2010 July 53 Number 1,ies Ser

Redesign and Operation of

the National Home and

Hospice Care Survey, 2007
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Suggested citation

Dwyer LL, Harris-Kojetin LD, Branden L, Shimizu IM. Redesign and Operation

of the National Home and Hospice Care Survey, 2007. National Center for

Health Statistics. Vital Health Stat 1(53). 2010.

Library of Congress Cataloging-in-Publication Data

Redesign and operation of the National Home and Hospice Care Survey, 2007.

p. ; cm. — (Vital and health statistics, series 1, Programs and collection

procedures ; no. 53) (DHHS publication ; no. (PHS) 2010–1329)

By Lisa L. Dwyer ... [et al.].

‘‘May 2010.’’

Includes bibliographical references.

ISBN 0–8406–0638–9

1. National Home and Hospice Care Survey (U.S.) 2. Home care services—

United States. 3. Hospices (Terminal care)—United States. 4. Medical care

surveys—United States. I. Dwyer, Lisa. II. National Center for Health Statistics

(U.S.) III. Series: Vital and health statistics. Ser. 1, Programs and collection

procedures ; no. 53. IV. Series: DHHS publication ; no. (PHS) 2010–1329.

[DNLM: 1. National Home and Hospice Care Survey (U.S.) 2. Home Care

Services—United States. 3. Hospice Care—United States. 4. Data Collection—

United States. 5. Hospices—United States. 6. Research Design—United States.

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Printed on acid-free paper.
Series 1, Number 53

Redesign and Operation of

the National Home and

Hospice Care Survey, 2007

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

July 2010

DHHS Publication No. (PHS) 2010–1329
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
Contents
 

Acknowledgments .......................................................................................... v 
 

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

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

Background ............................................................................................... 1 
 

Redesign Process........................................................................................... 2 
 

Content Redesign......................................................................................... 2 
 

Sampling Redesign ....................................................................................... 4 
 

Data Collection Instrument Redesign ......................................................................... 6 
 

Survey Supplement ....................................................................................... 6 
 

Field Procedures Redesign ................................................................................. 6 
 

National Survey Methods .................................................................................... 7 
 

Sampling Design and Selection ............................................................................. 7 
 

Interviewer Training ...................................................................................... 8 
 

Agency Recruitment ...................................................................................... 8 
 

Information for Survey Participants .......................................................................... 9 
 

Refusal Conversion ....................................................................................... 9 
 

Survey Instrument and Data Collection ......................................................................... 9 
 

CAPI System ............................................................................................ 9 
 

SAQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 
 

Data Quality Assurance ..................................................................................... 11 
 

Audio Recording ........................................................................................ 11 
 

Observations............................................................................................ 11 
 

Debriefing Calls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 
 

Data Collection Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 
 

Data Processing ........................................................................................... 12 
 

Disclosure Risk Review .................................................................................... 12 
 

Response Rates and Module Timings.......................................................................... 12 
 

Issues Affecting Response Rates ........................................................................... 14 
 

Nonresponse Bias Analysis................................................................................ 14 
 

Estimation Procedures...................................................................................... 14 
 

Reliability of Survey Estimates .............................................................................. 16 
 

Confidentiality ............................................................................................ 16 
 

Data Dissemination ........................................................................................ 16 
 

References ............................................................................................... 16 
 

iii
Appendixes

I.	 Recommendations From the Hospice Care Survey Technical Advisory Group Working Meeting ................... 18 
 

II.	 Content Wish List for the Redesigned National Nursing Home Survey ........................................ 21 
 

III.	 Recommendations From the Home Health Care Survey Technical Advisory Group Working Meeting ............... 24 
 

IV.	 Advance Mail Screener Script ......................................................................... 27 
 

V.	 Agency Advance Package Materials .................................................................... 31 
 

VI.	 Corporate Advance Package Materials .................................................................. 43 
 

VII.	 Set an Appointment Script ............................................................................ 68 
 

VIII.	 Appointment Confirmation Package Materials, Including Self-administered Staffing Questionnaire (SAQ) ........... 74 
 

IX.	 Appointment Confirmation Script ...................................................................... 96 
 

X.	 Reminder Call Script ................................................................................ 99 
 

XI.	 CAPI: Agency Qualifications and Characteristics (AQ) Questionnaire ....................................... 102 
 

XII.	 CAPI: Patient Health (PH) Questionnaire ............................................................... 126 
 

XIII.	 CAPI: Charges and Payments (PA) Questionnaire ........................................................ 171 
 

XIV.	 Agency Gaining Cooperation Debriefing Agenda and Discussion Guide ...................................... 179 
 

XV.	 Agency Visit Debriefing Agenda and Discussion Guide ................................................... 185 
 

Text Figures

1.	 Application of Donabedian’s model of assessing quality of medical care to home health and hospice care ............ 3 
 

2.	 Flow chart of data collection during the National Home and Hospice Care Survey agency interview................ 10 
 

Text Tables

A.	 Agency response rates ............................................................................... 12 
 

B.	 Number and percent distribution of in-scope sampled home health and hospice care agencies, by agency response
 

status and selected characteristics: National Home and Hospice Care Survey, 2007 .............................. 13 
 

iv
Acknowledgments
 

The redesigned National Home and

Hospice Care Survey (NHHCS) was

made possible through the hard work

and dedication ofa number of key

people both within and outside the

National Center for Health Statistics

(NCHS). We thank the members of our

technical advisory groups who shared

their expertise during this endeavor, and

we thank our Long-term Care Listserv

community, whose feedback was greatly

appreciated, particularly in helping to

finalize the survey content. Robin

Remsburg, formerly with NCHS,

skillfully led the redesign process

through the pilot test and provided

valuable historical documentation for

this report. Manisha Sengupta and

Eunice Park-Lee conducted the

nonresponse bias analysis and prepared

the related text and table found in this

report. We gratefully acknowledge

Genevieve Strahan and Alvin Sirrocco,

now retired from NCHS, whose work on

the redesign and on the survey since its

inception in the early 1990s was

invaluable. Members of the Long-term

Care Statistics Branch and the Technical

Services Branch worked tirelessly and

patiently on each phase of the redesign,

data collection, editing, and

development of the public-use files.

Lastly, we are indebted to the agency

directors and their staffs who allowed us

to collect these data and who were most

helpful during that process.

v
Objectives

This methods report provides an

overview of the redesigned National Home

and Hospice Care Survey (NHHCS)

conducted in 2007. NHHCS is a national

probability sample survey that collects

data on U.S. home health and hospice

care agencies, their staffs and services,

and the people they serve. The

redesigned survey included computerized

data collection, greater survey content,

increased sample sizes for current home

health care patients and hospice care

discharges, and a first-ever supplemental

survey called the National Home Health

Aide Survey.

Methods

The 2007 NHHCS was conducted

between August 2007 and February 2008.

NHHCS used a two-stage probability

sampling design in which agencies

providing home health and/or hospice care

were sampled. Then, up to 10 current

patients were sampled from each home

health care agency, up to 10 discharges

from each hospice care agency, and a

combination of up to 10 patients/

discharges from each agency that

provided both home health and hospice

care services. In-person interviews were

conducted with agency directors and their

designated staff; no interviews were

conducted directly with patients. The

survey instrument contained agency- and

person-level modules, sampling modules,

and a self-administered staffing

questionnaire.

Results

Data were collected on 1,036

agencies, 4,683 current home health care

patients, and 4,733 hospice care

discharges. The first-stage agency

weighted response rate (for differential

probabilities of selection) was 59%. The

second-stage patient/discharge weighted

response rate was 96%. Three public-use

files were released: an agency-level file, a

patient/discharge-level file, and a

medication file. The files include sampling

weights, which are necessary to generate

national estimates, and design variables to

enable users to calculate accurate

standard errors.

Keywords: home health c hospice c

long-term care c agencies

Redesign and Operation of the

National Home and Hospice

Care Survey, 2007

by Lisa L. Dwyer, M.P.H., and Lauren D. Harris-Kojetin, Ph.D.,

National Center for Health Statistics, Division of Health Care

Statistics; Laura Branden, Westat, Inc.; and Iris M. Shimizu, Ph.D.,

National Center for Health Statistics, Office of Research and

Methodology

Introduction

The National Home and Hospice

Care Survey (NHHCS) is a periodic,

nationally representative sample survey

of home health and hospice care

agencies in the United States. NHHCS

was inaugurated in September 1992

(preceded by a feasibility test in 1990

and a pretest in 1991) by the National

Center for Health Statistics (NCHS) as

part of the long-term care component of

the National Health Care Surveys

(NHCS) (1). NCHS surveys are

legislated under the National Health

Survey Act (P.L. 84–652) of 1956.

Section 306 (42 U.S.C. 242k) of the

Public Health Service Act authorizes

NCHS to collect statistics on health

resources and the utilization of health

care, which includes ‘‘home health

agencies and other health institutions’’

(2).

Originally designed as an annual

paper-and-pencil, intervieweradministered questionnaire that collected

basic information on home health and

hospice care agencies (1), NHHCS was

first conducted in 1992 and repeated in

1993, 1994, 1996, 1998, and 2000. Data

collected during these early years

included agency certification status,

patient health status and sources of

payment for care, and characteristics of

the staff employed by the agencies.

After 2000, NHHCS was taken out of

the field to be redesigned. When the

survey was reintroduced into the field in

2007, it was administered by a private

contractor; in previous years, the survey

had been administered by the U.S.

Census Bureau. This report describes the

redesign of NHHCS and the methods

used to collect information on home

health and hospice care agencies in the

21st century.

Background

Several factors contributed to the

NHHCS redesign. Increasingly, persons

aged 65 and over—who are expected to

account for nearly 20% of the U.S.

population by the year 2030 (3)—are

choosing to remain in their communities

as they age (4). Many of these elderly

persons live with complex medical

needs and disability resulting from

chronic illness (5) and can benefit from

the assistance of home health care

agencies. Postacute patients discharged

from hospitals following surgery or

other acute episodes receive care from

home health care agencies as well. In

1999, the U.S. 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 also ruled that the Americans with

Disabilities Act may require states to

provide community-based services rather

than institutional placements for

individuals with disabilities. These

decisions encouraged the provision of

community-based care (when desired

Page 1
Page 2 [ Series 1, No. 53

and possible) for persons of all ages

living with disabilities (6).

More Americans are also becoming

aware of and open to hospice care,

leading more people to choose hospice

care in the final stages of life.

According to the Centers for Medicare

& Medicaid Services (CMS), the

number of Medicare hospice patients

more than doubled between 1998 and

2008; the average length of stay for

hospice patients increased by 48%

during that time (7). As the number of

patients served by home health and

hospice care agencies increases, the

long-term care industry is working to

enhance its services and technologies—

such as special end-of-life programs,

pain management alternatives, and

electronic information systems to track

patient care—to provide high-quality

care.

In previous years, NHHCS collected

a limited amount of data on patients

(e.g., demographics, medical conditions,

and functional ability) and agency

characteristics. In 2000, CMS required

that Medicare-certified home health care

agencies submit health data on their

patients, thereby creating another public

source of home health care data. Other

data collection efforts such as the 1996

Medical Expenditure Panel Survey–

Nursing Home Component, the National

Long-term Care Survey (1982–2004),

the ongoing Medicare Current

Beneficiary Survey, and the annual

National Hospice and Palliative Care

Organization’s National Data Set Survey

obtain related information. NHHCS was

redesigned to complement these data

sources and to provide more data on

patient services, treatments, and

outcomes, as well as on agency

characteristics, to allow the exploration

of relationships between patient and

provider characteristics and patient

outcomes. The resulting 2007 NHHCS

collected valuable data on changes and

developments in this important sector of

the nation’s long-term care system.

Redesign Process

NHHCS was redesigned in response

to new developments in the home health

and hospice care sectors, including

changes in reimbursement systems and

performance monitoring. The survey

was expanded to better meet the data

needs of researchers and health care

planners who are working to ensure that

high-quality long-term care will be

available for younger persons with

disabilities and for the nation’s growing

senior population. The original survey

items were developed in the early 1990s

to address the growth in what was then

a relatively new sector of the health care

system: home health and hospice care.

Between 1990 and 1996, Medicare had

a more than fourfold increase in home

health care expenditures, largely due to

an increase in the number of visits per

home health care patient; spending

increased from $4 billion to $17 billion

(8).

Following that period, the use of

home health care declined dramatically

through 2000, which resulted in many

agencies closing. This occurred in part

because of the Medicare interim

payment system that, starting in October

1997, lowered the payment limits per

home health care visit and imposed a

per-beneficiary average cost limit on

home health care agencies. Another

reason for the dramatic decline was the

Medicare prospective payment system,

which went into effect in 1999 and

further drove reductions in home health

care utilization. The addition of quality

indicators derived from the Outcome

and Assessment Information Set

(OASIS) and public reporting of quality

measures by CMS, which aggregates

home health care patient information

and reports it at the agency level, also

contributed to changes in the delivery of

home health care.

Changes in payment for home

health and hospice care services in the

late 1990s, changes in the overall health

care system, and the major redesign of

the National Nursing Home Survey

(NNHS) in 2004 led to the redesign of

NHHCS. The survey was redesigned to

collect the following information:

+	 National baseline data on the

characteristics of home health and

hospice care agencies, their services,

and their patients, regardless of

whether they were participating in

publicly administered systems of

health insurance, such as Medicare

and Medicaid.

+	 Agency and patient data on

utilization, services offered, charges

for care, and quality of care,

including specific information on

end-of-life care.

+	 Information about priority

populations and disparities in care.

+	 Information about agency staffing

characteristics, such as staffing mix,

educational preparation, and

turnover rates.

In addition to changes in the

content of NHHCS, other aspects of the

survey (i.e., sampling design, the data

collection instrument, and field

procedures) were redesigned. The

overall redesign of NHHCS was

informed by the NNHS redesign, also

conducted by NCHS. The conceptual

model for the redesign process of both

NHHCS and NNHS was Donabedian’s

model of structure-process-outcomes:

structure influences process, which in

turn produces outcomes (9). For

example, structural elements of home

health care, such as key personnel,

advance practice registered nurses,

overtime policies, and staff turnover, are

thought to be factors associated with

various processes, such as immunization

practices and the use of palliative care.

These processes in turn may be studied

in relation to various outcomes among

patients, such as emergency room visits

and hospitalizations, pneumonia, falls,

pain management, and death (see

Figure 1).

Content Redesign

A number of key groups

participated in the content redesign

activities: NCHS experts in content,

statistical analysis, and survey methods;

NCHS’ Board of Scientific Counselors;

collaborating federal agencies;

academicians and long-term care

researchers; and industry representatives.

Two separate technical advisory groups

were convened—one for home health

care and the other for hospice

care—thus allowing each group to

examine the distinct attributes of the

two similar, but different, long-term care
 

 

 

 

 

 

Series 1, No. 53 [ Page 3

Structure 

• Key personnel 

• Advance practice RNs 

• Overtime policies 

• Staff turnover 

Process 

• Immunization practices 

• Pain management 

• Use of palliative care 

Outcomes 

• Emergency room visits 

• Hospitalizations 

• Pneumonia 

• Pain 

• Falls 

• Deaths 

Figure 1. Application of Donabedian’s model of assessing quality of medical care to home health and hospice care

settings and to shape the survey

redesign appropriately.

The initial NHHCS redesign work

began in February 2001, when the

Hospice Care Survey Technical

Advisory Group met to discuss possible

modifications to NHHCS and to the

methods for gathering useful data about

hospice patients. The group was charged

with reviewing research and policy data

needs for information about hospice

patients and providers and developing

recommendations for potential data

items, sampling frames, and survey

design changes. The group identified a

number of important issues that the

redesigned survey should address (see

Appendix I). The following

recommendations were incorporated into

NHHCS:

+	 Understand how people are cared

for and supported at the end of life

and how resources are being used.

+	 Obtain empirical data on the volume

of hospice care provided in this

country and the outcomes of that

care.

+	 Examine unplanned transfers from

hospice to nursing home care and

hospital.

+	 Examine the quality of hospice care

in nursing homes.

+	 Monitor changes in access to, and

the quality and cost of, hospice care,

with a focus on staffing.

+	 Gain a better understanding of the

types of providers involved in

hospice and end-of-life care.

+	 Estimate the number of patients and

family members receiving hospice

services.

+	 Elucidate the treatments provided,

standards of practice and

performance, medical management,

role of medical directors, and needs

of hospice providers.

+	 Determine how well hospices

implement advance directives.

Some of the subsequent NHHCS

redesign activities overlapped with the

redesign of NNHS. In January 2002, as

the content for the 2004 NNHS was

being finalized, an expert meeting of

select Department of Health and Human

Services stakeholders (i.e., the Agency

for Healthcare Research and Quality, the

Assistant Secretary for Planning and

Evaluation, CMS, and NCHS) was

convened. One outcome of this meeting

was a ‘‘wish list’’ for the NCHS surveys

of long-term care providers. Some

survey items that were included in the

redesigned NNHS were also considered

for inclusion in the redesigned NHHCS.

This wish list is given in Appendix II,

where items or related items in the 2007

NHHCS are noted with an asterisk. Not

all of the wish list items were

incorporated into the survey because of

the infeasibility, time constraints, or cost

of collecting the recommended item.

The Home Health Care Survey

Technical Advisory Group met in

January 2002. This meeting followed a

format similar to the Hospice Care

Survey Technical Advisory Group

working meeting, in which previous

versions of NHHCS were reviewed and

research and policy questions for the

redesigned survey were suggested and

discussed. Suggested topics included the

following:

+	 Limitations in access to care as

measured by waiting lists for

admission to programs or programs

not accepting new admissions.

+	 Involvement of informal caregivers

while patients receive home health

care services.

+	 Impact of all reimbursement sources

on types of care received.

+	 Home health care staffing

information, such as number of

employees, temporary employees

and contract staff, hours worked,

wages, availability of fringe

benefits, recruitment, and retention

measures.

+	 Variation in staffing practices and

impact on patients.

+	 Factors correlated with

rehospitalization.

+	 Level of computerized records in the

industry: Are medical records

computerized? Are management data

computerized? Do agencies have

any data from customer satisfaction

surveys they conducted?

+	 Trends in special needs of

nonelderly home health care

patients, such as use of special

equipment and devices and home

modification.

The Home Health Care Survey

Technical Advisory Group also

prioritized home health care data items

for the 2007 survey; these items are

listed in Appendix III.

In addition to expert opinion

provided by the technical advisory

groups, NCHS conducted an

environmental scan of other relevant

data collection efforts, both within the
Page 4 [ Series 1, No. 53

federal system and through profit and

not-for-profit agencies within the

long-term care industry. This was done

to determine what data gaps existed and

the ways that NHHCS could provide

data to fill these gaps. To the extent

possible, items were used from existing

survey instruments, including those that

were not necessarily created for a

nationally representative sample. The

findings from the technical advisory

groups and the environmental scan

culminated in a new questionnaire that

attempted to address the key

recommendations of the various

stakeholders. Although the technical

advisory groups felt strongly that each

component of NHHCS—home health

care and hospice care—merited separate

surveys, a combined survey was

maintained and fielded for the following

reasons: (a) a significant overlap in

information relevant to both agency

types and their patients; (b) the large

number of agencies that provided both

home health and hospice care services,

which would have experienced an

additional burden if asked to participate

in two separate surveys; and (c) the

substantial cost and personnel necessary

to conduct separate surveys.

In April 2005, the draft

questionnaire containing the proposed

list of agency- and patient-level items

was distributed to major stakeholders

who participated in the technical

advisory groups and other working

groups, as well as to the members of the

NCHS Long-term Care Listserv

community, many of whom had used

NHHCS data in the past. These

individuals were asked to evaluate and

rate each survey item based on its

importance (i.e., extremely important,

moderately important, or unimportant)

and to provide NCHS with comments

on the wording of the items. All of the

comments were compiled, summarized,

and reviewed by NCHS staff, who

weighed the importance of the content

and the participants’ comments versus

the feasibility of collecting the data.

Some items were eventually eliminated

from the survey based on experience

gained in the redesigned NNHS. For

example, some survey items (e.g., the

reason that medication was prescribed

and the adverse events experienced by

the patient) underperformed in the field

and in the pilot test and pretest of the

redesigned NHHCS, preventing NCHS

from collecting the intended

information. Although these items were

highly relevant and important, obtaining

valid and reliable responses for these

items was found not to be feasible when

they were piloted and pretested, hence

these items were eliminated from the

national survey. Four examples of such

items are listed here:

+	 Number of full- and part-time

clinical nurse specialists and nurse

practitioners working in the agency.

For the national survey, the item

was changed to a ‘‘yes’’ or ‘‘no’’

response to indicate the presence or

absence of these nursing staff.

+	 Whether the patient’s primary

caregiver outside of the agency was

paid for providing care to the

patient.

+	 Independent activities of daily

living.

+	 Frequency of the patient

experiencing pain.

Finalizing the content redesign of

NHHCS required many iterations and

consultation with industry experts. The

outcome of this effort led to the

development of the survey content that

was used in the pilot test, the pretest,

and eventually in the national survey.

Additional details on the pilot test and

pretest are discussed later in this report.

Sampling Redesign

The sampling redesign was another

critical element of the overall NHHCS

redesign and included consultation with

NCHS’ Office of Research and

Methodology. This section provides the

context for the sampling design used in

the 2007 NHHCS, which was different

from the 2000 NHHCS sampling design.

The 2000 NHHCS sampled six current

patients and six discharges from three

types of agencies (home health care

only, hospice care only, and mixed); no

attempt was made to distinguish patient

type (i.e., home health versus hospice

care and patients versus discharges) in

mixed agencies. For the 2000 NHHCS,

current patients were defined as those

patients who were on the rolls of the

home health or hospice care agency as

of midnight on the day immediately

before the date of the agency interview.

Also for the 2000 NHHCS, discharges

were defined as those patients who were

discharged from care by the home

health or hospice care agency during a

designated month within the 12-month

period from October 1, 1999, through

September 30, 2000; included were

discharges that occurred because of the

death of the patient.

In contrast to the sampling design

for the 2000 NHHCS, the 2007 NHHCS

sampled only current home health care

patients and only hospice care

discharges. The 2007 NHHCS sampling

design was developed, after much

deliberation, to address three key

sampling-related challenges and to do so

within available resources:

1.	 If discharges were to be sampled in

the 2007 NHHCS, NCHS needed to

create a closer link between agency

characteristics and practices at the

time of interview and experiences

and outcomes of patients who had

been discharged than occurred in the

2000 NHHCS. In the 2000 NHHCS,

each agency was randomly assigned

one month of the year from which to

sample all patients discharged from

that agency. For example, an

interview with a home health agency

in September 2000 collected

information about that agency’s

characteristics on the day of the

interview in that month. That agency

could have been randomly assigned

to collect information on home

health care patients discharged in

October 1999. As a result, the

agency data collected at the time of

interview (in the example,

September 2000) were not always

relevant to the experience of the

discharges (in the example, October

1999) who may have received care

as far back as 6–12 months prior to

the day of agency interview. This

time gap made it difficult to

establish the relationship between

agency characteristics and patient

experiences and outcomes. This was

a particular concern because levels

of administrative and nursing staffs

in these agencies can fluctuate
Series 1, No. 53 [ Page 5

dramatically over the course of 6–12

months.

2.	 The survey needed greater numbers

of cases to generate reliable

estimates for subgroup comparisons

of persons receiving home health or

hospice care. This challenge applied

to both current and discharged

patients. Several options were

explored to achieve this primary

goal of obtaining better estimates of

subgroups that were

underrepresented in previous

NHHCS years. Examples of desired

subgroup analyses include

comparing cancer and cardiovascular

disease rates between black persons

and white persons and comparing

rates of cancer and diabetes between

younger and older patients.

3.	 Because an increasing number of

agencies provide both home health

care and hospice care, it was

important to clearly identify patient

type (home health or hospice) in

these mixed agencies.

The first challenge (relevant only

for discharges) was to strengthen the

ability to link agency characteristics and

practices at the time of interview closer

in time to the experiences and outcomes

of patients who had been discharged.

This had to be done in a way that

enabled NHHCS to continue to provide

unbiased national estimates of the

annual number of discharges. To address

this challenge, we used the 2000

NHHCS data to explore the level of

monthly variation and seasonality in

admission diagnoses, as well as the

number of discharges among home

health care discharges and among

hospice care discharges. Because

diagnoses for home health care

discharges were found to vary across

months, obtaining a sample of these

discharges for the 3 months around the

time of the survey would produce a

biased annual estimate. These findings

influenced our decision not to sample

home health care discharges in the 2007

NHHCS.

In contrast to home health care

discharges, diagnoses for hospice care

discharges did not vary much across

months according to the 2000 NHHCS

data; hence, an unbiased annual national

estimate of the number of hospice care

discharges could still be made if the

survey sampled hospice care discharges

from agencies over only the 3-month

period before the agency interview.

Also, this approach made it possible to

explore relationships between outcomes

of hospice care discharges closer to the

time of the agency interview (compared

with the 2000 NHHCS) and agency

characteristics and practices at the time

of agency interview. Further, hospice

patients have a relatively short stay—an

average length of service of 47 days and

a median length of service of 16 days

for hospice care discharges in 2000

(10)—compared with home health care

patients and nursing home residents.

Hence, the 3-month sampling window

would enable information to be

collected on the entire episode of

hospice care for many of the hospice

care discharges. Another consideration

in deciding whether to sample

discharges or current patients among

agencies providing hospice services was

the fact that there are no national data

on hospice care patients comparable to

Medicare’s OASIS data on home health

care patients.

OASIS is a standardized assessment

instrument used as part of a

comprehensive assessment of all patients

receiving skilled care that is

reimbursable by Medicare or Medicaid.

OASIS data, which include

demographic, clinical, and functional

information, are used to monitor the

quality of patient care and to adjust

reimbursement for patient case mix.

Home health care agencies must submit

these data to the states, which then

transmit the data to CMS. Unlike with

current home health care patients,

agencies that provide hospice care

services are not required to complete

OASIS on hospice care patients; thus

there are no comprehensive assessment

data to link with current hospice care

patients to create an entire episode of

care. These factors influenced the

decision to sample hospice care

discharges only and not current hospice

care patients in the 2007 NHHCS.

The third challenge in the sampling

redesign involved distinguishing patient

type in mixed agencies, which had been

problematic in previous NHHCS

surveys. However, during the redesign

process and the pilot test of the

computer-assisted personal interviewing

(CAPI) instrument for the 2007 survey,

agencies were, in fact, able to

distinguish patient type and could

provide separate lists of home health

care patients and hospice care patients.

This enabled the number of each patient

type sampled to be monitored and

controlled and enabled the sampling of

equal numbers of home health care

patients and hospice care discharges. If

a mixed agency did not have sufficient

numbers of one patient/discharge type, a

larger sample of the other patient/

discharge type could be selected to

reach the per-agency target. This helped

NCHS to obtain the projected sample

sizes of current home health care

patients and hospice care discharges

necessary for subgroup comparisons.

Distinguishing patient type in mixed

agencies was also important in deciding

how many home health care patients

and hospice care discharges to sample in

mixed agencies. This decision needed to

be based on which was more important:

making patient-level estimates by

agency type (i.e., home health care only,

hospice care only, and mixed) or making

agency-level estimates by agency type.

The 2000 NHHCS data showed that the

sample of current home health care

patients and hospice care discharges was

not sufficient to make comparisons

among agency types. Moreover, trend

data from previous survey years

indicated that the distribution of agency

types had changed over time, with the

percentage of mixed agencies increasing.

Although it was initially believed that

making comparisons by agency type

was a reasonable objective, preliminary

estimates indicated that the sample size

of mixed-typed agencies would need to

be doubled, which would make the cost

of the survey prohibitive. This would

also reduce the number of single-type

agencies sampled, even though more

patients actually receive care from such

agencies, and would compromise our

ability to make estimates of patient/

discharge subgroups within single-type

agencies. NCHS consulted with major

trade associations (the National

Association for Home Care and

Hospice, the National Hospice and
Page 6 [ Series 1, No. 53

Palliative Care Organization, and the

American Board of Palliative and

Hospice Medicine) and with the NCHS

Board of Scientific Counselors. The

consensus among these groups was that

making comparisons by agency type

was interesting but not a high priority

for the industry; therefore, NCHS made

this a secondary goal for the redesigned

survey.

Data Collection Instrument

Redesign

A key enhancement to the 2007

NHHCS was the CAPI system—a

departure from the paper-and-pencil

mode used in previous surveys. The

only part of the redesigned NHHCS that

used paper and pencil was the

self-administered staffing questionnaire

(SAQ) that was mailed to agency

directors in their confirmation packages.

This strategy was also used for the 2004

NNHS. Because information on many of

the staffing items needed to be retrieved

from several different sources, the SAQ

enabled administrators to gather this

information prior to the survey

interview, saving valuable administrative

time during the onsite interview.

CAPI provided many benefits over

the data collection approach used in

previous years. First, the survey content

could be expanded significantly,

something that would have been

burdensome to both the interviewer and

respondent if the survey were

administered by paper and pencil.

Second, CAPI made it easier to collect

data by patient type (e.g., questions on

end-of-life care for hospice care

discharges and use of assistive devices

for home health care patients) because

of the programmed skip patterns. Third,

sampling algorithms programmed into

CAPI made the sampling of patients and

home health aides much easier than if it

was conducted by hand. Fourth, CAPI

had the potential to enhance data

quality. The system included automatic

data checks when responses were

entered that were outside of

predetermined ranges (i.e., ‘‘soft edits,’’

which issue a warning that can be

ignored, and ‘‘hard edits,’’ which require

a response within the expected range

before continuing), so that interviewers

could verify out-of-range responses in

real time, instead of post-data collection

when the respondent was no longer

available. Fifth, data could be

transmitted electronically to the central

office upon completion of the interview.

Survey Supplement

The NHHCS redesign provided a

national agency sample for conducting

the first national probability sample

survey of home health aides employed

by home health and hospice care

agencies—the National Home Health

Aide Survey (NHHAS). This

supplement was sponsored by the

Assistant Secretary for Planning and

Evaluation of the U.S. Department of

Health and Human Services. The home

health aides sampled in the NHHCS

agencies were contacted to participate in

NHHAS, which used computer-assisted

telephone interviewing. More

information on this supplement can be

found in the NCHS report, ‘‘Design and

Operation of the National Home Health

Aide Survey: 2007–2008’’ (11).

Field Procedures Redesign

The final element of the survey

redesign involved redesign of the

procedures that guided how information

was collected before and during the

field period. The increased survey

content, modified sampling design,

NHHAS survey supplement, and CAPI

instrument made it necessary to modify

field procedures that had been

appropriate for the much smaller

paper-and-pencil-based surveys

conducted in previous years. The

modified procedures affected how

sampled agencies were verified and

recruited, how field staff were recruited,

and how data were collected and

submitted to the central office of the

data collection contractor for coding and

editing.

An important component of

redesigning the field procedures was the

field management system, which was

uploaded on the interviewers’ laptops to

track all recruitment efforts and monitor

the data collection activity on all

sampled agencies. Before national data

collection began, sampled agencies were

screened to update the information

obtained from the agency sampling

frame. This procedure allowed NCHS to

confirm the agency name and address

and to collect the current agency

director’s name and title, agency hours,

and days of operation before mailing out

the advance packets. All changes to the

agency contact information were entered

into the field management system.

Another feature within the field

management system was the chain

tracking function. Because of the

increasing number of home health and

hospice care chains in the industry, a

strategy was developed to identify

agencies belonging to chains. This

included a management system for

linking and tracking chain membership

and contacts with corporate offices,

training interviewers on handling chains

when corporate approval was required,

and providing an electronic form for

interviewers to record chain contact

information provided by the sampled

agency.

Another detail about the redesigned

field procedures is that many of the new

survey items had an ‘‘other, specify’’

response option that interviewers could

use to record responses that did not fit

the standard response categories. These

responses were evaluated by NCHS

staff, who determined whether the

responses could fit into existing

response categories or warranted

creating a new response category if

there were enough cases.

After completion of each interview,

the interviewers transmitted their agency

interview files from their laptops to the

contractor’s central office. When the

central office had received all the case

materials, the field management system

indicated that the case was completed

and officially closed.

Also important to the field

procedures were the field interviewers

themselves, who recruited the agencies

and collected the data. Because of the

new CAPI system, the NHHCS

interviewers needed to have good

computer skills.

Prior to national implementation of

the 2007 NHHCS and its redesigned

elements, the survey and procedures

were pilot tested, cognitively tested, and
Series 1, No. 53 [ Page 7

pretested. Below is an overview of these

activities.

Pilot test

The NHHCS pilot test, which

collected agency- and person-level data

on the participating agencies, had

multiple purposes:

+	 To gain practical experience in

getting home health and hospice

care agencies to participate in

NHHCS.

+	 To gain experience with, and

identify any problems with, the

CAPI modules and procedures in

collecting data across multiple

respondents within an agency.

+	 To test obtaining and cleaning the

patient/discharge lists and the home

health aide lists.

+	 To test the procedures for collecting

contact information on the home

health aides from their employers

and to assess the quality of this

information.

The NHHCS pilot test was

administered in nine home health and

hospice care agencies in May and June

2006. These agencies were located in

six states.

Cognitive testing

A number of the agency-level and

patient/discharge items in the pilot test

required substantial revision; a few

others were deleted. Revisions were

cognitively tested with a small sample

of agency directors, by telephone.

Additional instrument revisions were

made as a result of the cognitive testing,

including deleting a few more questions,

making wording changes to others,

adding or combining response options,

and providing clearer definitions in the

CAPI help screens.

Pretest

The original goal of the pretest was

to serve as a trial run for the national

survey. Because the pilot test and the

resulting cognitive testing resulted in

many changes to the instrument, the

pretest goals were modified to focus on

the revised and new questions and

procedures and to evaluate interviewers’

ability to complete data collection for

each agency within a day’s time

according to the survey protocol. The

NHHCS pretest was administered in 25

agencies across three states in

November and December 2006.

The major outcome of the pretest

was that NCHS reduced the number of

sampled current home health care

patients and hospice care discharges

from 12 to 10 per agency. This would

allow interviewers to complete each

agency interview within a day.

Additional survey questions were

modified. A half day was added to the

interviewer training to cover agency

cooperation issues, chain issues, refusal

aversion and conversion strategies, and

appointment-setting and scheduling.

Lastly, practice sampling lists from

agencies with large patient populations

were incorporated into the interviewer

training to teach interviewers techniques

for resolving issues related to cleaning

patient lists, numbering patient lists, and

other sampling problems.

National Survey

Methods

Sampling Design and

Selection

Agency eligibility criteria

The 2007 NHHCS sampled three

types of agencies: home health care

only, hospice care only, and mixed

agencies that provided both home health

and hospice care services. Sampled

agencies were eligible to participate in

NHHCS if they met the following

criteria:

+	 They provided home health care

services, hospice care services, or

both types of services.

+	 They provided more services than

only homemaker or housekeeping

services or than only durable

medical equipment and supplies.

+	 In the case of agencies providing

home health care only, they had one

or more current patients at the time

of the agency interview.

+	 In the case of agencies providing

hospice care only, they had one or

more current patients or had one or

more discharges during the 3-month

period prior to the month of

interview.

+	 In the case of agencies providing

both home health and hospice care,

they had one or more current home

health or hospice care patients or

had one or more hospice care

discharges during the 3-month

period prior to the month of

interview.

Agencies that provided only homemaker

or housekeeping services, assistance

with instrumental activities of daily

living (IADLs), or durable medical

equipment and supplies were excluded

from the survey.

Sampling frame

NHHCS used a sampling frame of

U.S. home health and hospice care

agencies created from three sources: the

National Hospice and Palliative Care

Organization, Verispan, L.L.C., and the

CMS Provider of Services file. Agencies

affiliated with hospitals, government

entities, retirement centers, or similar

institutions where the agencies

maintained financial and patient records

independent of the larger institution

were included in the frame. The

combined files were matched, and

identified duplicates were removed,

resulting in a sampling frame of 15,488

agencies.

Sampling design

Sampling for NHHCS used a

stratified two-stage probability design.

The first stage was the selection of

agencies, where the primary strata of

agencies were defined by agency type

(i.e., home health care only, hospice

care only, and mixed) and metropolitan

statistical area (MSA) status. MSA

status could be ‘‘metropolitan’’ (a

county or group of contiguous counties

that contain at least one urbanized area

of 50,000 or more population; an MSA

may contain other counties that are

economically and socially integrated

with the central county, as measured by

commuting), ‘‘micropolitan’’ (a
Page 8 [ Series 1, No. 53

nonmetropolitan county or group of

contiguous nonmetropolitan counties

that contains an urban cluster of

10,000–49,999 persons; surrounding

counties with strong economic ties,

measured by commuting patterns, may

also be included), or ‘‘other,’’ according

to information available on the sampling

frame. For more information, visit:

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

inforeg_statpolicy/.

Within primary strata, facilities

were sorted by the following

characteristics: census region (Northeast,

Midwest, South, or West), ownership

(proprietary, nonprofit, government, or

unknown), certification status (Medicare,

Medicaid, or both), state, county, and

ZIP Code. Agencies were then selected

by using systematic sampling with

probability proportional to agency size,

using the number of employees to

estimate size. This stage consisted of a

two-phase sampling selection that

yielded the final sample of 1,545

agencies that was fielded for the 2007

NHHCS.

The second stage was the selection

of current patients for home health

care-only agencies, discharges for

hospice care-only agencies, and current

home health care patients and hospice

care discharges for mixed agencies. This

stage was carried out by the

interviewers during the agency

interview, with the aid of an algorithm

programmed into CAPI. The interviewer

first collected the census list(s), usually

from the agency director or designee.

The census list of current home health

care patients was the total number of

patients on the agency rolls as of

midnight on the day before the agency

interview. The census list of hospice

care discharges was the total number of

hospice care patients discharged during

a 3-month period starting 4 months

before the agency interview. For

example, if the agency interview was

conducted in October 2007, then the

census of hospice care discharges would

include all discharges (e.g., deaths or

patients terminating hospice services)

for June, July, and August 2007. A

hospice care patient could appear more

than once on a list if the patient had

been discharged, readmitted, and

discharged again during the 3-month

sample period. After collecting these

lists, the interviewer reviewed them to

ensure there were no duplicates and that

no current home health care patients had

been discharged since the census was

printed. The interviewer entered the total

number of patients/discharges into the

CAPI system, which randomly and

systematically selected 10 numbers from

the list of patients/discharges.

The target for patient sampling was

10 patients/discharges from every

agency. A sample of 10 current home

health care patients or hospice care

discharges was selected per agency that

had 10 or more current patients/

discharges. If a sampled home health

care-only agency or a sample hospice

care-only agency had fewer than 10

patients or discharges, respectively, then

all of the agency’s patients/discharges

were selected for the sample. In mixed

agencies, the sample of 10 was split

evenly to include 5 patients and 5

discharges. In mixed agencies with

fewer than 5 of one type (i.e., either

current home health care patient or

hospice care discharge), the full sample

of 10 was augmented with the other

type.

