes2 No

If D16 ≠2

Page 76[ Series 1, No. 49
Question item Code categories

Home Health Aides

asked and skip patterns Notes

e about benefits that are available at

d include benefits that are offered after a

nths on the job, and includes benefits offered

e it or not.

FOR EACH BENEFIT (a–m):1 Yes2 No

Current HHAs

you . . .

off, such as vacation or personal days?

ng on holidays?

sion plan?

ot include social security or railroad retirement

hild care subsidies or assistance?

g benefits?

insurance?

rk?

nt or subsidy?

k?

?

offer any other benefits?] OTHER BENEFIT

SPECIFY

If D19a (m)=1

_____________________

e about the hours you work on your current

ork more or fewer hours on this job, or is the

work about right?

1 More hours2 Fewer hours3 About right

Current HHAs

you cannot work more hours on this job?

e?

SELECT ALL THAT APPLY1 Agency has enough employees, does not

require more hours, no overtime2 Child care, family issues prevent working

more hours3 Going to school4 Another job

91 Other (SPECIFY)

If D20=1 Interviewer assigned home health

aide’s response to one or more of the

pre-coded categories provided for this

question.

you cannot work more hours on this job?] OTHER REASON

SPECIFY

If D21= 91

_____________________

y overtime to home health aides that work

a day, or over 40 hours in a week?

ply to live-ins.

1 Yes2 No

Current HHAs

patient who needs continuous care, are you

he patient until the next aide arrives?

Y: Continuous care is provided around the

ient.

1 Yes2 No3 Not applicable-don’t provide care topatients needing continuous care

This question is not asked if A6=1 orA4b=1 or 2.

ou have to stay past your shift?

es, or often?

1 Never2 Rarely3 Sometimes4 Often

If D25=1

Series 1, No. 49[ Page 77
Question item Code categories

Home Health Aides

asked and skip patterns Notes

ime? 1 Yes

2 No

If D26=2,3, or 4

ur job at {AGENCY} have you been given a

he past year, were you given a pay increase

NCY}}?

whether to take your current job as a home

AGENCY}, would you . . .

ely not take it?

the future, do you think your next job will be as

doing something else?

E’ ASK: What else would you do?

the future, do you think your next job will be

e or doing something else?]

1 Yes2 No1 Definitely take it2 Probably take it3 Probably not take it

4 Definitely not take it

1 Home health aide

2 CNA3 Medical assistant4 LPN5 LVN6 RN7 Other type of health care worker

8 Something else9 Don’t plan on having another job

OTHER JOBSPECIFY_____________________

Current HHAsCurrent HHAsCurrent HHAsIf D31=8

Interviewer assigned home healthaide’s response to one of the

pre-coded categories provided for this

question.

at {AGENCY}, you told me you also have

her job{s}. Why do you have more than one

e?

re than one job?]

SELECT ALL THAT APPLY1 Need the money2 Like the variety of jobs3 Cannot get enough hours on any one job

4 Like to work91 Other (SPECIFY)

OTHER REASON

SPECIFY_____________________

If D32 =91

Asked if A1=1 and still working at

least one other job (D3b1=96).

Interviewer assigned home healthaide’s response to one or more of the

pre-coded categories provided for this

question.

Page 78[ Series 1, No. 49
Home Health Aides

Question item Code categories asked and skip patterns Notes

how have you been traveling from home to 1 Drive by yourself Current HHAs Questions in Section E are asked of

agency) and from (your last patient/the agency) 2 Get a ride from others home health aides who were still

o not include transportation between patients. 3 Public transportation employed at the sampled agency at

MODE, PROBE:

rm of transportation that you use most often?

4 Walk, bicycle5 Taxi, van, or car service6 Carpool

the time of the National Home HealthAide Survey (NHHAS) (A1=1).

This question is not asked if A6=1.

YS ‘‘CAR’’ or ‘‘DRIVE’’ 91 Other (SPECIFY) Interviewer assigned home health

yourself, carpool, or get a ride from aide’s response to one of the

pre-coded categories provided for this

GED OVER TIME, PROBE: What have you question.

how have you been traveling from home to METHOD OF TRAVEL If E1=91

rom your last patient home? Do not include SPECIFY

n patients.] _____________________

{HOURS FROM D6 JOB 1} hours a week for 1 Yes Current HHAs This question is not asked if A6=1.

include any traveling time? 2 No

M D6 JOB 1} hours include travel time . . . FOR EACH LOCATION (a–c): If E1a1=1

(first patient/agency) and from your (last 1 Yes

home? 2 No

ncy and) patients?

