Vital and 

Health Statistics 

Plan and Operation: 

National Nursing Home 

Survey Followup, 

1987, 1988, 1990 

Series 1:


Programs and Collection Procedures


No, 30


This report describes the plan and operation for Wave 1,Wave 11,and Wave Ill 

of the National Nursing Home Survey Followup (NNHSF), a longitudinal study 

of the cohort of current residents and discharged residents sampled in 

the 1985 National Nursing Home Survey (NNHS), 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


Public Health Service


Centers for Disease Control and Prevention


Notional Center for Health Statistics


Hyaftsvllle, Maryland


September 1993


DHHS Publication No, [PHS) 93-1306

Copyright Information 

All material appearing in this report is in the public domain and may be 

reproduced or copied without permission: citation as to source, however, is 

appreciated 

Suggested Citation 

Gottfried IB, Bush MA, and Madans JH Plan and operation: National Nursing 

Home Survey Followup, 1987, 1988, 1990 National Center for Health Statistics 

Vital Health Stat l(30) 1993 

Library of Congress Cataloging-in-Publication Data 

Gottfried, llene B 

Plan and operation: National Nursing Home Survey Followup: 1987, 1988, 

1990 

p cm - (vital and health statistics Series 1, Programs and collection 

procedures; no 30) (DHHS publication; no (PHS) 93-1306) 

By llene B Gottfried, Mary Ann Bush, Jennifer H Madans 

“September 1993 ” 

Includes bibliographical references 

ISBN o-8406-0481-5 

1 National Nursing Home Survey Followup (U S ) 2 Nursing homesUtilization-United States-Statistics 3 Nursing home patients-United 

States-Longitudinal studies 4 Follow-Up Studies-United States I Bush, 

Mary Ann, 1954- II Madans, Jennifer H Ill National Center for Health 

Statistics (U S ) IV Title V Title: National Nursing Home Survey Followup 

VI Series VII. Series: DHHS publication: no (PHS) 93-1306 

[DNLM: 1 National Nursing Home Survey Followup (U S ) 2 Nursing 

Homes- United States 3 Long-Term Care 

W2 A N148va no 30 19931 

RA409 U44 no 30 

[RA997] 

362 1’0723 s--d&?0 

[362 1’6’09731 

DNLMIDLC 

for Library of Congress 93-l 7510 

CIP 

For sale by the U.S. Government Printing Office 

Superintendent of Documents 

Mail Stop: SSOP 

Washington, DC 20402-9328 
National Center for Health Statistics 

Manning Feinleib, M.D., Dr.P.H., Director 

Jack R. Anderson, Deputy Director 

Jacob J. Feldman, Ph.D., Associate Directorfor AnaZysis 

and Epidemiology 

Gail F. Fisher, Ph.D., Associate Directorfor Planning and 

ExtramuralProgra~s 

Peter L. Hurley, Associate Directorfor Vital and Health 

StatisticsSystems 

Robert A. Israel, Associate Directorfor International 

Statistics 

Stephen E. Nieberding, Associate Directorfor 

Management 

Charles J. Rothwell, Associate Directorfor Data 

Processingand Services 

Monroe G, Sirken, Ph.D., Associate Directorfor Research 

and Methodology 

David L. Larson, Assistant DirectoCAtlanta 

Office of Analysis and Epidemiology 

Jacob J. Feldman, Ph.D., Associate Director 

Division of Analysis 

Jennifer H. Madans, Ph.D., Acting Director 

Jennifer H. Madans, Ph.D., Deputy Director 

Jennifer H. Madans, Ph.D., Acting Chie$ Demographic 

Ana/wis Staff 

Diane M. Makuc, Dr.P.H., ChieJ Analytical Coordination 

Branch 

Sandra T. Rothwell, Chiej Longitudinal Ana@is Branch 
.

Contents 

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1985 National Nursing HomeSumey . . . . . . . . ,$, ...,, ,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Nursing Home SurveyFollowup Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .,... . . . . . . . . . . . . . . . . . . . . . 

Designation ofrespondent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Computer-assisted telephone interview system ... ,,,0. . . . . . . . . . . . . ..$. ,.. . . . . . . . . ... ,,,,, . . . . . . . . ,,,.,., 

Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s... . . . . . . . . . . . . . . . 

Wave I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Wave 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Wave III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Data tape information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s 

Appendixes 

1.	 Training and intewiewing schedule for the 1985 National Nursing Home Survey and the National Nursing 

HomeSumeyFollowup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

11, Study materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...! . . . . . . . . . . . . . . . . . . 

Text figures 

1.	 Number of cases studied in survey and followup Waves I, II, and III by vital status, eligibility, and interview 

completion: National Nursing Home Survey and Followup, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

2. Reasons for nonintemiew NationaI Nursing Home Survey Fo110wup,1985-90 . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Texttables 

A, Number and percent distribution of subjects in the three waves of the National Nursing Home Survey Followup 

cohort by selected characteristics of subjects, according to survey wave: United States, 1987,1988,1990 . . . . . 

B, Percent of cases with completed interviews in the three waves of the National Nursing Home Survey Followup 

cohort byselected characteristicsof the subjects and surveywave: United States, 1987,1988, 1990 . . . . . . . . . . 

; 

2 

2 

2 

3 

3 

4 

5 

5 

6 

7 

8 

10


11 

2 

4 

5 

5 

.,.

Ill 
---

Symbols 

Data not available 

. . . Category not applicable 

— Quantity zero 

0,0 Quantity more than zero but less than 

0.05 

z	 Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

* Figure does not meet standard of 

reliability or precision (100 or fewer 

estimated deaths; relative standard 

error of 30 percent or more) 

iv 
Plan and operation: 

National Nursing Home 

Survey Followup, 1987, 

1988, 1990 

by Ilene B, Gottfried, Mary Ann Bush, and 

Jennifer H. Madans, Ph. D., Office of Analysis and . 

“Epidemiology 

Introduction 

The National Nursing Home Survey Followup 

(NNHSF) is a longitudinal study that followed the cohort 

of current residents and discharged residents sampled in 

the 1985 National Nursing Home Survey (NNHS) (l-8). 

The NNHSF built on the data collected in the 1985NNHS 

by extending the period of observation by approximately 5 

years and providing longitudinal information on nursing 

home and hospital utilization. 

The followup consists of three waves of data collection. Wave I was conducted from August through December 1987,Wave II from July through November 1988, and 

Wave III from January through April 1990. 

The study-a collaborative project between the National Center for Health Statistics (NCHS) of the Centers 

, for Disease Control and Prevention (CDC) and the National Institute on Aging (MA) of the National Institutes 

of Health (NIH) –was conducted under the auspices of 

the U.S. Public Health Service. The followup was funded 

primarily by NIA, In collaboration with the Office of the 

Assistant Secretary for Planning and Evaluation (ASPE), 

several additional questions were added to the end of the 

Wave III interview. Funding for this section was provided 

by ASPE. 

The surveywas designed in response to the increasing 

demand for information on the dynamics of long-term 

care use. There has been a great deal of interest within 

both the public and private sectors in the structure and 

financing of long-term care services. However, until the 

NNHSF was conducted, these data were not available 

except for a few studies conducted in small geographic 

areas. The NNHSF provides data on the flow of persons in 

and out of long-term care facilities and hospitals. These 

utilization profiles can then be examined in relation to 

information on the resident, the facility, and the 

community. 

The National Nursing Home Survey Followup to the 1985 National 

Nursing Home Survey could not have been conducted without valuable 

assistance from many individuals and groups. Special thanks are extended to Dr. Richard Suzrnan of the Natioual Institute on Aging (NIA) 

for his dedication to this project and the financial support provided by 

NIA. The authors alsowish to acknowledgethe contribution of Research 

Triangle Institute, the contractor who conducted this study, and, especially,Nancy Monroe, who directed the survey team. 

The 1985 National Nursing Home Survey 

The 1985 National Nursing Home Suney collected a 

variety of data about long-term care facilities and their 

residents. (The Reference section lists several publications 

based on the 1985 NNHS,) Data were collected on a 

sample of patients who were current residents at the time 

of contact with the facility, as well as on a sample of 

discharges that occurred within the 12-month period prior 

to the facility contact. 

A flow chart of the design of the NNHS, the next-ofkin (NOK) interview, and the NNHSF is presented, along 

with the results of data collection, in figure 1. This figure 

shows the relationship among the surveys and provides 

information on the number of subjects eligible for each 

component, the number of completed interviews, and the 

number of subjects found to be deceased at each time of 

contact, There were 5,243 sampled current residents and 

6,023 sampled discharges in the NNHS. Detailed information collected on current residents pertained to dependence in activities of daily living, functional impairments, 

diagnoses, the receipt of services, cognitive and emotional 

status, charges, source of payments, history of nursing 

home use, and a number of other topics of considerable 

prognostic significance. For discharged residents, the information focused on diagnoses and services, source of 

payments, nursing home and hospital use prior to the 

sampled nursing home stay, hospitalizations during the 

sample stay, and nursing home readmission subsequent 

to the sample stay. 

To supplement the current and discharged resident 

components, the 1985 NNHS included an NOK component. The NOK interview, using a computer-assisted telephone interviewing (CATI) system, was designed to obtain 

information not readily available from patient records, or 

other sources in the nursing home, on the factors affecting 

patterns of nursing home and health care facility utilization. The identities of the potential respondents for this 

component were obtained as part of the Current Resident 

Questionnaire (CRQ) and the Discharged Resident Questionnaire (DRQ). The preferred respondents were relatives or friends of the subject who could provide 

information about the resident’s condition prior to being 

admitted to the nursing home. Thus, a “best” respondent, 

1 
““m 

I

Completed resident 

Interviews I 

eliiibk ior 

p;:: 

11,181. 