Home health aides employed by the

participating agencies were also sampled

during the agency interviews, using a

process similar to the sampling of

current home health care patients and

hospice care discharges. Further

information on the NHHAS is available

from: http://www.cdc.gov/nchs/

nhhas.htm.

Interviewer Training

The 2007 NHHCS was launched in

August 2007, immediately following the

5-day interviewer training. Eighty-six

interviewers successfully completed the

training and received their assignments.

Seven additional interviewers were hired

and trained for the survey in September

2007, using identical training methods.

Both training sessions consisted of a

home study that the interviewers

completed prior to in-person training.

The in-person training consisted of

interactive lectures and exercises,

scripted role plays, and self-administered

exercises. The major topics covered in

the training were as follows:

+	 Overview of the agency

questionnaire.

+	 Agency cooperation issues.

+	 Current home health care patient

and hospice care discharge

sampling.

+	 Overview of the patient health

questionnaire.

+	 Coding of medical conditions,

procedures, and medications.

+	 Sources of payment and home

health and hospice care financing.

+	 NHHAS sampling.

+	 SAQ.

+	 Overview of the field management

system that tracked the status of

each case (i.e., agency).

+	 Data quality control.

+	 Sampling errors.

+	 Finalizing cases.

+	 Ethics, data security, and

confidentiality.

The field interviewer staff was

divided into six regions, each managed

by a field supervisor.

Agency Recruitment

The agency recruitment process for

NHHCS followed a logical progression

from agency verification to agency

interview. In June 2007, specially

trained staff verified the name and

address of each sampled agency, its

hours of operation, and the name of its

director, using the Advance Mail

Screener script (Appendix IV). After the

screener calls were completed and the

eligibility of the sampled agencies was

confirmed, an advance package (see

Appendix V) was sent to each agency

director. The package included materials

that explained the survey and

encouraged participation: an NHHCS

folder, NHHCS brochure, advance letter

from the NCHS director, Ethics Review

Board (ERB) approval letter, ERB

waiver of authorization, letters of

support, an NCHS publication using

2000 NHHCS data, and an NCHS

confidentiality brochure. The package

also included a DVD with a video about

NHHAS (viewable at: http://

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

A similar package was created for

use when two or more sampled agencies

were part of the same chain. Experience
Series 1, No. 53 [ Page 9

with chain affiliations during the 2004

NNHS guided NCHS’ approach for

tracking chains and their affiliate

agencies in NHHCS. This corporate

advance package (see Appendix VI)

contained a corporate advance letter, an

ERB approval letter and ERB waiver of

authorization, letters of support, and an

NHHCS video on DVD (viewable at:

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

Additionally, the package enabled

interviewers to let agency directors

know that their parent organizations had

been notified about NHHCS.

The mailings of agency and

corporate advance packages were timed

to occur a short time before the national

interviewer training in late July. The

trained field interviewers followed up on

the agency advance packages, generally

within 1 week of the mailing, using the

Set an Appointment script (Appendix

VII). During the appointment-setting

calls, the interviewers confirmed receipt

of the advance package, verified agency

eligibility, addressed any questions or

concerns expressed by the director, and

attempted to schedule an agency

interview. An appointment confirmation

package (see Appendix VIII) was

shipped overnight to the director of each

appointed agency approximately 2

weeks before the interview. The

confirmation package included an

appointment confirmation letter and a

list of key items for data collection, as

well as the SAQ. The list of key items

detailed the types of information (e.g.,

Medicare agency provider number and

number of admissions and discharges

for 2006) that would be collected during

the agency interview and the type of

staff needed to assist with data

collection.

A week before the scheduled

interview, the interviewer placed an

appointment confirmation call to the

agency director or the director’s

designee, using the Appointment

Confirmation script (Appendix IX).

During this call, the interviewer

reviewed the items in the appointment

confirmation package that had been sent

to the director a few days earlier. The

interviewer also discussed how to

effectively prepare for the agency

interview, verified the agency’s address,

and answered any of the director’s

remaining questions.

Two business days before the

scheduled appointment, the interviewer

placed a reminder call to the agency

director, using the Reminder Call script

(Appendix X). If the director was not

available, the interviewer was instructed

to leave a message for the director as

the final contact before the interview.

Information for Survey

Participants

In addition to the advance packages

that were mailed to the agency directors

(and corporate offices, when necessary),

NCHS provided online information for

survey participants that included an

overview of NHHCS and its importance

in providing data about the home health

and hospice care industry. The Web

page also had a list of frequently asked

questions:

+	 What is the National Home and

Hospice Care Survey?

+	 Why should my agency participate?

+	 How are home health and hospice

care agencies selected?

+	 Is information given confidential?

+	 Does the HIPAA Privacy Rule allow

my agency to participate in this

survey?

+	 What is involved in participating?

+	 Whom can I contact if I have

additional questions?

A link to the NHHCS DVD was also

made available for survey participants.

Refusal Conversion

Achieving a high response rate was

an important goal of the NHHCS data

collection. NCHS’ experience with

refusals in the 2004 NNHS was a key

factor in developing and implementing a

comprehensive NHHCS refusal

conversion protocol early in the data

collection period. The strategy was

designed to provide interviewers with

tools, including a distance learning

program, to help them gain cooperation

from agency directors who were initially

reluctant or refused to participate in

NHHCS. The strategy had six basic

elements:

+	 Identifying reluctant agency

directors early in the data collection

period.

+	 Training a core of refusal

converters, within 3 weeks of

national training, who were

successful in gaining cooperation

quickly.

+	 Mailing a customized letter to

reluctant directors within 1–14 days

of initial contact with a field

interviewer.

+	 Visiting reluctant agency directors in

person within 15–30 days after the

agency was identified as an initial

refusal.

+	 Coordinating refusal conversion

activities with the corporate offices

of chain-affiliated agencies requiring

corporate approval.

+	 Monitoring the progress of the

NHHCS refusal conversion strategy.

A total of 32 interviewers were

trained in refusal conversion. The

converters completed a home study that

included reading materials and two

DVDs on gaining cooperation from

chains, instructions on how to use the

chain tracking system, related exercises,

and five sets of case materials

documenting various cooperation

problems. The post-workshop

component consisted of four conversion

role plays conducted in pairs, by

telephone.

Survey Instrument and

Data Collection

CAPI System

One of the most significant changes

to NHHCS was the shift from

paper-and-pencil administration to

computer administration. The NHHCS

CAPI system was similar in form and

function to that used in the 2004 NNHS.

The CAPI system was loaded onto each

interviewer’s laptop, enabling the

interviewer to enter data into the laptop

during the agency interview. The CAPI

instrument comprised five modules, as

illustrated in the flow chart in Figure 2:

an agency qualifications module, two
 

 

 

 

 

 

Agency qualifications (AQ) 

• Verify eligibility 

• Agency type 

• Licensure 

• Medicare ID numbers 

• Ownership 

• Current patients 

• Admissions/discharges for previous year 

• Services and charges by payer 

• Patient referral sources 

• Policies 

Patient health (PH) 

• Patient demographics 

• Advance directives 

• Diagnoses 

• Use of devices 

• 	Emergency care

 received 

• Medications taken 

• Other services received 

Charges and payments (PA) 

Aides information 

(collect in any order with

PS, PH, and PA) 

PS, PH, and PA information (collect in any order with AS) 

Self-administered staffing 

questionnaire (SAQ) (collect if 

available and not collected earlier) 

Collect contact 

information for aides • Total charges billed 

• Sources of payment 

• Amount paid by primary

 payment source 

Patient sampling (PS) 

• Collect current home health care patient 

census, hospice care discharge census list(s) 

• Clean list(s) 

• Sample current home health care

 patients and/or hospice care discharges 

Aides sampling (AS) 

• Collect home health

 aide list 

• Clean list 

• Sample aides 

• Key personnel background 

• Staff profile 

• Employee benefits 

• Technology capabilities 

END 

Page 10 [ Series 1, No. 53

Figure 2. Flow chart of data collection during the National Home and Hospice Care Survey agency interview

patient sampling modules to select

current home health care patients and/or

hospice care discharges and home health

aides, and two person-level modules to

collect patient health information and

patient information on charges and

sources of payment for care.

Agency Qualifications and

Characteristics (AQ) module

Although the CAPI system was

flexible and allowed interviewers to

administer the survey based on the

availability of designated agency staff, the

AQ module had to be administered first in

order to enable the other survey modules

(see Figure 2.) After the AQ was

completed, the patient sampling (PS)

module was available in the CAPI system.

It was necessary for interviewers to

complete the PS module before collecting

health and charges or billing information

on the sampled patients. AQ survey items

are provided in Appendix XI.
Series 1, No. 53 [ Page 11

Patient Health (PH) module

The PH module collected the same

information on sampled current home

health care patients as on sampled

hospice discharges. Respondents for

current home health care patients were

asked if CMS’ OASIS had been

completed on the patient, and the most

recent assessment date. Beginning in

1999, the federal government required

that all Medicare-certified home health

care agencies collect and submit health

data on their patients to the (then)

Health Care Financing Administration,

as part of a quality improvement

initiative (12). For several patient health

questions, CAPI displayed the

corresponding OASIS number, making it

easier for the respondent to find the

information in the sampled patient’s

OASIS, if available. Although the PH

module asked similar questions about

the health status of hospice care

discharges, the collection of this

information is not required by CMS.

Respondents for current home health

care patients were also asked about

hospitalizations and life expectancy. For

hospice care discharges, the PH module

collected additional information on

status at discharge (i.e., deceased or

not), level of hospice care, symptoms at

last visit, formal care or treatments at

the last visit, and discharge reason and

destination. PH survey items for the

current home health care patients and

hospice care discharges are provided in

Appendix XII.

Charges and Payment (PA)

module

The PA module collected

information on charges and sources of

payment for the care received by the

sampled patients/discharges. For current

home health care patients, the reference

period was the most recent complete

billing period, or the time since

admission if the patient had not been

there for a complete billing period. For

hospice care discharges, the reference

period was from admission to the

sampled discharge date. PA survey items

for the current home health care patients

and hospice care discharges are

provided in Appendix XIII.

SAQ

The SAQ was included in the

appointment confirmation packages

mailed to agency directors

approximately 2 weeks before their

scheduled agency interviews. The

questionnaire collected information on

the education and experience of agency

management, turnover and tenure of

nursing staff, employee benefits,

information technology capabilities, and

patient care revenue sources. The

directors were asked to fill out the

paper-and-pencil SAQ by the day of the

in-person agency interview. This

approach allowed the director time to

obtain the necessary information prior to

the in-person interview and enabled the

interviewer to collect the completed

SAQ before leaving the agency. The

SAQ is provided in Appendix VIII.

Data Quality

Assurance

The quality assurance (QA)

measures for the redesigned NHHCS

were multifaceted and included coded

audio recordings, interviewer

observations, interviewer debriefing

calls, data collection monitoring,

conference calls between NCHS and the

contractor, and field memos. These

measures were implemented to ensure

that data were collected consistently and

reliably across the sampled agencies.

Audio Recording

The contractor developed a data QA

software tool to audiorecord a subset of

items through the interviewer’s laptop

during the in-person agency interview

without interrupting the interview

process. The QA tool recorded and

coded a subset of agency interviews

during the first 8 weeks of data

collection. These audio recordings made

it possible for the contractor to identify

interviewers who needed additional

coaching. Moreover, the recordings,

which were done on a screen-by-screen

basis, helped the contractor identify

which survey items proved problematic

for interviewers or respondents. A group

of core items were recorded in all

interviews, and a set of predetermined

items were recorded with varying

frequencies across the interviews. By the

end of the 8 weeks, the contractor had

collected recordings from 402

interviews. Interviewer performance

issues identified by the coded audio

recordings were shared with

interviewers through direct and verbatim

feedback to improve interviewer

performance. In addition, the coding

identified four survey questions that

were problematic and led to additional

instructions to field interviewers on how

to ask those questions during the

interview.

Observations

In addition to the audio recordings,

NCHS and the contractor observed some

of the early interviews. Observers noted

module timings, problematic questions,

and respondents’ reactions to the

instrument and procedures. When

necessary, observers also provided

technical assistance and advice during

the interview.

Debriefing Calls

Another data QA measure was the

debriefing calls, focused on gaining

cooperation and conducting the agency

visits, that were held during the first 3

weeks of data collection. These calls

were moderated by the field supervisor

in each region, with mandatory

participation by all field interviewers.

During the debriefings, the interviewers

shared their early successes and

challenges in scheduling agency

interviews, as well as their experiences

in completing their first agency

interviews. The agenda and discussion

guides used by the moderators are given

in Appendixes XIV and XV. Upon

completion of the debriefings, a list of

helpful points was compiled into a field

memo and distributed to all field

interviewers.

Data Collection Monitoring

Another QA measure was the

weekly production reports generated by

the contractor. These reports, which
Page 12 [ Series 1, No. 53

informed NCHS on various aspects of

the survey and its progress, included

detailed information on the following:

+	 The status of the sampled agencies

(i.e., contacted, appointed, or

refused) by agency type and chain

status, including weekly trends.

+	 The disposition of the survey

modules (not started, refused,

completed, or ran out of time).

+	 The number and eligibility of

sampled current home health care

patients and hospice care discharges.

+	 The number of started, appointed,

and completed cases by region.

+	 The number of SAQs received by

the contractor’s central office.

+	 A listing of scheduled agency

interviews by date and assigned

interviewer.

+	 A summary report of the time

required to administer each survey

module, for completed interviews.

+	 Response rates by agency type.

These production reports were

reviewed by NCHS staff and discussed

during the weekly conference calls with the

contractor. These calls allowed NCHS to

raise data collection issues based on

information found in the production reports.

The calls also allowed the contractor to

inform NCHS about survey developments

that required NCHS’ input. Solutions to

issues or concerns were discussed during

the conference calls and were summarized

in a field memo, which was then

distributed to the field staff.

Data Processing

Data processing during the data

collection period involved both manual

and automated systems. One manual

system involved SAQs, which were

collected by the interviewers on the day

of the agency interview. Before leaving

an agency with a SAQ, the interviewer

checked the questionnaire to ensure that

the skip instructions had been followed

appropriately and the questionnaire had

been completed.

An example of the automated systems

used during data collection was the

automatic check within CAPI for

out-of-range responses. Hard and soft edit

checks and skip patterns were programmed

into CAPI based on the expected range of

responses for given questions. Hard edit

checks guided the interviewers to correct

unlikely responses (i.e., require a response

within the expected range before

continuing, such as the one for the month

of a patient’s admission to an agency,

which was prompted if a response greater

than 12 was entered). Soft edit checks

prompted the interviewers to verify or

correct other unlikely, but possible,

responses (i.e., issue a warning that can be

ignored, such as the one for the number of

current home health care patients being

served by the sampled agency, which was

prompted if a response greater than 1,000

was entered) before moving on to the next

survey item.

Data processing following data

collection involved, among other things, the

coding of ‘‘other, specify’’ data. For

example, medication data that were entered

into the ‘‘other, specify’’ fields and did not

have an existing drug code were coded by

the contractor and NCHS. Medication

names that were entered as text strings into

the ‘‘other, specify’’ fields and that did not

have a code in the drug database were

assigned new drug codes. A similar process

was used to code the medication data

collected in the 2004 NNHS (for detailed

information on how new codes were

assigned, refer to the NCHS report

‘‘Collecting Medication Data in the 2004

National Nursing Home Survey,’’ available

at: http://www.cdc.gov/nchs/nnhs/

nnhs_products.htm). Also, medical

diagnoses and medical procedures not

previously coded were assigned an

appropriate code in the 2007 NHHCS.

In addition to medication data, many

other items in NHHCS allowed an ‘‘other,

Table A. Agency response rates

specify’’ response, where the interviewer

entered responses that did not fit neatly into

one of the preexisting categories. Where

appropriate, ‘‘other, specify’’ responses

were back-coded and new categories were

created. ‘‘Other, specify’’ responses that

revealed the identity or geographic location

of agencies were edited to prevent

unintended disclosure.

Disclosure Risk

Review

NHHCS data files intended for

public-use release underwent extensive

disclosure risk review to prevent the

identity of any agencies, patients, or

persons who participated in the survey

from being made known to the public. For

unusual characteristics and continuous

variables, NCHS checked for clustering of

responses within facilities. Furthermore,

NCHS checked to see if these clustered

attributes varied by geography and were

represented in the universe file. When there

was disclosure risk, NCHS perturbed the

data and then ensured that the perturbation

did not affect the estimates.

Response Rates and

Module Timings

Of the 1,545 sampled agencies

selected for NHHCS, 84 were ineligible

because they did not meet the survey

criteria, were out of business, were

duplicates, or had merged with another

entity (Table A). Interviews were completed

Response category Number Percent

Total sampled agencies............................. 1,545 100

Total agencies out of scope .......................... 84 5

Ineligible .................................... 43 3

Out of business ................................ 15 1

Duplicate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1

Merged . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1

Total agencies in scope............................. 1,461 100

Total refusal.................................... 425 29

Final agency refusal ............................. 235 16

Final corporate refusal ............................ 190 13

Total complete . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,036 71

NOTE: Percentages may not add up to 100 due to rounding.

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.
Series 1, No. 53 [ Page 13

Table B. Number and percent distribution of in-scope sampled home health and hospice care agencies, by agency response status and

selected characteristics: National Home and Hospice Care Survey, 2007

Responding

Responding Nonresponding agency percent

Total sample agency agency distribution

percent

distribution

percent

distribution

percent

distribution

Response

rate2

(weighted by

the inverse

(weighted by (weighted by (weighted by (weighted by of the

Number of the inverse the inverse the inverse the inverse probability of

sampled in- of the of the of the of the Unweighted selection and

Agency characteristics

scope

agencies1

probability

of selection)

probability

of selection)

probability

of selection)

probability

of selection)

response

rate

adjusted for

nonresponse)3

All agencies .............

Agency type4

Home health care only .......

Hospice care only ..........

Mixed .................

Ownership4,5,6

For-profit ...............

Voluntary nonprofit .........

Government/other ..........

Unknown ...............

Census region4

Northeast ...............

Midwest ................

South .................

West ..................

MSA status4,7

Metropolitan .............

Micropolitan. . . . . . . . . . . . . .

Other. . . . . . . . . . . . . . . . . .

Affiliation5

Chain .................

Independent .............

Medicare certification status4,8

Certified ................

Not certified. . . . . . . . . . . . . .

Unknown ...............

Medicaid certification status4,5,8

Certified ................

Not certified. . . . . . . . . . . . . .

Unknown ...............

1,461

577

471

413

334

670

288

169

230

368

638

225

610

455

396

287

1,174

396

942

123

357

981

123

100

78

14

8

46

30

13

11

13

21

53

13

74

14

13

28

73

45

35

20

35

46

20

100

74

16

9

42

34

13

11

11

21

51

17

67

17

16

28

72

50

36

15

36

49

15

100

44

32

28

51

24

13

12

16

21

56

7

84

9

8

27

73

39

35

26

32

42

26

59

56

68

72

54

67

58

58

50

59

56

77

53

74

75

60

58

64

59

44

62

63

44

71

64

78

73

58

80

68

67

65

76

68

77

62

76

79

73

64

70

73

54

68

74

54

100

75

15

10

65

28

7

0

13

21

52

14

73

14

12

30

70

84

16

0

82

18

1

1

In-scope agencies are agencies that provided home health or hospice care services to patients at the time of the survey or recently before the survey.

2

Numerator is the number of sampled in-scope agencies that participated in NHHCS; denominator is all sampled in-scope agencies.

3

Final estimates include adjustment for the inverse of the probability of selection, adjustment for nonresponse, ratio adjustment to the sampling frame based on region and Medicare status, and

calibration to correct for over- or undersampling in the sampling frame.

4

Chi-square test of association is significant (p > 0.0001) between responding versus nonresponding distribution and indicated agency characteristic.

5

Not used for nonresponse adjustment.

6

Percent distribution comparable to ownership data from the Home Health Compare files from the Centers for Medicare & Medicaid Services, available at: http://www.medicare.gov/Download/

downloaddb.asp.

7

Metropolitan statistical areas (MSAs) and micropolitan statistical areas are geographic entities defined by the U.S. Office of Management and Budget for use by federal statistical agencies in

collecting, tabulating, and publishing federal statistics. An MSA contains a core urban area of 50,000 or more population; a micropolitan statistical area contains an urban core of at least 10,000 (but

less than 50,000) population.

8

Percent distribution comparable to 2000 NHHCS.

NOTES: NHHCS is National Home and Hospice Care Survey. Percentages may not add up to 100 due to rounding.

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.

with 1,036 of the 1,461 in-scope agencies,

for a first-stage agency unweighted

response rate of 71% and a weighted (for

differential probabilities of selection)

response rate of 59% (Table B). The

second-stage patient/discharge unweighted

response rate was 95% and the weighted

response rate was 96% (not shown).

The average time per completed

case was 30 hours. This includes the

time the interviewer spent recruiting the

agency to participate in the survey,

conducting the agency interview, and

submitting all data to the contractor’s

central office.
Page 14 [ Series 1, No. 53

Issues Affecting Response

Rates

Refusal to participate was largely

due to the perceived burden of data

collection among the agency directors

and corporate officers. Many directors

explained that the demands of patient

care precluded them from devoting a

full day of staffing resources to the

agency interview. Another important

reason was chain cooperation issues.

Although time and resources were

devoted before and during data

collection to identifying chain-affiliated

agencies and to mailing corporate

advance packages, many agency

directors still resisted participating in the

survey. These refusals among

corporate-affiliated agencies were

followed by refusal conversion activities

that were similar to those for the

stand-alone agencies. By the end of data

collection, 95 chains had refused to

participate in NHHCS, which

represented 220 agencies that had been

identified as chain affiliated. The data

collection end date was extended from

January 6, 2008, to February 29, 2008,

to enable completion of 181 more

interviews, which included 96 converted

cases.

Nonresponse Bias Analysis

The response rate for the 2007

NHHCS, weighted by the inverse of the

probability of selection, was 59%.

Table B presents the percent distribution

of selected agency characteristics among

responding and nonresponding agencies.

Responding and nonresponding agencies

were not significantly different by chain

affiliation but were significantly

different by the following agency

characteristics: agency type (home

health care only, hospice care only,

mixed), ownership type (for-profit,

voluntary nonprofit (i.e., operated under

voluntary or nonprofit auspices,

including church-related organizations),

government/other, or unknown), census

region, MSA status (metropolitan,

micropolitan, other), Medicare

certification status (certified, not

certified, unknown), and Medicaid

certification status (certified, not

certified, unknown). Metropolitan and

micropolitan statistical areas are

geographic entities defined by the Office

of Management and Budget for use by

federal statistical agencies in collecting,

tabulating, and publishing federal

statistics.

Table B also presents the

unweighted response rates and the

response rates weighted by the inverse

of the probability of selection among

agencies with different characteristics.

Higher cooperation was gained among

agencies with voluntary nonprofit

ownership, located in the West and

Midwest, in nonmetropolitan areas, with

known certification status (i.e., known to

be certified by Medicare and Medicaid

or not certified, versus unknown),

affiliated with a chain, and which

provided only hospice care services or

both home health care and hospice care

services. The effect of this differential

response is minimized by using a

nonresponse adjustment factor that takes

into account census region, MSA status,

Medicare certification status, and agency

type. These variables were selected for

nonresponse adjustment because they

were deemed most important for

analysis and for providing estimates. To

evaluate the effect of nonresponse

adjustments on selected survey

estimates, the last column of Table B

shows estimates weighted by the inverse

of the probability of selection and

adjusted for nonresponse. Except for

Medicare certification status, all other

estimates among responding agencies

that were adjusted for nonresponse (i.e.,

census region, MSA status, and agency

type) came closer to the distribution in

the sample, which in turn represents the

distribution in the frame or universe of

agencies. The higher proportion of

agencies that are Medicare-certified

among responding agencies relative to

their proportion in the sample is likely

to have resulted from a combination of

misclassifications in the frame that were

corrected at the time of interview,

changes in certification status between

the time of frame construction and

interview, and the low response rate of

noncertified agencies that limited the

ability to effectively adjust for

nonresponse. Among variables that were

not used to adjust for nonresponse,

estimates for ownership and Medicaid

certification status were also affected by

‘‘unknown’’ status at the time of

interview, changes between the time of

frame construction and interview, and

misclassifications in the frame that were

corrected at the time of interview. The

percent distribution of ownership status

was comparable to the ownership data

from CMS, and the percent distribution

categories for Medicare and Medicaid

certification status was comparable to

the 2000 NHHCS.

Estimation Procedures

Because the statistics from NHHCS

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 NHHCS

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,

or any other nonsampling error. The

chances are about 95 in 100 that an

estimate from the sample differs by less

than twice the standard error from the

value that would be obtained from a

complete census.

Standard errors can be calculated

for agency, patient/discharge, and

medication estimates by using any

statistical software package, as long as

clustering within agencies and other

aspects of the complex sampling design

are taken into account. Software

products such as SAS (13), Stata (14),

and SPSS (15) have these capabilities.

Statistics presented in NCHS

publications are computed using

SUDAAN software (16), which

produces standard error estimates for

statistics from complex sample surveys.

SUDAAN employs a first-order Taylor

series approximation of the deviation of

estimates from their expected values. All
Series 1, No. 53 [ Page 15

three of the NHHCS public-use files

(agency, patient/discharge, and

medication) include design variables that

designate each record’s stratum marker

and the first-stage unit (or cluster) to

which the record belongs. The design

variables used to estimate characteristics

in the patient/discharge public-use file

are the same design variables that

should be used for the medication data,

which were collected at the patient/

discharge level. (The patient/discharge

public-use file contains data on both the

current home health care patients and

the hospice care discharges.)

In the agency public-use file, the

variable STRATUM indicates one of the

subpopulations used in the stratified

sampling, and the agency indicated by

the variable AGENCYID is the primary

sampling unit. POPAGY represents the

total number of agencies in a stratum

for the finite population correction.

There are two survey weights:

SAMAGYWT for estimates not

correlated with agency size and

SIZAGYWT for estimates correlated

with agency size (e.g., estimates of total

staff across all agencies). The data

dictionary for the agency public-use file

has a Technical Notes section that

provides an example of the syntax for

using these design variables to describe

the sampling design in SUDAAN. The

NHHCS data dictionary for the agency

public-use file is available on the

NHHCS website at: ftp://ftp.cdc.gov/

pub/Health_Statistics/NCHS/

Dataset_Documentation/NHHCS/2007.

The patient/discharge public-use file

has two stages. The stratum in the first

stage is indicated by the variable

PSTRATA, in which the primary

sampling unit is the agency indicated by

the variable PTAGYNUM. The variable

for the finite population correction in

the first stage is POPAGN. In the

second stage, the stratum is the variable

PHTYPE, and the secondary sampling

unit is the observation (i.e., patient or

discharge) indicated by the variable

PATNUM. There is no finite population

correction in the second stage with the

patient/discharge public-use file;

therefore, the second stage is treated as

sampling with replacement. In

SUDAAN, to treat the second stage as

sampling with replacement, the variable

POPPAT is used and has a value of –1.

In many other statistical packages,

failure to designate a variable for finite

population correction at the second stage

results in sampling with replacement.

The survey weight is SAMWT. The data

dictionary for the patient/discharge

public-use file has a Technical Notes

section that provides an example of the

syntax for using these design variables

to describe the sampling design in

SUDAAN. The NHHCS data dictionary

for the patient/discharge public-use file

is available on the NHHCS website at:

ftp://ftp.cdc.gov/pub/Health_Statistics/

NCHS/Dataset_Documentation/NHHCS/

2007.

The current home health care

patient sample describes individuals

receiving home health care on the night

before data collection began and

represents home health care utilization

on any given day between August 2007

and February 2008. The hospice care

discharge sample describes the annual

number of discharges from hospice care.

This sampling design requires the data

user to always conduct separate analyses

of current home health care patients and

hospice care discharges, using the

PHTYPE variable. For current home

health care patients, PHTYPE = 1, and

for annual hospice care discharges,

PHTYPE = 2. To properly account for

the sampling design in the calculation of

standard errors, both current home

health care patients and hospice care

discharges must be used in all analyses.

All analyses should be conducted using

the subpopulation command in the

statistical software package.

Because NHHCS is a sample survey

and is designed to produce national

estimates for agencies and current home

health care patients and hospice care

discharges, data analyses must include

survey weights, to inflate the sample

numbers to national estimates. Each

record in the public-use files has a

weight for this purpose. By aggregating

the weights, national counts can be

estimated.

NHHCS estimators take into

account the selection procedures of the

complete survey design to develop the

final survey weight for each sampled

agency and each sampled patient/

discharge. An estimator Xˆ for any given

population total X can be expressed as a

weighted sum over all sampled units,

defined as

Xˆ = ∑u x(u)W(u)

where u represents a sampled unit, x(u)

is the characteristic or response of

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

survey weight for sampled unit u. The

final weight W(u) for each sampled unit

is the product of up to three

components:

1.	 Inverse of the probability of

selection.

2.	 Nonresponse adjustment.

3.	 Ratio adjustment.

The first component of the weight

for each sampled unit (agency, home

health care patient, or hospice care

discharge) is the inverse of the unit’s

selection probability. For the current

home health care patient or hospice care

discharge, the selection probability is the

product of two selection probabilities:

the probability of selecting the agency

to the NHHCS sample and the

probability of selecting the current home

health care patient or hospice care

discharge within the sampled NHHCS

agency. The inverse of the product of

these probabilities is used for weighting.

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 to be 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 (i.e., 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. This adjustment is made

for three types of nonresponse. The first

two types are agency level, and the third

is person level (patient/discharge). The

first type occurs when in-scope agencies

do not respond to NHHCS. In NHHCS,

the second type occurs when an
Page 16 [ Series 1, No. 53

in-scope agency does not provide the

number of current home health care

patients or hospice care discharges

within the respective agency. The third

type occurs when the administrative and

medical records of the sampled current

home health care patients or hospice

care discharges are not made available

to complete the survey.

The third component applies only to

weights used to estimate numbers of

agencies. This component involves ratio

adjustments that are made within groups

defined by census region and agency

type to account for use of probability

proportional to size when selecting the

agency sample. The numerator of the

ratio was the number of agencies in the

sampling frame within each group, and

the denominator was the estimated

number of agencies for that same group.

No ratio adjustment was made to other

weights (i.e., agency weights for

agency-level estimates for parameters

other than numbers of agencies and

weights for patients/discharges). Finally,

the weights described above were

smoothed within groups defined by

census region and agency type if there

were outlier sampling 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

Estimates published by NCHS must

meet reliability criteria based on the

relative standard error (RSE or

coefficient of variation) of the estimate

and on the number of sampled records

on which the estimate is based. The

RSE is a measure of variability and is

calculated by dividing the standard error

of an estimate by the estimate itself. The

result is then converted to a percentage

by multiplying by 100. Guidelines used

by NCHS authors to determine whether

estimates should be presented in tables

of NCHS published data reports include

the following:

+	 If the estimate is based on fewer

than 30 sampled cases, the value

of the estimate is not reported.

This is usually indicated with an

asterisk (*).

+	 If the estimate is based on 60 or

more sampled cases and the RSE is

less than 30%, the estimate is

reported and is considered reliable.

+	 All other reported estimates should

not be assumed to be reliable. These

include estimates with an RSE of

30% or more and estimates based on

30–59 cases, regardless of RSE.

Confidentiality

Participation in NCHS surveys is

strictly voluntary, and information collected

on agencies and individuals is confidential.

The Health Insurance Portability and

Accountability Act allows health

establishments to disclose protected health

information without patient authorization

for public health purposes and for research

that has been approved by an institutional

review board with a waiver of patient

authorization. NCHS enforces strict

procedures to prevent the disclosure of

confidential data in survey operations and

data dissemination. In accordance with

NCHS’ confidentiality mandate (Section

308(d) of the Public Health Service Act (42

U.S.C. 242m)), no information collected in

NHHCS 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 consent to do so has been obtained

in writing from the sampled individual or

establishment. The NHHCS protocol was

approved by the NCHS Research Ethics

Review Board. The information provided

by the agencies sampled in NHHCS is

used for statistical research and reporting

purposes only.

Data Dissemination

The 2007 NHHCS data are

available in public-use files on the

NHHCS website at: ftp://ftp.cdc.gov/

pub/Health_Statistics/NCHS/Datasets/

NHHCS/2007. Three NHHCS files have

been released: agency, patient/discharge,

and medication. Technical notes that

include a summary of the survey, data

dictionaries, and input statements are

also available on the website. Questions

about these data may be directed to the

NCHS Office of Information Services,

Information Dissemination Staff, at

1–800–232–4363 or

NCHSquery@cdc.gov, or to the

Long-term Care Statistics Branch at

301–458–4747.

References

1.	 Haupt BJ. Development of the National

Home and Hospice Care Survey.

National Center for Health Statistics.

Vital Health Stat 1(33). 1994. Available

from: http://www.cdc.gov/nchs/data/

series/sr_01/sr01_033acc.pdf.

2.	 National Center for Health Statistics.

Current legislative authorities of the

National Center for Health Statistics:

Enacted as of November 1999.

Hyattsville, MD. 2000. Available from:

http://www.cdc.gov/nchs/data/misc/

legis99.pdf.

3.	 Hobbs FB. Population profile of the

United States [online]. U.S. Census

Bureau. Available from: http://

www.census.gov/population/www/popprofile/elderpop.html.

4.	 Aging in Place Initiative: Developing

livable communities for all ages: Facts

[online]. Partners for Livable

Communities. Available from:

http://www.aginginplaceinitiative.org/

index.php?option=com_content&task

=view&id=16&Itemid=45. [Accessed

October 2008.]

5.	 Trends in the elderly population

[online]. Aging in the Know. AGS

Foundation for Health in Aging.

Available from: http://www.healthin

aging.org/agingintheknow/chapters_

print_ch_trial.asp?ch=2. [Accessed

October 2008.]

6.	 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, DC: Office of Disability,

Aging, and Long-Term Care Policy

(DALTCP). May 14, 2003. Available

from: http://aspe.hhs.gov/daltcp/reports/

ltcwork.htm.
Series 1, No. 53

[ Page 17

7.	 Centers for Medicare& Medicaid

Services. Medicare hospice data trends:

1998–2008. Available as

Medicare_Hospice_Data_Top_20_2008.

pdf from http://www.cms.gov/Hospice/,

under Downloads, ‘‘Hospice Data

1998–2008.’’

8.	 Liu K, Long SK, Dowling K. Medicare

interim payment system’s impact on

Medicare home health utilization.

Health Care Financ Rev 25(1): 81–97.

2003.

9.	 Donabedian A. Evaluating the quality

of medical care. Milbank Mem FundQ

44(3 Suppl):166–206. 1966.

10.	 Haupt BJ. Characteristics of hospice

care discharges and their length of

services: United States, 2000. National

Center for Health Statistics. Vital

Health Stat 13(154). 2003. Available

from: http://www.cdc.gov/nchs/data/

series/sr_13/sr13_154.pdf.

11.	 Bercovitz A, Moss AJ, Sengupta M,

Harris-Kojetin LD, 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. Available

from: http://www.cdc.gov/nchs/data/

series/sr_01/sr01_049.pdf.

12.	 U.S. Department of Health and Human

Services. Medicare and Medicaid

programs: Reporting Outcome and

Assessment Information Set (OASIS)

data as part of the conditions of

participation for home health agencies.

Fed Regist 64(15):3748–63. 1999.

13.	 SAS/STAT, release 9.1.3 [computer

software]. Cary, NC: SAS Institute.

2003.

14.	 Stata, release9 [computer software].

College Station, TX: StataCorp. 2005.

15.	 SPSS for Windows, release 15.0

[computer software]. Chicago, IL:

SPSS. 2006.

16.	 SUDAAN, release 10.1 [computer

software]. Research Triangle Park, NC:

Research Triangle Institute. 2008.
Page 18 [ Series 1, No. 53

Appendix I. Recommendations From the Hospice Care Survey Technical

Advisory Group Working Meeting

February 8, 2001, Bethesda, MD

Attendees

Irma E. Arispe, Ph.D., National Center for Health Statistics

Amy Bernstein, Sc.D., National Center for Health Statistics

Stephen R. Connor, Ph.D., National Hospice and Palliative Care Organization

Linda Demlo, Ph.D., National Center for Health Statistics

Marilyn J. Field, Ph.D., Institute of Medicine

Barbara Haupt, D.V.M., National Center for Health Statistics

Esther Hing, National Center for Health Statistics

Keith Hoffman, National Center for Health Statistics

Thomas Hoyer, Health Care Financing Administration

Timothy J. Keay, M.D., M.A.-TH., University of Maryland School of Medicine

Judith Lund Person, Carolinas Center for Hospice and End-of-Life Care

Dale Lupu, Ph.D., American Board of Hospice and Palliative Care

Jennifer Madans, Ph.D., National Center for Health Statistics

Thomas McLemore, National Center for Health Statistics

R. Sean Morrison, M.D., Mount Sinai School of Medicine

Janet Neigh, National Association for Home Care-Hospice Association of America

Robin E. Remsburg, Ph.D., National Center for Health Statistics

Julia H. Rowland, Ph.D., National Cancer Institute

William D. Spector, Ph.D., Agency for Healthcare Research and Quality

Genevieve Strahan, National Center for Health Statistics

Joan M. Teno, M.D., Brown University

Jonathan VanGeest, Ph.D., American Medical Association

Discussion leader

Amy Bernstein, Sc.D., National Center for Health Statistics

Recommendations

Rationale and most important research/policy questions related to hospice care

+	 Learn as much as possible about hospice and palliative care providers across all settings, how they provide services, and

service payment, because tax dollars pay for Medicare and Medicaid services.

+	 Begin to examine the needs of patients and families/caregivers served by existing programs, as well as gaps in services.

+	 Understand where and how people are cared for and supported at the end of life, and how resources are being used.

+	 Obtain empirical data on the volume of hospice care provided in this country and the outcomes of hospice care (e.g., good

death experience).

+	 Understand how vulnerable populations are being cared for in this era of cost control (e.g., the degree of difficulty in getting

care and what needs are unmet).

+	 Examine unplanned transfers from hospice to the nursing home care and the hospital.

+	 Examine the quality of hospice care in nursing homes.

+	 Better understand end-of-life care in all settings and for all persons with a terminal illness, e.g., in children and the elderly, in

persons with cancer and Alzheimer’s disease (i.e., where and by whom the care is provided).

+	 Monitor changes in access to and quality and cost of hospice care, with a focus on staffing (staff versus volunteers, contracting

arrangements, fringe benefits, training).

+	 Better understand the types of providers involved in hospice/end-of-life care.

+	 Determine who is choosing hospice care, why they delay entry into hospice care, why physicians do or do not refer patients to

hospice care, and the paths through which patients enter hospice care.

+	 Estimate the numbers of patients and family members receiving hospice services.