include any other time.] OTHER TRAVEL If E1a2 (c) =1

SPECIFY

_____________________

orked, how much time did you spend traveling UNIT Current HHAs This question is not asked if A6=1.

ere you saw your patients/your first patient}/ 1 Hours

2 Hours and minutes3 Minutes

worked how much time did you spend traveling SPECIFY HOURS If E1b1=1 or 2

ere you saw your patients/your first patient}/ _____________________

worked how much time did you spend traveling SPECIFY MINUTES If E1b1=2 or 3

ere you saw your patients/your first patient}/ _____________________

orked, (after leaving the agency) how much UNIT This question is not asked if A6=1 or

nd traveling between {facilities to see 1 Hours A4b=1.

s and in-patient facilities/patients}? 2 Hours and minutes

3 Minutes

worked, (after leaving the agency) how much SPECIFY HOURS If E1c1=1 or 2

nd traveling between {facilities to see _____________________

s and in-patient facilities/patients}?]

worked, (after leaving the agency) how much SPECIFY MINUTES If E1c1=2 or 3

nd traveling between {facilities to see _____________________

s and in-patient facilities/patients}?]

orked, how much time did you spend traveling UNIT Current HHAs This question is not asked if A6=1.

/the last place where you saw your patients/ 1 Hours

? 2 Hours and minutes

3 Minutes

Series 1, No. 49[ Page 79
Question item Code categories

Home Health Aides

asked and skip patterns Notes

worked, how much time did you spend

st patient/the last place where you saw your

our home?]

SPECIFY HOURS_____________________

If E1d1=1 or 2

worked, how much time did you spend

st patient/the last place where you saw your

our home?]

SPECIFY MINUTES_____________________

If E1d1=2 or 3

, did you miss any time from work because of

rtation?

1 Yes2 No

Current HHAs This question is not asked if A6=1.

work did you miss because of transportation

ast month.

timate is fine.

TIME MISSED FROM WORK

SPECIFY NUMBER_____________________

If E2=1

work did you miss because of transportation

UNIT:1 Days2 Hours

If E2=1

place to live when you are not providing care? 1 Yes

2 No

If A6=1

e about you and the people living with you in

nd you that all of your answers will be kept

NUMBER OF ADULTS

SPECIFY_____________________

Current HHAs

SIZE TO LIVE-INS THE HOUSEHOLD IS

}

your household are adults, age 18 or older, not

ease count people who normally stay with you

er week.

e/Is the person} in your household that {are/is}

working full-time or part-time?

1 Yes2 No

If E4≠0

e in your household are children age 17 or

NUMBER OF CHILDRENSPECIFY

Current HHAs

_____________________

F CHILDREN FROM E6}, how many are your

en you are responsible for?

NUMBER OF CHILDRENSPECIFY

If E6= 2–19

_____________________

F CHILDREN FROM E6a} children, how many of

while you are working at {AGENCY}?

NUMBER OF CHILDREN

SPECIFY

If E6a=2–19

_____________________

or a child you are responsible for? 1 Yes, respondent’s own child or responsible

for child2 No, not respondent’s child or not responsiblefor child

If E6=1

child care while you are working at {AGENCY}? 1 Yes

2 No

If E6a=1 orE6c =1

did you miss any time from work because of

e arrangements?

1 Yes2 No

If E6d=1 or E6b=2–19

Page 80[ Series 1, No. 49
Question item Code categories

Home Health Aides

asked and skip patterns Notes

work did you miss because of problems with

ast month.

timate is fine.

TIME MISSED WORK

SPECIFY NUMBER_____________________

If E7=1

work did you miss because of problems with

UNIT1 Days2 Hours

If E7=1

get paid for, are you currently taking care of a

e, or friend who has a disability or health

1 Yes2 No

Current HHAs

, did you miss any time from work because of

a family member, relative, or friend?

1 Yes2 No

If E9=1

ou miss?

ast month.

timate is fine.

TIME MISSED WORK

SPECIFY NUMBER_____________________

If E10=1

ou miss?] UNIT

1 Days2 Hours

If E10=1

k you about sources of income and support

d.

ed cash welfare for families and children,

s TANF or Temporary Assistance for Needy

to be called AFDC, or Aid to Families with

Again, everything you tell me is confidential.

1 Yes2 No

Current HHAs

de electronically transferred benefits.

F GRANT MAY BE SHARED WITH

/BOYFRIEND/GIRLFRIEND.

iving cash welfare or TANF? 1 Yes

2 No

If E12=1

ed Food Vouchers or food items from WIC

nfants, and Children Program?