I 

Camn:z 

hrtarvitivs 

Oeceesed eases 

at 9,077 eliiible 

next-of-kin for Wave I 

interviews interviews 

3,026 6,607 , 

11 

b!d 

I intefviawe 

I 4,040 

eoo~y 

interviews 

i 

Oaccye:at 3,666 

interviews 

723 eaatw 

ti%’%111 

I interviews 

j 3,121 

Dweesedat I 3,041 Wave Ill IIIntelviewe 

IJ?K-1 

Figure 1. Survey design, number of eligible subjects, and number 

of completed cases: National Nursing Home Survey and 

Foi]owUP, 1985 

usually the next of kin, was identfied and then contacted 

by telephone for the NOK interview. In some cases, the 

subject, him- or herself, was interviewed for the NOK 

component. Information was obtained on the resident’s 

status prior to the sample admission, past use of nursing 

homes, hospital admissions and discharges, activities of 

daily living at admission, reasons for entering the nursing 

home, method of payment, current vital status, and living 

2 

arrangements. All residents with a completed CRQ or 

DRQ were eligible to be interviewed for the NOK component if information was available to contact the resident or 

a next of kin. 

As stated earlier, the current resident file contained 

5,243 cases, and the discharge resident file contained 6,023 

sample discharge cases (9). Since the DRQ sample is an 

event sample, an individual resident could have had more 

than one stay in the discharged resident sample and/or in 

both the current resident and discharged resident samples. The NOK interview, however, was designed to follow 

residents and not events. Thus, only the first stay for any 

resident was eligible for the NOK interview. There were 

11,181 individuals–5,200 CRQ’S and 5,981 DRQ’s -

identified on the resident CRQ/DRQ tapes after accounting for those residents who had had more than 1 sampled 

stay. The NOK interview was conducted about 3 months 

after the facility contact, beginning in October 1985, Of 

those eligible, 9,077 respondents were interviewed, 1,073 

cases were not fielded, and 1,010were fielded but did not 

respond. Thirty-three percent (3,023 cases) of the sample 

were found to be deceased. A detailed account of the 

training and interviewing schedule is provided in appendix I. Copies of all pertinent study materials (advance 

letters, forms, and questionnaire) can be found in 

appendix II. 

National Nursing Home Survey Followup 

Design 

Designation of respondent 

In all waves of the followup, the previous wave’s 

respondent would be the first individual contacted for 

information on a new wave. As a result, facility staff acted 

as respondents if the subject had been a nursing home 

resident at the last contact, and community-based individual served in this capacity if the subject had been discharged into the community. The survey was designed to 

allow for the contact of more than one respondent, if 

necessary, to maximize the amount of information collected. For example, if an interview with a community 

respondent revealed that the subject had been readmitted 

to a facility, that facility could then be contacted to obtain 

information on utilization since the admission, as well as 

on current status. Conversely, if an initial interview with 

facility personnel indicated that the subject had been 

discharged, a new respondent could be contacted (either a 

relative or the subject, depending on the type of discharge) to provide information on the subject’s current 

status. Although more than one respondent could be 

contacted for data collection purposes, information was 

merged from all respondents concerning a subject to 

provide one complete, continuous record of nursing home 

and hospital stays. 

Questionnaire 

The NNHSF questionnaire is divided into sections, 

Unless otherwise noted, the same questionnaire was used 
I 

j 

; 

j 

I

t 

I 

! 

I 

I 

I 

i 

in all waves of the followup. Questions in section A 

(Resident sample) were asked only if the subject resided 

in a nursing home at the time of the previous datacollection wave. These questions determined whether the 

subject was still a resident at the specified facility and if 

the stay had been uninterrupted; if the subject had been 

discharged alive; to what place the subject had been 

discharged; and how many times the subject had been 

discharged and readmitted to the facility since the last 

date of contact, Section B pertained to subjects not 

residing in a nursing home at the last contact and those 

identified as deceased in section A, information on vital 

status, date and State of death, and use of hospice care 

was obtained. Questions in section C were asked of 

surviving subjects and obtained information on current 

living arrangements. 

Section D focused on stays in nursing homes since the 

last contact other than those reported in section A. 

Residents who had been in the same nursing home continuously since the last contact did not receive this section. 

Section E obtained information on hospital stays. 

Section F collected data for administrative purposes. 

Information on participation in the Medicare program 

was obtained in section G, and section H dealt with 

payment for nursing home care. The Wave III questionnaire also included section I, which collected administrative data, and section J, which asked about the disposition 

of the subject’s own home, 

Up to three respondents could have been contacted to 

participate in the Wave III interview: a “core respondent” 

to answer questions in the main portion of the questionnaire; a “core 2 respondent” to update the information 

given by the core respondent if the core respondent did 

not know the current status of the subject; and a “section 

J respondent” to answer questions in that section if a 

facility respondent was used for the main questionnaire. 

(In a few cases, a facility provided responses to section J.) 

Since these questions were only asked in Wave III, 

that information is not available for subjects who. were 

known to be deceased at the facility contact, at the NOK 

interview, or in Wave I or Wave II of the followup. Those 

eligible for section J represent a very select subgroup of 

the original cohort. This subgroup was diminished further 

by 187cases where residents were eligible for section J but 

did not receive the questionnaire because an appropriate 

respondent could not be identified. Therefore, great care 

should be taken when generalizing the data in section J, 

Computer-assisted telephone interview 

system 

The NNHSF interviews were conducted using a 

computer-assisted telephone interview (CATI) system, in 

which data collection and data entry occur concurrently 

and the flow of the interview is computer controlled. 

The CATI questionnaire used for the NNHSF was a 

modified version of that developed for the NOK component of the NNHS. At each wave, questions were asked 

concerning vital status, nursing home and hospital 

utilization since the last contact, current living arrangements, Medicare number, and source of payment. 

Programming was slightly modified at Wave 11 and 

again at Wave HI: 

In Wave II, valid bates were “identified in two ways:


For cases completed in Wave I, valid dates were


restricted to those occurring in 1987; however, for


cases not completed in Wave I, earlier dates were


allowed.


A second facility was not contacted in Wave I; how-


ever, for Wave II, CATI was altered to allow for a


respondent from a second facility.


For Wave III, an additional set of Questions [sec­


tion J) was added to the original questi&naire used in


Waves I and II. These questions were programmed as


part of the Wave III CATI questionnaire, and the


CATI program was altered to allow for up to three


respondents.


Unless otherwise specified on the questionnaire, 

CATI was programmed for the NNHSF so that the same 

set of questions was asked irrespective of whether the 

respondent was a subject, a next of kh, or a facility 

official. 

Procedures 

Approximately 1-2 weeks before the start of the data 

collection period, advance letters were mailed to respon- . 

dents (see appendix 11).’ A letter was mailed to each 

primary respondent for whom an address was available. 

For respondents who had participated in previous interviews, both the letter and the oral introduction in the 

interview thanked the respondent for earlier cooperation 

and reviewed the purpose of the survey. For newly identified respondents, the letter and interview introduction 

stated the purpose of the study in greater detail. For 

respondents for whom no address was available or who 

received no letter, a special introductory paragraph was 

added to the questionnaire, which included the contents 

of the letter. 

Many respondents to the Wave I followup were the 

original sample facilities because a large number of survey 

subjects were still residents in these facilities at the time 

the NOK interview was administered. Likewise, many of 

the respondents in Waves II and 111were the facilities in 

which the Wave II and Wave III residents lived at the time 

of those interviews. Those facilities that would have been 

requested to complete a questionnaire for more than one 

case were identified and sent a single letter listing all their 

residents’ about whom inquiries would be made. This 

reduced the number of contacts with these facilities and 

eliminated the need for multiple letters to the same 

nursing home. The CATI questionnaire was programmed 

to allow the interviewer to complete all cases within a 

single nursing home on one call without having to reread 

the introduction. 

Telephone contacts were made primarily during daytime hours, including weekends. As necessary, interviews 

were conducted during the evening hours. Upon 

3 
contacting the appropriate respondent, the interviewer 

proceeded with the interview, if possible, or scheduled a 

time to call back. A minimum of five attempts were made 

to contact each potential respondent for whom there 

appeared to be a workable telephone number. 

If a nursing home refused to participate or could not 

be contacted, all cases that would have been completed by 

the facility were converted to proxy interviews. In some 

cases, the names of the proxies to be contacted were 

furnished by the facility in most cases, however, interviewers had to use the names listed in the CATI respondent 

roster for the NOK interview and for earlier waves of the 

followup. 

If a designated respondent could or would not participate, the interviewer attempted to obtain the name and 

telephone number of another potential respondent to 

contact. If the designated respondent could not be located, other contact names contained in the CATI ile 

were examined, and attempts were made to locate and 

interview another individual. 

Reasons for nonintefiews are presented in figure 2. 

The majority of noninterviews stemmed from the inability 

to locate and/or contact another respondent. Reasons 

for refusals ranged from “not interested” and “don’t 

want to” to “need permission” and “short of staff.” 

“Medically/physically incompetent” and language barriers 

were included in the “other” category. The “not attempted” category in Wave I was due to interviewer error. 

(These cases were followed up in Wave II.) 

In addition to the reminder in the advance letters, 

respondents were again informed before the interview 

that their participation was voluntary and that the information provided would be held in confidence. 