+	 Clarify the definition of hospice care and distinguish hospice from other kinds of treatment.

+	 Elucidate the treatments provided, standards of practice/performance, medical management, role of medical directors, and

needs of hospice providers.
Series 1, No. 53 [ Page 19

+	 Benchmark quality-of-care indicators.

+	 Examine longitudinal trends in the provision of hospice care, patterns of utilization among physicians, and the geographic

penetration of hospice care.

+	 Look at how the NHHCS can be integrated with other surveys.

+	 Identify the costs of care, especially drug costs.

+	 Determine how well hospices implement advance directives, e.g., what are they and how are they followed.

Hospice variables that should/can be collected

Facility-level variables

Provider organization:

+	 Existence of formal contracts with other providers (e.g., nursing homes, assisted living facilities).

+	 Affiliations with nursing homes, hospitals, or other providers.

+	 Whether the organization is part of a non-profit/for-profit/proprietary organization.

+	 Whether the organization is part of a provider chain or managed care system.

+	 Inpatient arrangements (number of hospice beds in different settings).

+	 Percentage of hospice beds.

+	 Inpatient occupancy rate.

+	 Availability of special services (e.g., for AIDS patients).

+	 Service delivery area by ZIP code or county (could be linked to number of patients who died).

Staffing:

+	 Disciplines available in the setting: whether a particular service is on call, provided in house, or contracted.

+	 Number of full-time equivalents (FTEs) per patient served.

+	 Number of visits by discipline and FTE.

+	 Use of volunteers and number of hours they provide.

+	 Gender and ethnicity of care providers.

+	 Preparation/special training of providers.

+	 Staff turnover and stability rate.

+	 Level of staff support.

+	 Cultural competence (language, sensitivity to death traditions).

Services/quality of care:

+	 Admission criteria, including exclusion criteria (e.g., does not accept children, patients without insurance, patients desiring

chemotherapy or radiation).

+	 Admission and death data by county (to match with county death certificates).

+	 Case mix.

+	 Average length of stay.

+	 Days of care by level of care and payer source.

+	 Number of patients served by discipline.

+	 Medicare certification.

+	 Accreditation.

+	 Number of citations in surveys (to examine the issue of fraud in chart documentation).

+	 Patient satisfaction.

+	 Number of bereavement encounters per family (limit to visits or telephone calls).

+	 Types and extent of services provided to family members pre-death and post-death.

+	 Diagnoses in relation to National Hospice Organization (NHO) guidelines.

+	 Presence of a drug formulary and composition of the formulary (classifying drugs would be easier than costing out of drugs,

but still would be difficult).

+	 Number of nursing home patients on service at any given time or per year.

+	 Number or percent of revocations and non-death discharges.

+	 Location of deaths.

+	 Movement of patients into inpatient facilities.

+	 Percent of admissions to inpatient beds (e.g., during the last 48 hours of life).

+	 Whether continuous care is actually provided to patients (e.g., days of care by level of care).
Page 20 [ Series 1, No. 53

Costs/expenditures:

+	 How operating funds are expended (cost report by category).

+	 Cost of drugs in relation to services or cost of prescriptions per day (drug data could be compared with that of other providers,

as captured in other surveys).

+	 Barriers to medication access because of cost.

+	 Source of the provider organization’s income, including the extent to which operations and capital expenditures are supported

by charitable contributions.

+	 Fiscal viability scale to identify institutions at risk in a geographic area.

Patient-level variables

Service delivery/continuity of care:

+	 Services delivered (as documented in the patient record) versus services offered.

+	 Which disciplines delivered the services (as documented in the patient record).

+	 Number of different types of health care providers serving the patient.

+	 Continuity of care of various types of health care provider (e.g., number of different RNs seeing patient in the home).

+	 Discharges to skilled nursing facility.

+	 Number of hours of care provided by the primary caregiver and nature of the care.

+	 Location of care.

+	 Amount of time spent in patient visits/contacts.

+	 Number of ‘‘unplanned’’ hospital admissions.

+	 Number of emergent pain calls to staff.

+	 Number of rescue or emergency department (ambulance/EMS) calls made by patient or family.

+	 Number of unanticipated initiations of CPR.

Patient and family/caregiver support and comfort:

+	 Assessment of patient pain, depression, and agitation.

+	 Whether or not a pain scale is used (and other process measures).

+	 Level of pain at specified time points (e.g., admission, 24 or 48 hours after admission, just before death).

+	 Place of death and whether it was the patient’s preferred place of death.

+	 Presence of patient preference documentation in the medical record.

+	 Personal trade-offs required for the patient to enter hospice care.

+	 Patient satisfaction with care.

+	 Level of training in self-care.

+	 Performance scale score (need to use a consistent scale).

+	 Medications administered.

+	 Assessment of family/primary caregiver function.

+	 Amount/type of backup provided to primary caregiver.

Demographics:

+	 Age.

+	 Gender.

+	 Marital status.

+	 Race/ethnicity.

+	 Education.

+	 Street address for patient at home, including ZIP Code.

+	 Diagnosis.

+	 Venue of care prior to admission.

+	 Social support status (e.g., living at home, number of children 18 and younger living at home).
Series 1, No. 53 [ Page 21

Appendix II. Content Wish List for the Redesigned National Nursing

Home Survey

*Items or related items found on current survey

PATIENT-LEVEL ITEMS:

+	 Sociodemographics

o Age*

o Race*

o Ethnicity*

o Gender*

o Education

o Income (how much detail?)

o Marital status*

o Other?

+	 Health and functional status

o Activities of daily living (ADLs)/instrumental activities of daily living (IADLs) at admission

o ADLs/IADLs current resident*

o ADLs/IADLs at discharge for discharge resident*

o ADLs/IADLs at some other point?

o Cognitive status (how many points in time?)

o Conditions* (International Classification of Diseases (ICD) and/or checklists) (how many points in time?)

o Depression scale?

o Pain scale?

o Quality-related indicators (pressure sores, pain management, urinary catheters,* falls, hospitalizations, tube feedings,

restraints, psychotropic drugs, etc.)

o Other?

o Social Support/Family Involvement

o Palliative Care/End-of-life Care/ Hospice care

+	 Services/care received

o Therapies*

o Drugs

o Devices*

o Tests

o Immunizations/preventive services*

o Quality-of-life-related activities (involvement in nursing home activities, e.g., crafts, church, etc.)

o Other?

+	 Costs/payment

o Source of payment*

o Out of pocket

o Spend-down history

o Other?

+	 Reason for admission to the facility, why admitted to the nursing home versus another facility, whether they could be cared for

in other less-intensive settings, other options available in the geographic area

FACILITY-LEVEL ITEMS:

+	 Units (type*, beds*, criteria for admission or exclusion?)

+	 Services offered*

+	 Staffingo Full-time*

o Part-time*

o Vacancies
Page 22 [ Series 1, No. 53

o Agency use

o Absenteeism

o Turnover/retention (bedside staff, director of nursing (DON), administrator, medical doctor (MD))

o Expertise/Training

– Training of medical director
 

c American Medical Directors Association (AMDA)
 

c Gerontologist
 

– Training of Nursing Staff
 

c Certified Nurses
 

c Clinical Nurse Specialist
 

o Involvement in educational programs (nursing assistants (NAs), nurses, other)

+	 Specialty programs*

o Dementia

o Ventilator weaning

– Rehab?

– Spinal cord injuries

– HIV/AIDS

– Mental retardation (MR)

+	 Payment streams

+	 History (years in business)

+	 Ownership*

+	 Contracts/carve-outs

+	 Integration with other providers and services (part of a life-care community? A chain?* A health care system? A managed care

system?)

+	 Formulary/practice-based research network (PBRN)

+	 Guidelines/protocols required (Do they profile providers? How? Do they require use of specific pain scales?) Best Practices,

e.g., implementation of protocols/programs that have been demonstrated to improve outcomes (toileting programs, skin care

programs, screening/treatment of depression, etc.)

+	 Volunteer Programs*

– Types-augmentation/enhancement of services, or replacement of services

+	 Staff Questions (if there is a special staffing supplement)

o Satisfaction

o Length of service in facility

o Length of stay (LOS) in LTC

o Length of service in general

o Hours worked

o Education

o Training

o Continuing education

o Work-related injuries

o Safety (perceptions)

o Other?

+	 Family/Caregiver/Next-of-Kin Questions (if there is a supplement)

o Informed consent

o Satisfaction with facility (care)

o Burden:

– Emotional

– Financial

o Health status of patient prior to institutionalization

o Health services used by patient immediately prior to institutionalization

o Services (if any) received by family (e.g., financial counseling, spiritual counseling)

o Services family provides for patient not included in institutional costs (e.g., laundry)
Series 1, No. 53 [ Page 23

SAMPLING/DESIGN ISSUES:

+	 Whom to sample? Discharges? Residents? If we sample residents, how much retrospective info should we collect?

+	 Can we get all of the care a person receives over a time period, including hospitalizations, admissions and discharges, etc.?

How?

+	 What should the time frame be?

+	 What is the reference date?

+	 Can we survey at multiple points in time?

+	 Can we do a family/caregiver supplement?

+	 Can we do a staffing supplement?

+	 Can we do special unit supplements?

+	 How can we incorporate state information? Could we make estimates for some states?
Page 24 [ Series 1, No. 53

Appendix III. Recommendations From the Home Health Care Survey

Technical Advisory Group Working Meeting

January 28, 2002

Attendees

Irma Arispe, Ph.D., National Center for Health Statistics

Hakan Aykan, Assistant Secretary for Planning and Evaluation

Amy Bernstein, Sc.D., National Center for Health Statistics

Linda K. Demlo, Ph.D., National Center for Health Statistics

Janice Edwards, Centers for Medicare and Medicaid Services (CMS)

Trena Ezzati-Rice, National Center for Health Statistics

Vicki Freedman, Ph.D., Polisher Research Institute at Philadelphia Geriatric Center

Wil Gehne, Centers for Medicare and Medicaid Services

Henry Goldberg, Abt Associates, Inc.

Barabara Haupt, D.V.M., National Center for Health Statistics

Esther Hing, National Center for Health Statistics

Julia Holmes, Ph.D., National Center for Health Statistics

Ed Hunter, National Center for Health Statistics

Carrie Jones, National Center for Health Statistics

Enid Kassner, AARP Public Policy Institute

Harriet Komisar, Ph.D., Georgetown University

Bruce Leff, M.D., Johns Hopkins School of Medicine

James Lubitz, National Center for Health Statistics

Thomas McLemore, National Center for Health Statistics

Christopher Murtaugh, Ph.D., Visiting Nurse Service of New York

D.E.B. Potter, Agency for Healthcare Research and Quality

Robin Remsburg, Ph.D., National Center for Health Statistics

Patricia A. Rusca, Visiting Nurse Association of Central New Jersey

Linda Scott, Johns Hopkins Home Care Group

Al Sirrocco, National Center for Health Statistics

William D. Spector, Ph.D., Agency for Healthcare Research and Quality

Mary St. Pierre, National Association for Home Care

Genevieve Strahan, National Center for Health Statistics

Virginia Tritschler, Visiting Nurse Association of Boston

Bob Wardwell, Visiting Nurse Association of America

Mary Weakland, Centers for Medicare and Medicaid Services

Discussion Leader

Amy Bernstein, Sc.D., National Center for Health Statistics

Recommendations

Rationale and most important research/policy questions related to home health care

+	 Effects of the Medicare Home Health Agency Prospective Payment System (PPS) on home health providers and their patients.

+	 Post-PPS changes in patterns of services offered by home health agencies and received by patients.

+	 Changes in services received for specific patient populations of varying disability levels and how the cost of these services

changed/ as well as the payment sources used to pay for care.

+	 Favorable and unfavorable outcomes of care (quality of care).

+	 Information on volume of services provided by agencies, including number of visits patients received per episode of care,

number of readmissions during a year.

+	 Trends on number of providers, patients served, size measures.

+	 Characteristics of non-certified home health agencies.

+	 Limitations in access to care as measured by existence of wait lists for admission to program, or not accepting new

admissions.

+	 Safety and appropriateness of care received by patients.
Series 1, No. 53 [ Page 25

+	 Existence of informal caregivers while patient receives home health services.

+	 Post-PPS true cost of services versus amount reimbursed by various reimbursement sources.

+	 Impact of all reimbursement sources on type of care received.

+	 Levels of care provided by home health agencies and comparability of these services with other long-term care settings.

+	 Comparable information on agencies and patients across all payers.

+	 Home health staffing information such as: number of employees, temporary employees and contract staff, hours worked,

wages, availability of fringe benefits, recruitment and retention measures.

+	 Impact of staff shortage (where it exists) on patient care provided.

+	 Expand the survey to cover ‘‘home care’’ providers in addition to home health providers.

+	 Linked claims data from Medicare files for sampled patients.

+	 Variation in staffing practices and impact on patients, particularly minority and other subpopulations.

+	 Services that differentiate ‘‘home care’’ versus ‘‘home health’’ patients.

+	 Factors correlated with re-hospitalization.

+	 How use of Medicaid and Medicare for payment affects type of care/services received.

+	 Level of computerized records in the industry: Are medical records computerized? Are management data computerized? Do

agencies have any data from customer satisfaction survey that they conducted?

+	 Efficiency measures introduced by agencies to lower operating cost, such as telemedicine.

+	 Linkage data that would permit matching provider (market) context variables such as percentage elderly in local area, to the

data set.

+	 Trends in special needs of non-elderly home health patients, such as use of special equipment and home modification.

Priority home health data items for the NHHCS

Patient data items:

+	 Readmissions to home health agency within a given time period.

+	 Emergent care while in a home health program.

+	 Outcome and Assessment Information Set (OASIS) outcome measures for Medicare and non-Medicare patients, including its

4-point severity scale.

+	 Severity/illness measures including: weight loss or anorexia, inability to walk, hand grip strength.

+	 Prognosis.

+	 Homebound status as recorded on OASIS and using other definitions (I can’t get out of my house/ I won’t get out of my

house).

+	 Length of episode of care, including time care paid for all payers.

+	 Development of new problems during the episode of care.

+	 Self-care independence.

+	 ADLs, IADLs, cognitive impairments (all on OASIS).

+	 Presence of caregiver at home.

+	 Information on changes in use of assistive devices during episode of care (also on OASIS).

+	 English as a second language; patient’s preferred language; How does staff communicate with patient? Are teaching materials

in patient’s language?

+	 Patient’s payment sources, including whether has long-term care insurance.

+	 Patient income/poverty status.

+	 Diagnosis specific (e.g., cardiac) services provided.

Facility data items:

+	 Home health staffing information such as: number of employees or FTE staff, temporary employees and contract staff, hours

worked, wages, availability of fringe benefits, recruitment and retention measures, FTE staff by staff type.

+	 Staffing satisfaction.

+	 Is agency hospital based or free-standing?

+	 Provider ID or linkage variables needed for linkage to other files such as the Area Resource File.

+	 Number of visits made by staff type (registered nurse (RN), licensed practical nurse (LPN), physical therapist, etc.) during the

year.

+	 Types of services provided, including new innovations, such as telemedicine.

+	 Accreditation information.

+	 Are services provided under a physician’s plan of care? Are your physicians proactive or passive?

+	 Is agency making a profit (revenues, expenses, cost)?

+	 Revenue payer mix at agency level (% Medicare revenues, % Medicaid revenues, % health maintenance organization (HMO),

etc.).

+	 Whether agency had certified ICD9 coders or coding software.
Page 26 [ Series 1, No. 53

+ Staff training.

+ Average cost per visit by staff type (skilled nursing, home health aide, etc.).

+ Services provided to assisted living facilities; # of contracts with assisted living facilities and other organizations.

+ Number of staff with laptop computers, existence of computerized records system.

+ Measures of outcome at the facility level; resources used to meet needs.

+ Did agency refuse, cut-off admissions and why?

+ Any patients transferred to another home health agency?

+ Any agency outsourcing?

+ Any website marketing?

Research priorities
 

Participants were asked to prioritize areas that the next NHHCS should cover. The following areas were identified:
 

+ Cost/expenditures/charges/payment sources/revenues.

+ OASIS-type outcome measures.

+ Caregiver at home.

+ Staffing.

+ Readmissions and emergent care.

+ Facility structure.

+ Services, including telemedicine and palliative care.

+ Volume of services.

+ New technologies or new services added in past year.

+ Changes agencies made in response to PPS.

+ Expanding the survey to cover home care agencies.

Areas where developmental work is needed before NHHCS can be changed

+ Developing a home care agency sampling frame.

+ Identifying classification methods (for the sampling frame) that differentiate between home care and home health agencies.

+ How to improve matching rates when linking with the OASIS.

+ Developing methods for linkages with Medicare/Medicare claims data, Provider of Service file, other claims data sets.

+ Contractual relationships between home health branches/health systems/managed care organizations.

+ Homebound definition.
 

AFFIX AGENCY LABEL HERE 

Series 1, No. 53 □ Page 27 

Appendix IV. Advance Mail Screener Script 

SCREENER FINAL RESULT: ______________ 

National Home and Hospice Care Survey (NHHCS) 

Advance Mail Screener 

1.	 Hello, my name is ___________. I’m working on the National Home and Hospice Care Survey sponsored by 

the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics. I’m 

calling to confirm the mailing address and the name of the agency director. 

 

Is this [SAMPLED AGENCY NAME PREPRINTED ABOVE] at [ADDRESS PREPRINTED ABOVE]? 

YES ............................................................... 1 (GO TO Q11) 

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

2.	 [What is the name/address of this agency/place?] RECORD NAME AND/OR ADDRESS CHANGES. 

AGENCY NAME: __ 

ADDRESS: 

PHONE:	 _______________________________________________________________ 

3.	 INTERVIEWER: IS THIS AGENCY’S NAME DIFFERENT THAN THE SAMPLED AGENCY NAME 

PREPRINTED ABOVE (OTHER THAN MINOR MISSPELLING)? 

YES, AGENCY NAME CHANGED............................................. 1
 

YES, SOME OTHER AGENCY.................................................. 2 (GO TO Q5)
 

YES, NOT A HOME HEALTH/HOSPICE AGENCY ................... 3 (GO TO Q5)
 

NO.............................................................................................. 4
 

4.	 INTERVIEWER: IS THE ADDRESS DIFFERENT THAN THE SAMPLED AGENCY ADDRESS 

PREPRINTED ABOVE (OTHER THAN MINOR MISSPELLING, ZIP CODE, OR AREA CODE CHANGE)? 

YES ............................................................... 1 (GO TO Q9) 

NO & Q3=1 ‘AGENCY NAME CHANGED’ .... 2 (GO TO Q4a) 

NO & Q3=4 ‘NO’ ............................................ 3 (GO TO Q11) 
Series 1, No. 53 □ Page 28 

4a. Was this agency previously called [SAMPLED AGENCY NAME]? 

YES ............................................................... 1 (GO TO Q11) 

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

DON’T KNOW................................................ -8 (GO TO Q7)
 

5. Can I reach [SAMPLED AGENCY NAME] at some other telephone number or address? 

YES ............................................................... 1 (GO TO Q6)
 

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

DON’T KNOW................................................ -8 (GO CLOSING 1)
 

6. What is that address and phone number? 

ADDRESS: 

________________________________________________________ 

________________________________________________________ 

________________________________________________________ 

PHONE: _________________________________________________ 

DON’T KNOW ......................................................................................... -8
 

7. Is this (agency/place) associated with [SAMPLED AGENCY NAME]? 

YES ............................................................... 1 

NO ................................................................. 2 (GO TO CLOSING 1) 

R HAS NO INFORMATION ABOUT 

SAMPLED AGENCY ................................ 3 (GO TO CLOSING 1)
 

8. Can you tell me how they are associated? CIRCLE ASSOCIATION/RELATIONSHIP. 

HOSPITAL CONTACTED, SAMPLED AGENCY WITHIN THIS HOSPITAL 1 

CORPORATE/CENTRAL OFFICE CONTACTED, SAMPLED AGENCY 

IS AFFILIATED WITH THIS CORPORATE/CENTRAL OFFICE...... 2 

OTHER, SPECIFY ....................................................................................... 3 

___________________________________________________________ 

___________________________________________________________ 

GO TO CLOSING 1 

9. Was this agency previously located at [THE ADDRESS ON THE LABEL]? 

YES ............................................................... 1 (GO TO Q11) 

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

DON’T KNOW ............................................... -8 

 
Series 1, No. 53 □ Page 29 

10.	 Did this agency merge with [AGENCY PREPRINTED ON THE LABEL]? 

YES ............................................................... 1 (RECORD ANY 

DETAILS ABOUT 

THE MERGE BELOW 

THEN GO TO 

CLOSING 1) 

NO ................................................................. 2 (GO TO CLOSING 1)
 

DON’T KNOW ............................................... -8 (GO TO CLOSING 1)
 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

11.	 I have some information that I would like to mail to the director of your agency. May I please have the 

director’s name and title? ASK IF NECESSARY: Is that Mr or Ms (DIRECTOR’S LAST NAME)? 

DIRECTOR NAME: 

FIRST	 LAST 

TITLE: 

DIRECTOR PREFIX (CIRCLE ONE): MR MS DR SR 

12.	 What are the business hours for this office? 

 

INTERVIEWER: RECORD EACH TIME AND CIRCLE AM OR PM. 

OPENING TIME:_________________ AM PM CLOSING TIME:_________________ AM PM 

13.	 What days of the week is this office open for business? 

 

MONDAY - FRIDAY..................................................................................... 1
 

OTHER, SPECIFY ....................................................................................... 2
 

CLOSING 1 Thank you very much for your time. 

END. GO TO BOX 1 

BOX 1
 

INTERVIEWER NAME: __________________________________________________________________
 

DATE: ___________________________________________
 

n □ CHECK BOX IF NO NAME OR ADDRESS CHANGES OR ONLY MINOR CHANGES. DISPOSITION CODE 

= C1- SCREENER COMPLETE. RECORD FINAL CODE ON FRONT PAGE OF SCREENER. 

n □ CHECK BOX IF MAJOR NAME OR ADDRESS CHANGE TO SAMPLED AGENCY (Q3=2, OR 3; Q5=1; 

Q7=1 OR 2; Q8=3; OR Q9=2). DISPOSITION CODE = C2 – NAME/ADDRESS CHANGE, NCHS REVIEW 

REQUIRED. RECORD FINAL CODE ON FRONT PAGE OF SCREENER. 
 

 

 

 

 

 

Series 1, No. 53 □ Page 30 

n □ CHECK BOX IF AGENCY MERGED WITH ANOTHER AGENCY (Q10=1). DISPOSITION CODE = C4 – 

AGENCY MERGED, NCHS REVIEW REQUIRED. RECORD FINAL CODE ON FRONT PAGE OF SCREENER. 

n □ CHECK BOX IF NO HOME HEALTH OR HOSPICE AGENCY AT THIS TELEPHONE NUMBER, CALL DA 

FOR A BETTER NUMBER AND RE-ADMINISTER SCREENER. DISPOSITION CODE = C3 – AGENCY 

FOUND AT DIFFERENT LOCATION, NCHS REVIEW REQUIRED. RECORD FINAL CODE ON FRONT PAGE 

OF SCREENER. 

n IF NO GOOD TELEPHONE NUMBER OBTAINED, DISPOSITION CODE 10 = TRACING REQUIRED. 

n □ CHECK BOX IF AGENCY FOUND AT DIFFERENT LOCATION, READMINISTER SCREENER. 

DISPOSITION CODE = C3 – AGENCY FOUND AT DIFFERENT LOCATION, NCHS REVIEW REQUIRED. 

RECORD FINAL CODE ON FRONT PAGE OF SCREENER. 

n NOTE: FOR CODES C2, C3, C4, SEND A COPY OF COMPLETED ADVANCE MAIL SCREENER TO NCHS 

FOR REVIEW. 
Series 1, No. 53 [ Page 31

Appendix V. Agency Advance Package Materials

NHHCS folder (front)

National Home and
 

Hospice Care Survey
 

National Health Care Survey 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 32 [ Series 1, No. 53

NHHCS folder (back)

NCHS data are released in printed reports, CD-ROMs, 

diskettes, and through the NCHS home page on the 

World Wide Web. 

For further information and to access NCHS products, 

visit the NCHS home page at www.cdc.gov/nchs/. 

To obtain additional information about the 

National Home and Hospice Care Survey, 

visit the Web site: www.cdc.gov/nchs/nhhcs.htm. 

05-0433 (08/05) 
Series 1, No. 53 [ Page 33

NHHCS brochure (front cover)
 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 34 

Advance Letter From NCHS Director (front) 

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road, room 3418 

Hyattsville, Maryland 20782 

Dear Administrator: 

The National Center for Health Statistics of the Centers for Disease Control and Prevention is conducting a nationwide 

survey of home health and hospice agencies. The purpose of the National Home and Hospice Care Survey (NHHCS) is 

to collect data on the characteristics of home health and hospice agencies and their patients, discharges, and staff. The 

survey is used by researchers, policy analysts, and practitioners to track changes in home health and hospice care 

utilization, costs, agency characteristics, staffing, and services provided, and to project future long-term health care 

needs. For more information, please visit the NHHCS website at www.cdc.gov/nchs/nhhcs.htm and see a short video 

about the NHHCS. 

The purpose of this letter is to invite you to participate in the NHHCS. This survey includes a randomly selected 

nationwide sample of home health and hospice agencies, each of which represents a number of similar agencies. It is 

essential that we obtain data from all sample agencies in order to achieve accurate and complete statistics. Information 

is collected primarily by personal interview with administrators or their staff. No patient will be contacted at any time. 

A small sample of home health aides will be selected to participate in a voluntary offsite telephone interview. Your 

participation is voluntary, there are no penalties for refusing to answer any questions, and you may stop at any time. 

You may be asked to take part in other government surveys sometime in the future. Taking part in any other survey is 

also voluntary. 

As part of this survey, the name, Social Security Number, Medicare Number, and Medicaid Number will be collected 

for each sampled patient and discharge. This information will be used only for statistical purposes, which will include 

obtaining Outcome and Assessment Information Set (OASIS) data about the home health patients from the Centers for 

Medicare and Medicaid Services and matching against the vital statistics records of the National Center for Health 

Statistics. Data collection for the NHHCS is authorized by the Public Health Service Act (Title 42, United States Code, 

Section 242k). All information collected is held in the strictest confidence, and will be used only to prepare statistical 

summaries. Please be assured that there are several ways that the Privacy Rule (as mandated by the Health Insurance 

Portability and Accountability Act [HIPAA]) allows you to participate. In particular, disclosures of patient data are 

permitted for public health purposes and for research that has been approved by an Ethics Review Board – both of 

which apply to this survey. 

I want to emphasize further that the information you and your staff supply will be used solely for statistical research 

and reporting purposes. The only parties that can receive such data are those we’ve told you about on the back of this 

letter. In accordance with Section 308(d) (42 U.S.C. 242m) of the Public Health Service Act and the Confidential 

Information Protection and Statistical Efficiency Act (PL 107-347)], no information collected in this survey 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. A report with information from the last survey is enclosed to illustrate how the data will be 

presented. 

Within the next few weeks, a representative from Westat, the contractor conducting the survey on our behalf, will 

contact you for an appointment. If you have any questions, please call a NHHCS representative at 1-888-798-6678. I 

greatly appreciate your cooperation. 

Sincerely, 

/Edward J. Sondik, Ph.D./ 

Director, National Center for Health Statistics 

Enclosures 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 35 

Advance Letter From NCHS Director (back) 

National Home and Hospice Care Survey (NHHCS)
	

Frequently Asked Questions
	

I’m asked to participate in studies all the time. What makes this one any different? 

The NHHCS is a large national study that, because of its size and design, can provide information that is representative of 

all home health and hospice agencies in the United States. Since the NHHCS is a periodic survey, the results can be used 

to track changes that are taking place in these types of agencies over time. The survey has been developed collaboratively 

by several government agencies. The survey is endorsed by industry associations, including the National Association for 

Home Care and Hospice and the National Hospice and Palliative Care Organization. For more information about the 

survey visit www.cdc.gov/nchs/nhhcs.htm 

What other home health and hospice agencies are you going to visit? 

This is a random national sample and we do not release the names of these agencies to anyone. This is to protect 

individual agencies and the patients they serve. 

Why can’t some other agency take our place? 

If you do not participate, the unique qualities of your agency will be lost. The survey will be used by Congress and 

decision makers who will formulate policy for the next decade. You represent other agencies like yours. If you don’t 

participate, there is no guarantee that home health agencies and/or hospices like yours will be adequately represented. 

We don’t want industry decisions based on this survey to be made without all types of agencies, including those like 

yours, represented. 

Will the data be held confidential? 

The NHHCS is authorized by Congress in Section 306 of the Public Health Service Act (42 USC 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 information that would directly identify the agency, 

patients, or staff are: (1) WESTAT – hired to conduct this survey, and (2) our collaborators – persons who 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. By law we cannot release information that could identify your agency, 

patients, or staff 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, fined, and/or imprisoned. 

My st aff is i ncredibly o verworked r ight n ow. I n eed t o k now h ow much of t heir t ime will b e r equired for t his 

survey. How long will this take? 

We will need about 30 minutes with you or someone you designate to answer questions about your agency. We will also 

collect information about a sample of 10 current home health patients and/or hospice discharges that will take 

approximately 25 minutes for each person sampled. In addition, in order to conduct a telephone survey during nonworking with a sample of your home health aides, we will need a list of the home health aides employed by your agency. 

The interviewer will accommodate the schedules of your staff members to complete these tasks as quickly as possible. 
 

 

 

Series 1, No. 53 □ Page 36 

Ethics Review Board Approval Letter 

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road, Room 1209 

Hyattsville, Maryland 20782 

MEMORANDUM 

May 2, 2007 

From:	 Stephen Blumberg, Ph.D. 

Chair, NCHS Research ERB 

Anjani Chandra, Ph.D. 

Vice Chair, NCHS Research ERB 

Continuation of Protocol #2006-05 National Home and Hospice Care Survey 

To:	 Genevieve Strahan, 

Lisa Dwyer, 

The NCHS Research ERB reviewed the request for approval of Continuation of Protocol #2006-05 National 

Home and Hospice Care Survey on April 18, 2007. Continuation of Protocol #2006-05 is approved for the 

maximum allowable period of one year. 

IRB approval of protocol #2006-05 will expire on 05/12/2008. 

If it is necessary to continue the study beyond the expiration date, a request for continuation approval 

should be submitted about 6 weeks prior to 05/12/2008. 

Any problems of a serious nature should be brought to the immediate attention of the Research ERB, and any 

proposed changes should be submitted for Research ERB approval before they are implemented. 

Please submit "clean" copies of the revised protocol or consents and any other revised forms to this office for
 

the official protocol file.
 

Please call or e-mail me or Dewey LaRochelle if you have any questions.
 

/Stephen Blumberg, Ph.D./
 

Chair, NCHS Research ERB
 

/Anjani Chandra, Ph.D./
 

Vice Chair, NCHS Research ERB
 
 

 

 

 

 

 

Series 1, No. 53 □ Page 37 

Ethics Review Board Waiver of Authorization Letter 

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road, 

Hyattsville, Maryland 20782 

May 2, 2007 

From:	 Stephen Blumberg, Ph.D. 

Chair, NCHS Research ERB 

Anjani Chandra, Ph.D. 

Vice Chair, NCHS Research ERB 

Protocol #2006-05 National Home and Hospice Care Survey 

To:	 Genevieve W. Strahan, BS 

The NCHS Research Ethics Review Board reviewed and granted the request for continuation of approval of 

Protocol #2006-05 National Home and Hospice Care Survey, which included a request for Waiver of 

Authorization for Use or Disclosure of Protected Health Information based on 45 CFR 46, as allowed in the 

Health Insurance Portability and Accountability Act of 1996 (HIPAA), 164.512(i)(2)(iv)(C). Approval of Protocol 

#2006-05 will expire on 05/12/2008. 

The Board granted the following waiver of Protocol #2006-05 National Home and Hospice Care Survey based 

on 45 CFR 46.116, as allowed in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 

164.512(i)(2)(iv)(C): 

In accordance with 45 CFR 46.116(d) the Board voted (10-0) to approve the request for waiver of 

informed consent for the patients. The Board found that the research involves no more than minimal 

risk to the subjects, that the waiver will not adversely affect the rights or welfare of the subjects, and 

that the research could not practicably be carried out without the waiver or alteration. 

In accordance with 45 CFR 46.117(c) the Board voted (10-0) to approve the request for waiver of 

documentation of informed consent for the facility administrators. The Board found that the research 

involves no more than minimal risk of harm to the subjects and involves no procedures for which 

written informed consent is normally required outside the research context. 

In accordance with 45 CFR 46.117(c) the Board voted (10-0) to approve the request for waiver of 

documentation of informed consent for the home health care aides. The Board found that the 

research involves no more than minimal risk of harm to the subjects and involves no procedures for 

which written informed consent is normally required outside the research context. 

Any problems of a serious nature resulting from implementation of this amendment should be brought to the 

attention of the Research ERB, and any proposed changes should be submitted for Research ERB approval 

before they are implemented. 

/Stephen Blumberg, Ph.D./
 

Chair, NCHS Research ERB
 

/Anjani Chandra, Ph.D./
 

Vice Chair, NCHS Research ERB
 
Dear Hospice Administrator: 

I am writing to encourage your participation in the 2007 National Home and Hospice 

Care Survey to be conducted by the Center for Disease Control’s National Center for 

Health Statistics (NCHS). This survey collects baseline and trend information from a 

sample of both home health agencies and hospices throughout the United States. 

NHPCO has worked in collaboration with NCHS on a number of projects to help 

improve our understanding of hospice care in the US. Recently the NCHS has redesigned 

their survey with input from NHPCO. We are confident that data from our own annual 

National Data Set can be used collaboratively with the periodic NCHS survey to improve 

our understanding of hospice trends in the country. 

Strict confidentiality is maintained in the conduct of this survey and only summary data 

will be published and made available to health planners, researchers, health professionals, 

NHPCO, and the public. Your participation assures that the reporting of hospice trends 

will be based on the input of industry professionals. We appreciate your cooperation in 

this effort. 

Sincerely, 

/J. Donald Schumacher, PsyD/ 

President and CEO 

1700 Diagonal Rd, Suite 625, Alexandria, Virginia USA 

703-837-1500 voice 703-837-1233 fax 

www.nhpco.org 
 

August 2006 

Dear Administrator: 

I am writing to encourage you to participate in the 2007 National Home and Hospice Care 

Survey (NHHCS) that will be administered by the Centers for Disease Control and Prevention 

and the National Center for Health Statistics (NCHS). The survey, conducted periodically since 

1992, is designed to collect data on home health and hospice agencies, their services and staff, 

and their patients. These data provide useful information about our industry to agency owners, 

their suppliers, and health care planners. 

The NHHCS allows timely and convenient data collection through its new computer-assisted 

data collection system. The survey will collect information on important topics such as 

immunization policies and practices, family and caregiver services, staff training, and patient 

health status and medications. As with all NCHS surveys, strict confidentiality will be maintained 

and only summary data will be published and made available to the public. 

Some agencies sampled to participate in the 2007 NHHCS will also be asked to help in a firstever national survey of home health aides⎯the National Home Health Aide Survey. This 

survey, which will be conducted by telephone during non-working hours, will ask sampled home 

health aides to share their experiences as direct care workers in the home health industry. Their 

feedback will help to inform policy changes and work practices that can promote retention of 

home health aides in, and attract others to, this field. If your agency is selected for this 

supplemental survey, I hope we can count on your cooperation. 

Your participation in the 2007 National Home and Hospice Care Survey ensures that agencies 

like yours will be represented in the survey. Furthermore, your participation gives the home 

health industry greater information to address critical issues that affect fragile and chronically ill 

children and older adults who receive care through your agencies. 

Again, I cannot over-emphasize the importance of this survey and your valuable input. I hope 

we can count on your support in this effort. 

Sincerely, 

/Val J. Halamandaris/ 

President 
Page 40 [ Series 1, No. 53

NCHS Report: Series 13, No. 161, June 2006
Series 1, No. 53 [ Page 41

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics 

National Ambulatory Medical Care Survey 

National Hospital Ambulatory Medical Care Survey 

National Survey of Ambulatory Surgery 

National Hospital Discharge Survey 

National Survey of Residential Care Facilities 

National Nursing Home Survey 

National Home and Hospice Care Survey 

For further information NCHS data are released in printed reports, CD-ROMs, and on the NCHS website, 

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

 or 

For more information about how NCHS protects the information you provide, see: 

http://www.cdc.gov/nchs/about/policy/

 confidentiality.htm or contact: 

Information Dissemination Staff 


 3311 Toledo Road, Room 5412
 Hyattsville, MD 20782
 For specific questions about how NCHS 
protects the information you provide, 
contact:
 

Confidentiality Officer


 Peter Meyer
 

3311 Toledo Road, Room 4113
 Hyattsville, MD 20782
 

Telephone: (301) 458-4375
 E-mail: prm7@cdc.gov
 

CS207911 

T32894 (11/2009) 
Protecting the public’s privacy...no idle pledge

ure (back)

mbers, 

ers! 

A message from the Director of NCHS 

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NCHS is well known for the high quality statistical information it provides. Maintaining that level of quality is not possible unless those who provide us with this information can be guaranteed confidentiality. The confidentiality of records is of primary concern to NCHS. This principle is firmly grounded in federal laws, including the Privacy Act, the Public Health Service Act, the E-Government Act of 2002, and Title 18 of the United States Code. NCHS staff must sign a pledge to obey these laws and associated regulations to prevent disclosure of information, and they must follow strict procedures concerning data access, physical protection of records, avoidance of disclosure, and maintenance of confidentiality. 

NCHS collaborates with other organizations (for example, the U.S. Census Bureau and private research companies) to collect and process data for NHCS. These groups have an impeccable record of protecting the privacy of survey respondents. 

information without patient authorization for public health purposes and for research that has been approved by an institutional review board (IRB) with a waiver of patient authorizaation. The NHCS meets both of these criteria. As part of the IRB approval process, reviews were conducted of the surveys' procedures for handling protected health information, and practices were determined to be appropriate for safeguarding respondent confidentiality. Additionally, disclosures may be made under a data-use agreement with NCHS for some surveys that do not collect directly identifiable data. Copies of IRB approval letters and other related materials, such as data-use agreements, are available upon request for each component survey of the NHCS. There are several things that you must do to assure compliance with the Privacy Rule when participating in the survey. First, the privacy notice that you generally provide to your patients must indicate that patient information may be disclosed for either research or public health purposes. Second, you may need to keep a record of the disclosure that shows that some data from the patient's medical record were disclosed to CDC for NHCS (we will provide forms to assist you in record keeping). If you do not transmit health information electronically (such as claims data), you are not subject to the Privacy Rule or the requirements described above. For additional information on the HIPAA Privacy Rule, see:

 http://www.hhs.gov/ocr/hipaa 

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule permits you to make disclosures of protected health 

Page 42[ Series 1, No. 53
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 43 

Appendix VI. Corporate Advance Package Materials 

Corporate Advance Letter (front) 

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road, room 3418 

Hyattsville, Maryland 20782 

Dear Administrator: 

The National Center for Health Statistics of the Centers for Disease Control and Prevention is conducting a nationwide 

survey of home health and hospice agencies. The purpose of the National Home and Hospice Care Survey (NHHCS) is to 

collect data on the characteristics of home health and hospice agencies and their patients, discharges, and staff. The 

survey is used by researchers, policy analysts, and practitioners to track changes in home health and hospice care 

utilization, costs, agency characteristics, staffing, and services provided, and to project future long-term health care needs. 