1 Yes2 No

Current HHAs

iving Food Vouchers or food items from WIC? 1 Yes

2 No

If E14=1

ed benefits from the program called SSI or

y Income?

de electronically transferred benefits.

1 Yes2 No

Current HHAs

iving SSI or Supplemental Security Income? 1 Yes

2 No

If E15a=1

ed food stamp benefits?

de electronically transferred benefits.

1 Yes2 No

Current HHAs

iving food stamps? 1 Yes

2 No

If E16a=1

n public housing, receive a rent subsidy such

ay a lower rent because the government pays

1 Yes2 No

Current HHAs

Series 1, No. 49 [ Page 81
Home Health Aides

Question item Code categories asked and skip patterns Notes

vision

e about your supervisor at {AGENCY}. FOR EACH STATEMENT (a–d): Current HHAs Questions in Section F are asked of

whom you report about your day-to-day 1 Strongly agree home health aides who were still

ember this survey is confidential. 2 Somewhat agree employed at the sampled agency at

some statements about your supervisor.

trongly agree, somewhat agree, somewhat

3 Somewhat disagree4 Strongly disagree

the time of the National Home HealthAide Survey (NHHAS) (A1=1).

disagree with each statement.

vides clear instructions when assigning work

upportive of progress in my career, such as

ens to me when I am worried about a patient’s

s me when I am doing a good job

e about the time you spend with and how you Current HHAs Questions in Section G are asked of

on your current job at {AGENCY}. home health aides who were still

employed at the sampled agency at

the time of the National Home HealthAide Survey (NHHAS) (A1=1).

This statement is not read if A6=1.

ur patient caseload and schedule. How many 1 Knows total visits Current HHAs This question is not asked if A6=1.

your patients during the week of Sunday, 2 Does not know total visits WEEKSTART and WEEKEND were

gh {today/Saturday},{WEEKEND}? date filled, beginning with Sunday’s

date, the full week preceding theinterview.

F VISITS. NUMBER OF VISITS If G1a=1

SPECIFY

_____________________

ur patient workload by patient or by day. Which 1 Per patient If G1a=2

2 Per day

t week, [Sunday, {WEEKSTART through

EKEND}], how many patients did you see . .

.

FOR EACH TIME

NUMBER OF PATIENTS

_____________________

If G1a2 =1

ek?

k?

?

?

ek?

nts seen more than seven times per week?}

ou make on . . . FOR EACH DAY If G1a2 =2

NUMBER OF VISITS

_____________________

w many patients did you care for? NUMBER OF PATIENTS If G1a=1 or G1a2=2

SPECIFY

_____________________

Page 82[ Series 1, No. 49
Question item Code categories

Home Health Aides

asked and skip patterns Notes

are for the same patients on most weeks you

ts you are assigned to change each week you

ew patients or discharges due to deaths or

ask you about things you do directly with

ng them dress, bathe, get in and out of bed, or

worked, how much time do you have to give

patients who need this type of assistance?

ave . . .

ime,

week worked, how much time do you have to

that don’t directly involve the patients? This

meal or food preparation, laundry, or record

have . . .

ime,

u feel patients respect you, as part of their

1 Same patients2 Patients change3 Combination1 More than enough time

2 Enough time3 Not enough time1 More than enough time

2 Enough time3 Not enough time4 Doesn’t do these types of tasks

1 A great deal2 Somewhat3 Not at all

Current HHAsCurrent HHAsCurrent HHAsCurrent HHAs

This question is not asked if A6=1.

Interviewer assigned home healthaide’s response to one of the

pre-coded categories provided for this

question.Interviewer assigned home healthaide’s response to one of the

pre-coded categories provided for this

question.

do the patients you care for let you know

good job?

he time,

?

couraged by {AGENCY} to discuss the care

ents with their families?

DICATES AT LEAST ONE FAMILY MEMBER,

1 Always or most times

2 Sometimes3 That never happens

1 Yes2 No

Current HHAsCurrent HHAs

u feel your supervisor respects you, as part of

1 A great deal2 Somewhat3 Not at all

Current HHAs

Series 1, No. 49[ Page 83
Question item Code categories

Home Health Aides

asked and skip patterns Notes

u a few questions about how satisfied you are

as a home health aide at {AGENCY}.are confidential.

are you with your job?

ed, or

ed?

1 Extremely satisfied2 Somewhat satisfied

3 Somewhat dissatisfied

4 Extremely dissatisfied

Current HHAs Questions in Section H are asked of

home health aides who were still

employed at the sampled agency at

the time of the National Home HealthAide Survey (NHHAS) (A1=1).

a list of job characteristics and I would like

reason why you continue to work in your

FOR EACH REASON (a–k):

1 Yes2 No

Current HHAs

ork in your current job because . . .

r others?

hours?

k independently?

good?

with the other members of the care team?

with your supervisor?

overtime?

the work you do?

t?

you continue to work in your current job? OTHER REASON

SPECIFY

If H2 (k)=1

_____________________

st mentioned, what is the most important

nue to work at your job?