Wave 1 

The Wave I followup cohort was composed of two 

types of cases: 

. All subjects with a completed NOK interview who 

were not known to be deceased at the time of that 

interview 

. Subjects who were eligible for the NOK interview and 

were not known to be deceased, but for whom a : 

completed interview was not obtained 

Of the 6,607 subjects identified for inclusion in Wave 

I, 6,051 were in the first group, and 556 in the second. 

There were 1,751 males and 4,261 females, ranging in age 

from 3 years to 106 years old. The majority (65 percent) of 

the eligible cases came from the current resident sample, 

as was the situation in Waves II and HI. 

Six hundred and six subjects (606) did not respond to 

the Wave I contact (figure 2), and 33 percent of those 

contacted were found to be deceased. Seventy-three percent of the cohort were found to be residents of the 

sample nursing homes, and another 10 percent were in 

another nursing home. (See table A.) 

While the overall response rate for Wave I was 

91 percent, the rate did vary according to certain characteristics of the sample, Table B outlines the response rates 

according to selected subject characteristics. The response 

rate was higher for residents who were selected as part of 

the current resident sample and who were residents at the 

sample facility at the last contact (96 percent). The response rates were lowest for those who were not residents 

in a facility at last contact (70 percent) and for those who 

did not have a completed NOK interview (69 percent), 

can’t locate IssiNot attempted m Rafuaad u Oulai

Wave I Wave II Wave Ill 

~1% 

Figure 2. Reasons for noninterview: National Nursing Home Survey Followup, 1985-90 

4 
Table A Number and percent distribution of subjects in the three waves of the National Nursing Home Survey Followup cohort 

by selected characteristics of subjects, according to survey wave: United States, 1987, 1988, 1990 

Characteristic Wave \ Wave II Wave Ill 

Number Percent Distribution Number Percent Distribution Number Percent Distribution 

Total . . . . . . . . . . . . . . . . 6,607 100.0 4,040 100.0 3,121 100.0 

Resident sample status 

Current resident . . . . . . . . . 4,324 65.4 2,763 66.9 2,149 68.9 

Discharged resident. . . . . . . 2,283 34.6 1,257 31.1 972 31.1 

NOK response status 

NOKQ completed . . . . . . . . 6,051 91.6 3,787 93.7 2,927 93.6 

NOKQ not completed. . . . . . 556 8.4 253 6.3 194 8.2 

Residence at last contact 

Sample nursing home . . . . . 4,791 72.6 2,692 71,6 2,141 68.6 

Other nursing home. . . . . . . 644 9.7 597 14.8 557 17.8 

Not a nursing home. . . . . . . 1,172 17.7 551 13.6 423 13.6 

NOTES: NOK Is next of kin. NOKQ is neti-of-kin questionnaire. 

More than 75 percent of noninterviewed cases involved a . Eligible Wave I subjects for whom, through inter­ .:	 subject or nonfacility proxy respondent, and more than 

85 percent of these nonintewiews resulted from an inability to locate the respondent. Reasons for noninterviews 

among facility respondents were refusal and the inability 

to locate the respondent. Refusals were involved in about 

8 percent of the total of the nonintemiews. , 

Wave II 

The 4,040 subjects eligible for the Wave H cohort 

included: 

.	 Wave I subjects for whom an interview was obtained, 

who were alive at the time of the interview, and who 

did not require a facility followup for complete information at Wave I 

.	 Wave I subjects for whom an interview was obtained, 

who were alive at the time of the interview, but who 

required a facility followup to obtain complete 

information 

Table B: Percent of caaes with completed interviews in the three 

waves of the National Nursing Home Survey Followup cohort by 

selected characteristics of the subjects and survey wave: 

United States, 1987, 1988, 1990 

Characteristics Wave I Wave II Wave Ill 

Percent 

Total . . . . . . . . . . . . . . . . 90.8 97.1 97.4 

Resident sample status 

Current resident . . . . . . . . . 96.1 97.9 98.3 

Discharged resident. . . . . . . 80.9 95.5 95.9 

NOK response status 

NOKQ completed . . . . . . . . 92.8 97.7 97.8 

NOKQ not completed. . . . . . 69.1 SS.3 92.1 

Reeldence at last contact 

Sample nursing home . . . . . 96.5 99.3 96,6 

Other nursing home. . . . . . . 62.4 91.9 96.4 

Not a nursing home. . . . . . . 69.6 86.7 93.1 

NOTES: NOK Is nsxt of kin. NOKQ is next-of-kin questionnaire. 

viewer error, no interview attempt was made 

Some information was collected on 3,868 subjects – 1,069 males and 2,799 females –for an overall response rate of 97 percent (table B). The response rate was 

almost the same whether a resident was selected as part of 

the current resident sample (98 percent) or the discharged 

resident sample (96 percent). The response rates were 

highest for residents who had been in nursing homes at 

the time of the last contact and for residents with a 

completed next-of-kin questionnaire. At the time of contact, 723 subjects (19 percent) were found to be deceased. 

Wave Ill 

There were 3,160 subjects originally deemed eligible 

for a Wave III interview: those who were alive at the time 

of the Wave II interview and for whom some information 

was obtained during Wave II. However, some of the 

subjects for whom only partial information was obtained 

in the Wave II survey were not included in Wave 111 

because the only respondents located at the time of the 

Wave II interview for these subjects could not provide 

up-to-date information on the subjects’ current status. In 

addition, after the completion of Wave II, it was found 

that some subjects who were believed to be alive at Wave 

II had actually died prior to the Wave II interview. The 

Wave II data was then updated to reflect the final status of 

these subjects, and those subjects were excluded from 

Wave 111.Ultimately, a total of 3,121 subjects were eligible 

for interviewing at Wave III. 

Some information was obtained at Wave HI on 3,041 

subjects for an overall response rate of 97 percent (table B). The response rates were almost equal regardless of 

current or discharged resident sample status, The response rates were only slightly higher for those residents 

with a completed next-of-kin questionnaire who were 

residents of nursing homes at last contact. 

5 
Information on the core questionnaire was complete 

for 2.995 subiects (98 Dercent). An additional 46 cases had 

only partial core irifor-mation~Complete section J information was obtained for 2,845 subjects (93 percent). As 

mentioned earlier,, for 187 subjects either no section J 

respondent could be located or the located respondent 

refused to be interviewed. Nine of the subjects for whom 

section J was complete had only partial core information 

available. Information for the combined interview (both 

the core and section J questionnaires) was complete for 

2,836 subjects (93 percent). 

Estimation procedures 

The information contained on the microdata tapes 

combines data on subsets of the original current resident 

and discharged resident samples. However, the current 

resident and discharged ,resident samples were originally 

designed to be analyzed separately. Although it is possible 

to combine the samples in certain instances, the procedures for doing so are not discussed here. 

In analyzing the data, it is also important to note: 

. The discharge resident sample is an event sample, and 

an individual could have multiple records on the 

discharged resident file or have records on both the 

discharged resident file and the current resident file. 

. However, each record on the followup tapes represents a person rather than an event, so an individual 

can only have one record on the followup files. 

These factors affect how the data should be analyzed. 

Decisions concerning the appropriate way to weight 

the data should take into account the objectives of the 

analysis, the design of the current resident and discharged 

resident samples, and nonresponse to the resident questionnaires and/or the NOK interviews. Some analyses may 

require more complicated weighting strategies than are 

discussed here, A statistician shouId be consulted in those 

instances. The data tapes contain the original weights for 

the current and discharged resident samples and the two 

sets of weights derived for the NOK interview file. A 

discussion of these weights and a description of the NOK 

interview file are provided in the Public-Use Data Tape 

Documentation of the Next-of-Kin Component of the 

1985 National Nursing Home Survey. Weights have not 

been constructed that take into account nonresponse in 

the NNHSF. However, nonresponse rates are low. Also, 

NOK weights are not available for subjects for whom 

there was no NOK interview but who may have been 

interviewed in Waves I, II, and 111. This complicates 

weighting procedures even further. 

The weighting procedures used to analyze data from 

the NNHS and the NNHSF depend on the objectives of 

the analysis. For example, information on utilization history from the NOK interview and the NNHSF can be used 

to supplement the information from the resident questionnaires. In this situation, the data from the NOK and 

NNHSF tapes would be matched to the CRQ/DRQ tapes, 

6 

and nonresponse to the NOK and the NNHSF would be 

treated as missing data. The weights provided on the CRQ 

and DRQ data tapes are included on the Wave III tape in 

columns 550-557 and 574-581, respectively. These weights 

do not include adjustments for nonresponse to the NOK 

interview or to the Wave I, Wave 11, or Wave 111 

interviews. 

Alternatively, the data available on the NOK tape 

may be central to the analysis, and the investigator might 

want to use weights that take into account nonresponse to 

the NOK interview. Nonresponse to the NOK questionnaire could have resulted from failure to obtain sufficient 

information on the CRQ/DRQ to contact a next of kin or 

from failure to complete an interview. Therefore, two 

weights for each sample case (current resident or discharged resident with a completed NOK) are provided, 

One of these estimators weights the NOK data to the 

number of CRQ or DRQ cases with an identified next-ofkin respondent. This estimator is the product of the base 

weight for sample current or discharged residents, adjustments for the presence of next of kin, and adjustments for 

nonresponse to the NOK questionnaire in cases where a 

respondent was identified, The second estimator weights 

the NOK data to the total number of DRQ or CRQ cases, 

This estimator assumes that persons without a next of kin 

have essentially the same characteristics as those for 

whom next of kin were listed. This estimator is the product 

of the CRQ/DRQ base weight and adjustments for nonresponse to the NOK questionnaire, as indicated previously. 