Visit the NHHCS website at www.cdc.gov/nchs/nhhcs.htm for additional information about the survey. 

This letter is to inform you that some of the agencies in your organization may be invited to participate in the NHHCS. 

This survey includes a randomly selected nationwide sample of home health and hospice agencies, each of which 

represents a number of similar agencies. It is essential that we obtain data from all sample agencies in order to achieve 

accurate and complete statistics. Information is collected primarily by personal interview with administrators or their 

staff. No patient will be contacted at any time. A small sample of home health aides will be selected to participate in a 

voluntary offsite telephone interview. Although the agency’s participation is voluntary, there are no penalties for refusing 

to answer any questions. It is important that we obtain data from all sample home health and hospice agencies in order to 

achieve accurate and complete statistics. 

As part of this survey, the name, Social Security Number, Medicare Number, and Medicaid Number will be collected for 

each sampled patient and discharge. This information will be used only for statistical purposes, which will include 

obtaining Outcome and Assessment Information Set (OASIS) data about the home health patients from the Centers for 

Medicare and Medicaid Services and matching against the vital statistics records of the National Center for Health 

Statistics. Data collection for the NHHCS is authorized by the Public Health Service Act (Title 42, United States Code, 

Section 242k). All information collected is held in the strictest confidence, and will be used only to prepare statistical 

summaries. Please be assured that there are several ways that the Privacy Rule (as mandated by the Health Insurance 

Portability and Accountability Act [HIPAA]) allows you to participate. In particular, disclosures of patient data are 

permitted for public health purposes and for research that has been approved by an Ethics Review Board – both of which 

apply to this survey. 

I want to emphasize further that the information that the staff of your agencies supply will be used solely for statistical 

research and reporting purposes. The only parties that can receive such data are those we’ve told you about on the back of 

this letter. In accordance with Section 308(d) (42 U.S.C. 242m) of the Public Health Service Act and the Confidential 

Information Protection and Statistical Efficiency Act (PL 107-347)], no information collected in this survey 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. A report with information from the last survey is enclosed to illustrate how the data will be presented. 

Within the next few weeks, a representative from Westat, the contractor conducting the survey on our behalf, will contact 

the agencies for an appointment. If you have any questions, please call an NHHCS representative at 1-888-798-6674. I 

greatly appreciate your cooperation. 

Sincerely, 

/Edward J. Sondik, Ph.D./ 

Director, National Center for Health Statistics 

Enclosures 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 44 

Corporate Advance Letter (back) 

National Home and Hospice Care Survey (NHHCS) 

Frequently Asked Questions 

Our agencies are asked to participate in studies all the time. What makes this one any different? 

The NHHCS is a large national study that, because of its size and design, can provide information that is 

representative of all home health and hospice agencies in the United States. Since the NHHCS is a periodic 

survey, the results can be used to track changes that are taking place in these types of agencies over time. The 

survey has been developed collaboratively by several government agencies. The survey is endorsed by industry 

associations, including the National Association for Home Care and Hospice and the National Hospice and 

Palliative Care Organization. For more information about the survey, visit www.cdc.gov/nchs/nhhcs.htm. 

What other home health and hospice agencies are you going to visit? 

This is a random national sample and we do not release the names of these agencies to anyone. This is to protect 

individual agencies and the patients they serve. 

Why can’t other agencies besides ours participate? 

If your agencies do not participate, the unique qualities of your agencies will be lost. The survey will be used by 

Congress and decision makers who will formulate policy for the next decade. Your agencies represent other 

similar agencies. If your agencies don’t participate, there is no guarantee that home health agencies and/or 

hospices like yours will be adequately represented. We don’t want industry decisions based on this survey to be 

made without all types of agencies, including those like your agencies, represented. 

Will the data be held confidential? 

The NHHCS 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 

information that would directly identify the agency, patients, or staff are: (1) Westat – hired to conduct this 

survey, and (2) our collaborators – persons who 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. By law we cannot release information that could 

identify your agencies, patients, or staff 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, fined, and/or 

imprisoned. 

Staff in my agencies is incredibly overworked right now. I need to know how much of their time will be 

required for this survey. How long will this take? 

We will need about 30 minutes with the agency di rector or someone he or she designates to answer questions 

about the agency. We will also collect information about a sample of 10 current home health patients and hospice 

discharges that will take approximately 25 m inutes for each person sampled. I n addition, in order to conduct a 

telephone survey during non-working hours with a sample of home health aides, we will need a list of all home 

health ai des em ployed by the agency. T he i nterviewer will accommodate t he schedules o f t he agency st aff 

members to complete these tasks as quickly as possible. 
 

 

Series 1, No. 53 □ Page 45

 17 August 2006 

Dear Director: 

On behalf of the Board of Directors of the Paraprofessional Healthcare Institute 

(PHI), I am writing to urge you to participate in the National Home and Hospice 

Care Survey, conducted by the U.S. Centers for Disease Control and Prevention’s 

National Center for Health Statistics. 

For the first time in its history, the National Home and Hospice Care Survey will 

gather information directly from home health aides working for home health 

and hospice agencies, which is crucial to helping industry leaders such as 

yourself recruit and retain a highly-qualified, direct-care staff. 

PHI is a national healthcare institute that focuses exclusively on the recruitment 

and retention of paraprofessional workers in long-term care – home health aides, 

certified nursing assistants and personal care attendants. For this reason, PHI is 

highly supportive of the new National Home Health Aide Survey, and I hope you in 

turn will urge the staff at your agency to participate. 

From this special survey, the long-term care field will learn from home health 

aides about: 

Φ How and why they became home health aides; 

Φ Their work history and experiences; 

Φ What they like about being home health aides; 

Φ How the demands of the job affect them individually; and 

Φ If they are thinking of leaving the field, what opportunities 

and changes might keep them working in long-term care. 

The entire field will share in the findings of the survey, which will help providers 

and policymakers develop new programs and public policies to address the 

growing “care gap” across the nation—many more individuals needing care with 

too few workers able and willing to provide that care. 
 

 

We have been assured that names of participating home health aides from your 

agency, and where they work, will be kept private; the original data will be used 

for statistical purposes only. Therefore, strict provisions of confidentiality are 

maintained. Only summary data will be published and made available to health 

professionals such as yourself, health planners, researchers, and the public. 

The willingness of the home health aides selected from your agency to 

participate will be essential to ensure that the survey is an accurate 

representation from across the country. Please encourage the home health aides 

selected from your agency to take part in the National Home Health Aide Survey. 

We at PHI believe you will find the information from this survey worthy of your 

help, and worthy of the participation of the home health aides within your 

agency. 

Sincerely, 

/Steven L. Dawson/ 

 President 

 
National Association of Health Care Assistants 

National Headquarters: 1201 L Street NW, Washington, DC 20005 

Operations Center: 2709 W 13th Street, Joplin, MO 64801 

800.784.6049 www.nahcacares.org 

Dear Director: 

I encourage you to participate in the National Home and Hospice Care Survey conducted by the U.S. Centers 

for Disease Control and Prevention’s National Center for Health Statistics. Your agency was chosen to be 

part of a nationally representative sample of home and hospice agencies and your participation is important 

to the success of the overall national study. 

There is an important new component in the home and hospice care survey—a feature not part of previous 

surveys conducted by the National Center for Health Statistics. Included this time is a survey of home health 

aides who care for patients in home health and hospice agencies—The National Home Health Aide Survey. 

Today the nation is facing a critical shortage of home health aides, nursing assistants, and other direct-care 

workers in long-term care as the generation of “baby boomers” ages. We need today—probably more than 

ever before—to hear from home health aides about their work history, their experiences, and the challenges 

they encounter in their work to better inform discussions on changes in policy and practice that can help 

attract people to join long-term care as home health aides. 

Any personal information in the survey will be kept confidential, including names of participating home 

health aides and the name of your agency. The data will be used for research purposes only where rules of 

confidentiality are followed. Only aggregate research results will be made public and available. 

Again, please participate in the National Home and Hospice Care Survey. And encourage the home health 

aides selected from your agency to be part of The National Home Health Aide Survey. 

I thank you for your cooperation and assistance. 

Your partner in caring, 

/Lori J. Porter/ 

Co-founder & CEO 

A membership of professional nursing assistants dedicated to quality patient care.... 
Series 1, No. 53 □ Page 48

December 6, 2007 

Dear VNA CEO: 

I am writing to encourage your participation in the 2007 National Home and Hospice 

Care Survey being conducted by the Federal Center for Disease Control’s National 

Center for Health Statistics (NCHS). This survey collects baseline and trend information 

from a sample of home health agencies and hospices across the United States. 

It is important for you to participate in the survey if you are selected as part of the 

sample. If you do not participate, your agency’s information will not be included and 

thus the survey will prove less representative of VNAs. The data collected in this survey 

is used by researchers and policy makers to assess the current adequacy of home health 

and hospice care as well as influencing future policy decisions. 

The information collected in the survey is kept strictly confidential and only summary 

data, not identifying your VNA, will be published or made available to the public. The 

survey protocol has been approved under both HIPPA and Privacy Act Standards. 

Thank you for your cooperation in assuring that this survey includes VNA data and is 

thus fully representative of the entire home health and hospice community. 

Sincerely, 

/Andy Carter/ 

CEO 
Series 1, No. 53 [ Page 49

NHHCS DVD Slide Presentation

Slide 1. Music plays. National Home and Hospice Care Survey logo

appears with Department of Health and Human Services and CDC logos

below.

Slide 2. Welcome to the National Home and Hospice Care Survey.
Page 50 [ Series 1, No. 53

Slide 3. The National Home and Hospice Care Survey (also known as

NHHCS) gathers data from a nationally representative sample to describe

the nation’s home health and hospice care agencies and the health

status of their patients.

Slide 4. This survey is part of a family of health care establishment and

provider-based surveys conducted by the National Center for Health

Statistics (or NCHS).
Series 1, No. 53 [ Page 51

Slide 5. The data from the National Home and Hospice Care Survey and

other NCHS surveys provide critical information to answer important

questions and policy issues that are part of the national debate on health

care.

Slide 6. Over the past several years, the home health and hospice

industry as a whole has witnessed many changes in the kinds of

services and care it offers.
Page 52 [ Series 1, No. 53

Slide 7. As part of the 2007 National Home and Hospice Care Survey,

1,500 (fifteen hundred) home and hospice care agencies around the

country will be randomly selected and asked to participate by providing

data that will be used to address current and proposed home health and

hospice care policy.

Slide 8. These randomly selected agencies will represent the more than

10,000 home health and hospice care agencies in the United States that

provide care and support to more than 2.2 million elderly, disabled, and

chronically ill people.

Your participation guarantees that home health and/or hospice agencies

like yours will be adequately represented.
Series 1, No. 53 [ Page 53

Slide 9. Information from these agencies will provide a comprehensive

understanding of how home health and hospice agencies are changing

and how their services are used in this country.

Slide 10. The National Home and Hospice Care Survey is a large national

survey that, because of its size and design, can provide information that

is representative of all home health and hospice agencies in the United

States.

It is a resource that will serve the country—Congress, policymakers, the

home health and hospice industry, and health care researchers and

planners.
Page 54 [ Series 1, No. 53

Slide 11. Data from each participating agency will be combined and
 

released only in summary form in reports and tables.
 

No agency, staff, or patients will be individually identified.
 

Slide 12. Data collection for the National Home and Hospice Care Survey

is allowed by the Health Insurance Portability and Accountability Act

(HIPAA) and has been approved by the NCHS Ethics Review Board.
Series 1, No. 53 [ Page 55

Slide 13. HIPAA permits the disclosure of patient data for public health

purposes and for research that has been approved by an Ethics Review

Board—both of which apply to this survey.

Slide 14. Every home health and hospice care agency that participates in

the survey will contribute important information that will help to describe

and improve home health and hospice care throughout the country.

Here are a few examples of questions that were answered when the last

National Home and Hospice Care Survey was conducted in 2000.
Page 56 [ Series 1, No. 53

Slide 15. What is the primary payment source for most home health care

patients?

Medicare was the primary payment source for the majority of home

health care patients at 52%, followed by Medicaid at 20%, and private

sources at 17%.

Slide 16. What are the most prevalent primary admission diagnoses for

home health patients and hospice care patients?

The most common diagnoses for home health care patients were

diseases of the circulatory system and for hospice care patients,

malignant neoplasms.
Series 1, No. 53 [ Page 57

Slide 17. How many home health care and hospice patients received help

with activities of daily living (ADLs)?

Over half of home health care patients and three-fourths of hospice

patients received help from the agency with at least one ADL.

Slide 18. These, and other important data, are provided through the

National Home and Hospice Care Survey.
Page 58 [ Series 1, No. 53

Slide 19. The survey is authorized by the Public Health Service Act,

which mandates and authorizes the collection of these data.

The law also states that all information collected is held in the strictest

confidence and is to be used only for statistical research and reporting

purposes.

Slide 20. The National Home and Hospice Care Survey is endorsed by

industry associations, including the National Association for Home Care

and Hospice and the National Hospice and Palliative Care Organization.
Series 1, No. 53 [ Page 59

Slide 21. The survey will help the home health and hospice industry

develop more effective ways of meeting the needs of current and future

home health and hospice patients.

Slide 22. The survey uses trained interviewers to gather information

directly from agency directors and staff during an in-person visit at your

agency.
Page 60 [ Series 1, No. 53

Slide 23. The interviewers will use a computer-assisted interviewing

instrument to collect data on home health and hospice agencies, their

services, their staff, and their patients and discharges, using agency and

medical records.

Patients are not contacted directly to collect information.

Slide 24. The information collected about each agency will include: size,

ownership, certification status, types of services and care provided,

basic service charges, staffing, and policies.
Series 1, No. 53 [ Page 61

Slide 25. During the visit, a small sample of current home health patients

and hospice discharges will be randomly selected.

Agency staff who are familiar with patient records will be asked to use

these records to provide information about the selected patients.

Slide 26. The patient data collected will include: demographic

characteristics, functional and health status, diagnoses, medications,

services received, and sources of payment for their home health and

hospice care.
Page 62 [ Series 1, No. 53

Slide 27. The survey will also collect the name, social security number,
 

Medicare number, and Medicaid number for each sampled home health
 

patient and hospice discharge.
 

NCHS will use this information to match to the Outcome and Assessment
 

Information Set, or OASIS, data from the Centers for Medicare &
 

Medicaid Services for home health patients.
 

NCHS also plans to use the patient and discharge names and social
 

security numbers for future followup studies, such as matching against
 

vital statistics records at NCHS.
 

Slide 28. This year, home health and hospice agencies will also be asked

to participate in a first-ever nationwide survey of home health aides.

Home health aides provide the majority of direct care to people receiving

home health and hospice care services.
Series 1, No. 53 [ Page 63

Slide 29. For the National Home Health Aide Survey (also referred to as

the NHHAS), a sample of 6,000 home health aides will be selected to

participate in a telephone interview during non-working hours.

Slide 30. Home health aides employed to assist patients with activities of

daily living will be selected from each agency at the time of the agency

visit. Each home health aide who participates in the survey will receive

$35.
Page 64 [ Series 1, No. 53

Slide 31. The National Home Health Aide Survey is sponsored by the

Department of Health and Human Services, which has made the

long-term care workforce a major focus of its policy research agenda.

Slide 32. In 2004, the Department of Health and Human Services also

sponsored the National Nursing Assistant Survey (the NNAS), the

first-ever national survey of nursing assistants working in nursing

homes.
Series 1, No. 53 [ Page 65

Slide 33. Together, the National Home Health Aide Survey and the

National Nursing Assistant Survey will improve our understanding of the

direct care workforce.

These surveys will provide data to help address the pending shortage in

the long-term care workforce and the challenges long-term care

providers face in ensuring there are enough experienced home health

aides to provide high-quality care.

Slide 34. Westat, a nationally known survey research organization with

headquarters in the Washington, D.C., area will collect the National Home

and Hospice Care Survey and the National Home Health Aide Survey

data under contract with NCHS.
Page 66 [ Series 1, No. 53

Slide 35. The National Home and Hospice Care Survey is sponsored by

the Centers for Disease Control and Prevention’s National Center for

Health Statistics.

Both CDC and NCHS are part of the U.S. Department of Health and

Human Services.

Slide 36. NCHS, as the nation’s principal health statistics agency,

provides accurate, relevant, and timely data to identify and address

health issues.

NCHS’ statistical data help to guide our country’s public health and

health policy decisions.
Series 1, No. 53 [ Page 67

Slide 37. Thank you for taking the time to learn about this important

national health care survey conducted by NCHS.

We look forward to your participation!

Slide 38. For more information about uses of the National Home and

Hospice Care Survey and the National Home Health Aide Survey data, or

for access to the data for your own research, navigate on this website

when the video has ended. www.cdc.gov/nchs/nhhcs.htm
 

AFFIX AGENCY LABEL HERE 

Series 1, No. 53 □ Page 68 

Appendix VII. Set an Appointment Script 

National Home and Hospice Care Survey (NHHCS)
 

Set an Appointment Script
 

1. Hello, may I please speak to [AGENCY DIRECTOR] regarding some materials that we sent (a few days 

ago)? My name is ____________________________ and I’m working on the National Home and Hospice 

Care Survey sponsored by the Centers for Disease Control and Prevention (CDC) and the National Center 

for Health Statistics (NCHS). 

YES......................................................... 1 (GO TO Q3)
 

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

2.	 Is there a better time for me to speak to (Mr./Ms.) [AGENCY DIRECTOR]? 

PREFERRED DATE: ___________ TIME: ___________ AM/PM 

 DON’T KNOW -8 

 REFUSED -7 

 

GO TO CLOSING 2 

3.	 (Hello, my name is ____________________________, and I am calling about the National Home and 

Hospice Care Survey sponsored by the Centers for Disease Control and Prevention (CDC) and the National 

Center for Health Statistics (NCHS).) 

First, is [HOME HEALTH/HOSPICE AGENCY NAME] a (home health/home care) agency, a hospice 

agency, or both a (home health/home care) and hospice agency? 

HOME HEALTH ONLY .................................................. 1
 

HOSPICE ONLY............................................................ 2 GO TO Q5 
 

BOTH HOSPICE AND HOME HEALTH........................ 3
 

NOT A HOME HEALTH OR HOSPICE AGENCY......... 4
 

4.	 What type of business/company is this? 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

Those are all of the questions I have for now. Thank you very much for your time. END THE CALL. GO TO BOX 1. 
Series 1, No. 53 □ Page 69 

BOX 1	 INTERVIEWER: AGENCY IS INELIGIBLE - NOT A HOME HEALTH OR HOSPICE AGENCY. ENTER AN 

EROC WITH A DISPOSITION CODE OF 41-INELIGIBLE NOT A HOME HEALTH OR HOSPICE AGENCY. 

COMPLETE THE NIRF AND INCLUDE INFORMATION FROM Q4. 

5.	 Some home health and hospice agencies only serve as a central office and do not provide services to 

patients from the central office. Does this agency location provide services to patients? 

YES, AGENCY PROVIDES PATIENT SERVICES .......... 1 (GO TO Q7) 

AGENCY DOES NOT PROVIDE PATIENT SERVICES .. 2 

6. I’ll have to contact my supervisor to find out how to proceed. I may be contacting you again. Thank you 

very much for your time. END THE CALL. GO TO BOX 2. 

BOX 2	 INTERVIEWER: AGENCY IS INELIGIBLE - NO ELIGIBLE CURRENT HOME HEALTH PATIENTS OR 

HOSPICE DISCHARGES. ENTER AN EROC WITH A DISPOSITION CODE OF 42-NO ELIGIBLE 

CURRENT HOME HEALTH PATIENTS OR HOSPICE DISCHARGES. COMPLETE THE NIRF AND 

INCLUDE INFORMATION FROM Q5. FEDEX COPY OF THIS SCRIPT TO WESTAT. 

7.	 Did you receive the package of materials that we sent (a few days ago)? 

YES......................................................... 1
 

NO........................................................... 2 (GO TO Q9)
 

8.	 Have you had a chance to review the material? 

YES......................................................... 1 (GO TO Q15)
 

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

9.	 Shall I describe the survey to you now or would you prefer that I call you back after you have reviewed the 

materials? (I’ll re-send them.) 

DESCRIBE SURVEY.............................. 1 (GO TO Q14)
 

CALL BACK ............................................ 2
 

10.	 Is this a good time of day to call or is there a better time? 

PREFERRED DATE: ___________ TIME:___________ AM/PM 

11.	 INTERVIEWER: DO THE MATERIALS NEED TO BE REMAILED? (Q7=2 “NO”) 

 

YES......................................................... 1 (GO TO Q12)
 

NO........................................................... 2 (GO TO CLOSING 2)
 

 
Series 1, No. 53 □ Page 70 

12. I would like to confirm that we have your correct address to re-mail the package. According to my records, 

you are located at (AGENCY ADDRESS). Is this correct? 

YES......................................................... 1 (GO TO Q13)
 

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

RECORD CORRECT ADDRESS: 

______________________________________________________________________________________ 

________________________________________________________________________________ 

________________________________________________________________________________ 

13.	 I will put this package in the mail today. 

GO TO CLOSING 2 

14. INTERVIEWER: PROVIDE SUMMARY DESCRIPTION OF SURVEY AS NEEDED, 

THEN GO TO Q15. 

The National Home and Hospice Care Survey is a nationally representative sample of agencies that provide 

home health and hospice care. 

Its purpose is to collect information on home health and hospice agencies, services provided, their staff, and 

their patients’ health, demographics, and sources of payment. 

■	 [HOME HEALTH/HOSPICE AGENCY NAME] was randomly selected. 

■	 Short interview with the director. 

■	 The survey requires an interviewer to visit your agency: 

- to collect information about your agency and staff; 

- to collect medical and billing information about a sample of current patients/hospice discharges; 

and 

- to select a sample of home health aides and their home addresses and telephone numbers 

from all aides employed by your agency. The selected aides will be contacted at home during 

non-working hours for the National Home Health Aide Survey. 

■	 Confidentiality is ensured by federal law. 

■	 A sample of home health and hospice agencies is intended to produce estimates for United States 

home health and hospice agencies. 

■	 The findings will provide critical input to national issues on home health and hospice care. 

15.	 Do you have any questions about (the material you received/the information I just provided to you)? 

YES .............................................................. 1 (GO TO BOX 3)
 

NO .............................................................. 2 (GO TO Q16)
 
 

BOX 3 ANSWER DIRECTOR’S QUESTIONS AS APPROPRIATE.
 

THEN CONTINUE WITH Q16.
 

16.	 I would like to set an appointment to come to your agency on [IDEAL APPOINTMENT DATE] at [IDEAL 

APPOINTMENT TIME] to conduct the survey. Is this a convenient time for you? 

INTERVIEWER: APPOINTMENT TIME MAY BE NO LATER THAN 9:30 AM. 

IDEAL APPOINTMENT DATE:____________ IDEAL APPOINTMENT TIME:_____________ AM/PM 

YES ....................................................................................................... 1 

NO, RESCHEDULE .............................................................................. 2 

DATE:____________ TIME:_____________ AM/PM 

NO, CALL BACK .................................................................................. 3 

DATE:____________ TIME:_____________ AM/PM (GO TO CLOSING 2) 

NEED CORPORATE/CHAIN APPROVAL ............................................ 4 (GO TO Q22) 

REFUSED ............................................................................................ -7 (PROBE FOR REASON AND 

 RECORD. END THE CALL. 

REASON FOR REFUSAL __________________________________ COMPLETE EROC & NIRF) 

__________________________________________________________________________________ 

17.	 We would also like your support in promoting the National Home Health Aide Survey. We will send you 

flyers about the survey that can be posted in a prominent location where home health aides will likely see it. 

We will also send you a short video about the survey. 

The National Home Health Aide Survey will provide information needed to recruit, retain, and develop this 

essential paraprofessional workforce. The survey is designed to determine the likelihood that workers will 

continue in their present positions and the factors that affect those decisions, including job satisfaction, 

education and training, advancement opportunities, benefits, working conditions, and personal or family 

demands. 

This survey of home health aides will be conducted as a separate telephone interview during non-working 

hours with a sample of workers who provide patient assistance with ADLs. 

We would also like to send you a letter that can be distributed to each of the home health aides in your 

agency to let them know about the survey and that they might be selected for the survey. So that we can 

send you enough letters to distribute to ALL home health aides at your agency, about how many home 

health aides does your agency directly employ? 

APPROXIMATE NUMBER OF HOME HEALTH AIDES: 

18.	 Do you have any questions about the National Home Health Aide Survey? 

BOX 4 ANSWER DIRECTOR’S QUESTIONS AS APPROPRIATE.
 

THEN CONTINUE WITH Q19.
 

Series 1, No. 53 □ Page 71 
Series 1, No. 53 □ Page 72 

19.	 According to my records, you are located at (AGENCY ADDRESS). Is this correct? 

RECORD CORRECT ADDRESS: 

______________________________________________________________________________________ 

________________________________________________________________________________ 

________________________________________________________________________________ 

20. We will send out an appointment confirmation letter as a reminder of the appointment we just scheduled. To 

whom should this letter be addressed please? What is (your/his/her) title? ASK IF NECESSARY: Is that Mr 

or Ms (DIRECTOR’S LAST NAME)? 

DIRECTOR NAME: 

DIRECTOR TITLE: 

DIRECTOR PREFIX (CIRCLE ONE): MR MS DR SR 

21.	 And where should we come when we arrive at your agency? 

WRITE LOCATION: __________________________________________________________________ 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

GO TO CLOSING 2 

22. What is the name of your parent corporation/chain? 

CORPORATE/CHAIN NAME: 

 

REFUSED .................................................................................. -7 (CLOSING 2)
 

23.	 Who would we need to contact at your corporate/chain office for the 2007 National Home and Hospice 

Care Survey? What is (his/her) name and title? IF AGENCY DIRECTOR OFFERS TO CONTACT 

CORPORATE/CHAIN OFFICE, SAY: Thank you very much for offering to contact your corporate office. I 

would like this information in case we need to followup with the corporate office to send additional 

information about the survey. 

CONTACT PERSON NAME: 

CONTACT PERSON TITLE: 

DON’T KNOW/NOT AVAILABLE................................................ -8
 

REFUSED................................................................................... -7
 
Series 1, No. 53 □ Page 73 

24.	 What is the mailing address and phone number for [CORPORATE/CHAIN CONTACT]? 

RECORD MAILING ADDRESS: 

ADDRESS: 

 

CITY: STATE: ZIP: 

CORPORATE/CHAIN CONTACT PHONE: - ­ 

DON’T KNOW/NOT AVAILABLE................................................... -8
 

REFUSED ...................................................................................... -7
 

CLOSING 1 Thank you very much for your time. END CALL. THEN GO TO Q25. 

25.	 AGENCY DIRECTOR INDICATED CORPORATE/CHAIN APPROVAL IS NEEDED. INDICATE WHETHER 

THE AGENCY DIRECTOR OFFERED TO FOLLOWUP WITH CORPORATE/CHAIN OFFICE. 

DIRECTOR OFFERED TO FOLLOWUP ................................... 1 

DIRECTOR DID NOT OFFER TO FOLLOWUP ..................... 2 

CORPORATE/CHAIN NAME REFUSED................................ -7 

CLOSING 2 Thank you very much for your time. 

BOX 5 

INTERVIEWER: 

n UPDATE AGENCY NAME AND ADDRESS INFORMATION, DIRECTOR’S NAME, AND TITLE AND THE 

NUMBER OF HOME HEALTH AIDES AS APPROPRIATE USING THE AGENCY INFO BUTTON. 

n RECORD APPOINTMENT INFORMATION ON CALENDAR AND EROC AS APPROPRIATE. 

n UPDATE CASE DISPOSITION IN IFMS BY ENTERING EROC & APPOINTMENT DATE AS APPROPRIATE. 

n IF CORPORATE CONTACT/CHAIN APPROVAL REQUIRED, ENTER AN EROC WITH AN INTERIM CODE OF 

36-CO APPROVAL REQUIRED. 

n IF AGENCY LOCATION IS A CENTRAL OFFICE AND PATIENT SERVICES NOT PROVIDED AT LOCATION 

(Q5=2), ENTER AN EROC WITH AN INTERIM CODE OF 42-NO ELIGIBLE HOME HEALTH PATIENTS OR 

HOSPICE DISCHARGES. CONTACT SUPERVISOR IMMEDIATELY. FEDEX COPY OF THIS SCRIPT TO 

WESTAT. 

n IF ADDRESS OR NAME CHANGE (OTHER THAN MINOR MISSPELLING, ZIP CODE, OR AREA CODE 

CHANGE), ENTER AN EROC WITH AN INTERIM CODE OF 52-NAME/ADDRESS CHANGE, NCHS REVIEW 

REQUIRED. CONTACT SUPERVISOR IMMEDIATELY. 

n CONNECT TO WESTAT AND TRANSMIT. 
Series 1, No. 53 □ Page 74 

Appendix VIII. Appointment Confirmation Package Materials, 

Including Self-administered Staffing Questionnaire (SAQ) 

Appointment Confirmation Letter 

August 1, 2007 

Ms. Alice Collins, Executive Director 

Collins Home Care 

145 Janet Lane 

Stuckeyville, MD 15432 

Dear Ms. Collins: 

Thank you for agreeing to participate in the National Home and Hospice Care Survey (NHHCS) sponsored by the Centers 

for Disease Control and Prevention’s (CDC) National Center for Health Statistics. This is to confirm an appointment with a 

Westat field representative that is scheduled at Collins Home Care on Tuesday, August 21, 2007, at 10 a.m. We have 

enclosed a “Summary of Key Items for Data Collection” to give you an overview of the data collection process and the 

information we will need. 

Please have available a daily census of all home health patients (exclude patients who only receive homemaker services 

and/or durable medical equipment/supplies) as of midnight Monday, August 20, 2007 if your agency serves home health 

patients, and/or a separate list of all hospice discharges with their discharge month, day, and year for 3 months beginning 

with April 2007 if your agency serves hospice patients. 

Also, our representative will need a list of all home health aides who are currently employed and paid by your agency and 

who provide assistance with eating, transferring, toileting, dressing, and bathing to patients. This list should include the 

names (or other identifiers) of all home health aides. Having this information readily available will help to shorten the visit. 

After the interviewer selects the sample of (up to 6) home health aides from this list for the National Home Health Aide 

Survey (NHHAS), he/she will also need someone from your staff to provide some contact information for the selected home 

health aides (full name, home address, and home phone). 

Enclosed are NHHAS flyers for you to post in prominent locations to inform home health aides in your agency about the 

survey. In addition, copies of a letter about the NHHAS are enclosed and can be distributed to each home health aide in 

your agency. We also have enclosed a video about the NHHAS for you to share with your home health aides. NHHAS 

endorsement letters from the National Association of Health Care Assistants (NAHCA) and the Paraprofessional Healthcare 

Institute (PHI) encouraging you to participate in the survey are also enclosed. 

An important part of the NHHCS is to obtain information about the people who manage the agency and the people who 

provide home a nd hos pice c are. To c onserve your t ime dur ing our v isit, t his information a bout y our a gency will be 

collected t hrough a s elf-administered q uestionnaire. Please c omplete t he en closed s taffing q uestionnaire at y our 

convenience. The interviewer will collect the completed questionnaire during the visit to your agency. Again, thank you for 

your he lp i n t his i mportant s urvey. I f you ha ve a ny que stions, pl ease c all me at 1 -888-798-6674 o r em ail me at 

laurabranden@westat.com. 

Sincerely, 

/Laura Branden/ 

Associate Project Director 

Enclosures 

(90002) 
Series 1, No. 53 □ Page 75 

List of Key Items for Data Collection 

Summary of Key Items for Data Collection 

Agency Visit Activities 

Approximately 30 minutes of the director’s (or designee’s) time will be needed to answer questions about 

the agency, patients, its services and practices, and staff. Access to the following information will help to 

shorten the visit. 

n Service rates for Medicaid and private pay patients 

n Medicare agency provider number 

n Number of admissions and discharges for 2006 

n If your agency provides home health care, a list of all current patients served by this 

agency as of midnight Monday, August 20, 2007. Exclude patients who only receive 

homemaker services and/or durable medical equipment/supplies. 

n If your agency provides hospice care, a list of all hospice discharges with their 

discharge month, day, and year for 3 months, April 2007 to June 2007. 

Sampled Patient Information 

The survey collects information about the sampled patients and discharges. To collect this medical and 

billing information, we will meet with staff who are familiar with the medical and billing records. Agency 

staff will answer specific questions ab out t he sampled p atients an d discharges; t he i nterviewer will n ot 

obtain the information directly from the medical records. 

Approximately 25 minutes per patient is required to collect the following information: 

•	 Health s tatus i nformation for hom e he alth pa tients o btained f rom O ASIS da ta a nd 

medical records 

•	 Health status information for hospice discharges obtained from medical records 

•	 Services received from the agency 

•	 Medications taken 

•	 Expenditure i nformation i ncluding: t otal charges, s ources of payment, and amount 

paid by patient/discharge for most recent billing period for home health patients and 

the most recent episode of care for hospice patients 

Home Health Aide Sampling Information 

We will also need a list of all home health aides who assist patients with ADLs and who are employed and 

paid by the agency as of midnight Monday, August 20, 2007. The list should include employee names (or 

other identifiers). 

For the home health aides (up to 6) selected for the National Home Health Aide Survey (NHHAS), their 

home address and phone number will be needed at the time of the visit. 

Approximately 20 minutes of the director’s (or designee’s) time will be needed for these activities. 
Page 76 [ Series 1, No. 53

Self-administered Staffing Questionnaire (SAQ)

OMB #: 0920-0298
 

Exp.: 07/31/2009
 

Agency Name: 

Agency ID: 

Staffing Questionnaire 

Prepared for the 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

by 

Westat 

1650 Research Boulevard 

Rockville, MD 20850 

1-888-798-6674 

2007 

National 

Home and 

Hospice Care 

Survey 
 

 

 

Series 1, No. 53 [ Page 77

Dear Director/Administrator, 

The National Center for Health Statistics (NCHS) of the Centers for Disease 

Control and Prevention (CDC) is conducting the National Home and 

Hospice Care Survey on a randomly selected nationwide sample of home 

health care and hospice agencies. This voluntary survey is authorized by 

Federal Law. 

We would like some information about the staff of your agency, including 

their training, benefits, and experience. Any information you provide will 

be used only for research purposes and will be held in strict confidence. It 

will not be released to anyone, other than the agencies involved in the 

survey that are listed in the Dear Director letter sent to you previously, 

without the consent of the individual or the establishment in accordance 

with Section 308(d) of the Public Health Service Act (42 USC 242m) and 

the Confidential Information Protection and Statistical Efficiency Act 

(PL 107-347). 

If you wish to comment on any question or qualify your answers, please 

feel free to use space in the margins or on the inside of the final page. 

Your comments will be read and taken into account. 

Please answer all of the questions in reference to the agency listed on the 

front cover. 

NOTICE - Public reporting burden of this collection of information is estimated to average 50 minutes per response, including the time for reviewing 

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An 

agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control 

number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden 

to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS E-11, Atlanta, GA 30333, ATTN: PRA (0920-0298). 

Assurance of Confidentiality - All information which would permit identification of an individual, a practice, or an establishment will be held confidential, will 

be used only by persons engaged in and for the purpose 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 the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the 

Confidential Information Protection and Statistical Efficiency Act (PL 107-347). 
2 No 

1 Yes 

2. Does this ag

have a nursi

2 No 

1 Yes 

3. What is the 

agency's Dir

Mark one bo

1 Diploma 

2 Associate

3 Bachelors

4 Masters D

91 Other nur

Page 78 [ Series 1, No. 53

A Background of Director 

These first few questions ask about the 

background of this agency's 

Director/Administrator. 

1. Does this agency currently have a 

Director/Administrator (or acting) on staff? 

SKIP TO QUESTION 10.

ency's Director/Administrator 

ng degree? 

SKIP TO QUESTION 4.

highest nursing degree that the 

ector/Administrator holds? 

x. 

Degree in Nursing 

s Degree in Nursing 

 Degree in Nursing 

egree in Nursing 

sing degree (PLEASE SPECIFY) 

4. What is the highest degree of any kind that 

the agency's Director/Administrator holds? 

Mark one box. 

1 Diploma Degree in Nursing 

2 Associates Degree in Nursing 

3 Associates Degree in Health Care Administration 

4 Associates Degree (other health related) 

5 Associates Degree (not health related) 

6 Bachelors Degree in Nursing 

7 Bachelors Degree in Health Care Administration 

8 Bachelors Degree (other health related) 

9 Bachelors Degree (not health related) 

10 Masters Degree in Nursing 

11 Masters Degree in Health Care Administration 

12 Masters Degree (other health related) 

13 Masters Degree (not health related) 

91 Other (PLEASE SPECIFY) 

1 
2 No 

1 Yes 

6. What other 

this agency

Mark all tha

0 None 

1 America

(ANCC) 

Nursing 

Health, e

2 Certificat

associati

Hospice 

Rehabilit

7. About how 

Administrat

Write numb

a N

b N

c N

Series 1, No. 53 [ Page 79

5. Does this agency's Director/Administrator have 

a Certified Home or Hospice Care Executive 

(CHCE) certification? 

medical specialty certifications does 

's Director/Administrator have? 

t apply. 

n Nurses Credentialing Center
 

certification (Nurse Practitioner,
 

Case Management, Public/Community
 

tc.)
 

ion from a professional health care 

on/organization [for example, Certified 

and Palliative Nurse (CHPN), Certified 

ation Registered Nurse (CRRN), etc.] 

long has he/she been the Director/ 

or at this agency? 

er in only one box. 

umber of weeks 

OR 

umber of months 

OR 

umber of years 

8. Altogether, about how long has he/she worked 

as Director/Administrator at any home health or 

hospice agency, including this one? 

Write number in only one box. 

a Number of weeks 

OR 

b Number of months 

OR 

c Number of years 

9. Does the agency's Director/Administrator also 

serve as the Director of Nursing for this 

agency? 

This person may be called the Director of 

Professional Services or Clinical Director 

or is the clinical lead manager or 

supervisor nurse. 

2 No CONTINUE TO QUESTION 10.

1 Yes SKIP TO QUESTION 14. 

2 
Page 80 [ Series 1, No. 53

Background of B Director of Nursing 

10. The following questions are about the Director 

of Nursing at this agency. 