ONSES IF NECESSARY

MOST IMPORTANT REASON

1 Enjoy caring for others

2 Flexible schedule or hours

Asked if more than one item at

H2a–k= 1.

3 Able to work independently4 The salary or pay is good

5 The benefits6 Enjoy working with the other members of

the care team7 Enjoy working with your supervisor

8 The opportunity for overtime

9 Feel good about the work you do

10 Career advancement11 Other reason

isfied, somewhat satisfied, somewhat

ely dissatisfied with the following aspects of

work?

?

FOR EACH JOB ASPECT (a–d):1 Extremely satisfied2 Somewhat satisfied

3 Somewhat dissatisfied

4 Extremely dissatisfied

Current HHAs

gs that people like and dislike about their jobs.

es of problems or incidents that make your job

lt or cause you to dislike your job.

e?

SELECT ALL THAT APPLY1 HHA communication problems with agencystaff2 Misinformation about patient’s health3 Patient communication problems with

Current HHAs Interviewer assigned home health

aide’s response to one or more of the

pre-coded categories provided for this

question.

agency

Page 84[ Series 1, No. 49
Question item Code categories

Home Health Aides

asked and skip patterns Notes

4 Travel problems (distance, bad directions)

5 Problem patients

6 Clients families7 Coworkers8 Supervisor9 Pay10 Benefits11 Workload; too little, too much

12 Nothing, no complaints91 Other (SPECIFY)

ngs that people like and dislike about their

e types of problems or incidents at work that

u to work there or cause you to dislike your

TYPE OF PROBLEMSPECIFY_____________________

If H5=91

ember needed care and asked your advice

health care from {AGENCY}, would you . . .

it,

t,

end it, or

ot recommend it?

1 Definitely recommend2 Probably recommend3 Probably not recommend4 Definitely not recommend

Current HHAs

ember asked your advice about taking a home

ENCY}, would you . . .

d it,

d it,

mend it, or

not recommend it?

1 Definitely recommend2 Probably recommend3 Probably not recommend4 Definitely not recommend

Current HHAs

ing for a different job either as a home health

ng else?

s survey is confidential.

1 Yes2 No3 No, but thinking about it

Current HHAs Interviewer assigned home health

aide’s response to one of the

pre-coded categories provided for this

question.

u will leave this job at {AGENCY} in the next

1 Very likely2 Somewhat likely

3 Not at all likely

Current HHAs

you think you would leave?

asons?

SELECT ALL THAT APPLY1 Different job or opportunity2 Schedule3 Retirement4 Travel problems5 Pay6 Moving to a different area7 Workload; too little, too much8 Lack of respect or appreciation9 Supervisor10 Job too physically demanding11 Nothing, no complaints

91 Other (SPECIFY)

H8=1,2 Interviewer assigned home health

aide’s response to one or more of the

pre-coded categories provided for this

question.

s why you think you would leave?] OTHER REASON

SPECIFY_____________________

If H9=91

Series 1, No. 49[ Page 85
Home Health Aides

Question item Code categories asked and skip patterns Notes

e thinking about {AGENCY}. I’m going to read FOR EACH STATEMENT (a–d): Current HHAs Questions in Section I are asked of

and for each one, tell me whether you 1 Strongly agree home health aides who were still

what agree, somewhat disagree, or strongly 2 Somewhat agree employed at the sampled agency at

3 Somewhat disagree the time of the National Home Health

} 4. Strongly disagree Aide Survey (NHHAS) (A1=1).

my agency for my work

allenging work

e patient care decisions

y ability to do my job

u a few questions about how you think people

as a home health aide. 12 Very much Somewhat Current HHAs

nk society values or appreciates your work as 3 Not at all

nk your supervisor values or appreciates the 1 Very much Current HHAs

me health aide? 2 Somewhat

3 Not at all

nk the organization at {AGENCY} values or 1 Very much Current HHAs

you do as a home health aide? 2 Somewhat

3 Not at all

think your work is? 1 Very important Current HHAs

2 Somewhat important

3 Not important at all

t, or

ave you ever been discriminated against

or ethnic origin? This could be from your

ent’s family.