As noted earlier, the NOK weights do not include adjustments for nonresponse to the Wave I, Wave II, or Wave 

III questionnaires. 

The use of the provided weights is complicated by the 

design features of the CRQ, the DRQ, the NOK questionnaire; and the NNHSF. In particular, it is important to 

keep in mind that the DRQ is an event sample. That is, 

events, rather than persons, are sampled. Thus, an individual can appear more than once on the sampling list, 

Although the CRQ is a sample of persons and not of 

events, some current residents were also included in the 

discharge sample if they were discharged from the nursing 

home in the previous 12 months. 

Although they use the basic CRQ and DRQ samples, 

the NOK component and the NNHSF follow persons. 

This is a particular problem for the DRQ sample. All 

information for persons sampled more than once is included on one record; the reference date for the utilization history questions is the earliest sampled discharge 

date (question 24 of the NOK interview). Thus, information on the characteristics of the person at the time of 

admission (questions 2-19) is collected only for this first 

sampled stay. If an investigator wants to make inferences 

about discharge “events,“ it is necessary to add cases to 

the file that duplicate the information for those persons 

who appear in the discharge sample more than once, 

Information on the identification (ID) numbers of each of 

the discharged resident’s other sampled stays is in positions 53-59 and 60–66 of the NOK tape. When 
I 

records are duplicated to add cases to represent all 

discharged resident stays, the ID numbers in positions 1–7 

of the added records should be changed to match the ID 

numbers identified in positions 53-59 and 60–66 of the 

original record. 

For example, if a resident has two stays listed on the 

discharge file, and the first sampled discharge has an ID 

number of 1000001 (positions 1–7), the ID number of the 

\ second stay 0000002) is stored in positions 53-59. When 

the inform~t~on is duplicated, the ID for the duplicate stay 

must be changed to 1000002. In addition, stay information 

must be rearranged to identi$ the appropriate sampled 

stay and stay sequences for each new record. Furthermore, information on subject characteristics prior to admission for other-than-the-first sampled stay will be 

missing. 

Similarly, ‘if the investigator wishes to make inferences 

about all current residents, it is necessary to add current 

resident cases to the file for each resident with stays 

recorded in both the discharge and current resident samples by duplicating the appropriate information for the 

discharge resident case and changing the status to “current resident” by changing the ID number. 

For example, cases with ID numbers in positions 

67-73 of the NOK tape should be duplicated and treated 

as CRQ cases with the ID number changed to the CRQ 

ID found in positions 67–73. Stay information must also 

be arranged to identi~ the appropriate sampled stay and 

stay sequences for each new record. Moreover, because all 

of these cases were originally sampled as current resident 

cases (but retained as discharge cases on the NOK file), 

the CRQ weights in NOK positions 388-395,396-403, and 

404-411 should be used to make estimates for current 

residents. The DRQ weight fields should be blanked out 

for these resident cases. The cases that were included in 

both the CRQ and DRQ samples are the only cases on the 

NOK file with both CRQ and DRQ weights. 

Analyses using the DRQ sample to make inferences 

about persons must take into account the fact that the 

probability of being selected for the survey increases with 

the number of nursing home stays during the sample 

period; that is, persons with many stays are more likely to 

be selected into the samples. 

There are two ways to compensate for this, One way is 

to restrict estimates to’cases where the sampled stay is the 

first eligible stay that the individual had during the sampling frame. In another method, the investigator can 

adjust the base weight by dividing by the probability of an 

individual (not events) being selected and adjusting for 

nonresponse. The calculation of the probability of selection for an individual with multiple stays is complex and 

should be computed under the guidance of a statistician. 

The information needed to make both of these modifications is available in the DRQ files. Additional complications result from analyses that involve, combining the CRQ 

and DRQ samples. For example, some data items were 

collected in the CRQ questionnaire but not in the DRQ 

questionnaire. 

Data tape information 

Public-use data tapes for Wave I, Wave II, and Wave 

HI of the National Nursing Home Survey Followup have 

been released and are available from the National Technical Information Service (NTIS), In addition, all components of the 1985NNHS (including the NOK data tape) 

are available as public-use data tapes through the NTIS. 

The NOK and followup tapes can be linked to the 1985 

National Nursing Home Survey public-use data tapes. The 

subject’s identification number can be used to link all 

three waves of the followup files to the NNHS files and to 

the NOK file. 

7 
References 

I.	 Hing E, Sekscenski E, Strahan G. The National Nursing 

Home Survey 1985 summary for the United States, National Center for Health Statistics. Vital Health Stat 13(97). 

1989. 

2.	 Hing E. Effects of the prospective payment system on 

nursing homes. National Center for Health Statistics. Vital 

Health Stat 13(98). 1989. 

3.	 Hing E. Nursing home utilization by current residents, 

United States, 1985. National Center for Health Statistics. 

Vital Health Stat 13(102). 1989. 

4.	 Sekscenski E. Discharges from nursing homes: 1985 National Nursing Home Survey. National Center for Health 

Statistics. Vital Health Stat 13(103). In press. 

5.	 Strahan G. Nursing home characteristics: preliminary data 

from the 1985 National Nursing Home Survey. Advance 

data from vital and health statistics, no. 131. Hyattsville, 

Maryland: National Center for Health Statistics. 1987, 

&	 Hing E. Use of nursing homes by the elderly: preliminary 

data from the 1985 National Nursing Home Survey, Advance data from vital and health statistics, no. 135. Hyattsville, Maryland: National Center for Health Statistics. 1987, 

7.	 Sekscenski E. Discharges from nursing homes: preliminary 

data from the 1985 National Nursing Home Survey, Advance data from vital and health statistics, no, 142, Hyattsville, Maryland: National Center for Health Statistics. 1987, 

8.	 Strahan G. Characteristics of registered nurses in nursing 

homes: preliminary data from the 1985 National Nursing 

Home Survey. Advance data from vital and health statistics, 

no. 152. Hyattsville, Maryland: National Center for Health 

Statistics. 1988. 

9.	 National Center for Health Statistics. Public-use data tape 

documentation: National Nursing Home Survey, 1985, 

Hyattsville, Maryland: Public Health Service, 1988, 

8 
Appendixes


i


Contents 

1.	 Training and interviewing schedule for the 1985 National Nursing Home Survey and the National


Nursing Home Survey Followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


IL Study materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...,,,,, . . . . . . . . . ,,, ,., ,.. . . . . . . . . . ,,, . . .


Advance letter to subject . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Advance letter to proxy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Advance letter to nursing home administrator . . . . . . ..$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


NNHSF confidentiality assurance form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$ $... . . . . . . . . . . . . . . . . . . .


Certification log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


NNHSFnonresponse report form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Problem resolution report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , , . . . . . . . . . . . . . . . . . , . . . . . . . . . . . , . . ..


NNHSFWave I questionnaire . . . . . . . . . . . . . . . . . . . . . ..$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


NNHSFWave II questionniare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


NNHSFWave III questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


10 

11 

11 

12 

13 

14 

15 

16 

17 

18 

33 

48 

.9 
Appendix I 

Training and 

interviewing schedule 

for the 1985 National 

Nursing Home Survey 

and the National Nursing 

Home Survey Followup 

Planning for the 1985 National Nursing Home Survey 

(NNHS) began in 1983. A pretest was conducted from 

March, 1984 through January 1985. Planning for the National Nursing Home Survey Followup (NNHSF) began in 

the summer of 1986, and Office of Management and 

“Budget (OMB) approval was obtained on Februa~ 2, 

1987.The training and interviewing schedule is presented 

below. 

Time period Type of trainingfinterviewing 

March 1984	 NNHS pretest: interviewer 

training 

April-June 1984	 NNHS pretest: field 

interviewing 

June 1984	 NNHS pretesti computer-’ 

assisted telephone interview 

(CATI) training, Round I 

June-August 1984	 NNHS pretest: CATI 

interviewing, Round I 

January 1985	 NNHS pretest: CATI 

training, Round II 

January-March 1985	 NNHS pretest: CATI interviewing, Round 11 

July–August 1985


August 1985-January 1986


October 1985


October 1985-March 1986


August 1987


August-December 1987


July 1988


July–November 1988


January 1990


January-April 1990


1985 NNHS: interviewer 

training 

1985 NNHS: field interviewing 

Next-of-kin (NOK) interview: CATI training 

NOK CATI 

interviewing 

NNHSF: CATI training, 

Wave I 

NNHSF CATI interviewing, Wave I 

NNHSF CATI training, 

Wave II 

NNHSF CATI interviewing, Wave II 

NNHSF: CATI training, 

Wave 111 

NNHSF: CATI interviewing, Wave 111 

10

Appendix II 

Study materials 

Advance letterto subject


Dear Participant:


Ayearor so ago you participated in the National Nursing Home Survey.


This survey was conducted by the National Center for Health Statistics,


an agency.gf the United States Public Health Service. Your cooperation


was most helpful to us and the informationyou provided has proved to


“ be extremely valuable. The purpose of this letter is to inform you that


the survey is being extended to obtain more complete information for health


planners who develop policy and provide services for the elderly.


You may recall speaking with us about events occurring before and during


your nursing home experience. In the next few weeks, an interviewer from


Research Triangle Institute, the firm under contract to do this survey,


will be contacting you by telephone and will ask you abrief set of questions


about any additional hospitalizations and nursing home admissions you


might have had since the last time we talked to you. The National Center


for Health Statisties is authorized by Section 306 (42 USC 242K) of the


Public Health Service Act to collect this kind of information.