This person may be called the Director of 

Professional Services or Clinical Director or is 

the clinical lead manager or supervisor nurse 

who reports to this agency's 

Director/Administrator. 

Does this agency currently have a Director of 

Nursing (or acting) on staff? 

2 No SKIP TO QUESTION 16. 

1 Yes 

11. What is the highest nursing degree the 

Director of Nursing holds? 

Mark one box. 

1 Diploma Degree in Nursing 

2 Associates Degree in Nursing 

3 Bachelors Degree in Nursing 

4 Masters Degree in Nursing 

91 Other nursing degree (PLEASE SPECIFY) 

12. What is the highest degree of any kind the 

Director of Nursing holds? 

Mark one box. 

1 Diploma Degree in Nursing 

2 Associates Degree in Nursing 

3 Associates Degree in Health Care 

Administration 

4 Associates Degree (other health related) 

5 Associates Degree (not health related) 

6 Bachelors Degree in Nursing 

7 Bachelors Degree in Health Care 

Administration 

8 Bachelors Degree (other health related) 

9 Bachelors Degree (not health related) 

10 Masters Degree in Nursing 

11 Masters Degree in Health Care Administration 

12 Masters Degree (other health related) 

13 Masters Degree (not health related) 

91 Other (PLEASE SPECIFY) 

3
 
0 None 

1 Ameri

(ANC

Practiti

Public/

2 Certific

associ

Hospic

Rehab

Series 1, No. 53 [ Page 81

Profile of Nursing Staff C 

13. What medical specialty certifications does this

agency's Director of Nursing have? 

Mark all that apply. 

can Nurses Credentialing Center 

C) certification, (for example, Nurse 

oner, Nursing Case Management, 

Community Health, etc.) 

ation from a professional health care 

ation/organization [for example, Certified 

e and Palliative Nurse (CHPN), Certified 

ilitation Registered Nurse (CRRN), etc.] 

14. About how long has he/she been the

Director of Nursing at this agency? 

Write number in only one box. 

a Number of weeks 

OR 

b Number of months 

OR 

c Number of years 

15. Altogether, about how long has he/she been

the Director of Nursing at any home health or 

hospice agency, including this one? 

Write number in only one box. 

a Number of weeks 

OR b Number of months 

OR c Number of years 

Next, we would like to know about the 

background and turnover of this agency's 

staff. 

16. Approximately what percentages of the RNs

currently on staff have the following as their 

highest education/training? 

Write percentage on each line. If none, please 

enter "0." Your entries should equal 100% 

Percent of RNs 

a % Diploma 

b % Associate Degree 

c % BS/BSN (4 years) 

d % MS/MSN or higher 

1 0 0 % Total 

17. Do any of the RNs currently on staff have

any specialty certifications? 

(Examples include: palliative care, pain 

management, wound and ostomy care, 

gerontology, rehabilitation, nursing 

administration, medical-surgical nursing, 

public/community health, etc.) 

2 No SKIP TO QUESTION 19.

1 Yes CONTINUE TO QUESTION 18.

4 
2 1 Palliative

2 1 Wound a

2 1 Pain Man

2 1 Gerontol

2 1 Public/Co

19. Does this agency h

Advanced Practice 

both full-time and p

Mark one box in ea

No Yes 

2 1 Clinical N

2 1 Nurse Pr

20. Does this agency e

employ any of the f

Do not include cont

Mark one box in ea

No Yes 

2 1 RNs 

2 1 LPNs/LV

2 1 Certified 

2 1 Non-certif

2 No SKIP TO QUESTION 23. 

1 Yes 

2. How many? 

Do not include contract workers. 

a Number of full-time RN employees 

b Number of part-time RN employees 

OR 

c Number of FTE RN employees 

3. Does this agency currently have any 

LPN/LVN employees on staff? 

Do not include contract workers. 

2 No SKIP TO QUESTION 25. 

1 Yes 

4. How many? 

Do not include contract workers. 

Page 82 [ Series 1, No. 53

18. Do any of the RNs on staff have the 

following certifications? 

Mark one box in each row. 

No Yes 

 Care 

nd Ostomy Care 

agement 

ogy 

mmunity Health 

ave the following types of 

Nurses on staff? Include 

art-time employees 

ch row. 

urse Specialist 

actitioner 

ver employ or seek to 

ollowing? 

ract workers. 

ch row. 

Ns 

HHAs/CNAs 

ied Aides 

21. Does this agency currently have any 

RN employees on staff? 

Do not include contract workers. 

2

2

2

a Number of full-time LPN/LVN 

employees 

b Number of part-time LPN/LVN 

employees 

OR 

c Number of FTE LPN/LVN employees 

5 
Do not include co

2 No SKI

1 Yes 

26. How many? 

Do not include co

a Number of

HHA/CNA 

b Number of

HHA/CNA 

OR 

c Number of

employees

27. Does this agency 

non-certified aide 

Do not include co

2 No SKI

1 Yes 

28. How many? 

Do not include co

a Number of

2 No SKIP TO QUESTION 38. 

1 Yes 

30. Does this agency currently use any 

RN contract workers? 

2 No SKIP TO QUESTION 32. 

1 Yes 

31. How many? 

a Number of full-time RN contract 

workers 

b Number of part-time RN contract 

workers 

32. Does this agency currently use any 

LPN/LVN contract workers? 

2 No SKIP TO QUESTION 34. 

1 Yes 

33. How many? 

a Number of full-time LPN/LVN contract 

Series 1, No. 53 [ Page 83

25. Does this agency currently have any 

certified HHA/CNA employees on staff? 

ntract workers. 

P TO QUESTION 27.

ntract workers. 

full-time certified 

employees 

 part-time certified 

employees 

 FTE certified HHA/CNA 

currently have any 

employees on staff? 

ntract workers. 

P TO QUESTION 29. 

ntract workers. 

 full-time non-certified 

aide employees 

b Number of part-time non-certified 

aide employees 

OR 

c Number of FTE non-certified aide 

employees 

29. Does this agency currently use any 

contract workers for ANY of the following 

staff: RNs, LPNs, certified HHAs/CNAs, or 

non-certified aides? 

workers 

b Number of part-time LPN/LVN contract 

workers 

6 
2 No S

1 Yes 

35. How many? 

a Numbe

HHA/C

b Numbe

HHA/C

36. Does this agen

non-certified ai

2 No 

1 Yes 

37. How many? 

a Numbe

contrac

b Numbe

contrac

38. Does this agen

vacancies for 

RNs, LPNs/LV

non-certified ai

This would incl

employees for 

recruiting, eve

contract worke

2 No 

1 Yes 

2 No SKIP TO QUESTION 41.

1 Yes 

0. How many? 

a Number of full-time RN vacancies 

b 
 Number of part-time RN vacancies 

1. Does this agency currently have any 

LPN/LVN vacancies? 

2 No SKIP TO QUESTION 43.

1 Yes 

2. How many? 

a Number of full-time LPN/LVN 

vacancies 

b Number of part-time LPN/LVN 

vacancies 

3. Does this agency currently have any 

certified HHA/CNA vacancies? 

2 No SKIP TO QUESTION 45.

1 Yes 

4. How many? 

a Number of full-time certified 

Page 84 [ Series 1, No. 53

34. Does this agency currently use any certified 

HHA/CNA contract workers? 

KIP TO QUESTION 36.

r of full-time certified 

NA employees
 

r of part-time certified 

NA employees 

cy currently use any 

de contract workers? 

SKIP TO QUESTION 38. 

r of full-time non-certified aide 

t workers 

r of part-time non-certified aide 

t workers 

cy currently have any 

ANY of the following staff: 

Ns, certified HHAs/CNAs, or 

des? 

ude vacant positions for 

which you are actively 

n if for now you are using 

rs. 

SKIP TO QUESTION 47. 

CONTINUE TO QUESTION 39. 

39. Does this agency currently have any 

RN vacancies? 

4

4

4

4

4

HHA/CNA vacancies 

b Number of part-time certified 

HHA/CNA vacancies 

7 
2 No SKIP TO 

1 Yes 

46. How many? 

a Number of fu

aide vacanci

b Number of p

aide vacanci

47. Over the past 3 mont

ANY of the following 

certified HHAs/CNAs, 

Do not include contra

2 No SKIP TO

1 Yes 

48. Did this agency hire a

months? 

2 No SKIP T

1 Yes 

49. How many? 

a Number of full

b Number of par

Series 1, No. 53 [ Page 85

45. Does this agency currently have any 

non-certified aide vacancies? 

QUESTION 47. 

ll-time non-certified 

es 

art-time non-certified 

es 

hs, did this agency hire

staff: RNs, LPNs/LVNs, 

or non-certified aides? 

ct workers. 

 QUESTION 56. 

ny RNs in the past 3

O QUESTION 50. 

-time RNs hired 

t-time RNs hired 

50. Did this agency hire any LPN/LVNs in the

past 3 months? 

2 No SKIP TO QUESTION 52.

1 Yes 

51. How many? 

a Number of full-time LPN/LVNs hired 

b Number of part-time LPN/LVNs hired 

52. Did this agency hire any certified HHAs/CNAs 

in the past 3 months? 

2 No SKIP TO QUESTION 54.

1 Yes 

53. How many? 

a Number of full-time certified 

HHAs/CNAs hired 

b Number of part-time certified 

HHAs/CNAs hired 

54. Did this agency hire any non-certified aides 

in the past 3 months? 

2 No SKIP TO QUESTION 56.

1 Yes 

55. How many? 

a Number of full-time non-certified aides 

hired 

b Number of part-time non-certified aides 

hired 

8 
2 No SKIP T

1 Yes 

62. How many? 

a Number of 

HHA/CNAs

b Number of 

HHA/CNAs

63. Were there any nonterminations in the 

2 No SKIP T

1 Yes 

64. How many? 

a Number o

aides ter

b Number o

aides ter

Page 86 [ Series 1, No. 53

56. Over the past 3 months, have any of the 

following staff terminated employment: RNs, 

LPNs/LVNs, certified HHAs/CNAs, or 

non-certified aides? 

This would include both voluntary and 

involuntary terminations (retired, dismissed,
 

resigned).
 

Do not include contract workers. 

2 No SKIP TO QUESTION 65. 

1 Yes 

57. Were there any RN terminations in the past

3 months? 

2 No SKIP TO QUESTION 59.

1 Yes 

58. How many? 

a Number of full-time RNs terminated 

b Number of part-time RNs terminated 

59. Were there any LPN/LVN terminations in

the past 3 months? 

2 No SKIP TO QUESTION 61. 

1 Yes 

60. How many? 

a Number of full-time LPN/LVNs 

terminated 

b Number of part-time LPN/LVNs 

terminated 

61. Were there any certified HHA/CNA 

terminations in the past 3 months? 

O QUESTION 63.

full-time certified 

 terminated 

part-time certified 

 terminated 

certified aide 

past 3 months? 

O QUESTION 65. 

f full-time non-certified 

minated 

f part-time non-certified 

minated 

9 
RNs 0 OR a OR b OR c 

LPNs/ 

LVNs 0 OR d OR e OR f 

Certified 

HHAs/ 0 OR g OR h OR i 

CNAs 

Noncertified 0 OR j OR k OR l 

Aides 

66. About what percentage of this agency's current 

nursing staff have been employed for more 

than 1 year? 

Write in percentage in each box. If none for 

a staff type, please enter "0." 

Percent employed
 

more than 1 year
 

a % of RNs 

b % of LPNs/LVNs 

c % of Certified HHAs/CNAs 

d % of Non-certified Aides 

Series 1, No. 53 [ Page 87

65. What is the average length of orientation at

this agency for the following types of newly 

hired nursing staff? 

For each employee type, write length of orientation in 

appropriate box. 

If no orientation, check the NONE box. 

None HOURS DAYS WEEKS 

67. If hired today, what would be the hourly 

wage of entry-level nursing staff at this 

agency? 

Write in dollar amount in each box. 

Entry-level
 

Hourly Wages
 

$ .
 RNs


.
 LPNs/LVNs 

.
 Certified HHAs/CNAs 

.
 Non-certified Aides 

PLEASE CONTINUE 

TO NEXT PAGE 

$

$

$

10 
Page 88 [ Series 1, No. 53

68. Does this agency use any volunteers to help 

your current patients or this agency's staff in 

any way? 

2 No SKIP TO QUESTION 72.

1 Yes 

69. What kinds of services do they provide? 

Mark all that apply. 

1 General office help 

2 Homemaker/household services 

3 Personal care (haircuts, nail care, massage, 

etc.) 

4 Transportation services 

5 Visiting with patients 

6 Bereavement/family support 

7 Recreational activities 

8 Pet therapy 

9 Religious/spiritual activities 

91 Other (PLEASE SPECIFY) 

70. About how many volunteer workers 

currently provide services for this agency? 

a Number of volunteers 

71. In total, how many of this agency's current 

patients receive services from any of your 

volunteer workers? 

a Number of current patients 

OR 

b % Percent of current patients 

D Profile of Other 

Agency Workers 

72. Is this agency ever used as a clinical or 

training site for students? 

2 No SKIP TO QUESTION 74. 

1 Yes 

73. For what types of students? 

Mark all that apply. 

1 Home Health Aide 

2 Nurse (RN, LPN) 

3 Advance Practice Nurse (NP, CNS) 

4 Physician Assistant 

5 Medical Student/Intern/Resident 

6 Therapist (Physical, Speech, Occupational) 

7 Social Worker 

91 Other (PLEASE SPECIFY) 

11
 
2 
 1 
 Physicians 

2 
 1 
 Dental healt

2 
 1 
 Psychiatrist

2 
 1 
 Psychologis

2 
 1 
 Nutritionists

2 
 1 
 Occupation

2 
 1 
 Occupation

2 
 1 
 Physical Th

2 
 1 
 Podiatrists 

2 
 1 
 Respiratory 

2 
 1 
 Social Work

2 
 1 
 Speech Pat

2 
 1 
 Compleme

(CAM) Prov

Series 1, No. 53 [ Page 89

74. Does this agency have any of the following 

types of staff or contract personnel who 

provide services to patients served by this 

agency? 

Please mark "No" or "Yes" for each 

personnel type. 

No Yes 

h professionals 

s 

ts 

, Dietitians 

al Therapists 

al Therapy Assistants 

erapists 

Therapists 

ers 

hologists/Audiologists 

ntary Alternative Medicine 

iders 

75. Which of these nursing staff retention/ 

recruitment strategies are used by this
 

agency?
 

Mark all that apply. 

1 
 Employee recognition programs (employee of 

the month, staff dinners/luncheons, etc.) 

2 
 Reimbursement for workshops/conferences 

3 
 Sign-on bonus 

4 
 Recruitment bonus 

5 
 Career ladder positions for Nurses 

6 
 Career ladder positions for HHAs/CNAs 

7 
 Flexible scheduling or job sharing 

8 
 Bonus/paid time off 

9 
 Sabbatical 

10 
 Tuition (reimbursement or direct payment for 

employees/new hires) 

11 
 Payback for unused sick/vacation time 

91 
 Other (PLEASE SPECIFY) 

12
 
1 
 Full

2 
 Full

spo

3 
 Par

em

4 
 Par

em

5 
 Oth

dis

6 
 Ret

7 
 401

8 
 Pai

9 
 Pai

10 
 Pai

rea

11
 Oth

12 
 Mil

13 
 Uni

14 
 Cel

15 
 Car

con

16 
 Ed

91 
 Oth

Page 90 [ Series 1, No. 53

E Employee Benefits 

76. What types of employee benefits are 

offered to full-time RN and LPN/LVN staff 

by this agency? 

Mark all that apply. 

y paid health insurance plan for employee 

y paid health insurance plan for employee 

use/dependents 

tially paid health insurance plan for 

ployee 

tially paid health insurance plan for 

ployee spouse/dependents 

er employee insurance plan (dental, vision, 

ability, life)
 

irement/pension
 

k plan/tax-deferred annuity
 

d vacation/holidays
 

d sick days
 

d time off days for “other/personal”
 

sons
 

er paid bonuses
 

eage reimbursement/agency car
 

forms
 

l phones/reimbursements
 

eer promotion/development (workshops, 

ferences, certification exam, etc.) 

ucation reimbursement 

er (PLEASE SPECIFY) 

77. What types of employee benefits are 

offered to full-time HHA/CNA staff by 

the agency? 

Mark all that apply. 

1 
 Fully paid health insurance plan for employee 

2 
 Fully paid health insurance plan for employee 

spouse/dependents 

3 
 Partially paid health insurance plan for 

employee 

4 
 Partially paid health insurance plan for 

employee spouse/dependents 

5 
 Other employee insurance plan (dental, vision, 

disability, life)
 

6 
 Retirement/pension
 

7 
 401k plan/tax-deferred annuity
 

8 
 Paid vacation/holidays
 

9 
 Paid sick days
 

10 
 Paid time off days for “other/personal”
 

reasons
 

11
 Other paid bonuses
 

12 
 Mileage reimbursement/agency car
 

13 
 Uniforms
 

14 
 Cell phones/reimbursements
 

15 
 Career promotion/development (workshops, 

conferences, certification exam, etc.) 

16 
 Education reimbursement 

91 
 Other (PLEASE SPECIFY) 

13
 
Series 1, No. 53 [ Page 91

78. Does this agency currently have an Electronic Medical Records system? This is a computerized 

version of the patient's medical information used in the management of the patient's health care. 

Exclude electronic records used only for billing purposes and required documentation, such as OASIS 

files. 

2 No 

1 Yes SKIP TO QUESTION 80. 

79. Does this agency have plans to obtain an Electronic Medical Records System within the next year?

2 No SKIP TO QUESTION 81. 

1 Yes SKIP TO QUESTION 81. 

80. With this agency's current Electronic Medical Records system, please indicate for each component 

listed below, whether it is used, available but not used, or not available. 

Mark one box on each line. 

Available/ Not 

Used Not used Available 

1 2 3 Computerized Physicians Order Entry (CPOE) - prescriptions, labs, tests, etc. 

1 2 3 Test results (chest x-rays, labs, etc.) 

1 2 3 Patient demographics 

1 2 3 Electronic reminders for tests (labs, imaging, etc.) 

1 2 3 Clinical Decision Support System (CDSS) contraindications, allergies, guidelines, etc. 

1 2 3 Clinical notes 

1 2 3 Public health reporting (notifiable diseases) 

1 2 3 Sharing medical records electronically with other agencies 

81. For each item below, please indicate whether or not this agency uses any of the following 

Management Systems electronically? 

Mark one box in each row. 

No Yes 

2 1 Billing system 

2 1 Inventory control (i.e. bar coding) 

2 1 Human Resources management (personnel records) 

2 1 Staff management (e.g., staffing scheduling, etc.) 

2 1 Accounting 

F Agency Information Technology 

Capabilities 

14
 
2 1 Other telemedicin

85. For about what percentage of

Enter percent of current patie

0 None OR a

communication and informatio

2 No SKIP TO QUESTI

1 Yes 

84. For each item below, please in

telemedicine capabilities? 

Mark one box in each row. 

No Yes 

2 1 Routine telephone mo

care provider/monitor 

2 1 E-mail access to healt

2 1 Video consults with he

2 1 Routine video monitori

care provider/monitor 

2 1 Routine non-video mo

(e.g., regular transmis

e ca

 thi

nts 

Page 92 [ Series 1, No. 53

82. For each item below, please indicate whether or not this agency uses any of the following 

Education Systems?
 

Mark one box in each row.
 

No Yes 

2 1 Satellite Broadcast capability (in service, training) 

2 1 Staff Internet access 

2 1 Patient Internet access (web site with patient educational materials) 

83. Does this agency use any telemedicine capabilities? Telemedicine is the use of electronic 

n technologies to provide or support clinical care at a distance. 

ON 86.

dicate whether or not this agency uses any of the following 

nitoring of patients' health, involving conversation with nurse or other health 

h professionals for patients/caregivers 

alth care professionals 

ng of patients' health, involving conversation with nurse or other health 

nitoring of patients' health, without conversation 

sion of vital signs) 

pability (PLEASE SPECIFY) 

s agency's current patients is telemedicine used? 

or mark the None box. 

% of patients 

15 
devices. 

2 No SKIP TO Q

1 Yes 

87. How many of your direct 

0 None 

1 Some 

2 All 

88. How many of your admin

these? 

0 None 

1 Some 

2 All 

89. Do any other staff use 

2 
 No 

1 
 Yes (PLEASE SPEC

16 

PLEASE CONTINUE 

TO NEXT PAGE 

Series 1, No. 53 [ Page 93

86. Does this agency's staff use any system for 

Electronic Point of Care Documentation? 

Include PDAs (Personal Digital Assistants) 

Notebook PCs, or other portable handheld 

UESTION 91.

care staff use these? 

istrative staff use 

these? 

IFY) 

90. Are these devices used for any of the 

following? 

Mark one box in each row. 

No Yes 

2 1 Computerized Physicians Order Entry 

(prescriptions/pharmacy, labs, tests) 

2 1 Test results 

2 1 Electronic reminders for tests 

2 1 Clinical Decision Support System 

guidelines or reference systems 

2 1 E-mail communication with agency 

staff/other staff 

2 1 Scheduling appointments/visits 

2 1 OASIS 

2 1 Other (PLEASE SPECIFY) 
Page 94 [ Series 1, No. 53

Thank you 

for your cooperation. 

G 

91. Has this agency developed a written plan for 

management of patients during an influenza 

pandemic? 

0 No, not started 

1 Yes, in progress 

2 Yes, completed 

92. About what percentage of this agency's patient 

care revenue comes from each of the following? 

Write percentage on each line. If none, please 

enter "0." Your entries should equal 100% 

Percent of revenue 

a % Medicare 

b % Medicaid 

c % Private insurance 

d % Patient payments 

e % Other sources 

1 0 0 % Total 

Agency Information 

Other 

17
 
Series 1, No. 53 [ Page 95

WESTAT 

1650 Research Boulevard 

Rockville, Maryland 20850 
 

AFFIX AGENCY LABEL HERE 

Series 1, No. 53 □ Page 96 

Appendix IX. Appointment Confirmation Script 

National Home and Hospice Care Survey (NHHCS)

Appointment Confirmation Script 

 

Interviewer Name:
 

Interviewer ID Number: NHHC
 

1.	 Hello, my name is ____________________________, and I work for Westat on the National Home and 

Hospice Care Survey sponsored by the Centers for Disease Control and Prevention (CDC) and the National 

Center for Health Statistics (NCHS). 

May I please speak to (Mr./Ms.) [AGENCY DIRECTOR] regarding the appointment confirmation package of 

survey materials that we sent (a few days ago)? 

YES ............................................................... 1 (GO TO Q4)
 

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

2.	 Is there a better time for me to speak to (Mr./Ms.) [AGENCY DIRECTOR]? 

PREFERRED DATE: ___________ TIME: ___________ AM/PM 

 DON’T KNOW -8 

 REFUSED -7 

 

3.	 Thank you very much for your time. 

END THE CALL 

4.	 Hello, my name is ____________________________, and I work for Westat on the National Home and 

Hospice Care Survey sponsored by the Centers for Disease Control and Prevention (CDC) and the National 

Center for Health Statistics (NCHS). Did you receive the appointment confirmation package of survey 

materials that we sent (a few days ago)? 

YES ............................................................... 1
 

NO ................................................................. 2 (GO TO Q6)
 

5.	 Have you had a chance to review the material? 

YES ............................................................... 1 (GO TO Q9)
 

NO ................................................................. 2
 
Series 1, No. 53 □ Page 97 

6.	 Shall I go over the materials with you or would you prefer that I call you back after you have reviewed the 

materials (I’ll re-send them to you.)? 

DESCRIBE MATERIALS .............................. 1 (GO TO Q8)
 

CALL BACK................................................... 2
 

7. Thank you very much for your time. I’ll call back in a couple of days. END THE CALL. 

8.	 INTERVIEWER: PROVIDE SUMMARY DESCRIPTION OF MATERIALS AS NEEDED, THEN GO TO Q9. 

The package included a letter confirming the [APPOINTMENT DATE] as the day I’ll visit. It also asked if you 

could provide a list of all current patients as of midnight before [APPOINTMENT DATE] if your agency 

serves home health patients, (and/or) a list of all hospice discharges with their discharge month, day, and 

year for 3 months beginning with [4 FULL MONTHS BEFORE APPOINTMENT DATE MONTH AND YEAR] 

if your agency provides hospice care and a list of home health aides employed by the agency as of midnight 

before [APPOINTMENT DATE]. 

9.	 Do you have any questions about (the material you received/the information I just provided to you)? 

YES ............................................................... 1 (GO TO BOX 1)
 

NO ................................................................. 2 (GO TO Q10) 

BOX 1 INTERVIEWER: ANSWER DIRECTOR’S QUESTIONS AS APPROPRIATE. THEN CONTINUE WITH Q10. 

10.	 I would like to confirm the appointment day and time: READ APPOINTMENT DAY AND TIME FROM CASE 

MATERIALS. 

APPOINTMENT CONFIRMED ...................... 1 (GO TO Q12) 

NEED TO RESCHEDULE ............................. 2 (GO TO Q11) 

11.	 I’m sorry that doesn’t work for you. In that case, I would like to come to your agency on [IDEAL 

APPOINTMENT DATE] at [IDEAL APPOINTMENT TIME]. Is this a convenient time for you? 

IDEAL APPOINTMENT DATE:____________ IDEAL APPOINTMENT TIME:_____________ AM/PM 

YES ............................................................................................ 1 (GO TO Q12) 

NO, RESCHEDULE 2 (COLLECT DATE AND TIME) 

DATE:____________ TIME:_____________ AM/PM THEN END CALL) 

RECORD DATE ON CALENDAR AND ENTER AN EROC IN THE IMS. 

NO, CALL BACK ....................................................................... 3 

DATE:____________ TIME:_____________ AM/PM (END THE CALL) 

RECORD DATE ON CALENDAR AND ENTER AN EROC IN THE IMS. 

REFUSED ................................................................................. 4	 (PROBE FOR REASON AND 

 RECORD. END THE CALL. 

REASON FOR REFUSAL ____________________________	 COMPLETE THE NIRF.) 

_________________________________________________ 
Series 1, No. 53 □ Page 98 

12. We’d like to meet with the person who is most knowledgeable about the information we’ll need. 

13. CONFIRM ADDRESS, DIRECTIONS, AND MEETING LOCATION.
 

END: Thank you very much for your time.
 

INTERVIEWER: 

n UPDATE AGENCY NAME, ADDRESS, AND DIRECTOR INFORMATION USING THE AGENCY INFO BUTTON 

AS APPROPRIATE. 

n WRITE APPOINTMENT INFORMATION ON CALENDAR AS APPROPRIATE. 

n UPDATE CASE DISPOSITION ON THE ROC AND IN THE IMS USING THE EROC. 

n CONNECT TO WESTAT AND TRANSMIT. 
 

AFFIX AGENCY LABEL HERE 

Series 1, No. 53 □ Page 99 

Appendix X. Reminder Call Script 

National Home and Hospice Care Survey (NHHCS)

Reminder Call Script
 

AFFIX INTERVIEWER
 

MINI-LABEL HERE
 

1. Hello, my name is ____________________________ and I’m working on the National Home and 

Hospice Care Survey sponsored by the Centers for Disease Control and Prevention (CDC) and the National 

Center for Health Statistics (NCHS). 

May I please speak to (Mr./Ms.) [AGENCY DIRECTOR] regarding our upcoming appointment? 

YES ............................................................... 1 (GO TO Q4) 

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

2. May I be transferred to (his/her) voice mail to leave a message or may I leave a message with you? 

YES ............................................................... 1 

NO ................................................................. 2 (GO TO Q2b) 

2a. LEAVE A BRIEF MESSAGE ABOUT THE SCHEDULED APPOINTMENT, ALONG WITH EITHER YOUR 

HOME NUMBER OR THE NHHCS TOLL FREE NUMBER 1-888-798-6674 IN CASE THE DIRECTOR HAS 

ANY QUESTIONS BEFORE THE APPOINTMENT. END THE CALL. 

2b. Is there a better time for me to speak to (Mr./Ms.) [AGENCY DIRECTOR] before [APPOINTMENT DATE]? 

PREFERRED DATE: ___________ TIME: ___________ AM/PM 

 DON’T KNOW -8 

 REFUSED -7 

 

3. Thank you very much for your time. 

END THE CALL 

4.	 Hello, my name is ____________________________. I work for Westat on the National Home and Hospice 

Care Survey sponsored by the Centers for Disease Control and Prevention (CDC) and the National Center 

for Health Statistics (NCHS). 
 

I’m calling to confirm my appointment with you and your staff at [APPOINTMENT TIME] on [APPOINTMENT 

DATE for this survey. 

APPOINTMENT CONFIRMED ...................... 1 (GO TO Q6)
 

NEED TO RESCHEDULE ............................. 2 (GO TO Q5)
 

5.	 I’m sorry that doesn’t work for you. In that case, I would like to come to your agency on [IDEAL 

APPOINTMENT DATE] at [IDEAL APPOINTMENT TIME]. Is this a convenient time for you? 

INTERVIEWER: APPOINTMENT TIME SHOULD BE AS CLOSE AS POSSIBLE TO THE OPENING TIME 

 FOR THE AGENCY AND NO LATER THAN 10:00 AM. 

IDEAL APPOINTMENT DATE:____________ IDEAL APPOINTMENT TIME:_____________ AM/PM 

YES ............................................................................................ 1 (GO TO Q6) 

NO, RESCHEDULE 2 (COLLECT DATE AND TIME, 

DATE:____________ TIME:_____________ AM/PM THEN END CALL) 

RECORD DATE ON CALENDAR AND ENTER AN EROC IN THE IMS. 

NO, CALL BACK ....................................................................... 3 

DATE:____________ TIME:_____________ AM/PM (END THE CALL) 

RECORD DATE ON CALENDAR AND ENTER AN EROC IN THE IMS. 

REFUSED ................................................................................. 4	 (PROBE FOR REASON AND 

 RECORD. END THE CALL. 

REASON FOR REFUSAL ____________________________	 COMPLETE THE NIRF.) 

_________________________________________________ 

_________________________________________________ 

_________________________________________________ 

6.	 CONFIRM AGENCY NAME, ADDRESS, AND MEETING LOCATION FROM CASE MATERIALS. 

REQUEST DIRECTIONS TO THE AGENCY. 

 

 

 

 

7.	 Do you have any questions I can answer before our visit on [APPOINTMENT DATE]? 

YES .............................................................. 1
 

NO ................................................................. 2 (GO TO Q9)
 

Series 1, No. 53 □ Page 100 
Series 1, No. 53 □ Page 101 

8.	 INTERVIEWER: ANSWER QUESTIONS. REFER TO SUMMARY DESCRIPTION OF ITEMS NEEDED 

FOR THE INTERVIEW AS NEEDED, THEN GO TO Q9. 

READ INFORMATION FOR THE APPROPRIATE AGENCY TYPE: 

HOME HEALTH AGENCY: 

§ a list of all current patients as of midnight before [APPOINTMENT DATE]. The list should exclude 

patients who only receive homemaker services and/or durable medical equipment/supplies. 

§ a list of home health aides employed by the agency as of midnight before [APPOINTMENT DATE]). 

HOSPICE AGENCY: 

§ a list of all hospice discharges with their discharge month, day, and year for 3 months beginning 

with [4 FULL MONTHS BEFORE APPOINTMENT DATE MONTH AND YEAR] 

§ a list of home health aides employed by the agency as of midnight before [APPOINTMENT DATE). 

 

MIXED AGENCY: 

§ a list of all current patients as of midnight before [APPOINTMENT DATE]. The list should exclude 

patients who only receive homemaker services and/or durable medical equipment/supplies. 

§ a list of all hospice discharges with their discharge month, day, and year for 3 months beginning 

with [4 FULL MONTHS BEFORE APPOINTMENT DATE MONTH AND YEAR]). 

§ a list of home health aides employed by the agency as of midnight before [APPOINTMENT DATE]). 

FOR ALL AGENCY TYPES:
 

We will be asking for the agency’s Medicare Provider ID number, payment rates for Medicaid and 

private pay patients, and the number of admissions and discharges for 2006.
 

BOX 1 INTERVIEWER: ANSWER DIRECTOR’S QUESTIONS AS APPROPRIATE. THEN CONTINUE WITH Q9. 

9.	 After speaking with you, I’d like to meet with the person who is most knowledgeable about the information I’ll 

need about patient records and billing information. 

END: I’m looking forward to meeting you and your staff . Thank you very much for your time. 

INTERVIEWER: 

n UPDATE AGENCY NAME, ADDRESS, AND DIRECTOR INFORMATION IN THE AGENCY INFO TASK OF 

THE IMS AS NEEDED. 

n WRITE ANY MODIFIED APPOINTMENT INFORMATION ON YOUR CALENDAR. 

n UPDATE RECORD OF CALLS AND EROC TO REFLECT ALL CONTACT ATTEMPTS MADE WITH THE 

AGENCY AND ANY CHANGES TO THE APPOINTMENT TIME OR DATE. 
Series 1, No. 53 □ Page 102 

Appendix XI. CAPI: Agency Qualifications and 

Characteristics (AQ) Questionnaire 

AQPRE Help Screens 

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

NOTICE – Public reporting burden of this collection of information is estimated to 

average 30 minutes per response, including the time for reviewing instructions, 

searching existing data sources, gathering and maintaining the data needed, and 

completing and reviewing the collection of information. An agency may not 

conduct or sponsor, and a person is not required to respond to a collection of 

information unless it displays a currently valid OMB control number. Send 

comments regarding this burden estimate or any other aspect of this collection of 

information, including suggestions for reducing this burden to: CDC/ATSDR 

Reports Clearance Officer, 1600 Clifton Road, MS E-11, Atlanta, GA 30333, 

ATTN: PRA (0920-0298). 

 

Assurance of Confidentiality – All information which would permit identification 

of an individual, a practice, or an establishment will be held confidential, will be 

used only by persons engaged in and for the purpose 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 the establishment in accordance with section 

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

AQ5 - A chain is defined as having two or more agencies under one ownership 

 or operation. 

AQ13- The year recorded should reflect the year the sampled hospice agency, 

under its current ownership, began delivering services. 

AQ14 -The year recorded should reflect the year the sampled home health care 

agency, under its current ownership, began delivering services. 
 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 103 

AQ15- The agency is for profit if it is owned by an individual, a partnership, or a 

corporation. 

The agency is private nonprofit if it is owned by a religious group or a 

nonprofit corporation, etc. 

AQ16A - Referral services provide information about services available from public 

and private providers. They may also order or arrange services but they do 

not provide the services directly. 

AQ17/18 - Pending refers to the fact that the paperwork for Medicare certification 

of the agency has been submitted to CMS but the final approval and 

certification number have not been sent or issued to the agency. 

AQ25 B - The agency type according to the Medicare certification on file: 

•	 81=Hospice (non-hospital based) 

•	 82=Hospice (hospital-based) which includes 32X, 33X, 34X 

AQ20/21 - Pending refers to the fact that the paperwork for Medicaid certification 

of the agency has been submitted to CMS but the final approval and 

certification number have not been sent or issued to the agency. 

AQ28 - “Hospital” is a broad concept. It includes the following: 

• acute care hospitals; 

• private psychiatric hospitals; 

• state or county hospitals for the mentally ill; 

• Department of Veterans Affairs hospitals and medical centers; 

• state hospitals for the mentally retarded; 

•	 chronic disease, rehabilitation, geriatric, and other long-term hospitals; 

and, 

• other places that are commonly called hospitals. 

“Health care system” is an organized system that provides medical care, 

including inpatient, emergency, ambulatory care, and diagnostic 

procedures to a population. Many times, the system will have satellite 

facilities where some or all services may be offered. 
 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 104 

AQ29 - Formal contracts- The parties to an arrangement have attempted to spell 

out all terms in a legal contract or letter of agreement. A preferred 

provider agreement is considered a formal contract. 

AQ 34/35 - Complementary and Alternative Medicine (CAM) is a group of diverse 

medical and health care systems, practices, and products that are not 

presently considered to be part of conventional medicine. Examples 

include acupuncture, dietary supplements, and homeopathic medicine. 

AQ36 - Pharmacy services (also referred to as Pharmaceutical Services) refer to 

the system of appropriate methods and procedures for the dispensing and 

administering of drugs and biologicals under the direction of a qualified 

pharmacist. This includes evaluation of patients’ responses to the 

medication therapy, identification of adverse drug reactions, and taking 

appropriate corrective action. Drugs and biologicals must be obtained from 

community or institutional pharmacists or stocked by the agency. The 

agency must furnish the drugs and biologicals for each patient, as specified 

in each patient’s care plan. The use of drugs and biologicals must be 

provided in accordance with accepted professional principles and 

appropriate Federal, State, and local laws. 

AQ37 - Ethical issues- Regarding what is in accordance with law and accepted 

principles of right and wrong in the profession/industry. 

AQ46 - Open Access means the hospice accepts anyone who meets the eligibility 

requirements for hospice. (Eligibility requirement is that individual must 

have a medical prognosis that his or her life expectancy is 6 months or less 

if the illness runs its normal course.) The patients may continue their 

current treatment or start new treatments. 
 

AQ5 

 Is AGENCY part of a chain? 

 PRESS F1 FOR HELP SCREEN. 

 1 YES 

 2 NO 

 RF 

 DK 

AQ5A 

 What is the name of the chain? 

 Enter Chain Name. 

 ________________________________ 

AQ6 

 Is AGENCY a (home health/home care) agency, a hospice agency or does this 

 agency serve both (home health/home care) and hospice patients? 

 1 HOME HEALTH/HOME CARE AGENCY ONLY 

 2 HOSPICE AGENCY ONLY 

 3 BOTH HOME HEALTH/HOME CARE AND HOSPICE AGENCY 

 91 NONE OF THE ABOVE 

AQ6A 

 What type of service do you provide? 

 

 _____________________________________ 

 Refused
 

 Don’t know
 

AQ6B 

 Does this agency provide its patients with ONLY homemaker 

 services and durable medical equipment and supplies or are OTHER types of 

 services to patients also provided? 

 0 ONLY HOMEMAKER SERVICES AND/OR EQUIPMENT/SUPPLIES 

 1 OTHER SERVICES (ALSO) PROVIDED 

 2 REFUSED

 DON’T KNOW 

Series 1, No. 53 □ Page 105 
 

AQ7 

 How many (home health/home care) admissions did AGENCY have during calendar
 

year?
 

Only include this agency's home health patients for this location.
 

NUMBER OF ADMISSIONS.
 

 ______________________________ 

 REFUSED
 

 DON'T KNOW
 

AQ8 

How many (home health/home care) discharges did AGENCY have during calendar 

Year? 

 

Only include this agency's home health discharges for this location. 

NUMBER OF DISCHARGES 

 _______________________________ 

 REFUSED
 

 DON'T KNOW
 

 AQ9 

What is the number of (home health/home care) patients currently being served by 

 {AGENCY} at this location? 

 

ENTER NUMBER OF CURRENT PATIENTS. 