1 Yes2 No

Current HHAs

your answers are confidential.

d discrimination from (ITEMS a–e) at your FOR EACH SOURCE (a–e): If I8=1

1 Yes2 No

mbers or friends

nt

e team

SPECIFY)

nce discrimination from?] OTHER SOURCE If I10e=1

SPECIFY_____________________

Page 86[ Series 1, No. 49
Question item Code categories

Home Health Aides

asked and skip patterns Notes

e about any times you may have been hurt or

at your job as a home health aide. Include

ies that you reported to the agency, that

tion, or that caused you to miss work.

Current HHAs Questions in Section J are asked of

home health aides who were still

employed at the sampled agency atthe time of the National Home HealthAide Survey (NHHAS) (A1=1).

ur job with {AGENCY}, have you had

months that you have been working for

had any]...

ng pulled back muscles?

ed muscles?

unds, or cuts?

types of bruising?

your job?

FOR EACH INJURY (a-h):1 Yes2 No

Current HHAs

ur job with {AGENCY}, have you had any/

onths working for {AGENCY}, did you have any

ur job?]

OTHER INJURYSPECIFY_____________________

If J2(h)=1

ur job/During the past 12 months}, how many

ou hurt or injured while working for

Y: Include only work-related injuries that you

y, that required medical attention or that

ork.

NUMBER OF TIMES

SPECIFY_____________________

If J2=1

happen?

e?

SELECT ALL THAT APPLY1 Lifting, repositioning, bathing or handling

patients2 Slips, trips, falls3 Aggression, violence, abuse by patients4 Bumping into, hitting, or using equipment

5 Performing household chores

91 Other (SPECIFY)

If J2=1 Interviewer assigned home health

aide’s response(s) to one or more ofthe pre-coded categories provided for

this question.

s happen?] HOW INJURY HAPPENED

SPECIFY

If J4=91

_____________________

ur job/During the past 12 months}, in total, how

unable to work because of the injuries?

L DAYS: Count a missed day if you were out

re.

NUMBER OF DAYSSPECIFY_____________________

If J2=1

r job at {AGENCY}, have you ever used lifting

or lifting patients who cannot move around on

1 Yes2 No

Current HHAs

sent in patients’ homes when they are

r never?

1 Always2 Sometimes3 Never

Current HHAs

Series 1, No. 49[ Page 87
Question item Code categories

Home Health Aides

asked and skip patterns Notes

ere any other devices or equipment that you

b safer that is typically missing in patients’

1 Yes2 No

Current HHAs

ent or devices? SELECT ALL THAT APPLY

1 Bathing aids (shower chairs, adapted

shower stalls, other bathing systems)

2 Bedrails3 Belts-back4 Belts-walking, gait belts (with handles)

5 Electric beds6 Lifts, lifting aides or equipment7 Sheets (slip or roller)8 Sliding boards (to move patient from bed to

chair)9 Toilet seat risers

10 Trapeze bars11 Walker, canes12 Wheelchairs91 Other (SPECIFY)

If J9=1 Interviewer assigned home health

aide’s response(s) to one or more ofthe pre-coded categories provided for

this question.

ment or devices?] OTHER EQUIPMENT

SPECIFY_____________________

If J10= 91

Page 88[ Series 1, No. 49
Question item Code categories

Home Health

asked and skip

Aides

patterns Notes

ons are

tell me

about your background.

is confidential.

All HHAs

irth? SPECIFY

________SPECIFY________SPECIFY________

MONTH

_____________

DAY

_____________

YEAR

_____________

All HHAs

d are you? SPECIFY

________

AGE

_____________

Asked if

of birth)

K1aa-ac (month,

is unknown.

day, or year

E SEX,

e?

OR ASK IF NOT KNOWN 1

2

FemaleMale

All HHAs

Latina/Latino}? 1 Yes

2 No

All HHAs

a list of five race categories. Please

at you consider yourself to be.

self....

lack,

aska Native,

acific Islander?

choose SELECT ALL THAT APPLY

1 White

2 African American, Black

3 American Indian, Alaska Native

4 Asian

5 Native Hawaiian, Pacific Islander

91 Other

All HHAs

a list

at you

of five race categories. Please

consider yourself to be.]

choose OTHER RACE

SPECIFY

_____________________

If K3=91

ried, living with a partner

d, divorced, widowed, or

in a marriage-like

have you never been

1

23456

Married

Living with partnerSeparatedDivorcedWidowedNever married

All HHAs

ade or year you completed in

OTHER COUNTRY: And what

ool you completed?

school?

is the highest

0 None1 1st grade2 2nd grade3 3rd grade4 4th grade5 5th grade6 6th grade7 7th grade8 8th grade9 9th grade10 10th grade11 11th grade12 12th grade13 1 year college, trade school