Letme reassure you that all collected information will be held in strict


confidence and will not be released to anyone or used in any way other


than in statistical summaries. These summaries will only be presented


in a manner which ensures that no individual can be identified.


Your continuing participation in this survey is voluntary, and there are


no penalties for your refusal to participate. You may be assured’, however,


that your participation is greatly appreciated and that your individual


contribution to this survey is needed by health planners.


Sincerely yours,


Manning Feinleib; M.D., Dr.P.H.


Director


11

Advance letter to proxy 

Dear Participant:


A year or so ago you participated in the National Nursing Home Survey.


This survey was conducted by the National Center for Health Statistics,


an agency of the United States Public Health Service. Your cooperation


was most helpful to us and the informationyou provided has proved to


be extremely valuable. The purpose of this letter is to inform you that


the survey is being extended to obtain more complete information for health


planners who develop policy and provide services for the elderly.


You may recall speaking with us about events occurring before and during


the nursing home experience of the person whose name appears below. In


the next few weeks, an interviewer from Research Triangle Institute, the


firm under contract to do this survey, will be contacting you by telephone


and will ask you a brief set of questions about any additional hospitalizations


and nursing home admissions this person might have had since the last


time we talked to you. The National Center for Health Statistics is authorized


by Section 306 (42 USC 242K) of the Public Health Service Act to collect


this kind of information.


Let me reassure you that all collected information will be held in strict


confidence and will not be released to anyone or used in any way other


than in statistical.summaries. These summaries will only be presented


in a manner whichensuresthat no individualcan be identified.


Your continuing participation in this survey is voluntary, and there are


no penalties for your refusal to participate. You may be assured, however,


that your participation is greatly appreciated and that your individual


contribution to this survey is needed by health planners.


Sincerely yours,


.2’?-


Manning Feinleib, M.D., Dr.P.H. 

Director 

12

Advance letter to nursing home 

administrator 

Dear Administrator:


In 1985, the National Center for Health Statistics, an agency of the United 

States Public Health Service, conducted the National Nursing Home Survey. 

This survey was a nationwide sample survey of current and recent nursing 

home residents. The persons whose names appear below were listed as residents 

of your facility at the time of the survey. 

The survey is being extended in order to obtain more complete information


for health planners who develop policy and provide services for the elderly.


In the next few weeks, an interviewer from Research Triangle Institute,


the firm under contract to do this survey, will be contacting you by telephone


and will ask you a brief set of questions about these residents. The interview


process will be greatly facilitated if you will have the records for these


residents accessible when the interviewer calls. The National Center


for Health Statistics is authorized by Section 306 (42 USC 242K) of the


Public Health Service Act to collect this kind of information.


Let me reassure you that all collected information will be held in strict


confidence and will not be released to anyone or used in any way other


than in statistical summaries. These summaries will only be presented


in a manner which ensures that no individual can be identified.


Your continuing participation in this survey is voluntary, and there are


no penalties for your refusal to participate. You may be assured, however,


that your participation is greatly appreciated and that your individual


contribution to this survey is needed by health planners.


Sincerely yours,


2+?i? 

Manning Feinleib, M.D., Dr.P.H.


Director


13

NNHSF confidentiality assurance form 

RESEARCH TRIANGLE INSTITUTE 

Center for Survey Research 

National Nursing Home Survey Follow-up


Confidentiality Assurance


In accordance with Section 308(d) of the Public Health Service Act (42 U.S.C.


242m), the Director of the National Center for Health Statistics assures each


respondent that the confidentiality of responses to this information request


will be maintained by the contractor and NCHS, and that no information 

obtained in the course of this activity may be disclosed in a manner in which


the particular establishment or individual supplying the information or


described in it is identifiable, unless suchestablishmentor individualhas


consentedto such a disclosure, to anyone other than authorized staff of NCHS.


I have carefully read and understand the National Center for Health Statistics 

assurance which pertains to,the confidential nature of all records to be 

handled in regard to this survey. As-an employee of the contractor I 

understand that I am prohibited by law from disclosing any such confidential 

information which has been obtained under the terms of this contract to anyone 

other than authorized staff of NCHS. 

(Signature)


(Name Printed)


(Date)


Post Office Box 12194 Research Triangle Park. North Carolina 27709 Telephone: 919541-6000 

14

-------------- ------- ------- --------------- -------------- -----

Certification log 

Certification Log


National Nursing Home Survey Follow-up


(NNHSF)


CATI NUMBER CATI NUMBER CATI NUMBER


,.


CERTIFICATION:	 I certify that I have fulfilled the legal requirements of


the Privacy Act by reading the standard introduction to the


respondents for the cases listed above.
 -----.- -----..-


Signature: Interviewer ID #: Date:


15

NNHSF nonresponse report form 

NATIONAL NURSING HOME SURVEY FOLLOW-UP	 CATI NO. INT. ID. 

BREAKOFF . . . . . .01 RESULT CODE 

?IONRESPONSEREPORT FORM REFUSAL . . . . . .02 RESULT CODE—

a.m.


DATE ._l_/— TIME p.m.


. REASONS FoR REFusAL/BREAKoFF (CIRCLE ALL THAT APpLy):


Too busy. . . . . . . . . . . . .01 Hungupphone . . . . . . . . . . . . . .0!


Interview will take too long . . . 02 Negative about government . . . . . . . . 0[


Will not give information Negativeabout surveys . . . . . . . . . 07


ont)hone . . . . . . . . . . .03 No reasonuiven . . . . . . . . . . . ..OE


Concerhed about confidentiality . 04 Other (sPEtIFy) 09


� sTRENGTH OF REFusAL (CIRCLE ONE): 

Mild--no hostility, good possibility of conversion . . . . . . . . . . . . . . . . . . 01


Firm, but @hostile--gave specific reason . . . . . . . . . . . . . . . . . . . . . . 02


Very firmandhostile. . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . ..03


, DID THE RESPONDENT ASK ABOUT ANY OF THE FOLLOwING (cIRcLE ALL THAT APpLY): 

The study purpose . . . . . . . . 01 Sponsorship . . . . . . . . . . . . ...05


Useofthedata . . . . . . ...02 Whycallhim/her . . . . . . . . . . ..Of


Confidentiality of information . . 03 Legitimacy of interview . . . . . . . . . 01


RTI . . . . . . . . . . . . ...04 Other (SPECIFY) 0[


WHAT EFFORTS WERE MADE TO OBTAIN PARTICIPATION? WHAT DID THE RESPONDENT SAY?


) FOLLOW-UP ACTIONS


DATE BY I ACTION TAKEN AND RESULT (USE CONTINUATION SHEET IF NECESSARY)


FINAL RESULT


Final Result Code Assigned _ Approved By: Date:


PROJECT STAFF REVIEW: Approved: Date:


Returned for additional actions as follows:


16

Problem resolution report 

Yational	 Nursing Home Survey Cati No.: Question No.: 

. 

Date: Supervisor: 

(Project 3934) 

Resolved by: 

FO11OW-UD

Problem Resolution Report


1. Brief Description of Problem:


?. Resolution By: Date:


1. Notes: 

17

NNHSF Wave I questionnaire€

THE NATIONAL NURSING HOME SURVEY FOLLOWUP: WAVE I, 1987


QUESTIONNAIRE


Notice: All information on this questionnaire which would permit


identification of the individual will be held in strict


confidence, will be used only by persons engaged in and for the


purposes of the survey, and will not be disclosed or released to


other persons for any purpose in accordance with---the
Public


Health Service Act (42 USC 242m).


18

--

NATIONAL NURSING HOME SURVEY FOLLOWUP: WAVE I, 1987


I. INTRODUCTION


Hello. My name is . I’m calling from


on behalf of the United States Public Health Service in


Washington, D.C.


To make sure I have dialed correctly, is this --?


1= YES 

2= No (REDIAL) 

May I please speak to --?


1= RESPOmEm AVAILABLE (Reintroduce yOuRsELF AS 

NECESSARY) 

2= RESPONDENT NOT AvAImLE (mKE APPOImNT) 

3= RESPONDENT UNABLE TO PARTICIPATE - IF RESPONDENT


DECEASED


SAY : I’m very sorry. Maybe you will be able to help


us .


Ia. TO BE USED FOR PREVIOUSLY CONTACTED RESPONDENTS


You may remember that we spoke to you a year or so ago and asked


you some questions about --’s use of nursing homes. Your


cooperation at that time was most helpful. We are now


interested in finding out what has happened to -- with regard to


any nursing home stays or short-term hospitalizations -- may


have had since then. This information is being collected to


assist health planners who provide services for the elderly.


(SKIP TO Id.)


Ib. TO BE USED FOR NEW RESPONDENTS


In 1985 the National Center for Health Statistics, an agency of


the U.S. Public Health Service, conducted a survey of current


and former nursing home residents. -- was selected at random to


take part in this study. We are now interested in finding out


what happened to -- with regard to any nursing home stays or


short-term hospitalizations may have had since then. This


information is being collected to assist health planners who


provide services for the elderly. (SKIP TO Id.)


Ic. TO BE USED FOR FACILITY RESPONDENTS


You may remember that in 1985 your facility was contacted during


the National Nursing Home Survey sponsored by the National


Center for Health Statistics, an agency of the U.S. Public


Health Service. We are now interested in finding out what has


19

happened to the sample residents who were in your facility at


that time. This information is being collected to assist health


planners who provide services for the elderly. (SKIP TO Id.)