 ________________________________ 

 REFUSED
 

 DON'T KNOW
 

AQ10 

How many hospice admissions did (AGENCY} have during calendar year ? 

 

Only include this agency's hospice admissions for this location. 

ENTER NUMBER OF ADMISSIONS. 

 _________________________________ 

 REFUSED
 

 DON'T KNOW
 

Series 1, No. 53 □ Page 106 
 

AQ11 

How many hospice discharges did {AGENCY} have during calendar year? 

Only include this agency's hospice discharges for this location. 

ENTER NUMBER OF DISCHARGES. 

 

 ____________________________ 

 REFUSED
 

 DON'T KNOW
 

AQ11A 

Did this agency have any hospice patients discharged in {BEGMONTH} through 

 {ENDMONTH} of 2007? 

 1 YES 

 2 NO 

 REFUSED 

 DON'T KNOW 

AQ12 

What is the number of hospice patients currently being served by {AGENCY} at this 

location? 

 

ENTER NUMBER OF CURRENT PATIENTS. 

 _______________________________ 

 REFUSED
 

 DON'T KNOW
 

AQ13 

In what year was this agency established to provide hospice care? 

 

ENTER A 4-DIGIT YEAR. __________ 

 

PRESS F1 FOR HELP SCREEN.
 

 REFUSED
 

 DON'T KNOW
 

AQ14 

In what year was this agency established to provide (home health/home care) 

services? 

 

ENTER A 4-DIGIT YEAR. ___________ 

 

PRESS F1 FOR HELP SCREEN. 

 REFUSED
 

 DON'T KNOW
 

Series 1, No. 53 □ Page 107 
 

AQ15 

 Which one of these categories on this card best describes the ownership of this 

 agency? 

 

 PRESS F1 FOR HELP SCREEN. 

 

1 FOR PROFIT 

2 PRIVATE NONPROFIT 

3 CITY/COUNTY/STATE GOVERNMENT 

4 DEPARTMENT OF VETERANS AFFAIRS 

5 OTHER FEDERAL AGENCY 

91 OTHER (SPECIFY) 

 

REFUSED 

DON'T KNOW 

AQ15A 

SPECIFY OWNERSHIP (91) 

 WRITE OTHER TYPE OF OWNERSHIP. _____________________________ 

 REFUSED
 

 DON'T KNOW
 

AQ16A
 

 

What are {AGENCY}’s patient referral sources for (home health/home/hospice) care?
 

SELECT ALL THAT APPLY.
 

 1 HOSPITAL 

2 NURSING HOME 

3 ASSISTED LIVING FACILITY 

4 PHYSICIAN’S OFFICE 

5 OUTPATIENT MEDICAL/SURGICAL CENTER 

6 REHABILITATION FACILITY 

7 PATIENT/FAMILY/FRIEND 

8 OTHER HOME HEALTH/HOSPICE AGENCY 

9 INSURANCE PROVIDER/PAYER SOURCE 

10 COMMUNITY ORGANIZATION 

 91 OTHER (SPECIFY) 

REFUSED 

DON'T KNOW 

Series 1, No. 53 □ Page 108 
 

AQ16B

Whatotherreferralsourcewasusedforcarethat?

Enterotherreferralsource(s).

_______________________________________

AQ16C 

Which one of the referral sources you mentioned refers the greatest number of 

(home health/home care/hospice) patients to this agency? 

 

***What would you say is the main source of this agency’s (home health/home care/hospice) 

patient referrals? 

 

SELECT ONLY ONE. 

 

 

ENTER NUMBER OF MAIN REFERRAL SOURCE (AQ16A). __________ 

 

 REFUSED 

 DON'T KNOW 

AQ17 

Is this agency currently certified by MEDICARE as a Home Health Agency? 

PRESS F1 FOR HELP SCREEN. 

 1 YES 

 2 NO 

 3 PENDING 

 REFUSED 

DON'T KNOW 

AQ18 

Is this agency currently certified by MEDICARE as a Hospice? 

PRESS F1 FOR HELP SCREEN. 

 

 1 YES 

 2 NO 

 3 PENDING 

REFUSED 

DON'T KNOW 

AQ19 

What is the MEDICARE provider number for {AGENCY}? 

 

ENTER MEDICARE PROVIDER NUMBER. ________________ 

 REFUSED 

 DON'T KNOW 

Series 1, No. 53 □ Page 109 
Series 1, No. 53 □ Page 110 

AQ19A 

 

 MEDICARE provider number verification
 

 I have entered {AQ19/MEDICARE PROVIDER NUMBER}. Is this correct?
 

 

1 YES
 

2 NO
 

AQ20
 

 Is this agency currently certified by MEDICAID as a Home Health Agency?
 

 

 PRESS F1 FOR HELP SCREEN.
 

 

1 YES 

2 NO 

3 PENDING 

REFUSED 

DON'T KNOW 

AQ21 

 Is this agency currently certified by MEDICAID as a Hospice? 

 

 PRESS F1 FOR HELP SCREEN. 

 

1 YES 

2 NO 

3 PENDING 

REFUSED 

DON'T KNOW 

AQ23a1
 

 How much does MEDICAID pay this agency for __________________?
 

1 RESPONDENT PROVIDES A SINGLE RATE 

2 RESPONDENT PROVIDES A RANGE 

3 SERVICE NOT OFFERED 

 

REFUSED 

DON'T KNOW 
Series 1, No. 53 □ Page 111 

AQ23a2 

 How much does MEDICAID pay this agency for __________________? 

 

ENTER SINGLE RATE IN WHOLE DOLLARS. ___________ 

 REFUSED 

 DON'T KNOW 

AQ23a2a
 

 How much does MEDICAID pay this agency for _________________?
 

1 VISIT 

2 HOUR 

3 HALF HOUR 

4 15 MINUTES 

91 OTHER (SPECIFY) 

AQ23a2b
 

 MEDICAID SINGLE RATE UNIT – OTHER SPECIFY
 

 What is the MEDICAID single rate unit for other specify (AQ23a2a-91)?
 

 

 SPECIFY UNIT. ______________
 

AQ23a3 

 MEDICAID LOWEST RATE 

 How much does MEDICAID (lowest rate ) pay this agency for ______________________? 

ENTER LOWEST RATE IN WHOLE DOLLARS.________________ 

 REFUSED 

 DON'T KNOW 

AQ23a4 

 MEDICAID HIGHEST RATE 

How much does MEDICAID (highest rate) pay this agency for ________________________?
 

 

ENTER HIGHEST RATE IN WHOLE DOLLARS._________________
 

 REFUSED
 

 DON'T KNOW
 
 

4 15 M

91 OTHE

AQ23a4b
 

 MEDICAID HIGH A

 What is the MEDI

 

 SPECIFY UNIT. __

AQ23Aa1 

 PRIVATE HOME HEA

 How much does this 

 ________________

 

1 RESP

2 RESP

3 SERV

 

REFU

DON'

AQ23Aa2 

 PRIVATE HOME H

How much does t

______________

 

 

ENTER SINGLE R

Series 1, No. 53 □ Page 112 

AQ23a4a 

 MEDICAID HIGH AND LOW RATE UNIT 

 How much does MEDICAID pay this agency for ___________________? 

1 VISIT 

2 HOUR 

3 HALF HOUR 

INUTES 

R (SPECIFY) 

ND LOW RATE UNIT – OTHER SPECIFY
 

CAID high and low rate unit for other specify (AQ23a4a – 91)?
 

____________
 

LTH CARE RATE TYPE 

agency charge SELF OR PRIVATE PAY home health patients for 

____ ? 

ONDENT PROVIDES A SINGLE RATE 

ONDENT PROVIDES A RANGE 

ICE NOT OFFERED 

SED 

T KNOW 

EALTH CARE SINGE RATE 

his agency charge SELF OR PRIVATE PAY home health patients for 

______ ? 

ATE IN WHOLE DOLLARS. _________________ 
 

AQ23Aa2a 

 PRIVATE PAY SINGLE RATE UNIT 

 How much does this agency charge SELF OR PRIVATE PAY home health patients for 

__________________ ? 

 

1 VISIT 

2 HOUR 

3 HALF HOUR 

4 15 MINUTES 

 

91 OTHER (SPECIFY) 

 

AQ23Aa2b 

 PRIVATE SINGLE RATE UNIT OTHER SPECIFY 

 ENTER OTHER SPECIFY (AQ23Aa2a – 91). 

 

 SPECIFY UNIT. ______________ 

 

AQ23Aa3 

 PRIVATE HOME HEALTH CARE LOWEST RATE 

How much does this agency charge SELF OR PRIVATE PAY home health patients for 

___________________ ? 

 

 

ENTER LOWEST RATE IN WHOLE DOLLARS. __________________ 

AQ23Aa4 

 PRIVATE HOME HEALTH CARE HIGHEST RATE 

 How much does this agency charge SELF OR PRIVATE PAY home health patients for 

_____________________ ? 

 

 

ENTER HIGHEST RATE IN WHOLE DOLLARS. ___________ 

Series 1, No. 53 □ Page 113 
Series 1, No. 53 □ Page 114 

AQ23Aa4a 

 PRIVATE PAY HIGH AND LOW RATE UNIT – OTHER SPECIFY 

How much does this agency charge self or private pay home health patients for 

 _____________________ ? 

 

1 VISIT 

2 HOUR 

3 HALF HOUR 

4 15 MINUTES 

 

91 OTHER (SPECIFY) 

AQ23Aa4b 

 PRIVATE HIGH AND LOW RATE UNIT OTHER SPECIFY 

 ENTER OTHER SPECIFY (AQ23Aa4a – 91). 

 

 SPECIFY UNIT. ______________ 

AQ25A1 

 HOSPICE SERVICES MIX MODE 

 About how many of this agency’s HOSPICE patients are currently receiving 

 ________________ ? 

 1 RESPONDENT PROVIDES NUMBER OF PATIENTS 

2 RESPONDENT PROVIDES % OF PATIENTS 

 REFUSED 

 DON'T KNOW 

AQ25A2 

 HOSPICE SERVICE MIX NUMBER 

About how many of this agency’s HOSPICE patients are currently receiving 

________________ ? 

 

ENTER NUMBER OF PATIENTS. _______________ 

 REFUSED
 

 DON'T KNOW
 
Series 1, No. 53 □ Page 115 

AQ25A3 

 HOSPICE SERVICE MIX PERCENTATE 

 

 About how many of this agency’s hospice patients are currently receiving 

 __________________ ? 

 

 ENTER PERCENTAGE OF PATIENTS. _____________ 

 REFUSED
 

 DON'T KNOW
 

AQ25B
 

 Does this agency consider itself a Free Standing hospice agency, a Hospital Based
 

agency, a Home Health Based agency or a Nursing Home Based agency?
 

 

 This would be the same as this agency’s MEDICARE filing status for Agency.
 

 

SELECT ONE.
 

 

PRESS F1 FOR HELP SCREEN.
 

 

1 FREE STANDING AGENCY 

2 HOSPITAL BASED AGENCY 

3 HOME HEALTH BASED AGENCY 

4 NURSING HOME BASED AGENCY 

 REFUSED 

 DON'T KNOW 

AQ25C 

Does this hospice operate any dedicated hospice facilities or units? 

 

 ***This is a facility or unit that has one or more beds that are owned or 

 leased by the hospice and staffed by hospice, and whose major policies 

 and procedures are set by the hospice. 

1 YES 

2 NO 

 

REFUSED 

DON'T KNOW 

AQ25D 

 

 How many INPATIENT HOSPICE BEDS does this agency have in these dedicated 

 

 facilities or units?
 

 

 ENTER NUMBER OF BEDS. __________________
 

 REFUSED
 

 DON'T KNOW
 
 

 

Series 1, No. 53 □ Page 116 

AQ28 

SHOW CARD AQ28.
 

 

Is this agency owned or is it in operation with any of the following places or organizations?
 

 

SELECT ONLY ONE.
 

 

PRESS F1 FOR HELP SCREEN.
 

 

1 OUTPATIENT MEDICAL/SURGICAL CENTER 

2 MANAGED CARE ORGANIZATION 

3 HOSPITAL 

4 SKILLED NURSING FACILITY 

5 HEALTH CARE SYSTEM 

6 NO, TOTALLY INDEPENDENT AGENCY 

91 OTHER (SPECIFY) 

 

REFUSED 

DON'T KNOW 

AQ28A 

 AGENCY AFFILIATION – OTHER SPECIFY (AQ28 – 91) 

 SPECIFY PLACE/ORGANIZATION. _______________________ 

 REFUSED 

 DON'T KNOW 

AQ29 

SHOW CARD AQ29. 

 

 Does AGENCY have a FORMAL CONTRACT with any of these outside agencies 

 or organizations where you provide services to their patients? 

 

 

 *** This refers to FORMAL CONTRACTS with other places besides the one 

 this agency is owned or in operation with that you just mentioned. 

 

SELECT ALL THAT APPLY. 

 

PRESS F1 FOR HELP SCREEN. 

 

 1 ASSISTED LIVING FACILITY/ BOARD AND CARE HOME / LIFE CARE/ 

 CONTINUING CARE RETIREMENT COMMUNITY 

 2 HOSPITAL 

 3 SKILLED NURSING FACILITY 

 4 HOSPICE 

 5 MANAGED CARE/PRIVATE INSURANCE PROVIDER 

 6 NO FORMAL CONTRACT WITH OUTSIDE AGENCIES/ORGANIZATIONS 

91 OTHER (SPECIFY) 

 

REFUSED 

DON'T KNOW 
 

AQ29A
 

 FORMAL CONTRACT OTHER SPECIFY (AQ29 – 91)
 

SPECIFY TYPE OF AGENCY OR ORGANIZATION.
 

 ___________________________________________________ 

AQ30 

SHOW CARD AQ30. 

 

Please look at this card and tell me if your agency is ACCREDITED by any of these 

organizations. 

 

SELECT ALL THAT APPLY. 

 

 1 ACCREDITATION COMMISSION FOR HEALTH CARE (ACHC) 

 2 COMMUNITY HEALTH ACCREDITATION PROGRAM (CHAP) 

 3 JOINT COMMISSION FOR ACCREDITATION OF HEALTHCARE 

 ORGANIZATIONS (JCAHO) 

 4 OTHER ACCREDITATION (SPECIFY) 

 5 NOT ACCREDITED 

 

 REFUSED 

 DON'T KNOW 

AQ30A
 

 AGENCY ACCREDITATION OTHER SPECIFY (AQ30 – 4)
 

 SPECIFY TYPE OF ACCREDITATION.
 

 _______________________________________________ 

AQ31 

Does this agency provide staff training to understand CULTURAL DIFFERENCES AND 

BELIEFS that may affect delivery of services? 

1 YES 

2 NO 

 

 REFUSED 

 DON'T KNOW 

Series 1, No. 53 □ Page 117 
 

91 OTHER STA

 

 REFUSED 

 DON'T KNOW 

 

AQ32A 

 CULTURAL TRAIN

 SPECIFY TYPE O

 _____________

 

AQ33 

SHOW CARD AQ

 

Are any of thes

 

SELECT ALL TH

 1 PROVIDE 

 2 PATIENT-

 COMMONL

 3 PROVIDE 

 4 NONE OF 

91 OTHER (S

 

 REFUSED

 DON'T K

AQ33A 

 COMMUNICATI

 

 SPECIFY TYPE 

 ____________

Series 1, No. 53 □ Page 118 

AQ32 

 CULTURAL TRAINING
 

 

 For which staff is training mandatory?
 

 

SELECT ALL THAT APPLY.
 

 

 1 ADMINISTRATIVE/CLERICAL/MANAGEMENT STAFF – ALL 

 2 ADMINISTRATIVE/CLERICAL/MANAGEMENT STAFF – SOME 

 3 DIRECT SERVICE PROVIDERS – ALL 

 4 DIRECT SERVICE PROVIDERS – SOME 

 5 VOLUNTEERS – ALL 

 6 VOLUNTEERS – SOME 

 7 NO MANDATORY TRAINING FOR ANY STAFF 

FF (SPECIFY) 

ING – OTHER SPECIFY (AQ32 – 91) 

F STAFF, AND SPECIFY IF ALL OR SOME. 

_________________________________________ 

33.
 

e COMMUNICATION PRACTICES used with this agency’s patients?
 

AT APPLY.
 

INTERPRETER SERVICES 

RELATED MATERIALS TRANSLATED INTO LANGUAGES OF 

Y REPRESENTED GROUPS IN SERVICE AREA 

MULTI-LINGUAL STAFF 

THE ABOVE 

PECIFY) 

NOW 

ON PRACTICES - OTHER SPECIFY (AQ33 - 91) 

COMMUNICATION PRACTICE. 

__________________________ 
 

AQ34 

SHOW CARD AQ34
 

 

 Which of these SERVICES does this agency offer?
 

 

Include services offered by this agency as a result of contractual arrangements.
 

 

PRESS F1 FOR HELP SCREEN.
 

 

SELECT ALL THAT APPLY.
 

 

 1 COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) 

 2 DIETARY AND NUTRITIONAL SERVICES 

 3 ENTEROSTOMAL THERAPY 

 4 IV THERAPY 

 5 PHYSICIAN SERVICES 

 6 PODIATRY SERVICES 

 7 SKILLED NURSING/NURSING SERVICES 

 8 WOUND CARE 

 9 NONE OF THESE SERVICES 

 

REFUSED 

DON'T KNOW 

AQ35
 

SHOW CARD AQ35.
 

 

Which of these COMPLEMENTARY AND ALTERNATIVE MEDICINE therapies does this
 

agency use?
 

 

SELECT ALL THAT APPLY.
 

 

PRESS F1 FOR HELP SCREEN.
 

 

 1 ACUPUNCTURE 

 2 AROMATHERAPY 

 3 ART THERAPY 

 4 GUIDED IMAGERY/RELAXATION 

 5 MASSAGE 

 6 MUSIC THERAPY 

 7 PET THERAPY 

 8 SUPPORTIVE GROUP THERAPY 

 9 THERAPEUTIC TOUCH 

10 TENS (TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION) 

91 OTHER (SPECIFY) 

 

REFUSED 

DON'T KNOW 

AQ35A
 

 ALTERNATIVE MEDICINE THERAPIES USED – OTHER SPECIFY (AQ35 – 91)
 

SPECIFY OTHER COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) THERAPY.
 

 ____________________________________ 

Series 1, No. 53 □ Page 119 
 

AQ36
 

SHOW CARD AQ36.
 

 

Does AGENCY offer any of the SERVICES on this card?
 

Include services offered by this agency as a result of contractual arrangements.
 

 

PRESS F1 FOR HELP SCREEN.
 

 

SELECT ALL THAT APPLY.
 

 1 DURABLE MEDICAL EQUIPMENT 

 2 PHARMACY SERVICES 

 3 OCCUPATIONAL THERAPY 

 4 PHYSICAL THERAPY 

 5 RESPIRATORY THERAPY 

 6 SPEECH THERAPY/AUDIOLOGY 

 7 NONE OF THESE SERVICES 

91 OTHER THERAPY (SPECIFY) 

 

REFUSED 

DON'T KNOW 

AQ36A 

 

 OTHER SERVICES PROVIDED OTHER SPECIFY (AQ36 – 91) 

SPECIFY OTHER THERAPY. 

 ______________________________________ 

AQ37 

 SHOW CARD AQ37. 

 

Does AGENCY offer any of the OTHER SERVICES on this card?
 

Include services offered by this agency as a result of contractual arrangements.
 

 

PRESS F1 FOR HELP SCREEN.
 

 

SELECT ALL THAT APPLY.
 

 1 COMPANION SERVICES 

 2 CONTINUOUS HOME CARE 

 3 HOMEMAKER SERVICES 

 4 MEALS ON WHEELS SERVICES 

 5 ASSISTANCE WITH ACTIVITIES OF DAILY LIVING (ADLs) 

 6 TRANSPORTATION SERVICES 

 7 VOLUNTEER SERVICES 

 8 PASTORAL SERVICES/SPIRITUAL COUNSELING 

 9 MENTAL HEALTH SERVICES 

10 REFERRAL SERVICES 

11 RESPITE CARE 

12 (MEDICAL) SOCIAL SERVICES 

13 ETHICAL ISSUES COUNSELING 

14 GRIEF/BEREAVEMENT COUNSELING 

15 NONE OF THESE SERVICES 

REFUSED 

DON'T KNOW 

Series 1, No. 53 □ Page 120 
Series 1, No. 53 □ Page 121 

AQ38 

 SPECIAL PATIENT SERVICES
 

 

Does AGENCY provide services to any of the types of patients listed on this card?
 

 

SELECT ALL THAT APPLY.
 

 1 DEVELOPMENTALLY DISABLED 

 2 MATERNAL AND NEONATAL CARE PATIENTS 

 3 PATIENTS WITH HIV/AIDS 

 4 PATIENTS WITH ALZHEIMER'S DISEASE/DEMENTIA 

 5 PATIENTS RECEIVING PERITONEAL OR HEMODIALYSIS 

 6 PEDIATRIC PATIENTS 

 7 NONE OF THE ABOVE 

REFUSED 

DON'T KNOW 

AQ39 

 NO ADMIT - LACK OF STAFF 

In the past month, was this agency unable to admit patients because of lack of staff? 

 

 1 YES 

 2 NO 

REFUSED 

DON'T KNOW 

AQ40 

 NO ADMIT - LACK OF CAPABILITIES 

In the past month, was this agency unable to admit patients because of lack of 

 capabilities? 

 

[For example, patients with special or complex medical needs, ventilator patients, 

 patients with IVs-peripheral lines, IVs-central lines.] 

 1 YES 

 2 NO 

REFUSED 

DON'T KNOW 
 

AQ41 

 ADVANCE DIRECTIVES POLICY 

 SHOW CARD AQ41.
 

Does this agency follow any of these procedures regarding Advance Directives?
 

 

PROBE: Any others?
 

 

SELECT ALL THAT APPLY.
 

 1 ON ADMISSION, ASSESS WHETHER PATIENT HAS ANY ADVANCE DIRECTIVES 

 2 ON ADMISSION, PROVIDE WRITTEN INFORMATION ABOUT ADVANCE 

DIRECTIVES TO PATIENT 

 3 ON ADMISSION, PROVIDE ADVANCE DIRECTIVE FORM(S) TO PATIENT 

 4 EDUCATE PATIENT/FAMILY ABOUT ADVANCE DIRECTIVES 

 5 EDUCATE AGENCY STAFF ABOUT ADVANCE DIRECTIVES 

 6 ONLY IF REQUESTED, PROVIDE INFORMATION, FORMS, EDUCATION 

 7 NO PROCEDURES FOLLOWED 

91 OTHER (SPECIFY) 

 

REFUSED 

DON'T KNOW 

AQ41A
 

 ADVANCE DIRECTIVES POLICY – OTHER SPECIFY (AQ41 – 91)
 

 SPECIFY OTHER POLICY.
 

 ____________________________________ 

AQ42 

 ADVANCE DIRECTIVE STORAGE 

 Where does this agency maintain a copy of its patients' Advance Directives? 

 

SELECT ALL THAT APPLY. 

 1 NO DESIGNATED PLACE 

 2 WITH PATIENT'S RECORDS AT AGENCY 

 3 WITH PATIENT'S RECORDS AT PATIENT'S RESIDENCE 

 4 IN SPECIAL ADVANCE DIRECTIVES FILE AT AGENCY LOCATION 

91 OTHER (SPECIFY) 

 REFUSED 

 

AQ42A 

 

 ADVANCE DIRECTIVE STORAGE OTHER SPECIFY (AQ42 -91) 

 DESCRIBE STORAGE OF ADVANCE DIRECTIVE(S). 

 __________________________________________ 

Series 1, No. 53 □ Page 122 
 

AQ43 

 ADVANCE DIRECTIVE IMPLEMENTATION 

SHOW CARD AQ43. 

 

What specific actions does this agency take to make sure that patients’ Advance 

Directives are implemented? 

 

SELECT ALL THAT APPLY. 

 1 NOTIFY ATTENDING PHYSICIAN 

 2 INFORM AGENCY STAFF PROVIDING CARE TO PATIENT 

 3 INFORM FAMILY MEMBER/NEXT OF KIN 

 4 NO SPECIFIC ACTIONS TAKEN 

91 OTHER (SPECIFY) 

 

REFUSED 

DON'T KNOW 

AQ43A
 

 ADVANCE DIRECTIVE IMPLEMENTATION OTHER SPECIFY (AQ43 -91)
 

DESCRIBE IMPLEMENTATION OF ADVANCE DIRECTIVES.
 

 __________________________________________ 

AQ44 

 ADVANCE DIRECTIVES RESTRICTIONS 

Does this agency have any restrictions on implementing any kinds of Advance
 

Directives?
 

 

For example, not providing palliative sedation, CPR, or artificial life support services?
 

 1 YES 

 2 NO 

 

REFUSED 

DON'T KNOW 

AQ45 

 ADVANCE DIRECTIVES RESTRICTIONS
 

 

 What restrictions does this agency have?
 

 

 DESCRIBE ADVANCE DIRECTIVES RESTRICTIONS.
 

 _______________________________________ 

Series 1, No. 53 □ Page 123 
 

AQ46 

 OPEN ACCESS POLICY FOR HOSPICE PATIENTS 

 Does this agency have an Open Access policy for hospice patients? 

 

This is when an agency admits patients that are starting or in the middle
 

 of a course of Radiation or Chemotherapy.
 

 

PRESS F1 FOR HELP SCREEN.
 

 1 YES 

 2 NO 

 

AQ46A 

 OPEN

About

Open 

 

IF AG

 

ENTE

 

 REFU

 DON'

AQ48
 

 ENCO

SHO

 

Does 

vaccin

 

SELE

 

 1 

REFUSED 

DON'T KNOW 

ACCESS POLICY OTHER 

 how many of this agency’s current hospice patients were admitted under
 

Access?
 

ENCY HAS NO CURRENT HOSPICE PATIENTS, ENTER 9996.
 

R NUMBER OF OPEN ACCESS ADMISSIONS. ______________
 

SED
 

T KNOW
 

URAGE FLU VACCINATION
 

W CARD AQ48.
 

AGENCY do any of the following to encourage employees’ influenza
 

ations?
 

CT ALL THAT APPLY.
 

VACCINATIONS OFFERED ON SITE 

 2 VACCINATIONS OFFERED FOR FREE 

 3 VACCINATIONS OFFERED AT REDUCED COST 

 4 EMPLOYEE INCENTIVES PROVIDED FOR VACCINATION 

 5 PROOF OF VACCINATION (OR CONTRAINDICATION) REQUIRED FOR 

WORK/EMPLOYMENT 

 6 NONE OF THE ABOVE 

91 OTHER (SPECIFY) 

 

REFUSED 

DON'T KNOW 

Series 1, No. 53 □ Page 124 
 

AQ48A 

 ENCOURAGE FLU VACCINATION OTHER SPECIFY (AQ48 – 91) 

DESCRIBE OTHER WAYS TO ENCOURAGE VACCINATIONS. 

 ____________________________________________ 

AQ49 

 STAFF PERCENTAGE VACCINATED FOR FLU 

SHOW CARD AQ49. 

 

About what percentage of employees received a Flu shot last Flu season? 

 

 1 0% 

 2 1 TO 20% 

 3 21 TO 40% 

 4 41 TO 60% 

 5 61 TO 80% 

 6 81 TO 99% 

 7 100% 

REFUSED 

DON'T KNOW 

Series 1, No. 53 □ Page 125 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 126 

Appendix XII. CAPI: Patient Health (PH) Questionnaire 

PHPRE Help Screens 

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

NOTICE – Public reporting burden of this collection of information is estimated to average 25 minutes 

per response, including the time for reviewing instructions, searching existing data sources, gathering 

and maintaining the data needed, and completing and reviewing the collection of information. An 

agency may not conduct or sponsor, and a person is not required to respond to a collection of 

information unless it displays a currently valid OMB control number. Send comments regarding this 

burden estimate or any other aspect of this collection of information, including suggestions for reducing 

this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS E-11, Atlanta, GA 

30333, ATTN: PRA (0920-0298). 

Assurance of Confidentiality – All information which would permit identification of an individual, a 

practice, or an establishment will be held confidential, will be used only by persons engaged in and for 

the purpose 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 the establishment in accordance with section 308(d) of 

the Public Health Service Act (42 USC 242m). 

PH14A - Served as a member of the Army, Navy, Air Force, Marine Corps, Coast Guard, or as a 

commissioned officer of the Public Health Service, Environmental Science Services Administration or 

National Oceanic and Atmospheric Administration, or its predecessor, the Coast and Geodetic Survey. 

PH24 – A living will is a written document that allows a person to state in advance his/her wishes 

regarding the use or removal of life-sustaining or death-delaying procedures in the event of 

illness or injury. 

Do not resuscitate is a written order from a doctor that resuscitation should not be attempted if 

a person suffers cardiac or respiratory arrest. Such an order may be instituted on the basis of 

an advance directive from a person or from someone entitled to make decisions on his/her 

behalf, such as a health care proxy. 

Comfort measures only refer to pain medications, nursing care and treatments for the purpose 

of providing comfort and relieving pain only, not for curative purposes. 

A durable power of attorney is a written legal document by which an individual designates 

another person to act on his or her behalf. The power is durable in the sense that the authority 

endures in the event the individual becomes disabled or incapacitated. 

A health care proxy is a legal document in which an individual designates another person to 

make health care decisions if he or she is rendered incapable of making his/her wishes known. 

The health care proxy has, in essence, the same rights to request or refuse treatment that the 

individual would have if capable of making and communicating decisions. 

Organ donation is the removal of specific tissues of the human body from a person who has 

recently died, or from a living donor, for the purpose of transplanting them into other persons. 
Series 1, No. 53 □ Page 127

PH30 – A Primary Caregiver is a person who helps the majority of time in caring for someone who is ill, 

disabled, or aged. Some caregivers are friends or relatives who volunteer their help. Some people 

provide caregiving services for a cost. 

PH36 a-o – Co-morbid conditions are other diseases or illnesses the patient has.

PH41 – Healing status of pressure ulcers:

§ Fully granulating: 

o wound bed filled with granulation tissue to the level of the surrounding skin or new 

epithelium

o no dead space

o no avascular tissue (eschar and/or slough)

o no signs or symptoms of infection

o wound edges are open

§ Early/partia

≥ 2

l granulation: 

o 5% of the wound bed is covered with granulation tissue

o there is minimal avascular tissue (eschar and/or slough) (i.e., <25% of the wound bed 

is covered with avascular tissue)

o may have dead space

o no signs or symptoms of infection

o wound edges are open

§ Not healing

o Wound with ≥ 25% avascular tissue (eschar and/or slough) or

o Signs/symptoms of infection or

o Clean but non-granulating wound bed or

o Closed/hyperkeratotic wound edges or

o Persistent failure to improve despite appropriate comprehensive wound management 

PH25 - Refers to the place or location {SP} was staying in when he/she was referred to home health or 

hospice care.

PH25A - A skilled nursing facility provides short-term skilled nursing care on an inpatient basis, 

following hospitalization. These facilities provide the most intensive care available outside of a hospital.

A rehabilitation facility is a facility that provides an organized program of medical and clinical 

treatment designed to maximize residual physical, perceptual, and cognitive abilities following 

disablement.

Assisted living is a supportive housing facility designed for those who need extra help in their 

day-to-day lives but who do not require the 24-hour skilled nursing care found in traditional 

nursing homes. 
 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 128 

PH42 A – A person does not need assistance if they are able to get clothes and shoes out of closets 

and drawers, put them on and remove them (with or without dressing aids) without assistance. 

PH42 F – This refers only to the process of eating, chewing, and swallowing the food to be eaten, not 

preparing the food. If the patient had a feeding tube, code “yes.” 

PH44 G – A person does not need assistance if they are able to prepare and take all prescribed oral 

medications with the proper dosages and at the correct times. 

PH50 – Do not include medical devices that were used only during a visit to a doctor’s office or other 

medical care setting. 

PH64 – Standing order for pain medication refers to a pain medication that is administered at regular 

intervals, 24/7. Examples include timed doses around the clock and a synchromed pump. PRN order 

for pain medication refers to taking pain medication periodically, only when the patient feels that he/she 

needs it. 

PH66 - Telemedicine is the use of electronic communication and information technologies to provide or 

support clinical care at a distance. 

Services received from the hospice agency, even if performed through a contractor on behalf of the 

agency, are considered the same as the hospice agency providing the services itself. 

PH67 – Homemaker services include assistance in personal care, maintenance of a safe and healthy 

environment and services to enable the individual to carry out the plan of care. 

Continuous home care is where the hospice provides a minimum of eight hours during a 24­

hour day, which begins and ends at midnight. This care need not be continuous, i.e., four hours 

could be provided in the morning and another four hours in the evening, but care must reflect 

the needs of an individual in crisis (the period is which an individual requires continuous care for 

as much as 24 hours to achieve palliation or management of acute medical symptoms). The 

care must be predominantly nursing care provided by either a registered nurse (RN) or licensed 

practical nurse (LPN). In other words, at least half of the hours of care are provided by the RN 

or LPN. Homemaker or home health aide services may be provided to supplement the nursing 

care. 

Complementary and Alternative Medicine (CAM) is a diverse medical and health care systems, 

practices, and products that are not presently considered to be part of conventional medicine. 

CAM includes acupuncture, aromatherapy, art therapy, guided imagery/relaxation, hypnosis, 

massage, music therapy, pet therapy, reflexology, reiki, supportive group therapy, therapeutic 

touch, and TENS (transcutaneous electrical nerve stimulation). 
 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 129 

PH68 – Referral Services provide information about services available from public and private 

providers. They may also order or arrange services but they do not provide the services directly. 

Interpreter Services – refer to bilingual staff and/or health education materials that enable 

agency staff to provide health care to patients whose native language is not English. 

PH70 - Safety training – refers to when the hospice agency comes into a patient’s home to 

evaluate real or potential threats to the health and safety of the patient and to make 

recommendations (e.g., remove throw rugs that can trip a patient who uses a walker) to reduce 

or eliminate those threats. 

PH71 a-k – A visit is an episode of personal contact with the patient by staff of the HHA, or 

others under arrangements with the HHA, for the purpose of providing a covered home 

health service. One visit may be counted each time an HHA employee, or someone 

providing home health services under arrangements with the HHA, enters the patient’s 

home and provides a covered service to a patient who meets the criteria. If the HHA 

furnishes services in an outpatient facility under arrangements with the facility, one visit may 

be counted for each type of services provided. 

PH71 a-k If two individuals are needed to provide a service, two visits may be counted. If 

two individuals are present, but only one is needed to provide the care, only one 

visit may be counted. 

Example: (a) if an occupational therapist and an occupational therapist assistant 

visit the patient together to provide therapy and the therapist is there to supervise 

the assistant, one visit is counted; (b) if a nurse visits the patient in the morning to 

dress a wound and later must return to replace a catheter, two visits are counted; 

and (c) if the therapist visits the patient for treatment in the morning and the patient 

is later visited by the assistant for additional treatment, two are counted. 

PH71 f – Skilled Nursing Visits refer to nursing care provided by or under the supervision of 

a registered nurse (RN). 

PH73 – Emergent Care refers to any urgent, unplanned medical care. 

PH74 – Cardiac problems refers to problems related to the heart. 

Hypoglycemia refers to a deficiency of sugar in the blood caused by too much 

insulin or too little glucose.
 

Hyperglycemia refers to a higher than normal blood glucose level.
 

GI bleeding is gastrointestinal bleeding from a source within the gastrointestinal
 

tract such as an ulcer.
 
 

 

 

 

Series 1, No. 53 □ Page 130 

PH78 - IV Therapy: Includes hydration, pain pump. 

Respiratory Therapy: Includes oxygen (intermittent or continuous), ventilator 

(continually or at night), and continuous positive airway pressure received in 

one’s home. Therefore, a respiratory therapist does not need to be there in 

order for the respondent to indicate that the patient received respiratory 

therapy. 

Palliative Sedation: Palliative sedation is the use of sedative medications to 

relieve extreme suffering by making the patient unaware and unconscious (as in 

a deep sleep) while the disease takes its course, eventually leading to death. 

The sedative medication is gradually increased until the patient is comfortable 

and able to relax. Palliative sedation is not intended to cause death or shorten 

life. 

PH81 – Anorexia is diminished appetite or an aversion to food (distinct from anorexia 

nervosa). 
Series 1, No. 53 □ Page 131 

Patient Sampling HELP SCREEN 

Selecting the Current Patient Sample 

1.	 Get the list. It must contain all the patients currently receiving care from the agency as 

of midnight of the night before the interview. 

2.	 Clean the list 

§ Check for duplicates on the list. 

§ Correct the list if necessary. 

3.	 Number the list. Number all eligible names on the list sequentially. 

§ Check the numbers by groups of 50 or 100. 

4.	 Select the sample. Follow the instructions on CAPI: 

§ Enter the number of current patients (last number on your list) at item PS5. 

§ Find the line numbers displayed in the ‘Circle Number’ column in the roster at 

PS8, and circle the corresponding line numbers on the list of current patients. 

 

Discharge Sampling HELP SCREEN 

Selecting the Hospice Discharges Sample 

1.	 Get the list. It must contain all the hospice discharges for 3 months from the beginning 

month through the ending month 2007 as specified at PS2. 

2.	 Clean the list 

§ Correct the list if necessary. 

3.	 Number the list. Number all eligible names on the list sequentially. 

§ Check the numbers by groups of 50 or 100. 

4.	 Select the sample. Follow the instructions on CAPI: 

§ Enter the number of discharges (last number on your list) at item PS6. 

§ Find the line numbers displayed in the ‘Circle Number’ column in the roster at 

PS12, and circle the corresponding line numbers on the list of discharges. 

§ Enter the name corresponding to the line number into the roster, and the 

discharge date (month and day), if provided. 
Series 1, No. 53 □ Page 132 

PH1A ZIP CODE 

 What {is/was} {sampled patient}'s zip code? 

 

 ENTER ZIP CODE. _________ 

 

 IF HOME ADDRESS NOT AVAILABLE, ENTER 99. 

 

 REFUSED

 DON'T KNOW 

PH1 Patient OASIS Form Completion 

 Is there an OASIS form completed on this patient? 

 

 1 YES
 

 2 NO
 

 

 REFUSED

 DON'T KNOW 

PH2A Assessment Month OASIS Form 

 What is the assessment date of the most recent OASIS form completed for {sampled 

 patient} ? 

 

 ENTER MONTH (1-12). __________ 

 REFUSED 

 DON'T KNOW 

PH2B Assessment Day OASIS Form 

 

 What is the assessment date of the most recent OASIS form completed for {sampled 

 patient} ? 

 

 ENTER DAY. ________________ 

 REFUSED 

 DON'T KNOW 

PH2C Assessment Year OASIS Form 

 What is the assessment date of the most recent OASIS form completed for {sampled 

 person} ? 