14 2 years college, trade school15 3 years college, trade school16 College graduate17 Post college

All HHAs

Series 1, No. 49[ Page 89
Question item Code categories

Home Health

asked and skip

Aides

patterns Notes

school

ONE.

diploma or did you} {receive your 1

2

3

High school

GED

Neither, no

diploma If K5= <13 If K5=1–11, ‘receive your G.E.D.’

displayed.If K5=12, ‘get your high school

diploma or did you receive your

G.E.D.’ is displayed.

is

rsing assistant or CNA? 1 Yes

2 No

If A3 ≠5

categories best describes your total

t year, before taxes? Please include any

family members may have received from jobs,

rest, or any other sources. Please stop me

category . . .

timate is fine.

20,000,30,000,40,000,50,000,60,000,70,000,80,000, or

123456789

Less than $10,000$10,000 to under $20,000$20,000 to under $30,000$30,000 to under $40,000$40,000 to under $50,000$50,000 to under $60,000$60,000 to under $70,000$70,000 to under $80,000$80,000 or more

All HHAs

onths (that is, since {12 MONTHS

did you receive a flu shot?

BEFORE 1 Yes

2 No

All HHAs

say that your health

good, fair, or poor?

is . . . 1

2345

ExcellentVery goodGoodFairPoor

All HHAs

e United States?

mber this survey is confidential.

1 Yes2 No

All HHAs

en of the United States,

ugh naturalization?

or did you become a 1

2

Born

Naturalized

If K8=1

tly a citizen? What country? SPECIFY

________

COUNTRY

_____________

If K8=2

home health aide

tside of the United

t were you trained

or as some

States?

as?

other type of 1 Yes, trained as

2 Yes, trained as

3 Yes, trained as

4 Yes, trained as

5 Yes, trained as

nursing assistant6 No91 Yes, Other

MD (medical doctor)RN/LPN (nurse)paramedichome health aidenurse aide or certified

If K8=2 or K8a=2 Interviewer assigned

aide’s response(s) topre-coded categoriesquestion.

home health

one of the

provided for this

a home

tside of

health aide

the United

or as some

States?]

other type of SPECIFY

________

JOB

____

TITLE

_________

If K9a=91

Page 90[ Series 1, No. 49
Question item Code categories

Home Health Aides

asked and skip patterns Notes

ou speak?

SELECT ALL THAT APPLY1 American sign language2 Cantonese/Mandarin3 Creole4 Czech5 English6 French7 German8 Hindi9 Polish10 Portuguese11 Russian12 Spanish13 Swahili14 Tagalog91 Other (SPECIFY)

Current HHAs All remaining questions in Section K

apply to home health aides that were

still employed at the sampled agencyat the time of the National HomeHealth Aide Survey (A1=1).Interviewer assigned home healthaide’s response(s) to one or more ofthe pre-coded categories provided for

this question.

ou speak?] SPECIFY LANGUAGE If K9b =91

_____________________

to be your primary language? 1 American sign language

2 Cantonese/Mandarin3 Creole4 Czech5 English6 French7 German8 Hindi9 Polish10 Portuguese11 Russian12 Spanish13 Swahili14 Tagalog91 Other (SPECIFY)

Asked if more than one language

reported in K9b.Interviewer assigned home healthaide’s response(s) to one of the

pre-coded categories provided for this

question.

r to be your primary language?] SPECIFY LANGUAGE If K9c =91

_____________________

{K9b LANGUAGE(S) OTHER THAN

me health aide job at {AGENCY}?

r never?

1 Always2 Sometimes3 Never

Asked if more than one language

reported in K9b and K9c is 1–91.

e difficulty communicating with patients

different language than you?

r never?

1 Always2 Sometimes3 Never

Current HHAs

e difficulty communicating with patients

different background, different values, or

uld you say . . .

r never?

1 Always2 Sometimes3 Never

Current HHAs

e difficulty communicating with other members

m because they have a different background,

iefs than you? Would you say . . .

r never?

1 Always2 Sometimes3 Never

Current HHAs

Series 1, No. 49[ Page 91
Question item Code categories

Home Health Aides

asked and skip patterns Notes

estions about being a home health aide. Leaver HHAs Section L questions were asked of

home health aides who were

no longer working at the sampledAgency at the time of the National

Home Health Aide Survey (A2=1).

king as a home health aide? 1 Yes

2 No

Leaver HHAs

u will work as a home health aide again some

. .

or

1 Very likely2 Somewhat likely

3 Somewhat unlikely

4 Extremely unlikely

If L1=2

Page 92[ Series 1, No. 49

.