Id. You should have received a letter from Dr. Manning Feinleib,


the Director of the National Center for Health Statistics, which


described this study. Have you received this letter?


1= YES (SKIP TO Ie.)


2= NO


I’m sorry that you did not receive the letter. YOU should be 

receiving it shortly. Let me briefly outline its contents for 

you. 

The interviews for the 1987 National Nursinq Home Survey


Followup are authorized by the Public Health Service Ac~, Volume


42 of the U.S. Code, Section 242K. In accordance with this


legislation, all information on this questionnaire that would


permit identification of the individual will be held in strict


confidence, will be used only by persons engaged in and for the


purposes of the survey, and will not be disclosed or released to


other persons for any purpose.


Ie. Your participation in this survey is strictly voluntary, and


there are no penalties for your refusal to participate. You may


be assured, however, that your participation is greatly


appreciated.


If. ASK ONLY OF FACILITY RESPONDENTS


I will be asking about (READ NAME(S) FROM ASSIGNMENT LIST).


IF MORE THAN ONE: The first person I want to ask about is ---
 (SKIP TO Ih.)


Ig. ASK OF PROXY RESPONDENTS


Do you feel able to answer some questions about --?


1= YES (SKIP TO Ih.)


2= NO


Igl.	 Can you give me the name, address, and phone number of


someone or of a facility who knows about --?


1= YES


2= NO (SKIP TO END)


20 
Ig2 .


Ig3 .


Ig4 .


Ig5 .


Ig6 .


Ig7 .


what is the name?


ENTER NAME - LIMIT 35 CHARACTERS


What is the relationship of -- to --?


ENTER RELATIONSHIP -- LIMIT OF 20 CHARACTERS


What is the street address of --?


ENTER STREET ADDRESS -- LIMIT OF 25 CHARACTERS


What is the name of the city?


ENTER NAME OF CITY -- LIMIT OF 15 CHARACTERS


What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


What is the telephone number?


ENTER TELEPHONE NUMBER -- FORMAT: (xxx) YYY-ZZZZ


(IF “DKM OR ‘IRE”,THANK RESPONDENT AND CALL DIRECTORY


ASSISTANCE)


FINAL “DK” OR llRE”- (999) 999-9999


Thank you for your cooperation.


Good-bye. Have a nice (day/evening) .


Ih .	 INTERVIEWER : WHAT TYPE OF RESPONDENT WILL YOU BE


INTERVIEWING?


1= THE SUBJECT


2= PROXY


3= FACILITY OTHER THAN SAMPLE NURSING HOME


4= SAMPLE NURSING HOME


21 
NOTE : -- denotes the name of the subject or the appropriate


pronoun.


SECTION A ASKED ONLY IF SUBJECT WAS A RESIDENT IN A NURSING


FACILITY AT THE LAST CONTACT, OTHERWISE GO TO SECTION B


Al. IF FIRST RESPONDENT:


At the time of our contact on (date), -- was a resident of


(facility) . IS -- still a resident ?


IF SECOND RESPONDENT:


We have recently learned that -- was a resident of


(facility).


Is -- still a resident?


1= YES (SKIP TO A5)


2= NO


A2 .	 After (date), in what month and year was -- first


discharged?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 84-87)


A3 . Was -- alive at the time of the discharge?


1= YES


2= NO (SKIP TO B2)


A4 .	 Where was -- discharged to? (AFTER THIS QUESTION, SKIP TO


A9 )


(IF “HOSPITAL”, PROBE FOR SPECIFIC TYPE OF HOSPITAL)


;: 

3=


4=


5=


6=


7=


8=


9=


10= 

11= 

12=


OWN HOME OR APARTMENT


RELATIVE’S HOME OR APARTMENT


OTHER PRIVATE HOME OR APARTMENT


RETIREMENT HOME


BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


ANOTHER NURSING HOME


GENERAL OR SHORT-TERM HOSPITAL


MENTAL HOSPITAL


CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


HOSPICE


SOME OTHER PLACE


GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


22 
--

--

A5 . Has -- been a resident continuously in (facility) since€

(date)?€

I= YES (SKIP TO EI)€

2= NO€

A6 . When was -- first discharged after (date)?€

ENTER MONTH (RANGE 1-12)€

ENTER DAY (RANGE 1-31)€

ENTER YEAR (RANGE 84-87)€

A7 . When was -- next admitted to this nursing home?€

ENTER MONTH (RANGE 1-12)€

ENTER DAY (RANGE 1-31)€

ENTER YEAR (RANGE 84-87)€

A8 . Was discharged from that stay?€

1= YES 

2= NO (SKIP TO D1) 

REPEAT A6-A8 FOR UP TO 4 STAYS€

A8a. How many more times was -- admitted between (date) and€

now?€

ENTER NUMBER OF TIMES (RANGE 1-10)€

A8b . When was -- last admitted to this nursing home?€

ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)€

ENTER YEAR (RANGE 84-87)€

A9 . Was ever readmitted to (facility).after (date)?€

1= YES 

2= NO 

AlO . When was -- first admitted after (date)?€

ENTER MONTH (RANGE 1-12)€

ENTER DAY. (RANGE 1-31)€

ENTER YEAR (RANGE 84-87)€

All . When was -- discharged from that stay?€

ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)€

ENTER YEAR (RANGE 84-87)€

23 
--

--

--

--

A12 .€

A13 .€

A13a.€

A14 .€

A15 .€

A16 .€

B1 .€

B2 .€

B3 .€

Was alive at discharge?€

1= YES€

2= NO (SKIP TO B2)€

Was readmitted after that stay?€

1= YES 

2= No (SKIP To Bl) 

REPEAT A1O-A13 FOR UP TO 3 STAYS€

How many other times was -- admitted between (date) and€

now?€

ENTER NUM8ER OF TIMES (RANGE 1-10)€

When was -- last admitted to this facility?€

ENTER MONTH (RANGE 1-12)€

ENTER DAY (RANGE 1-31)€

ENTER YEAR (RANGE 84-87)€

When was last discharged from this facility?€

ENTER MONTH (RANGE 1-12)€

ENTER DAY (RANGE 1-31)€

ENTER YEAR (I@NGE 84-87)€

Was alive at discharge? 

1= YES 

2= NO (SKIP TO B2) 

(ASK oNLy IF NOT mom)


Is--- alive?€

1= YES (SKIP TO cI)


2= NO


On what date did -- die?€

ENTER MONTH (RANGE 1-12)


ENTER DAY” (RANGE 1-31)€

ENTER YEAR (RANGE 84-87)€

In what State did -- die?€

ENTER 2-LETTER STATE ABBREVIATION


OC= OTHER COUNTRY


24 
--

--

--

--

--

B4 . During the last 6 months before --’s death, that is, from


(date) to (date), did receive hospice care either at


home, in a hospital, in a nursing home, or in a


freestanding hospice?


I= YES (SKIP TO D1)


2= NO (SKIP TO Dl)


c1 . Where is staying now? 

(IF THE RESPONSE TO THIS QUESTION IS 7, ASK c2; OTHERWISE,


AFTER THIS QUESTION SKIP TO Dl)


(IF “HOSPITAL”, PROBE FOR SPECIFIC TYPE OF HOSPITAL)


1= OWN HOME OR APARTMENT


2= RELATIVE’S HOME OR APARTMENT


3= OTHER PRIVATE HOME OR APARTMENT


4= RETIREMENT HOME


5= BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


6= NURSING HOME


7= GENERAL OR SHORT-TERM HOSPITAL


8= MENTAL HOSPITAL


9= CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


10= HOSPICE


11= SOME OTHER PLACE


12= GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


What place is that?


ENTER VERBATIM RESPONSE LIMIT OF 50 C_CTERS


C2 . Where was living before being admitted to the hospital?


1= 

2=


3=


4=


5=


=
 6


7=


8=


9=


10=


11=


12=


OWN HOME OR APARTMENT


RELATIVE’S HOME OR APARTMENT


OTHER PRIVATE HOME OR APARTMENT


RETIREMENT HOME


BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


NURSING HOME


GENERAL OR SHORT-TERM HOSPITAL


MENTAL HOSPITAL


CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


HOSPICE


SOME OTHER PLACE


GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


What place was that?


ENTER VERBATIM RESPONSE LIMIT OF 50 CHARACTERS


25 
C3a.


C3b.


C3C.


C3d.


C3e.


What is the name of the nursing home?


1= (facility name)


IF NAME GIVEN IS THAT SHOWN ABOVE, ENTER “1”; OTHERWISE


ENTER NAME OF NURSING HOME -- LIMIT 50 CUCTERS


What is the street address of the home?


EtiER STREET ADDRESS -- LIMIT OF 25 CHARACTERS


What is the name of the city?


ENTER NAME OF CITY -- LIMIT OF 15 CHARACTERS


What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


What is the telephone number?


ENTER TELEPHONE NUMBER -- FORMAT: (xxx) YYY-ZZZZ


I!DKI1 oR lIREII
_ (999) 999-9999


(Other than the stays you have told me about), did -- have


any stays in a nursing-home or similar place after (date)?


1= YES


2= NO (SKIP TO EI)


IF SPEAKING TO FACILITY, TIME FRAME IS FROM DATE IN D1 UNTIL THE


LAST DATE RESPONDENT KNOWS ABOUT SUBJECT


D2 . When was -- first admitted to a nursing home after (date)?