 

 ENTER A 4-DIGIT YEAR. ______________ 

 

 REFUSED 

 DON'T KNOW 
 

 

 

PH4B 

 

 

 

 

 

 

PH4 

 

 

 

 

 

 

PH4D 

 

 

 

 

 

 

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 Wh

 Th

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 car

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 Rece

 Wh

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 car

 

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Series 1, No. 53 □ Page 133 

PH4A Admission Month 

 

 What was the date of {sampled patient}’s most recent admission with this agency?

 That is, the date (he/she) was admitted for the current episode of care. 

 

 On what date was the {sampled patient} admitted to this agency for the episode o

 care that ended on {Discharge date}? 

 

 ENTER MONTH (1-12). _________ 

 IF PATIENT RECEIVED ASSESSMENT ONLY, ENTER 99. 

EFUSED 

ON'T KNOW 

nt Admission Day 

at was the date of {sampled patient}’s most recent admission with this agency? 

at is, the date {he/she) was admitted for the current episode of care). 

 what date was the {sampled patient} admitted to this agency for the episode of 

e that ended on {Discharge date}? 

TER DAY (1-31). ___________ 

nt Admission Year 

at was the date of {sampled patient}’s most recent admission with this agency? 

t is, the date {he/she} was admitted for the current episode of care. 

what date was the {sampled patient} admitted to this agency for the episode of 

e that ended on {Discharge date} ? 

TER A 4-DIGIT YEAR. ___________ 

mission 

s this a re-admission for {sampled patient} to this agency for {home health/hosp

e? 

YES 

NO 

REFUSED 

DON'T KNOW 
 

PH5A Discharge Month 

 

 On what date was the {sampled patient} discharged from this agency?
 

 

 ENTER MONTH (1-12). ___________
 

 REFUSED
 

 DON'T KNOW
 

PH5B DischargeDay 

 On what date was the {patient} discharged from this agency? 

 

 ENTER DAY (1-31). _____________ 

 

 REFUSED 

 DON'T KNOW 

PH5C Discharge Year 

 On what date was {patient} discharged from this agency? 

 

 ENTER A 4-DIGIT YEAR. ____________ 

PH6 Deceased At Discharge 

 At discharge, was {patient} deceased? 

 

 1 YES 

 2 NO 

 

REFUSED 

DON'T KNOW 

PH7 Reason For Discharge 

 Why was {patient} discharged from this agency? 

 

 1 CONDITION STABILIZED OR IMPROVED 

 2 OBTAIN MORE AGGRESSIVE TREATMENT FOR CONDITION 

 3 MOVED TO GEOGRAPHIC LOCATION NOT SERVICED BY THIS AGENCY 

 91 OTHER (SPECIFY) 

 

REFUSED 

DON'T KNOW 

PH7A Specify Discharge Reason
 

 

 

 _

SPECIFY REASON FOR DISCHARGE. (PH7 – 91)
 

__________________________ 

Series 1, No. 53 □ Page 134 
 

PH9 Gend

 

 Is/

 1 

 2 

PH10A Birt

 

 Wh

 

 EN

 RE

 DO

Series 1, No. 53 □ Page 135 

PH8 Destination After Discharge 

 Where did {sampled patient} go after (he/she) was discharged from this agency? 

 

 1 PRIVATE HOME OR APARTMENT
 

 2 RESIDENTIAL CARE PLACE
 

 3 SKILLED NURSING FACILITY
 

 4 HOSPITAL
 

 5 ANOTHER HOSPICE FACILITY
 

 91	 OTHER PLACE (SPECIFY)
 

REFUSED
 

DON'T KNOW
 

PH8A Facility Type Description
 

 DESCRIBE FACILITY TYPE. (PH8 – 91)
 

 ____________________________________ 

er 

Was {sampled patient} male or female? 

MALE 

FEMALE 

REFUSED 

DON'T KNOW 

h Month 

at {is/was} {sampled patient}’s date of birth? 

TER MONTH (1-12). _____________ 

FUSED 

N'T KNOW 
Series 1, No. 53 □ Page 136 

PH10B Day of Birth 

 

 What {is/was} {sampled patient}’s date of birth? 

 

 ENTER DAY (1-31). _________________ 

 REFUSED 

 DON'T KNOW 

PH10C Birth Year 

 

 What {is/was} {sampled patient}’s date of birth? 

 

 ENTER A 4-DIGIT YEAR. _______________ 

 REFUSED 

 DON'T KNOW 

PH11 Discharge Age 

 

 Approximately how old {is/was} {sampled patient} at the time of 

 discharge}? 

 Enter Age. ___________________ 

 REFUSED 

 DON'T KNOW 

PH12 Hispanic or Latino Origin 

 {Is/Was} (he/she) of Hispanic or Latino origin? 

 1 YES 

 2 NO 

 REFUSED

 DON'T KNOW 
Series 1, No. 53 □ Page 137 

PH13 Race 

 

 SHOW CARD PH13. 

 

 Please look at this card and tell me what {sampled patient}’s race {is/was}? 

 

 SELECT ALL THAT APPLY. 

 1 AMERICAN INDIAN OR ALASKA NATIVE 

 2 ASIAN 

 3 BLACK OR AFRICAN AMERICAN 

 4 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 

 5 WHITE 

 91 OTHER RACE (SPECIFY) 

 

REFUSED
 

DON'T KNOW
 

PH13A Specify Race
 

 

 SPECIFY RACE. (PH13 – 91)
 

 

 ___________________________________ 

PH14 Marital Status 

 

 {Is/Was} {sampled patient} married, widowed, divorced, separated, never married, or living 

 with a partner in a marriage-like relationship? 

 

 IF NEEDED: (at time of discharge.) 

 1 MARRIED
 

 2 WIDOWED
 

 3 DIVORCED
 

 4 SEPARATED
 

 5 NEVER MARRIED
 

 6 LIVING WITH A PARTNER
 

REFUSED
 

DON'T KNOW
 

PH14A Veteran Status 

 {Is/Was} {sampled patient} a veteran of U.S. military service? 

 

 PRESS F1 FOR HELP SCREEN. 

 1 YES 

 2 NO 

REFUSED 

DON'T KNOW 
 

PH16 Medica

 

 What

 ____

 REFU

 DON'

PH17 Verify 

 I have 

 

 1 

 2 

PH18 Medic

 Is/Wa

 1 

 2 

 3 

PH19 Medic

 What

 NAM

 

 IF N

 REF

 DON

Series 1, No. 53 □ Page 138 

PH15 Medicare Enrolled 

 SHOW CARD PH15 

 

 {Is/Was} {sampled patient} enrolled in Medicare? 

 

 1 YES 

 2 NO 

 

REFUSED 

DON'T KNOW 

re ID Number 

 {is/was} (his/her) Medicare ID Number? 

_____________________ 

SED
 

T KNOW
 

Medicare Number 

entered {PH16/MEDICARE NUMBER}. Is this correct? 

YES 

NO 

aid Enrolled 

s {sampled patient} enrolled in Medicaid? 

YES 

NO 

MEDICAID PENDING 

REFUSED 

DON'T KNOW 

aid ID Number 

 {is/was} (his/her) {‘PREFERRED’ NAME FOR MEDICAID} {or ‘ALLOWED FOR’ 

E FOR MEDICAID} ID number? 

O MEDICAID NUMBER, ENTER 99. _____________ 

USED 

'T KNOW 
 

PH20 Verify Medicaid Number 

 I have entered {MEDICAID NUMBER}. Is this correct? 

 

 1 YES 

 2 NO 

PH21 Alpha Or Numeric SSN 

 Does {sampled patient}'s Social Security number begin with a letter or a number? 

 

 1 LETTER 

 2 NUMBER 

 

REFUSED 

DON'T KNOW 

PH21A Social Security Number
 

 What is {sampled patient}’s Social Security number?
 

 __________________________ 

PH22 Social Security Number
 

 

 What is {sampled patient}’s Social Security number?
 

 __________________________ 

PH23 Verify Social Security Number 

 I have entered {SOCIAL SECURITY NUMBER}. Is this correct? 

 

 1 YES
 

 2 NO

Series 1, No. 53 □ Page 139 
 

PH24 Advanced Directives Request 

 

 SHOW CARD PH24. 

 

 Which of the following Advance Directives {has {sampled patient} requested/are listed in 

 {sampled patient}’s medical records}? 

 

 SELECT ALL THAT APPLY. 

 

 PRESS F1 FOR HELP SCREEN. 

 

 1 LIVING WILL 

 2 DO NOT RESUSCITATE (DNR) 

 3 DO NOT HOSPITALIZE/DO NOT SEND TO EMERGENCY DEPARTMENT 

 4 FEEDING RESTRICTIONS 

 5 MEDICATION RESTRICTIONS 

 6 COMFORT MEASURES ONLY 

 7 DURABLE POWER OF ATTORNEY 

 8 HEALTH CARE PROXY/SURROGATE 

 9 ORGAN DONATION 

 10 NO ADVANCED DIRECTIVES PROVIDED
 

 91 OTHER (SPECIFY)
 

 

REFUSED
 

DON'T KNOW
 

PH24A Directive Description
 

 DESCRIBE OTHER ADVANCE DIRECTIVE(S). (PH24 – 91)
 

 _______________________________________ 

 

PH25 Where Stayed Before HHC 

 Immediately before {sampled patient} began receiving {home health/hospice} care 

 from this agency, was he/she an inpatient in a hospital, nursing home, or some other kind 

 of health care facility? 

 For the most recent episode of care. 

 

 PRESS F1 FOR HELP SCREEN. 

 1 YES 

 2 NO 

 REFUSED

 DON'T KNOW
 

Series 1, No. 53 □ Page 140 
 

 

PH25A Place Stayed Before Care 

 What kind of place was that? 

 

 PRESS F1 FOR HELP SCREEN. 

 

 1 HOSPITAL/EMERGENCY ROOM 

 2 NURSING HOME/SKILLED NURSING FACILITY/SUB-ACUTE FACILITY 

 3 REHABILITATION FACILITY 

 4 ASSISTED LIVING 

 91 OTHER (SPECIFY) 

REFUSED
 

DON'T KNOW
 

PH25B SPECIFY FACILITY TYPE
 

 

 What kind of place was that {OTHER SPECIFY}? (PH25A – 91)
 

 _____________________________ 

PH26 Where Stay After HHC 

 Does {sampled patient} now live in a private home or apartment, in a residential care 

 place or somewhere else? 

 

 Residential care place refers to an assisted living facility, a board 

 and care home, a life care or a continuing care retirement community. 

 

 1 PRIVATE HOME OR APARTMENT
 

 2 RESIDENTIAL CARE PLACE
 

 91 OTHER (SPECIFY) 

 

REFUSED
 

DON'T KNOW
 

PH26A Specify Place
 

 Specify Place. (PH 26 – 91)
 

_________________________ 

Series 1, No. 53 □ Page 141 
 

PH27 Where Staying Before HHC 

 Where was {sampled patient} staying when (he/she) first began receiving hospice care? 

 

 NOTE: A RESIDENTIAL CARE PLACE INCLUDES AN ASSISTED LIVING FACILITY, A BOARD 

 AND CARE HOME, A LIFE CARE OR A CONTINUING CARE RETIREMENT COMMUNITY. 

 

 1 THIS AGENCY'S INPATIENT/ RESIDENTIAL FACILITY
 

 2 PRIVATE HOME OR APARTMENT
 

 3 RESIDENTIAL CARE PLACE
 

 4 SKILLED NURSING FACILITY (NURSING HOME)
 

 5 HOSPITAL
 

 91 OTHER PLACE (SPECIFY) 

REFUSED
 

DON'T KNOW
 

PH27A Specify Facility Type 

 SPECIFY FACILITY TYPE. 

 ______________________ 

PH28 Where Last Day Hospice Care 

 

 Where was {sampled patient} staying on the last day (he/she) received hospice care ? 

 

 NOTE: A RESIDENTIAL CARE PLACE INCLUDES AN ASSISTED LIVING FACILITY, A BOARD 

 AND CARE HOME, A LIFE CARE OR A CONTINUING CARE RETIREMENT COMMUNITY. 

 1 THIS AGENCY'S INPATIENT/ RESIDENTIAL FACILITY
 

 2 PRIVATE HOME OR APARTMENT
 

 3 RESIDENTIAL CARE PLACE
 

 4 SKILLED NURSING FACILITY (NURSING HOME)
 

 5 HOSPITAL
 

 91 OTHER PLACE (SPECIFY) 

REFUSED
 

DON'T KNOW
 

PH28A Facility Type
 

SPECIFY FACILITY TYPE. (PH28 – 91)
 

 _________________________________ 

Series 1, No. 53 □ Page 142 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 143 

PH29 Living Companion During HHC 

Who does {sampled patient} currently live with? Or Who was (he/she) living with while 

receiving hospice care? 

SELECT ALL THAT APPLY. 

1 ALONE
 

2 SPOUSE/SIGNIFICANT OTHER
 

3 PARENT
 

4 CHILD (INCLUDING DAUGHTER/SON-IN-LAW)
 

5 OTHER FAMILY MEMBER
 

6 NON-FAMILY MEMBER(S)
 

REFUSED
 

DON'T KNOW
 

PH30 Any Outside Primary Care 

Does {sampled patient} now/or Did {sampled patient}} have a primary caregiver outside 

of this agency? 

PRESS F1 FOR HELP SCREEN. 

1 YES
 

2 NO
 

REFUSED
 

DON'T KNOW
 

PH32 Caregiver Relationship to Sampled Patient 

Who {is/was} {PATIENT}'s primary caregiver? 

1 SPOUSE/SIGNIFICANT OTHER 

2 PARENT 

3 CHILD (INCLUDING DAUGHTER/SON-IN-LAW) 

4 OTHER FAMILY MEMBER 

5 NOT RELATED 

REFUSED

 DON'T KNOW 
 

PH34 Primary Diagnosis 

 According to {sample patient}’s medical records, what was the primary diagnosis or 

 condition at the time (he/she) was admitted to this agency (that is, on or around 

 ADMISSION DATE)? _______________ 

 

 REFUSED
 

 DON'T KNOW
 

PH34A SPECIFY Primary Diagnosis 

 Specify Primary Diagnosis. 

 

 __________________________________ 

PH35 Current Primary Diagnosis 

 

 What is {sampled patients}’s current primary diagnosis or condition/What was the primary 

 diagnosis or condition at discharge? 

 

 __________________________________ 

 

 REFUSED
 

 DON'T KNOW
 

PH35A Specify Primary Diagnosis 

 Specify Primary Diagnosis. 

 ________________________________ 

PH36a_o Diagnoses At Discharge 

 What {are/were} all the other conditions {sampled patient} {currently has/had at
 

 discharge}?
 

 

 Anything else?
 

 

 PRESS F1 FOR HELP SCREEN.
 

 PH36A1_15 Specify Secondary Diagnoses 

 ________________________________ 

Series 1, No. 53 □ Page 144 
Series 1, No. 53 □ Page 145 

PH37 Surgical/Diagnostic Procedures at Admission 

 Did {sampled patient} have any surgical, diagnostic or therapeutic procedures or 

 treatments that were related to (his/her) admission to this agency (for the current 

 episode of care)? 

1 YES 

2 NO 

 

 REFUSED 

 DON'T KNOW 

PH38 Procedure/Operation Description 

 

 What kind of operation or procedure did {sampled patient} have? 

 

 Any others? 

 Enter all procedures. ___________________________ 

PH38A1_5 Other Specify Procedure / Operation
 

 Enter other specified procedures. ____________________
 

PH39 Pressure Ulcers Prior to Discharge 

 

 Does (sampled patient) now/or on the last day (patient) received hospice care, did 

 (he/she) have pressure ulcers? 

 

 **A pressure ulcer is any lesion caused by pressure, resulting in damage to underlying 

 tissue. 

1 YES 

2 NO 

 

 REFUSED 

 DON'T KNOW 
 

PH40 Highest Stage of Pressure Ulcer 

 SHOW CARD PH40 

 

 Please look at this card and tell me the highest stage of any pressure 

 ulcer the patient has now or had. 

 

 1 STAGE I
 

 2 STAGE II
 

 3 STAGE III
 

 4 STAGE IV
 

 5 UNSTAGED (NOT ASSESSED)
 

 REFUSED
 

 DON'T KNOW
 

PH41 Status At Highest Pressure Ulcer Stage
 

 SHOW CARD PH41
 

 

 What {is/was} the last recorded healing status of this pressure ulcer?
 

 

 PRESS F1 FOR HELP SCREEN.
 

 

 1 FULLY GRANULATING 

 2 EARLY/PARTIAL GRANULATION 

 3 NOT HEALING 

 91 OTHER (SPECIFY) 

 REFUSED 

 DON'T KNOW 

PH41A Specify Pressure Ulcer Status (PH41 – 91) 

 Other Specify status of pressure ulcer 

 ________________________________________ 

PH42 Pressure Ulcers Prior to Discharge 

 Is/Was patient comatose or in a vegetative state {at the time (he/she) was 

 admitted to this agency for hospice care}? 

 1 YES
 

 2 NO
 

 

REFUSED
 

DON'T KNOW
 

Series 1, No. 53 □ Page 146 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 147 

PH42A Need Help Dressing 

Does/At admission, did patient need any help from another person with the 

following activity? 

Dressing 

PRESS F1 FOR HELP SCREEN. 

1 YES 

2 NO 

REFUSED 

DON'T KNOW 

PH42A1 Agency Help Dressing 

Do/Did any agency staff help the patient with dressing? 

1 YES 

2 NO 

REFUSED 

DON'T KNOW 

PH42B Need Help Bathing 

Does/At admission, did patient need any help from another person with 

the following activity ? 

Bathing 

1 YES 

2 NO 

REFUSED 

DON'T KNOW 

PH42B1 Agency Help Bathing 

Do/Did any agency staff help patient with bathing? 

1 YES
 

2 NO
 

REFUSED 

DON'T KNOW 
Series 1, No. 53 □ Page 148 

PH42C Need Help Using Toilet 

 Does/At admission, did patient need any help from another person with the 

 following activity? 

 

 Using Toilet 

 

 1 YES 

 2 NO 

 

REFUSED 

DON'T KNOW 

PH42C1 Agency Help Toilet 

 

 Do/Did any agency staff help patient with using the toilet? 

 1 YES
 

 2 NO
 

REFUSED
 

DON'T KNOW
 

PH42D Help Getting In or Out of Bed or Chairs 

 

 At admission, did patient need any help from another person with the 

 following activity? 

 Getting in or out of bed or chairs 

 

 

 1 YES
 

 2 NO
 

 3 DOESN'T DO
 

 

 REFUSED
 

DON'T KNOW
 

PH42D1 Agency Help Getting In or Out of Bed
 

 

 Do/Did any agency staff help the patient with getting in or out of bed or chairs?
 

 

 1 YES 

 2 NO 

REFUSED 

DON'T KNOW 
 

PH42E Help in Walking Or Climbing Stairs 

 Does/At admission, did patient need any help from another person with the 

 following activity? 

 

 Walking or Climbing Stairs 

 

 

 1 YES
 

 2 NO
 

 3 DOESN'T DO
 

 

REFUSED
 

DON'T KNOW
 

PH42E1 Agency Help with Walking Or Climbing Stairs
 

 

 Do/Did any agency staff help the patient with walking or climbing stairs?
 

 

 1 YES 

 2 NO 

REFUSED 

DON'T KNOW 

PH42F Help Eating Or Feeding 

 

 At admission, did patient need any help from another person with the 

 following activity? 

 Eating or feeding (himself/herself) 

 

 

 PRESS F1 FOR HELP SCREEN. 

 _________________________________________ 

 REFUSED 

 DON'T KNOW 

PH42F1 Agency Help Eating
 

 Do/Did any agency staff help the patient with eating or feeding himself/herself?

 

 1 YES 

 2 NO 

REFUSED 

DON'T KNOW 

Series 1, No. 53 □ Page 149 


 
Series 1, No. 53 □ Page 150 

PH44G Preparing or Taking Medication Help 

 

 Does patient currently/did patient receive any help from this agency’s staff with the 

 following activity? 

 

 PRESS F1 FOR HELP SCREEN. 

 

 1 YES
 

 2 NO
 

 3 DOESN'T DO
 

REFUSED
 

 DON'T KNOW
 

PH47 Mental Status In Hospice Care 

 SHOW CARD PH47 

 

 Please look at this card and tell me which category best describes patient’s current 

 level of cognitive functioning or current mental status at the time (he/she) was 

 admitted to this agency for hospice care. 

 

 

 0	 NO COGNITIVE IMPAIRMENT 

 1	 REQUIRE{S/D} ONLY OCCASIONAL REMINDERS (IN NEW SITUATIONS) 

 2	 REQUIRE{S/D} SOME ASSISTANCE/DIRECTION IN CERTAIN SITUATIONS 

(IS EASILY DISTRACTED) 

 3	 REQUIRES A GREAT DEAL OF ASSISTANCE/DIRECTION IN ROUTINE SITUATIONS 

 4	 SEVERE COGNITIVE IMPAIRMENT (CONSTANTLY DISORIENTED, COMATOSE, 

 DELIRIUM) 

REFUSED
 

DON'T KNOW
 
Series 1, No. 53 □ Page 151 

PH48 Aids Or Devices Used 

 SHOW CARD PH48
 

 

 Which of these aids or special devices on this card does the patient use?
 

 

 PROBE: Any others?
 

 

 SELECT ALL THAT APPLY.
 

 

 1 WALKER/CANE/CRUTCH 

 2 WHEELCHAIR 

 3 MOTORIZED CART/SCOOTER 

 4 ORTHOTICS (INCLUDING BRACES) 

 5 PROSTHETICS (LIMBS) 

 6 NONE OF THESE 

REFUSED 

DON'T KNOW 

PH49 Activity Assistive Devices 

 SHOW CARD PH49
 

 

 Which of these aids or special devices on this card does the patient use?
 

 

 PROBE: Any others?
 

 

 SELECT ALL THAT APPLY.
 

 

 

 1 BEDSIDE COMMODE 

 2 ELEVATED/RAISED TOILET SEAT 

 3 HOSPITAL BED 

 4 SPECIALIZED MATTRESS (EGG CRATE, FOAM, AIR, GEL, ETC.) 

 5 SPECIALIZED CHAIRS (GERI CHAIR, LIFT CHAIRS) 

 6 GRAB BARS 

 7 TRANSFER EQUIPMENT (LIFTS, GAIT BELTS) 

 8 SHOWER CHAIR/BATH BENCH 

 9 OVER BED TABLE 

 10 EATING DEVICES (BUILT UP UTENSILS, PLATE GUARD, NON-SPILL CUP) 

 11 NONE OF THESE 

REFUSED 

DON'T KNOW 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 152 

PH50 Hospice Medical Devices Used 

SHOW CARD {PH50a/PH50b} 

Which of the medical devices on this card does the patient use/did patient use while in 

hospice care? 

PROBE: Any others? 

SELECT ALL THAT APPLY. 

PRESS F1 FOR HELP SCREEN. 

1 IV INFUSION PUMP (LARGE VOLUME) 

2 PATIENT CONTROLLED ANALGESIA PUMP 

3 AMBULATORY INFUSION PUMP (OTHER THAN INSULIN) 

4 PERITONEAL/HEMODIALYSIS 

5 OXYGEN (OXYGEN CONCENTRATOR, LIQUID, TANK OR OTHER DELIVERY SYSTEM) 

6 METERED DOSE INHALER 

7 APNEA MONITOR 

8 CONTINUOUS POSITIVE PRESSURE AIRWAY (CPAP) 

9 BLOOD GLUCOSE MONITOR 

10 ENTEROSTOMAL DEVICE (URINE OR STOOL BAG)
 

11 ENTERAL (NASOGASTRIC OR OTHER) TUBE FEEDING EQUIPMENT
 

12 PARENTERAL IV (TPN)
 

13 PRESSURE RELIEVING DEVICES (SPECIAL BED, MATTRESS, OR OVERLAY)
 

14 NONE OF THESE
 

REFUSED
 

DON'T KNOW
 

PH51 Agency Staff Support 

Does/Did this agency’s staff provide support with instruction, maintenance or monitoring of 

any of those medical devices for patient? 

1 YES 

2	 NO
 

REFUSED
 

DON'T KNOW
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 153 

PH52 Medical Devices 

Which ones? 

PROBE: Any others? 

SELECT ALL THAT APPLY. 

1 IV INFUSION PUMP (LARGE VOLUME) 

2 PATIENT CONTROLLED ANALGESIA PUMP 

3 AMBULATORY INFUSION PUMP (OTHER THAN INSULIN) 

4 PERITONEAL/HEMODIALYSIS 

5 OXYGEN (OXYGEN CONCENTRATOR, LIQUID, TANK OR OTHER DELIVERY SYSTEM) 

6 METERED DOSE INHALER 

7 APNEA MONITOR 

8 CONTINUOUS POSITIVE PRESSURE AIRWAY (CPAP) 

9 BLOOD GLUCOSE MONITOR 

10 ENTEROSTOMAL DEVICE (URINE OR STOOL BAG) 

11 ENTERAL (NASOGASTRIC OR OTHER) TUBE FEEDING EQUIPMENT 

12 PARENTERAL IV (TPN) 

13 PRESSURE RELIEVING DEVICES (SPECIAL BED, MATTRESS, OR OVERLAY) 

REFUSED
 

DON'T KNOW
 

PH53 Urinary Catheter Use 

During hospice care did patient have a urinary catheter? 

1 YES 

2 NO 

REFUSED 

DON'T KNOW 

PH54 Bladder Control Difficulty 

Does / Did patient have difficulty controlling (his/her) bladder? 

1 YES
 

2 NO
 

3 NOT APPLICABLE
 

REFUSED
 

DON'T KNOW
 
 

PH55 Ostomy Usage 

 Does/Did patient have a colostomy or ileostomy for bowel elimination? 

 

 1 YES 

 2	 NO
 

REFUSED
 

DON'T KNOW
 

PH56 Bowel Control Problem 

 Does/Did patient have difficulty controlling (his/her) bowels? 

 

 1 YES 

 2 NO 

REFUSED 

DON'T KNOW 

PH57A Month First Pain Assessed 

 On what date was patient first assessed for pain (for the episode of care 

 beginning on (admission date))? 

 

 ENTER MONTH. ___________________
 

 

 IF PATIENT NOT ASSESSED FOR PAIN SINCE ADMISSION, ENTER 99.
 

 

 IF PATIENT ASSESSED FOR PAIN ON SAME DAY AS ADMISSION, ENTER 97.
 

PH57B Day First Pain Assessed
 

 On what date was patient first assessed for pain (for the episode of care
 

 beginning on (admission date)). 

 

 ENTER DAY. _______________________
 

Series 1, No. 53 □ Page 154 
 

PH57B Year First Pain Assessed
 

 On what date was patient first assessed for pain (for the episode of care
 

 beginning on (admission date)). 

 ENTER 4-DIGIT YEAR. _______________________
 

PH58 Pain Assessment Tool Used 

 SHOW CARD PH58 

 

 What type of pain assessment tool was used to assess patient’s pain? 

 

 IF MORE THAN ONE PAIN ASSESSMENT TOOL REPORTED, ASK: 

 Which of those pain assessment tools gave the most accurate 

 assessment for patient’s pain level? 

 

 1 0-10 SCALE 

 2 0-5 SCALE 

 3 WORD SCALE (MILD, MODERATE, SEVERE) 

 4 FACE SCALE (0-5) 

 5 FACE SCALE (0-10) 

 6 FLACC 

 7 OBSERVATION OF PATIENT'S BEHAVIOR 

 8 PATIENT'S/FAMILY'S DESCRIPTION OF PAIN 

 91 OTHER ASSESSMENT TOOLS (SPECIFY) 

 

REFUSED
 

DON'T KNOW
 

 

PH58A Specify Pain Assessment Tool 

 Specify pain assessment tool. 

 ___________________________________________ 

Series 1, No. 53 □ Page 155 
Series 1, No. 53 □ Page 156
 

PH59A Pain Level Recorded 1
 

 What was the level of patient’s pain recorded at that assessment 

 (Date of assessment)? 

 

 0 PAIN LEVEL 0
 

 1 PAIN LEVEL 1
 

 2 PAIN LEVEL 2
 

 3 PAIN LEVEL 3
 

 4 PAIN LEVEL 4
 

 5 PAIN LEVEL 5
 

 6 PAIN LEVEL 6
 

 7 PAIN LEVEL 7
 

 8 PAIN LEVEL 8
 

 9 PAIN LEVEL 9
 

 10 PAIN LEVEL 10 

 

REFUSED
 

DON'T KNOW
 

 

PH59B Pain Level Recorded 2
 

 What was the level of patient’s pain recorded at that assessment on date of assessment? 

 

 0 PAIN LEVEL 0
 

 1 PAIN LEVEL 1
 

 2 PAIN LEVEL 2
 

 3 PAIN LEVEL 3
 

 4 PAIN LEVEL 4
 

 5 PAIN LEVEL 5
 

 

REFUSED
 

DON'T KNOW
 

PH59C Pain Level Recorded 3
 

 What was the level of patient’s pain recorded at that assessment on date of assessment? 

 

 1 PAIN LEVEL MILD
 

 2 PAIN LEVEL MODERATE
 

 3 PAIN LEVEL SEVERE
 

 4 NO PAIN
 

 

REFUSED
 

DON'T KNOW
 
 

PH59D What Level Pain Recorded 

 What was the level of patient’s pain recorded at that assessment on date of assessment? 

 

 IF PAIN CANNOT BE DESCRIBED, STATED OR REPORTED, ENTER 999. 

 

 ________________________________________ 

 REFUSED

 DON'T KNOW
 

PH60A Month Last Pain Assessed 

 When was the last time the patient was assessed for pain for the episode of care that 

 ended on (discharge date)? 

 

 

 ENTER MONTH. ______________ 

 

 REFUSED 

 DON'T KNOW 

PH60B Day Last Pain Assessed 

 When was the last time the patient was assessed for pain for the episode of care that 

 ended on (discharge date). 

 

 ENTER DAY. ____________ 

 

 REFUSED
 

 DON'T KNOW
 

PH60C Year Last Pain Assessed 

 

 When was the last time the patient was assessed for pain for the episode of care that 

 ended on (discharge date)? 

 

 ENTER A 4-DIGIT YEAR. __________ 

 REFUSED
 

 DON'T KNOW
 

Series 1, No. 53 □ Page 157 
 

PH61 Pain Assessment Tool Used 1 

 SHOW CARD PH61 

 

 What type of pain assessment tool was used to assess patient’s pain {that time}? 

 

 IF MORE THAN ONE PAIN ASSESSMENT TOOL REPORTED, ASK: 

 Which of those pain assessment tools gave the most accurate 

 assessment for the patient’s pain level? 

 1 0-10 SCALE
 

 2 0-5 SCALE
 

 3 WORD SCALE (MILD, MODERATE, SEVERE)
 

 4 FACE SCALE (0-5)
 

 5 FACE SCALE (0-10)
 

 6 FLACC
 

 7 OBSERVATION OF PATIENT'S BEHAVIOR
 

 8 PATIENT'S/FAMILY'S DESCRIPTION OF PAIN
 

 91 OTHER ASSESSMENT TOOLS (SPECIFY)
 

 REFUSED
 

DON'T KNOW
 

 

PH61A Specify Pain Assessment Tool X 

 Specify pain assessment tool. 

 ____________________________________ 

PH61B Pain Level Recorded 3X 

 What was the level of the patient’s pain recorded at that assessment (date of assessment)? 

 

 0 PAIN LEVEL 0
 

 1 PAIN LEVEL 1
 

 2 PAIN LEVEL 2
 

 3 PAIN LEVEL 3
 

 4 PAIN LEVEL 4
 

 5 PAIN LEVEL 5
 

 6 PAIN LEVEL 6
 

 7 PAIN LEVEL 7
 

 8 PAIN LEVEL 8
 

 9 PAIN LEVEL 9
 

 10 PAIN LEVEL 10
 

 

REFUSED
 

DON'T KNOW
 

Series 1, No. 53 □ Page 158 
 

PH61C Pain Level Recorded 4
 

 

 What was the level of the patient’s pain recorded at that assessment (date of assessment)?
 

 

 0 PAIN LEVEL 0 

 1 PAIN LEVEL 1 

 2 PAIN LEVEL 2 

 3 PAIN LEVEL 3 

 4 PAIN LEVEL 4 

 5 PAIN LEVEL 5 

 

REFUSED 

DON'T KNOW 

PH61D Pain Level Recorded 5 

 What was the level of the patient’s pain recorded at that assessment (on date of 

 assessment). 

 1 PAIN LEVEL MILD 

 2 PAIN LEVEL MODERATE 

 3 PAIN LEVEL SEVERE 

 4 NO PAIN 

 

REFUSED 

DON'T KNOW 

 

PH62 Pain Level Assessment Date 

 

 What was the level of the patient’s pain recorded at that assessment (on date of
 

 Assessment).
 

 

 RECORD DESCRIPTION OF PAIN LEVEL.
 

 

 IF PAIN LEVEL CANNOT BE DESCRIBED, STATED OR REPORTED, ENTER 999.
 

 _________________________ 

 REFUSED
 

 DON'T KNOW
 

Series 1, No. 53 □ Page 159 
 

PH64 Pain Management Strategy 

 SHOW CARD PH64 

 

 According to the patient’s medical record, what strategies on this card are/were used to 

 manage (his/her) pain. 

 SELECT ALL THAT APPLY. 

 

 PRESS F1 FOR HELP SCREEN. 

 1 STANDING ORDER FOR PAIN MEDICATION 

 2 PRN ORDER FOR PAIN MEDICATION 

 3 NON-PHARMACOLOGICAL METHODS (DISTRACTION, HEAT/COLD 

MASSAGE/POSITIONING, MUSIC THERAPY)
 

 4 NO STRATEGIES SPECIFIED
 

 91 OTHER (SPECIFY)
 

 REFUSED
 

DON'T KNOW
 

PH64A Specify Pain Management Strategy. 

 ____________________________________ 

Series 1, No. 53 □ Page 160 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 161 

PH66 Medical Services Received 

SHOW CARD {PH66A/PH66B} 

What services did/does the patient receive from this agency during the last 60 days
 

in which the patient was receiving care from the agency since admission during his/her
 

hospice care?
 

Include services received from the agency as a result of contractual arrangements.
 

SELECT ALL THAT APPLY.
 

PRESS F1 FOR HELP.
 

1 SKILLED NURSING SERVICES
 

2 PHYSICIAN SERVICES
 

3 PHARMACY SERVICES
 

4 PODIATRY SERVICES
 

5 WOUND CARE
 

6 DIETARY AND NUTRITIONAL SERVICES
 

7 TELEMEDICINE
 

8 NONE OF THESE
 

REFUSED
 

DON'T KNOW
 

PH67 Other Services Received 

SHOW CARD PH67 

What other services did/does the patient receive from this agency during the last 60 days 

in which the patient was receiving care from the agency since admission during his/her 

hospice care? 

Include services received from the agency as a result of contractual arrangements. 

PROBE: Any others on this card? 

SELECT ALL THAT APPLY. 

PRESS F1 FOR HELP 

1 HOMEMAKER SERVICES
 

2 ASSISTANCE WITH ADLs
 

3 VOLUNTEER SERVICES
 

4 CONTINUOUS HOME CARE
 

5 MEALS ON WHEELS
 

6 TRANSPORTATION
 

7 OCCUPATIONAL THERAPY
 

8 PHYSICAL THERAPY
 

9 RESPIRATORY THERAPY
 

10 SPEECH THERAPY/AUDIOLOGY
 

11 COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)
 

12 NONE OF THESE
 

REFUSED
 

DON'T KNOW
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 162 

PH68 Counseling and/or Psychosocial Services 

SHOW CARD PH68 

Which of these services were provided from this agency during the last 60 

days of care since admission? 

Include services received from {AGENCY} as a result of contractual arrangements. 

PROBE: Any others on this card? 

SELECT ALL THAT APPLY. 

PRESS F1 FOR HELP SCREEN. 

1 PASTORAL SPIRITUAL SERVICES
 

2 DIETARY COUNSELING
 

3 ETHICAL ISSUES COUNSELING
 

4 REFERRAL SERVICES
 

5 (MEDICAL) SOCIAL SERVICES
 

6 MENTAL HEALTH SERVICES
 

7 RESPITE SERVICES
 

8 INTERPRETER SERVICES
 

9 NONE OF THESE
 

REFUSED
 

DON'T KNOW
 

PH70 Service Type Provided 

SHOW CARD PH70 

Did this agency offer or provide the patient’s family members or friends any of the 

services listed on this card? Which ones? 

Include services received from the agency as a result of contractual arrangements. 

SELECT ALL THAT APPLY. 

PRESS F1 FOR HELP SCREEN. 

1 BEREAVEMENT 

2 CAREGIVER HEALTH/WELLNESS 

3 SPIRITUAL 

4 DIETARY 

5 DEALING WITH DIFFICULT BEHAVIORS 

6 MEDICATION MANAGEMENT/ADMINISTRATION 

7 EQUIPMENT USE 

8 PATIENT ADLS (BATHING, DRESSING, TOILETING, FEEDING, ETC.) 

9 SAFETY TRAINING 

10 SUSPECTED ABUSE/NEGLECT/EXPLOITATION 

11 REFERRAL/RESOURCE INFORMATION 

12 RESPITE CARE 

13 NO SERVICES OFFERED OR PROVIDED 

91 OTHER (SPECIFY) 

REFUSED
 

DON'T KNOW
 
 

PH70A Specify Service Type 

 

 Specify type of service. 

 __________________________________ 

PH71A Staff Visits Received 

 

 How many visits did (he/she) receive from agency’s staff for nursing services? 

 

 Nursing services include nursing care and nursing services provided by or under 

 the supervision of a RN. 

 

 Number of (nursing service) visits ___________ 

 REFUSED 

 DON'T KNOW 

PH71B Number of Staff Visits 

 

 How many visits did the patient receive from this agency’s staff during his/her hospice 

 care? 

 

 Number of (physician services) visits ___________ 

 

 REFUSED 

 DON'T KNOW 

PH71D Medical Social Services Visits 

 How many visits were there for medical social services? 

 

 PRESS F1 FOR HELP SCREEN. 

 

 Number of (medical social services) visits ___________ 

 REFUSED 

 DON'T KNOW 

PH71E Volunteer Services Visits 

 How many visits were there for volunteer services? 

 

 Number of (volunteer services) visits ___________ 

 

 REFUSED 

 DON'T KNOW 

Series 1, No. 53 □ Page 163 
 

 

 s

 

 

 

 

 

 

PH71G P

 

 

 i

 

 

 

 

 

PH71H O

 

 

 i

 

 

 

 

PH71I S

 

 

 i

 

 

 

 

staff 

staff 

Series 1, No. 53 □ Page 164 

PH71F Skilled Nursing Visits 

 How many visits did the patient receive for skilled nursing service from the agency’s staff 

 in the past 60 days (prior to interview) since admission? 

 

Nursing services include: nursing care and nursing services provided by or under the 

upervision of an RN. 