SELECT ALL THAT APPLY.1 Home care

If L1=1

h as a nursing home?

2 Long-term care3 Hospice care

4 Acute care5 Ambulatory care

e a home health aide, how long have you

f work? Do not count time between jobs or

of absence.

IF NECESSARY.

1 6 months or less2 More than 6 months but less than one year

3 One year but less than 2 years

4 2–5 Years5 6–10 Years

Leaver HHAs Interviewer assigned home health

aide’s response to one of the

pre-coded categories provided for this

question.

THS BUT LESS THAN ONE YEAR 6 11–20 Years

HAN 2 YEARS 7 More than 20 Years

RS

whether to become a home health aide again,

ne,

ne,

e one, or

not become one?

1 Definitely become one2 Probably become one3 Probably not become one4 Definitely not become one

Leaver HHAs

ember asked your advice, in general, about

alth aide, would you . . .

d it,

d it,

mend it, or

not recommend it?

1 Definitely recommend it2 Probably recommend it

3 Probably not recommend it

4 Definitely not recommend it

Leaver HHAs

u some questions about your home health

.

Leaver HHAs
Question item Code categories

Home Health

asked and skip

Aides

patterns Notes

you {quit/get

asons?

fired at/leave} {AGENCY}? SELECT ALL THAT APPLY

1 Problems with supervisor2 Problems with other members of the care

team3 Low pay4 Poor benefits (health insurance, vacation

days, etc.)5 Problems with agency working conditions,

policies or procedures6 Discrimination7 Sexual harassment8 Problems dealing with difficult/abusive

patients9 Problems dealing with patients families

10 Problems dealing with dying patients11 Too high a caseload

12 Too many responsibilities per patient

13 Job too physically demanding

14 Too few hours15 Travel distances to and from assignments

too great, transportation issues

16 Child care issues

17 Care for an elderly or disabled family

member18 Missed too many days of work

19 No opportunity for advancement20 Health or personal issues21 Injured on the job22 You, your family moved

23 Found a new, better job

24 To go back to school

91 Other (SPECIFY)

If D6D (Job 1) =2,3 Interviewer assigned home health

aide’s response(s) to one or morethe pre-coded categories provided

this question.

of

for

you {quit/get fired at/leave} {AGENCY}?] OTHER REASON

SPECIFY_____________________

If L7=91

de you stay working as a home

ds of benefits or incentives?

health aide at SELECT ALL THAT APPLY

1 Different supervisor, management2 Different or better co-workers3 Better working conditions, lighter workload

4 Better pay, benefits5 Better hours (more, less, regular)

6 Help with child, elder care

7 Transportation assistance, subsidy

8 Opportunities for advancement

9 More staff appreciation activities

10 More training, education offered

11 Different assignment12 Nothing would make me stay

91 Other (SPECIFY)

If D6d for Job 1 ≠3 Interviewer assigned home health

aide’s response(s) to one or morethe pre-coded categories provided

this question.

of

for

de you stay working as a home health aide at IF DONE

SPECIFY________

THIS,

_____

WOULD

_______

STAY

_

If L8a =91

ever discriminated against because of your

Please remember that all your answers are

1 Yes2 No

Leaver HHAs

Series 1, No. 49[ Page 93
Question item Code categories

Home Health

asked and skip

Aides

patterns Notes

inated against?

crimination take?

SELECT ALL THAT APPLY

1 Hostile or racist treatment or ridicule

2 Threats3 Physical assault

4 Assigned more difficult patients5 Assigned less difficult patients6 Assigned more hours7 Assigned fewer hours8 Unequal pay9 Fewer opportunities for promotion10 Assigned cases hard to reach because

transportation limitations

91 Other (SPECIFY)

of

If L9=1 Interviewer assigned home health

aide’s response(s) to one or morethe pre-coded categories provided

this question.

of

for

minated against?] FORM OF

SPECIFY_________

DISCRIMINATION

____________

If L10 =91

scrimination from

mbers or friends

nt

e team

SPECIFY)

(ITEMS a–e) at your job at FOR EACH

1 Yes2 No

SOURCE (a–e): If L9=1

nce discrimination from?] SOURCE

SPECIFY________

OF

___

DISCRIMINATION

__________

If L11(e)=1

s discrimination contribute

son,

ber of different reasons, or

at all?

to why you left this 1

23

ItItIt

waswaswas

theonenot

main reason

of a number of

a reason at all

different reasons

If L9=1

amily member asked your advice

h aide at {AGENCY}, would you

d it,

d it,

mend it, or

mend it?

about

. . .

taking 1

2

3

4

DefinitelyProbably

Probably

Definitely

recommend it

recommend it

not recommend

not recommend

it

it?