NOTE : IF DISCHARGED TO NH, DATE WILL BE DISCHARGE DATE


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 84-87)


D2a. How long was -- in the nursing home during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


26 
D3 .


D4 .


D5a.


D5b .


D5c .


D5d .


When was -- discharged from this nursing home stay?


20= STILL THERE (SKIP TO El)


50= DIED DURING THIS STAY (SKIP TO E1)


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 84-87)


Did -- have any other stays in a nursing home or similar


place after this stay?


1= YES


2= No (SKIP TO E1)


REPEAT D2-D4 FOR UP TO 3 STAYS


How many other stays did -- have in a nursing home or


similar place between (date) and now?


ENTER NUMBER (RANGE 1-10)


When was -- last admitted to a nursing home?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 84-87)


How long was -- in the nursing home during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


When was -- discharged from this nursing home stay?


20= STILL THERE (SKIP TO El)


50= DIED DURING THIS STAY (SKIP TO El)


ENTER MONTH (RANGE 1-12)


ENTER DAY- (RANGE 1-31)


ENTER YEAR (RANGE 84-87)


IF QUESTION A4=07 OR C1=07 (HOSPITAL), SKIP TO E2


27 
El.	 After (date), was -- a Patient in a general or short-term


hospital overnight or l~nger?


1= YES


2= NO (SKIP TO F)


IF SPEAKING TO FACILITY, TIME FRAME IS FROM DATE IN El UNTIL THE


LAST DATE RESPONDENT KNOWS ABOUT SUBJECT


E2.	 When was -- first admitted to a general or short-term


hospital after (date)?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 84-87)


E2a. How long was -- in the hospital during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


E3. When was -- discharged from this hospital stay?


20= STILL THERE (SKIP TO F)


50= DIED D17RINGTHIS STAY (SKIP TO F)


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 84-87)


E4.	 Did -- have any other stays in a general or short-term


hospital after this stay?


1= YES


2= NO (SKIP TO F)


REPEAT E2-E4 FOR UP TO 3 STAYS


E5a. How many other stays did -- have in a general or short­


term hospital between (date) and now?


ENTER NUMBER (RANGE 1-10)


28 
--

E5b .


[ 

1, 

E5c.


,1 

E5d .


F.


Fa.


Fb .


When was -- last admitted to a general or short-term


hospital?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 84-87)


How long was -- in the hospital during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


When was -- discharged from this hospital stay?


20= STILL THERE (SKIP TO F)


50= DIED DURING THIS STAY (SKIP TO F)


ENTER MONTH (RANGE 1-12) (SKIP TO F)


ENTER DAY (RANGE 1-31) (SKIP TO F)


ENTER yEAR (RANGE 84-87) (SKIP TO F)


ASK ONLY IF SUBJECT HAS BEEN DISCHARGED FROM A NURSING


HOME, OTHERWISE, SKIP TO G


Can you give me the name, address, and phone number of


someone or of a facility who knows about -- after -- was


discharged from your facility?


1= YES 

2= NO (SKIP TO G)


I


What is the name?


ENTER NAME -- LIMIT 50 CHARACTERS


IF FACILITY NAME GIVEN, DO NOT ASK. ENTER “FACILITYI!


FC . What i.sthe relationship of to --?


ENTER RELATIONSHIP -- LIMIT 20 CHAFU4CTERS


Fd . What is the street address of --?


ENTER STREET ADDRESS -- LIMIT OF 25 C~CTERS


29

Fe.


Ff .


Fg .


What is the name of the city?


ENTER NAME OF CITY -- LIMIT OF 15 CHARACTERS


What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


What is the telephone number?


ENTER TELEPHONE NUMBER -- FORMAT: (XXX) YYY-ZZZZ


!IDKII OR !IREII - (999) 999-9999


, 

G. As part of this survey, we would like to have --’s Medicare


number.- This number is n~eded to allow Medicare records to be


easily and accurately located and identified for statistical


research purposes.


The provision of --’s Medicare number is voluntary and will in


no way affect any benefits -- may be eligible for or -- is


receiving. This information is collected under the authority


of Section 306 of the Public Health Service Act. May I


have --’s Medicare number?


IF NUMBER ENTERED: VERIFY, CHANGE, OR RETURN THROUGH PROMPT


ENTER MEDICARE NUM8ER AND LETTER


FORMAT: 101OO1OO1A


IF NUMBER NOT ON SCREEN, ENTER ~tNONEr’


H1 .	 Medicaid is a national program which pays for health care


for persons in need.


When -- was first admitted to a nursing home, was --
 eligible to receive Medicaid benefits for nursing home


care?


I= YES, ELIGIBLE (SKIP TO H4)


2= NO, INELIGIBLE


3= NEVER ApPLIED (SKIP TO H5)


H2 . Why was ---ineligible?


1= TOO MUCH INCOME/ASSETS


2= OWNED PROPERTY


3= AGE


4= OTHER


5= PRIVATE WAY


30 
H3 .	 Did -- later become eligible and receive Medicaid benefits


for nursing home care?


1= YES 

2= NO (SKIP TO H5) 

H4.	 what year did -- begin to receive Medicaid benefits for


nursing home care?


ENTER LAST 2 DIGITS OF YEAR


(RANGE 65-87)


ASK ONLY IF THE SUBJECT IS CURRENTLY A RESIDENT OF A NURSING


HOME


H5 .	 I am going to read a list of ways in which facilities are


paid =or ~heir”services. Please answer “yes” or “no” to


~ach item that may have helped pay for the care -- is


currently receiving.


YES NO


Own income, family support, health insurance


.2


1. 

2.


3.


5.


6.


7.


8.


9.


10.


11.


retirement funds, Social Security . . . .
 Medicare. . . . . . . . . . . . . . . . .


Medicaid. . . . . . . . . . . . . . . .
 State funded indigent care (excluding


Medicaid) . . . . . . . . . . . . . . . .
 Other government assistance or welfare. .
 Religious organization, foundations,


volunteer agencies. . . . . . . . . . . .
 VA (Veterans Administration). . . . . . .
 Initial payment-life care funds . . . . .
 No charge made for care (facility assumes


cost)


Some other source . . . . . . . . . . . .


. . 1 

. . 1 .2 

. . 1 .2 

. . 1 .2 

. . 1 .2 

. . 1 .2 

. . 1 .2 

. . 1 .2 

. . 1 2 

. . 1 .2 

What other source helps pay for the care -- is currently


receiving?


ENTER RESPONSE -- LIMIT 50 CWCTERS


31 
ASK ONLY IF ‘YES’ TO MEDICAID AS A SOURCE OF PAYMENT


H5a.	 You told me that Medicaid helps pay for the care -- is


currently receiving.


Is that skilled nursing care (SNF) or intermediate nursing


care (ICF)?


1= SKILLED NURSING CARE ,“ 

2= INTERMEDIATE NURSING CARE 

3= OTHER


END


Thank you very much for answering these questions. We


appreciate your cooperation in the survey.


In case someone wants to get in touch with you to verify my


work, please give me your name.


ENTER NAME - LIMIT 50 CHAIUCTERS


IF SUBJECT, DO NOT ASK. ENTER “SELF”


IF FACILITY, DO NOT ASK. ENTER ‘lFACILHYII


What is your relationship to --?


ENTER RELATIONSHIP - LIMIT 20 CHARACTERS


Thank you again for your cooperation.


If you have questions, please feel free to call the National


Nursing Home Survey Followup, toll free.


Have a nice (day/evening).


32

NNHSF Wave II questionnaire 

I 

THE NATIONAL NURSING HOME SURVEY FOLLOWUP: WAVE II, 1988


i 

QUESTIONNAIRE


[ 

, 

[ 

i 

I 

Notice: All information on this


identification of the individual


I	 confidence, will be used only by


purposes of the survey, and will


other persons for any purpose in


I Health Service Act (42 USC 242m). 

questionnaire which would permit


will be held in strict


persons engaged in and for the


not be disclosed or released to


accordance with the Public


33 
--

--

--

NATIONAL NURSING HOME SURVEY FOLLOWUP: WAVE II


I. INTRODUCTION


Hello. My name is . I’m calling from


on behalf of the United States Public Health Service in


Washington, D.C.


To make sure I have dialed correctly, is this --?


1= YES 

2= NO (REDIAL) 

May I please speak to --?


I= RESPONDENT AVAIIJWLE (ReintrOdUCe yOuRsELF AS Necessary)


2= ReSpOndent NOT AVAILABLE (MAKE APPOImNT)


3= RESPONDENT UNABLE TO PARTICIPATE - IF RESPONDENT DECEASED


SAY : I’m very sorry. Maybe you will be able to help us.


Ia. TO BE USED FOR PREVIOUSLY CONTACTED RESPONDENTS


You may remember that we spoke to you a year or so ago and asked


you some questions about --’s use of nursing homes. Your


cooperation at that time was most helpful. We are now interested


in finding out what has happened to -- with regard to any nursing


home stays or short-term hospitalizations may have had since


then. This information is being collected to assist health


planners who provide services for the elderly. (SKIP TO Id.)


Ib. TO BE USED FOR NEW RESPONDENTS


In 1987 the National Center for Health Statistics, an agency of


the U.S. Public Health Service, conducted a survey of currenc and


former nursing home residents. was selected at random to take


part in this study. We are now interested in finding out what


happened to -- with regard to any nursing home stays or short-


term hospitalizations may have had since then. This


information is being collected to assist health planners who


provide services for the elderly. (SKIP TO Id.)