PRESS F1 FOR HELP SCREEN. 

Number of skilled nursing service visits ____________ 

REFUSED 

DON'T KNOW 

hysical Therapy Visits 

How many visits did the patient receive for physical therapy from the agency’s staff

n the past 60 days (prior to interview) since admission? 

PRESS F1 FOR HELP SCREEN. 

Number of physical therapy visits _______________ 

REFUSED 

DON'T KNOW 

ccupational Therapy Visits 

How many visits did the patient receive for occupational therapy from the agency’s 

n the past 60 days (prior to interview) since admission? 

PRESS F1 FOR HELP SCREEN. 

Number of occupational therapy visits ______________ 

REFUSED 

DON'T KNOW 

peech Therapy Visits 

How many visits did the patient receive for occupational therapy from the agency’s 

n the past 60 days (prior to interview) since admission? 

PRESS F1 FOR HELP SCREEN. 

Number of speech therapy visits _____________ 

REFUSED 

DON'T KNOW 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 165 

PH71J Medical Social Services Visits 

How many visits did the patient receive for occupational therapy from the agency’s staff 

in the past 60 days (prior to interview) since admission? 

PRESS F1 FOR HELP SCREEN.
 

Number of medical social service visits _____________ 

REFUSED
 

DON'T KNOW 

PH71K Home Health Aide and Homemaker Visits 

How many visits did the patient receive for occupational therapy from the agency’s staff 

in the past 60 days (prior to interview) since admission? 

PRESS F1 FOR HELP SCREEN.
 

Number of home health aide and homemaker visits _____________ 

REFUSED
 

DON'T KNOW
 

PH73 Emergency Care Services 

SHOW CARD PH73 

Did or has the patient used any of these services for emergent care during the last 60 

days (prior to interview) since admission ? 

SELECT ALL THAT APPLY. 

PRESS F1 FOR HELP SCREEN. 

1 HOSPITAL EMERGENCY ROOM (INCLUDES 23-HOUR HOLDING) 

2 DOCTOR'S OFFICE EMERGENCY VISIT/HOUSE CALL 

3 OUTPATIENT DEPARTMENT/CLINIC (INCLUDES URGICENTER SITES) 

4 NO EMERGENT CARE 

REFUSED
 

DON'T KNOW
 
 

PH74 Emergency Care Reason 

 For what reason did (he/she) obtain emergent care?
 

 

 SELECT ALL THAT APPLY.
 

 

 PRESS F1 FOR HELP SCREEN.
 

 

 1 MEDICATION PROBLEM/COMPLICATION (IMPROPER MEDICATION 

ADMINISTRATION, MEDICATION SIDE EFFECTS, TOXICITY, ANAPHYLAXIS) 

 2 NAUSEA, DEHYDRATION, MALNUTRITION, CONSTIPATION, IMPACTION 

 3 INJURY DUE TO A FALL 

 4 OTHER TYPE OF INJURY 

 5 RESPIRATORY PROBLEMS (E.G., SHORTNESS OF BREATH, RESPIRATORY 

INFECTION, TRACHEOBRONCHIAL OBSTRUCTION) 

 6 WOUND INFECTION, DETERIORATING 

WOUND STATUS, NEW LESION/ULCER 

 7 CARDIAC PROBLEMS (E.G., FLUID OVERLOAD, EXACERBATION OF CHF, 

CHEST PAIN) 

 8 HYPOGLYCEMIA/HYPERGLYCEMIA, 

DIABETES OUT OF CONTROL 

 9 GI BLEEDING/OBSTRUCTION 

 10 URINARY TRACT INFECTION (UTI) 

 11 UNCONTROLLED PAIN 

 91 OTHER (SPECIFY) 

REFUSED 

DON'T KNOW 

PH74A Specify Reason for Emergent Care 

 SPECIFY REASON FOR EMERGENT CARE. 

 ______________________________ 

PH75 Overnight Hospital Stay 

 

 Since being admitted to this agency has the patient had a hospital admission that 

 required an overnight stay where (he/she) she was not formally discharged from the 

 agency? 

 

 1 YES
 

 2 NO
 

 

 REFUSED
 

 DON’T KNOW
 

Series 1, No. 53 □ Page 166 
 

PH76a_y	 PRN Medications 

 

 What are the names of all the medications and drugs the patient currently 

 takes or was taking seven days prior to and on the day of his/her
 

 discharge/death while in hospice?
 

 

 Please include any standing, routine, or PRN medications.
 

 

 Enter all drugs. ______________ 

 

PH76A1_25	 Specify Medication 

 ________________________________ 

PH77	 Symptoms Prior to Discharge 

 SHOW CARD PH77 

 

 When this agency last provided care to the patient did (he/she) have any of these 

 symptoms? Before (his/her) death. 

 

 SELECT ALL THAT APPLY. 

 

 1 DIFFICULTY BREATHING (DYSPNEA)
 

 2 END STAGE RESTLESSNESS
 

 3 DEPRESSION
 

 4 PAIN
 

 5 CONSTIPATION
 

 6 ANOREXIA
 

 7 NONE OF THESE
 

 

 REFUSED
 

 DON'T KNOW
 

Series 1, No. 53 □ Page 167 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 168 

PH78 Care Or Treatments Received 

SHOW CARD PH78 

Which formal care or treatments did the patient receive while in hospice care? 

SELECT ALL THAT APPLY. 

PRESS F1 FOR HELP SCREEN. 

1 IV THERAPY 

2 TRANSFUSION 

3 TUBE FEEDING (NASOGASTRIC/OTHER ENTERAL FEEDINGS) 

4 HYPODERMCLYSIS 

5 TOTAL PARENTERAL NUTRITION (TPN) 

6 RESPIRATORY THERAPY 

7 RADIATION THERAPY 

8 CHEMOTHERAPY 

9 PALLIATIVE SEDATION 

10 NONE OF THESE 

REFUSED

 DON'T KNOW 

PH79 Level of Hospice Care 

SHOW CARD PH79 

Which level of hospice care on this card was the patient receiving at the time of 

his/her discharge? 

1 ROUTINE HOME CARE FOR PATIENTS 

RECEIVING HOSPICE SERVICES IN THEIR HOMES 

2 CONTINUOUS HOME CARE PROVIDED 8 TO 24 HOURS PER DAY 

PRIMARILY BY SKILLED HOSPICE PERSONNEL 

3 GENERAL INPATIENT CARE PROVIDED BY SKILLED HOSPICE STAFF 

4 INPATIENT RESPITE CARE TO RELIEVE THE PRIMARY CAREGIVER 

REFUSED

 DON'T KNOW
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 169 

PH80 Life Expectancy 

According to the patient’s medical record, does (his/her) current prognoses indicate a life 

expectancy of greater than 6 months, or 6 months or less? 

Is (he/she) only receiving palliative, end of life, or terminal care instead of active or 

curative treatment? 

0 YES, LIFE EXPECTANCY GREATER THAN 6 MONTHS 

1 YES, LIFE EXPECTANCY 6 MONTHS OR LESS 

2 NO, LIFE EXPECTANCY NOT INDICATED BUT RECEIVING PALLIATIVE/END OF 

LIFE CARE ONLY 

3 NO, LIFE EXPECTANCY NOT INDICATED AND NOT RECEIVING PALLIATIVE/END 

OF LIFE CARE 

REFUSED
 

DON'T KNOW
 

PH81 Symptoms Last Visit 

SHOW CARD PH81 

During this agency’s last visit to provide care to the patient, did (he/she) have any of 

these symptoms? 

SELECT ALL THAT APPLY. 

PRESS F1 FOR HELP SCREEN. 

1 DIFFICULTY BREATHING (DYSPNEA)
 

2 END STAGE RESTLESSNESS
 

3 DEPRESSION
 

4 PAIN
 

5 CONSTIPATION
 

6 ANOREXIA
 

7 NONE OF THESE
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 170 

PH82 Care or Treatment At Last Visit 

SHOW CARD PH82 

During this agency’s last visit, which formal care or treatments was {PATIENT} receiving? 

Include formal care/treatments the patient obtained from ANY provider, 

not just what the agency provided. 

SELECT ALL THAT APPLY. 

1 IV THERAPY 

2 TRANSFUSION 

3 TUBE FEEDING (NASOGASTRIC/OTHER ENTERAL FEEDINGS) 

4 HYPODERMCLYSIS 

5 TOTAL PARENTERAL NUTRITION (TPN) 

6 RESPIRATORY THERAPY 

7 RADIATION THERAPY 

8 CHEMOTHERAPY 

9 PALLIATIVE SEDATION 

10 NONE OF THESE 

REFUSED
 

DON'T KNOW
 
Series 1, No. 53 □ Page 171 

 __

PA1A M

 Is

 ty

 

 1 

 2 

 91 

PA1B Spe

 S

_________________________________________ 

Appendix XIII. CAPI: Charges and Payments (PA) 

Questionnaire 

PA1 Primary Source of Payment 

What {is/was} the primary source of payment for (sampled patient’s) home health/hospice 

 care? 

 IF PAYMENT NOT RECEIVED YET: What is the expected primary source of 

payment? 

1 MEDICARE 

2 MEDICAID 

3 TRICARE (FORMERLY CHAMPUS) 

4 DEPARTMENT OF VETERANS AFFAIRS 

5 CHAMPVA 

6 WORKER'S COMPENSATION 

7 OTHER GOVERNMENT 

8 PRIVATE INSURANCE 

9 LONG-TERM CARE INSURANCE 

10 SELF-PAY (PATIENT/FAMILY) 

11 NO CHARGE FOR CARE 

12 PAYMENT SOURCE NOT DETERMINED 

91 OTHER (SPECIFY) 

REFUSED 

DON'T KNOW 

edicare Fee Type 

 the Medicare fee for service (traditional Medicare), managed care, or some other 

pe of Medicare? 

FEE FOR SERVICE/TRADITIONAL MEDICARE
 

MANAGED CARE
 

OTHER MEDICARE 

REFUSED
 

DON'T KNOW
 

cify Medicare Type (PA1A – 91) 

PECIFY TYPE OF MEDICARE. 
 __________

 1 FEE 

 2 MAN

 91 OTH

 

REF

DO

PA1D Specify Medi

 SPECIFY TY

 _______

PA1E Specify Govt 

 SPECIFY OT

 _________

PA1F Private Insur

 Is the privat

 private insur

 1 FEE 

 2 MAN

 91 OTH

 

REF

DO

PA1G Specify Privat

 SPECIFY TYP

 _________

 

PA1H Specify Other 

 SPECIFY OTH

______________________________ 

Series 1, No. 53 □ Page 172 

PA1C Medicaid Fee Type 

 Is the Medicaid fee for service (traditional Medicaid), managed care, or some other 

 type of Medicaid? 

FOR SERVICE/TRADITIONAL MEDICAID
 

AGED CARE
 

ER MEDICAID 

USED
 

N'T KNOW
 

caid Type (PA1C – 91) 

PE OF MEDICAID. 

_____________________ 

Source Payment
 

HER TYPE OF GOVERNMENT SOURCE FOR PAYMENT.
 

_____________________________ 

ance Fee Type 

e insurance fee for service, managed care, or some other type of 

ance? 

FOR SERVICE
 

AGED CARE
 

ER PRIVATE INSURANCE 

USED
 

N'T KNOW
 

e Insurance (PA1F – 91) 

E PRIVATE INSURANCE. 

_________________________ 

Source Payment
 

ER SOURCE OF PAYMENT.
 
 

 

 

 

 

 

 

 

 

 _______________________________ 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 173 

PA2 Why Other Source Payment 

Is this because sampled patient (does/did not) have health insurance, or the agency’s 

services (he/she) received are not covered by insurance or some other reason? 

1 PATIENT DID NOT HAVE HEALTH INSURANCE
 

2 SERVICES NOT COVERED BY INSURANCE
 

91 OTHER (SPECIFY)
 

PA2A Specify Self Pay Reason (PA2 – 91) 

SPECIFY REASON FOR SELF-PAY. 

PA3 Other Payment Sources 

Besides {PA1 OR PA1F RESPONSE}, what {are/were} all other sources of payment 

for (sampled patient’s home health care) /(sampled patient’s hospice care)? 

SELECT ALL THAT APPLY. 

1 MEDICARE
 

2 MEDICAID
 

3 TRICARE (FORMERLY CHAMPUS)
 

4 DEPARTMENT OF VETERANS AFFAIRS
 

5 CHAMPVA
 

6 WORKERS COMPENSATION
 

7 OTHER GOVERNMENT
 

8 PRIVATE INSURANCE
 

9 LONG-TERM CARE INSURANCE
 

10 SELF-PAY (PATIENT/FAMILY)
 

11 NO OTHER PAYMENT SOURCES
 

91 OTHER (SPECIFY)
 

REFUSED
 

DON'T KNOW
 
PA3A Medicare Fee Type X 

 Is the Medicare fee for service (traditional Medicare), managed care, or some other 

 type of Medicare? 

 1 FEE FOR SERVICE/TRADITIONAL MEDICARE
 

 2 MANAGED CARE
 

 91 OTHER MEDICARE 

REFUSED
 

DON'T KNOW
 

PA3B Specify Type Medicare 

 

 SPECIFY TYPE OF MEDICARE.
 

 _______________________________________ 

PA3C Medicaid Type Fee 

 Is the Medicaid fee for service (traditional Medicaid), managed care, or some other 

 type of Medicaid? 

 

 1 FEE FOR SERVICE/TRADITIONAL MEDICAID
 

 2 MANAGED CARE
 

 91 OTHER MEDICAID
 

REFUSED
 

DON'T KNOW
 

PA3D Specify Type Medicaid 

 SPECIFY TYPE OF MEDICAID. 

 _____________________________________ 

 

PA3E Specify Other Govt Source Pay
 

 SPECIFY OTHER TYPE OF GOVERNMENT SOURCE FOR PAYMENT.
 

 _____________________________________ 

Series 1, No. 53 □ Page 174 
PA3F Private Insurance Fee Type X 

 Is the private insurance fee for service, managed care, or some other type of 

 private insurance? 

 1 FEE FOR SERVICE
 

 2 MANAGED CARE
 

 91 OTHER PRIVATE INSURANCE
 

REFUSED
 

DON'T KNOW
 

PA3G Private Insurance
 

 SPECIFY TYPE PRIVATE INSURANCE.
 

 _____________________________________ 

PA3H Other Source Payment Specify
 

 SPECIFY OTHER SOURCE OF PAYMENT.
 

 _____________________________________ 

PA4 Other Source Payment Reason 

 {Is/Was} the other source of payment "patient or family" because sampled patient does not 

 have health insurance, because the {agency’s services/hospice services} received 

 {are/were} not covered by insurance, or for some other reason? 

 1 PATIENT DID NOT HAVE HEALTH INSURANCE 

 2 SERVICES NOT COVERED BY INSURANCE 

 91 OTHER (SPECIFY) 

 

REFUSED
 

DON'T KNOW
 

PA4A Self Pay Reason (PA4 – 91) 

 SPECIFY REASON FOR SELF-PAY. 

 ________________________________________ 

Series 1, No. 53 □ Page 175 
 

Series 1, No. 53 □ Page 176 

PA6 Total Amount Billed 

 

 What was the total amount of the charges billed for sampled patient’s care received 

 for the last complete billing period (or since admission if (he/she) has not 

 been here for a complete billing period)/hospice care at the AGENCY? 

 

 IF NEEDED: This covers the time period from (his/her) admission on {ADMISSION 

 DATE} to (his/her) discharge on {DISCHARGE DATE}. 

 

 

 ENTER TOTAL AMOUNT OF CHARGES IN WHOLE DOLLARS. 

 

 IF NO CHARGES BILLED TO DATE, ENTER 0. 

 

 ___________________________________ 

 

 REFUSED

 DON'T KNOW 

PA7A Beginning Month Billed 

 What was the beginning date of the time period covered by this amount?
 

 

 ENTER MONTH (1-12). _____________
 

 

 REFUSED

 DON'T KNOW
 

PA7B Beginning Day Billed 

 What was the beginning date of the time period covered by this amount?
 

 

 ENTER DAY (1-31). _________________ 

 REFUSED
 

 DON'T KNOW
 

 

PA7C Beginning Year Billed 

 

 What was the beginning date of the time period covered by this amount? 

 

 ENTER YEAR. ________________ 

 
PA8A Ending Date Billed Month 

 What was the ending date of the time period covered by this amount?
 

 

 ENTER MONTH (1-12). _____________
 

 

 REFUSED

 DON'T KNOW
 

PA8B Ending Day Billed 

 What was the ending date of the time period covered by this amount?
 

 

 ENTER DAY (1-31). _________________ 

 REFUSED
 

 DON'T KNOW
 

 

PA8C Ending Year Billed 

 

 What was the ending date of the time period covered by this amount? 

 

 ENTER YEAR. ________________ 

 REFUSED 

 DON’T KNOW 

Series 1, No. 53 □ Page 177 
Series 1, No. 53 □ Page 178 

PA11 Total Amount Billed For Year 

 What was the total amount of the charges billed for sampled patient’s hospice 

 care at AGENCY for the 12-month period before (he/she) was discharged? 

 That would include the time period from (DATE ONE YEAR BEFORE DISCHARGE) to 

 (his/her) discharge on (DISCHARGE DATE). 

 

 

 ENTER WHOLE DOLLAR AMOUNT (0 to 999999). __________________ 

 REFUSED 

 DON'T KNOW 

PA14 Total Amount Paid 

 

 Of the total charges, how much did {PA1} pay?
 

 Include any amount {PA1} has already paid and additional payments you
 

 expect from {PA1}.
 

 

 ENTER WHOLE DOLLAR AMOUNT (0 to 999999). ________________
 

 REFUSED
 

 DON'T KNOW
 

PA14A Total Amount Paid Medicare FFS or TRICAR 

 

 Based on sampled patient’s current 60-day plan of care, what is the total 

 Medicare/TRICARE PPS payment, that is the RAP plus the final payment you 

 expect to receive for this 60-day episode? 

 ENTER WHOLE DOLLAR AMOUNT (0 to 999999). ________________ 
 

 

 

 

 

 

 

Series 1, No. 53 □ Page 179 

Appendix XIV. Agency Gaining Cooperation Debriefing 

Agenda and Discussion Guide 

National Home and Hospice Care Survey
 

Gaining Cooperation Debriefing Conference Call
 

A 90-minute Call Scheduled between
 

Wednesday, August 8, and Saturday, August 11, 2007 

Chair: Field Supervisor 

Participants: About Half of the Interviewers in the Region per Call, 2 Calls per 

Region 

Observers: Westat Home Office, Field Management Staff, NCHS Staff 

Objectives: 

1.		 To Provide Interviewers with a General Understanding of What Has Happened in 

the Region Since Training 

2.		 To Adjust Gaining Cooperation Approaches, Based on the Early Experience 

3.		 To Improve Gaining Cooperation Skills by Leveraging Off the Experience of the 

More Successful Interviewers 

Notes: 

1.		 Supervisors need to think about which interviewers to invite for each session and 

ask the interviewers to prepare for the call. 

2.		 A discussion guide for the calls will be drafted and distributed to supervisors 

before the end of training. 

3.		 More detailed planning for the gaining cooperation calls will occur in a
	

conference call with supervisors late the week of July 29.
	

4.		 Telephony monitoring will provide source material for the conference call, at the 

national level and (depending on accessibility) at the regional level. Home office 

staff will provide supervisors with the relevant numbers. 

5.		 A Westat home office member or the field manager will document the call. 

Agenda 

1.	 Roll Call and Welcome (less than 5 minutes) 

2.	 Summary of Activity in the Region (10 min.) 

a.		 Supervisor reviews number of eligible cases by priority group and 

provides current information on number/percent in the following statuses: 

appointment, complete, corporate approval required, initial refusal, no 

action, other pending. 

b.		 Comparison of region with national production. 
 

 

 

 

 

 

 

Series 1, No. 53 □ Page 180 

3.	 What Happens in a Visit (15 min.) 

a.		 Supervisor asks several interviewers who have completed interviews to 

summarize their experiences. 

b.		 Supervisor invites interviewers to reflect on what they might have done 

differently in the appointment setting and confirmation calls, based on the 

visit experience. 

4. Getting to the Director: What Works, What Doesn’t (15 min.) 

a.		 Supervisor invites selected interviewers to discuss experiences in getting 

through to the director on the phone, using the discussion guide 

b.		 Supervisor reviews minimum and maximum number of calls each 

interviewer in the group has made to get through to the director on their 

cases 

5.	 Director Questions that Surprised You (5 min.) 

a.		 Supervisor leads review of conversations with directors, using discussion 

guide, and invites interviewers to volunteer their most unusual questions 

and their most common experiences 

6.	 Scheduling an Appointment: Effective Tools (10 min.) 

a.		 Supervisor calls on 2 of the most successful interviewers to volunteer their 

approach in scheduling appointments 

b.		 Supervisor presents list of tools and techniques (listed in discussion 

guide), and invites group to discuss which has been most effective and 

ineffective so far 

7.	 Evaluation of Training, Materials Effectiveness (10 min.) 

a.		 Supervisor asks interviewers how prepared they felt to contact directors 

and set appointments after the classroom training; were there some skill 

areas that should have been more developed? 

b.		 Supervisor guides interviewers through review of a short list of gaining 

cooperation materials: what seemed most useful? Least useful? 

8. Review of Cooperation Goals for the Region and Next Steps (10 min.) 

a.		 Supervisor discusses remaining cooperation goals for the region and plan 

for achieving them 

b.		 Supervisor lists next steps for gaining cooperation 

9. Reminder and Preview of Next Week’s Call on Agency Visits (5 min.) 
 

 

 

Series 1, No. 53 □ Page 181 

National Home and Hospice Care Survey
 

Gaining Cooperation Debriefing Conference Call
 

Discussion Guide
 

1.	 Roll Call and Welcome (less than 5 minutes) 

[TAKE ATTENDANCE AND WELCOME EVERYONE TO THE CALL] 

2.	 Summary of Activity in the Region (10 min.) 

[PREPARE FOR THIS PART BY REVIEWING THE FIRST REPORTS 

AND FILLING IN THE NUMBERS.] 

We thought it would be good to start this call with a review of where we are 

coming out of training. Nationally we had 86 interviewers coming out of training 

in Baltimore, ___ in our region, and ___ of you are on this call. 

I receive a set of reports every Tuesday reflecting work you transmitted through 

Sunday night – these are what we call the “static” reports. I also get updates online, and I can look at the systems at any time and see the current status of things 

in our region. 

We have ___ eligible cases altogether in our region, and ___ of them have been 

assigned to interviewers. About half of them are Priority 1, and the other half are 

priority 2. 

You have ___ appointments (and __ completes, we’ll talk more about the 

completes in a minute). There are ___ cases with corporate approval required 

(32), ___ initial refusal ( ), and ___ in some other pending status.

 ___ have not been touched yet. Most of those are our priority 2s. 

This is (a little better than/about the same as/a little worse than) the country as a 

whole. Here are the national numbers: 

1530 eligible cases
	

___ appointments
	

___ completes 

___ corporate approval required 

___ initial refusal 

___ other pending 
 

 

 

 

 

 

 

Series 1, No. 53 □ Page 182 

___ no action 

Are there any questions before we go on?
	

3. What Happens in a Visit (15 min.) 

[IF NO ONE IN THIS GROUP HAS COMPLETED ANY INTERVIEWS 

YET, SKIP TO SECTION 4.] 

Next, I think it would be interesting for everyone to hear about how our first 

completed interview(s) went. 

[CALL ON INTERVIEWERS WHO HAVE TO COMPLETED 

INTERVIEWS TO GIVE HIGHLIGHTS FROM THE EXPERIENCE. USE 

THE FOLLOWING QUESTIONS TO GUIDE THE DISCUSSION]: 

How many respondents did you have in the agency?
	

Was it a home health, a hospice, or a mixed agency?
	

How did sampling go?
	

Did you have any trouble completing everything in a day?
	

[FOR HOSPICE AND MIXED]: How did the zip code form work?
	

What was your biggest problem during the interview?
	

Given what happened on the visit, is there anything you wish you had done
	

differently in the appointment setting call or the confirmation call or the 

reminder call? 

4. Getting to the Director: What Works, What Doesn’t (15 min.) 

Another issue we spent some time preparing you for in during the Baltimore 

training was getting through to the director on the phone. I’d like us to spend 

a few minutes reviewing how that has gone in the past few days, since you got 

home and started working through your Priority 1 cases in earnest. 

[CALL ON OTHER INTERVIEWERS WHO HAVEN’T SPOKEN YET 

TO TALK ABOUT THEIR EXPERIENCES GETTING THROUGH TO 

THE DIRECTOR. USE THE FOLLOWING QUESTIONS AS 

GUIDES]: 

We know that it can take a number of calls to each agency to reach the 

director and gain the agency’s cooperation. 
 

 

 

 

 

 

 

Series 1, No. 53 □ Page 183 

Let’s go around the group now. I’d like each of you to tell us how many 

agencies you called, how many agency directors you reached, and the 

outcome of each call you placed. That information will help guide the rest of 

our discussion. 

[CALL ON EACH INTERVIEWER TO REPORT ON THEIR 

EXPERIENCES CALLING THE AGENCY DIRECTORS.] 

Now I’d like to hear from those of you who were able to speak with at least 

one agency director. Please share your experiences speaking with the 

directors and what you think worked especially well that contributed to your 

success. 

[ASK ABOUT DIRECTOR QUESTIONS, COMMENTS, REACTIONS, 

OUTCOME OF CALLS. LISTEN TO RESPONSES AND GUIDE 

DISCUSSION. PROBE FOR APPROACHES THAT SEEMED TO BE 

EFFECTIVE IN GAINING DIRECTORS’ COOPERATION OR 

INTEREST IN THE SURVEY.] 

Now I’d like to hear about calls that did not result in a conversation with an 

agency director. Tell us any challenges you encountered trying to reach the 

agency director and your experiences with gatekeepers. 

[LISTEN TO RESPONSES AND GUIDE DISCUSSION. PROMPT 

TRAINEES TO ELICIT STORIES ABOUT GETTING ACCESS TO 

AGENCY DIRECTOR.] 

Based on your experiences today and our discussion, is there anything you 

would do differently when placing appointment-setting calls? 

[LISTEN TO RESPONSES AND GUIDE DISCUSSION.] 

The least number of calls any of you has had to make to reach a director is 1, 

but most of the time you’re not that lucky. What’s the greatest number of 

calls you’ve made to reach a director? 

5. Director Questions that Surprised You (5 min.) 

It helps to be prepared with answers to common questions directors ask. I 

know some of you write them down on post its and stick them up on the wall 

in front of you as you’re calling. Others make out lists. Whatever helps! 

Have any of your directors come up with new questions, something you didn’t 

anticipate? 

What do you think is the hardest question to answer? 
 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 184 

6. Scheduling an Appointment: Effective Tools (10 min.) 

Next, I’d like to spend a few minutes talking about the process of actually 

scheduling the appointment. 

[CALL ON 2 OF THE MOST SUCCESSFUL INTERVIEWERS TO 

VOLUNTEER THEIR APPROACH IN SCHEDULING 

APPOINTMENTS.] 

There are a lot of tools that can help in scheduling appointments. Some of 

them were in the agency advance package, and others were in your case 

folders or bulk supplies. Some of the best ones may be ones you’ve made 

yourself. Let’s talk for a few minutes about what seems to be most effective 

so far. 

First, the set an appointment script. How has that been working for you? 

How about the NHHCS calendar? 

There are a number of things in the advance package: 

• The advance letter from Dr. Sondik; 

• The FAQs; 

• The NHHCS folder; 

• The ERB letters; 

• The confidentiality brochure; 

• The endorsement letters; and 

• The report from the 2000 survey on computerized records. 

Have you found yourself referring to any of these to catch the director’s 

attention? Which ones? 

Do the directors volunteer anything about any of these materials? Good or 

bad? 

The advance letter mentions the NHHCS web site and the DVD that’s 

available there. Have any of you mentioned this in your appointment calls? 

Have any directors mentioned it? 

What about your own list of common questions and answers, or stock phrases 

like “HIPAA compliant”, or things you’ve written down on post it notes in 

front of your phone – have you done anything like this? Has it been helpful? 

7. Evaluation of Training, Materials Effectiveness (10 min.) 

Now, let’s talk about the classroom training a little bit. The home office staff 

have reviewed your evaluation forms, and for the most part, most of you rated the 

training pretty highly. Some things were clear low points – telephony practice 
 

 

 

 

 

Series 1, No. 53 □ Page 185 

Sunday night, for instance – but the agency calls and the debriefing we had 

Tuesday morning were rated very well. 

Now that you’ve had a little more experience contacting directors on your own, I
	

want you to look back on the training and tell me how well you think the training
	

prepared you to contact directors and set appointments. 

[PAUSE FOR TRAINEES TO ANSWER. CALL FOR VOLUNTEERS IF
 

NECESSARY.]
 

Were there some skill areas that could have been more developed? 

8. Review of Cooperation Goals for the Region and Next Steps (10 min.) 

[DISCUSS THE REMAINING COOPERTATION GOALS FOR THE
 

REGION AND PLAN FOR ACHIEVING THEM.]
 

[DISCUSS NEXT STEPS FOR GAINING COOPERATION; REVIEW
 

PLANS FOR FINISHING UP PRIORITY 1 AND BEGINNING WORK ON 

PRIORITY 2.]
 

9. Reminder and Preview of Next Week’s Call on Agency Visits (5 min.) 

Next week I’ll be scheduling another call, this one focused more on the first visits
	

to agencies and what we’ve learned from them. I will be in touch with you about
	

a schedule for that. The call will be sometime between Friday August 17 and 

Monday August 20. 

Do you have any questions about that, or anything else we’ve covered today? 
 

 

 

 

 

Series 1, No. 53 □ Page 186 

Appendix XV. Agency Visit Debriefing Agenda and 

Discussion Guide 

National Home and Hospice Care Survey
 

Agency Visit Conference Call
 

A 90-minute Call Scheduled between
 

Friday, August 17, and Monday, August 20, 2007 

Chair: Field Supervisor 

Participants: Interviewers in the Region 

Observers: Westat Home Office, Field Management Staff, NCHS Staff 

Objectives: 

1.		 To Share More Experiences from Data Collection Visits and Build More 

Confidence in Data Collection Skills 

2.		 To Identify Early Problems in Agency Visits and Take Corrective Action 

3.		 To Improve Interviewing Skills Early in the Data Collection Period 

Notes: 

1.		 Supervisors need to schedule the call with interviewers and ask them to prepare 

for the call. 

2.		 Supervisors need to review the discussion guide for the calls. 

3.		 Field observations, interviewer remarks, IRQs, and WesCARI behavior coding 

may provide source material for the conference call. 

4.		 A Westat home office member or the field manager will document the call. 

Agenda 

1.	 Roll Call and Welcome (less than 5 min.) 

2.	 Summary of Activity in the Region (10 min.) 

a.		 Supervisor reviews number of eligible cases by priority group and 

provides updated numbers/percents in the following statuses: 

appointment, complete, corporate approval required, initial refusal, no 

action, other pending 

b.		 Comparison of region with national production; emphasis on number of 

completes 
 

 

Series 1, No. 53 □ Page 187 

3.	 What Happens in a Visit (20 min.) 

a.		 Supervisor asks several interviewers who have completed interviews 

(perhaps different interviewers from the gaining cooperation calls the 

previous week) to summarize their experiences 

b.		 Supervisor polls interviewers on how much time their visits have taken so 

far. 

c.		 Guided discussion of longer cases, covering reasons for length, multiple 

respondents, degree of completion 

4.	 Time Management Tools During the Visit (10 min.) 

a.		 Supervisor lists tools available: staff schedules, choose-person screen, 

conducting PA by phone, etc. 

b.		 Tips for Efficient Interviewing (to be included in the discussion guide) 

5.	 Review of Sections and Questions That Can Be Problematic (20 min.) 

a.		 AQ 

b.		 PS 

c.		 AS 

d.		 PH 

e.		 PA 

6.	 Evaluation of Training, Materials, and CAPI Program Effectiveness (10 

min.) 

a.		 Supervisor asks interviewers how prepared they felt to conduct the CAPI 

interview after the classroom training; were there some skill areas that 

should have been more developed? 

b.		 Supervisor asks interviewers how prepared they felt to complete the other 

data collection tasks (sampling, collecting HHA contact info, obtaining 

and reviewing the SAQ, using the ROC and EROC, etc.) after the 

classroom training; were there some skill areas that should have been 

more developed? 

c.		 Supervisor guides interviewers through review of data collection 

materials: what seemed most useful? Least useful? 

7.	 Review of Cooperation Goals for the Region and Next Steps (10 min.) 
 

 

 

 

 

 

 

Series 1, No. 53 □ Page 188 

National Home and Hospice Care Survey 

Agency Visit Debriefing Conference Call 

Discussion Guide 

1.	 Roll Call and Welcome (less than 5 minutes) 

[TAKE ATTENDANCE AND WELCOME EVERYONE TO THE CALL] 

2.	 Summary of Activity in the Region (10 min.) 

[PREPARE FOR THIS PART BY REVIEWING THE SECOND WEEK’S 

REPORTS AND FILLING IN THE NUMBERS.] 

We’re going to start this call like we did the last one, with a review of where we 

are now, after you’ve all had at least a full week of time to work. 

I received my “static” report this Tuesday reflecting work you transmitted through 

Sunday. [I also got updates on-line, to see the current status of things in our
	

region.]
	

We have ___ eligible cases altogether in our region, and ___ of them have been 

assigned to interviewers. 

You have ___ appointments
	

___ completes
	

___ cases with corporate approval required (36),
	

___ initial refusal ( ), and 

___ in some other pending status.

 ___ have not been touched yet. Most of those are our priority 2s.
	

This is (a little better than/about the same as/a little worse than) the country as a
	

whole. Here are the national numbers:
	

1530 eligible cases
	

___ appointments
	

___ completes
	

___ corporate approval required
	

___ initial refusal
	

___ other pending 

___ no action 

Are there any questions before we go on?
	
 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 53 □ Page 189 

3. What Happens in a Visit (20 min.) 

Next, let’s talk about how everyone’s first visits to agencies have gone in the past 

week. This call is going to focus on those first visits in some detail. We want to 

hear mostly from those of you who have gone out on your first visit, but I want 

everyone else to listen in and ask questions whenever you hear something you’re 

curious about and want to understand better. OK? 

So how many of you have gone out on an agency visit? 

[COLLECT NAMES. CALL ON INTERVIEWERS WHO HAVE TO 

COMPLETED INTERVIEWS TO GIVE HIGHLIGHTS FROM THE 

EXPERIENCE. USE THE FOLLOWING QUESTIONS TO GUIDE THE 

DISCUSSION]: 

How many different people did you have to talk to in the agency to complete 

the interview? Did anyone have just one person all day, from the AQ through 

sampling and all the person-level sections? 

Who had the most people to talk to?
	

How many hospice agencies have we completed altogether so far? ____ 

How many home health? _____ 

Any mixed agencies?
	

Did any of you have any problems with sampling?
	

Did you have any trouble completing everything in a day?
	

I’d like to take down some numbers. 

ASK EACH INTERVIEWER WITH COMPLETES: 

What time was your appointment?
	

When did you show up at the agency?
	

When did you leave the agency?
	

Did you have time to take any breaks?
	

What was the total time you were there collecting data?
	

Were you able to complete everything before you left?
	

IF ANYONE SAYS NO: How many PH sections were you able to
	

complete?
	
 

 

 

 

 

 

 

Series 1, No. 53 □ Page 190 

IF ANY INTERVIEW TOOK 8 HOURS OR MORE,
 

OR IF ANY INTERVIEW WAS NOT COMPLETED IN ONE DAY,
 

ASK:
 

How many different people did you have to collect data from? 

Why do you think the interview took that long? 

Can you think of anything that might have cut down on the time? 

OTHER QUESTIONS: 

How did the zip code form work in the hospice agencies? 

What was your biggest problem during the interview? 

Given what happened on the visit, is there anything you wish you had done 

differently in the appointment setting call or the confirmation call or the 

reminder call? 

4.	 Time Management Tools During the Visit (10 min.) 

There are a number of tools to help you keep track of everything, to move through 

the interview as quickly as possible and get everything done that you need to 

finish in a day. I’m thinking of things like: 

•	 using the ORG to keep track of staff schedules 

•	 using the choose-person screen to follow the best order for people in the 

agency
	

• offering to conduct PA by phone, and 

•	 a checklist that was mailed to everyone earlier this week 

What has been effective for you so far in these early interviews? Anything else? 

Are there personal strategies you’ve tried that have worked for keeping things 

flowing and making the most efficient use of your time? 

If our region had to put a list together of ways to get everything done in the 

agencies, to help the other regions, what would you put at the top of the list? 

5.	 Review of Sections and Questions That Can Be Problematic (20 min.) 

Now let’s talk about each section of the CAPI instrument. 

a.		 AQ. First, the AQ. Has anyone had any problems with questions in the 

AQ? Which ones? 
 

 

 

 

 

Series 1, No. 53 □ Page 191 

b.	 PS. How about the patient sampling section? Has anything been 

problematic or confusing in it? 

c.	 AS. How about Aides Sampling? 

d.	 PH. Next, let’s spend some time talking about PH. Are there any 

questions your respondents find it hard to answer? 

How about the look-up lists for conditions and prescribed medicines? 

How have those been working for you? 

e.	 PA. And finally, PA. Anything that’s been difficult there? 

6.	 Evaluation of Training, Materials, and CAPI Program Effectiveness (10 

min.) 

Now let’s think back to your training at BWI two weeks ago. I want to ask you 

all something. How prepared did you feel to conduct the CAPI interview after 

the classroom training? 

Was there anything about CAPI that you wish you’d gotten more training on? 

How about the other data collection tasks? 

•	 Sampling? 

•	 Collecting HHA contact info 

•	 Obtaining and reviewing the SAQ 

•	 Using the ROC and EROC 

•	 Transmitting 

Finally, let’s review the data collection materials: what seemed most useful to 

you? 

[PAUSE FOR VOLUNTEERS] 

How about the case folder and agency information sheet?
	

The pens and ruler?
	

The DVDs?
	

The job aid booklet?
	

The show cards?
	

The help screens in CAPI?
	

The aides contact info form?
	
 

 

 

Series 1, No. 53 □ Page 192 

Anything else?
	

Which of these do you think was least useful?
	

7. Review of Cooperation Goals for the Region and Next Steps (10 min.) 

[DISCUSS THE REMAINING COOPERATION GOALS AND AGENCY 

VISIT GOALS FOR THE REGION AND PLAN FOR ACHIEVING 

THEM.] 

[DISCUSS NEXT STEPS FOR GAINING COOPERATION; REVIEW 

PLANS FOR FINISHING CONTACT WORK ON PRIORITY 2.] 

Do you have any questions about anything we’ve covered today? 
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
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CS210643T36730 (07/2010)DHHS Publication No. (PHS) 2010-1329, Series 1, No. 53