Leaver HHAs

Page 94[ Series 1, No. 49
Vital and Health Statistics

Series Descriptions

ACTIVE SERIES

Series 1.	 Programs and Collection Procedures—This type of report

describes the data collection programs of the National Center

for Health Statistics. Series 1 includes descriptions of the

methods used to collect and process the data, definitions, and

other material necessary for understanding the data.

Series 2.	 Data Evaluation and Methods Research—This type of

report concerns statistical methods and includes analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. Also included are

experimental tests of new survey methods, comparisons of

U.S. methodologies with those of other countries, and as of

2009, studies of cognition and survey measurement, and final

reports of major committees concerning vital and health

statistics measurement and methods.

Series 3.	 Analytical and Epidemiological Studies—This type of

report presents analytical or interpretive studies based on vital

and health statistics. As of 2009, Series 3 also includes

studies based on surveys that are not part of continuing data

systems of the National Center for Health Statistics and

international vital and health statistics reports.

Series 10.	 Data From the National Health Interview Survey—This

type of report contains statistics on illness; unintentional

injuries; disability; use of hospital, medical, and other health

services; and a wide range of special current health topics

covering many aspects of health behaviors, health status, and

health care utilization. Series 10 is based on data collected in

this continuing national household interview survey.

Series 11.	 Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

In this type of report, data from direct examination, testing,

and measurement on representative samples of the civilian

noninstitutionalized population provide the basis for (1)

medically defined total prevalence of specific diseases or

conditions in the United States and the distributions of the

population with respect to physical, physiological, and

psychological characteristics, and (2) analyses of trends and

relationships among various measurements and between

survey periods.

Series 13.	 Data From the National Health Care Survey—This type of

report contains statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

Series 20.	 Data on Mortality—This type of report contains statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Series 21.	 Data on Natality, Marriage, and Divorce—This type of

report contains statistics on natality, marriage, and divorce

that are not included in regular, annual, or monthly reports.

Special analyses by health and demographic variables and

geographic and trend analyses are included.

Series 23.	 Data From the National Survey of Family Growth—These

reports contain statistics on factors that affect birth rates,

including contraception and infertility; factors affecting the

formation and dissolution of families, including cohabitation,

marriage, divorce, and remarriage; and behavior related to

the risk of HIV and other sexually transmitted diseases.

These statistics are based on national surveys of women and

men of childbearing age.

DISCONTINUED SERIES

Series 4.	 Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents. The last Series 4 report was

published in 2002. As of 2009, this type of report is included

in Series 2 or another appropriate series, depending on the

report topic.

Series 5.	 International Vital and Health Statistics Reports—This

type of report compares U.S. vital and health statistics with

those of other countries or presents other international data of

relevance to the health statistics system of the United States.

The last Series 5 report was published in 2003. As of 2009,

this type of report is included in Series 3 or another series,

depending on the report topic.

Series 6.	 Cognition and Survey Measurement—This type of report

uses methods of cognitive science to design, evaluate, and

test survey instruments. The last Series 6 report was

published in 1999. As of 2009, this type of report is included

in Series 2.

Series 12.	 Data From the Institutionalized Population Surveys— The

last Series 12 report was published in 1974. Reports from

these surveys are included in Series 13.

Series 14.	 Data on Health Resources: Manpower and Facilities—

The last Series 14 report was published in 1989. Reports on

health resources are included in Series 13.

Series 15.	 Data From Special Surveys— This type of report contains

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics. The last

Series 15 report was published in 2002. As of 2009, reports

based on these surveys are included in Series 3.

Series 16.	 Compilations of Advance Data From Vital and Health

Statistics— The last Series 16 report was published in 1996.

All reports are available online, and so compilations of

Advance Data reports are no longer needed.

Series 22.	 Data From the National Mortality and Natality Surveys—

The last Series 22 report was published in 1973. Reports

from these sample surveys, based on vital records, are

published in Series 20 or 21.

Series 24.	 Compilations of Data on Natality, Mortality, Marriage, and

Divorce—The last Series 24 report was published in 1996.

All reports are available online, and so compilations of reports

are no longer needed.

For answers to questions about this report or for a list of reports published

in these series, contact:

Information Dissemination Staff

National Center for Health Statistics

Centers for Disease Control and Prevention

3311 Toledo Road, Room 5412

Hyattsville, MD 20782

1–800–232–4636

E-mail: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/nchs
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, Maryland 20782

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DHHS Publication No. (PHS) 2010-1325, Series 1, No. 49