Ic. TO BE USED FOR FACILITY RESPONDENTS


You may remember that in 1987 your facility was contacted during


the National-Nursing Home Survey sponsored by the National Center


for Health Statistics, an agency of the U.S. Public Health


Service. We are now interested in finding out what has happened


to the sample residents who were in your facility at that time.


This information is being collected to assist health planners who


provide services for the elderly. (SKIP TO Id.)


34 
Id. You should have received a letter from Dr. Manning Feinleib,


the Director of the National Center for Health Statistics, which


described this sludy. Have you received this letter?


I= YES (SKIP TO Ie.)


2= NO


I’m sorry that you did not receive the letter. You should be


receiving it shortly. Let me briefly outline its contents for


you .


The interviews for the 1987 National Nursing Home Survey Followup


are authorized by the Public Health Service Act, Volume 42 of the


U.S. Code, Section 242K. In accordance with this legislation,


all information on this questionnaire that would permit


identification of the individual will be held in strict


confidence, will be used only by persons engaged in and for the


purposes of the survey, and will not be disclosed or released to


other persons for any purpose.


Ie. Your participation in this survey is strictly voluntary, and


there are no penalties for your refusal to participate. You may


be assured, however, that your participation is greatly


appreciated.


If. ASK ONLY OF FACILITY RESPONDENTS


I will be asking about (READ NAME(S) FROM ASSIGmNT LIST).


IF MORE THAN ONE: The first person I want to ask about is ---
 (SKIP TO Ih.)


Ig. ASK OF PROXY RESPONDENTS


Do you feel able to answer some questions about --?


I= YES (SKIP TO Ih.)


2= NO


35 
Igl .


Ig2 .


Ig3 .


Ig4 .


Ig5 .


Ig6 .


Ig7 .


Can you give me the name, address, and phone number


someone or of a facility who knows about --?


1= YES


2= NO (SKIP TO END)


What is the name?


ENTER NAME - LIMIT 35 CHARACTERS


What is the relationship of -- to --?


ENTER RELATIONSHIP -- LIMIT OF 20 CHARACTERS


What is the street address of --?


ENTER STREET ADDRESS -- LIMIT OF 25 CHARACTERS


What is the name of the city?


ENTER NAME OF CITY -- LIMIT OF 15 CHARACTERS


What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


What is the telephone number?


ENTER TELEPHONE NUMBER -- FORMAT: (xxx) YYY-ZZZZ


of


(IF “DK” OR ‘IRE”,THANK RESPONDENT AND CALL DIRECTORY ASSISTANCE)


- (999) 999-9999


Thank you for your cooperation.


Good-bye. Have a nice (day/evening) .


Ih .	 INTERVIEWER: WHAT TYPE OF RESPONDENT WILL YOU BE


INTERVIEWING?


1= THE SUBJECT


2= PROXY


3= FACILITY OTHER THAN SAMPLE NURSING HOME


4= SAMPLE NURSING HOME


36 
NOTE : -- denotes the name of the subject or the appropriate


pronoun.


SECTION A ASKED ONLY IF SUBJECT WAS A FACILITY RESIDENT AT


WAVE I, OTHERWISE GO TO SECTION B
 ,1 

Al. IF FIRST RESPONDENT: 

‘1 At the time of our contact on (date), -- was a resident of 

(facility). IS -- still a resident ? 

IF SECOND RESPONDENT: 

We have recently learned that -- was a resident of 

(facility). 

Is -- still a resident? 

1= YES (SKIP TO A5) 

2= NO 

A2 . After (date), in what month and year was -- first 

discharged? 

ENTER MONTH (RANGE 1-12) 

ENTER DAY (RANGE 1-31) 

ENTER yEAR (WGE 86-88) 

A3 . Was -- alive at the time of the discharge?


1= YES 

2= NO (SKIP TO B2) 

A4 .	 Where was -- discharged to? (AFTER THIS


A9 )


(IF “HOSPITAL”, PROBE FOR SPECIFIC TYPE


1= OWN HOME OR APARTMENT 

2= RELATIVE’S HOME OR APARTMENT 

3= OTHER PRIVATE HOME OR APARTMENT 

4= RETIREMENT HOME 

QUESTION, SKIP TO


OF HOSPITAL)


5= BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


6= ANOTHER NURSING HOME


7= GENE~L OR SHORT-TERM HOSPITAL


8= MENTAL HOSPITAL


9= CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


10= HOSPICE


11= SOME OTHER PLACE


12= GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


37 
--

--

A5 .


A6 .


A7 .


A8 .


A8a.


A8b .


A9 .


AlO .


All .


Has -- been a resident continuously in (facility) since


(date)?


z= YES (SKIP TO EI)


2= NO


When was -- first discharged after (date)?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87,88)


When was -- next admitted to this nursing home?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87,88)


Was -- discharged from that stay?


1= YES


2= NO (SKIP TO Dl)


REPEAT A6-A8 FOR UP TO 4 STAYS


I 

How many more times was -- -admittedbetween (date) and now?


ENTER NUMBER OF TIMES (RANGE 1-10)


When was last admitted to this nursing home?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87-88)


Was ever readmitted to (facility) after (date)?


1= YES


2= NO (SKIP TO Bl)


When was -- first admitted after (date)?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87,88)


When was -- discharged from that stay?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87,88)


38 
--

--

--

I 

I


I A12. Was’-- alive at discharge?


I 

, 1= YES 

2= NO (SKIP TO B2) 

~’ A13. Was readmitted after that stay? 

1= YES [ 2= NO (SKIP TO Bl) 

REPEAT A1O-A13 FOR UP TO 3 STAYS


A13a. How many other times was -- admitted between (date) and


A14 .


A15 .


A16 .


B1 .


B2 .


B3 .


now?


ENTER NUMBER OF TIMES (RANGE 1-10)


When was last admitted to this facility?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87-88)


When was -- last discharged from this facility?


ENTER MONTH (lUUTGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87-88)


Was alive at discharge?


1= YES


2= NO (SKIP TO B2)


(ASK omIr IF NOT mom) 

Is -- alive?


I= YES (SKIp TO cl) 

2= NO 

On what date did -- die?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 86-88)


In what State did -- die?


ENTER 2-LETTER STATE ABBREVIATION


OC=OTHER COUNTRY


39 

1 
( 

B4. During the last 6 months before --’s death, that is, from


(date) to (date), did -- receive hospice care either at


home, in a hospital, in a nursing home, or in a


freestanding hospice?


1= yEs (SKIP TO DI)


2= NO (SKIP TO Dl)


1 cl. Where is -- staying now? ‘1 

(IF THE RESPONSE TO THIS QUESTION IS 7, AsK c2; 0THERV71SE,


AFTER THIS QUESTION SKIP TO Dl)


(IF “HOSPITAL”, PROBE FOR SPECIFIC TYPE OF HOSPITAL)


1= 

2=


3=


4=


5=


6=


7=


8=


9=


10=


11=


12=


OWN HOME OR APARTMENT


RELATIVE’S HOME OR APARTMENT


OTHER PRIVATE HOME OR APARTMENT


RETIREMENT HOME


BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


NURSING HOME


GENERAL OR SHORT-TERM HOSPITAL


MENTAL HOSPITAL


CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


HOSPICE


SOME OTHER PLACE


GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


What place is that?


ENTER VERBATIM RESPONSE -- LIMIT OF 50 CHAW4CTERS


C2 . Where was -- living before being admitted to the hospital?


1= 

2=


3=


4=


5=


6=


7=


8=


9=


10=


11=


12=


OWN HOME OR APARTMENT


RELATIVE’S HOME OR APARTMENT


OTHER PRIVATE HOME OR APARTMENT


RETIREMENT HOME


BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


NURSING HOME


GENERAL OR SHORT-TERM HOSPITAL m


MENTAL HOSPITAL


CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


HOSPICE


SOME OTHER PLACE


GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


What place was that?


ENTER VERBATIM RESPONSE -- LIMIT OF 50 CHARACTERS


40

C3a.


C3b .


C3C .


C3d.


C3e.


D1 .


What is the name of the nursing home?


1= (facility name)


IF NAME GIVEN IS THAT SHOWN ABOVE, ENTER ~~l!;;
OTHERWISE


ENTER NAME OF NURSING HOME -- LIMIT 50 CHARACTERS


What is the street address of the home?


ENTER STREET ADDRESS -- LIMIT OF 25 C~CTERS


What is the name of the city?


ENTER NAME OF CITY -- LIMIT OF 15 CHARACTERS


What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


What is the telephone number?


ENTER TELEPHONE NUMBER -- FORMAT: (xxx) YYY-ZZZZ


IIDKII OR IIREII - (999) 999-9999


(Other than the stays you have told me about), did -- have


any stays in a nursing home or similar place after (date)?


1= YES


2= NO (SKIP TO El)


IF SPEAKING TO FACILITY, TIME FRAME IS FROM DATE IN D1 UNTIL THE


LAST DATE RESPONDENT KNOWS ABOUT SUBJECT


D2 . When was -- first admitted to a nursing home after (date)?


NOTE : IF DISCHARGED TO NH, DATE WILL BE DISCHARGE DATE


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 86-88)


D2a. How long was -- in the nursing home during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE-:CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS

--

D3 .


D4 .


D5a.


D5b .


D5c.


D5d.


When was -- discharged from this nursing home stay?


20= STILL THERE (SKIP TO El)


50= DIED DURING THIS STAY (SKIP TO EI)


ENTER MO* (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 86-88)


Did -- have any other stays in a nursing home or similar


place after this stay?


1= YES


2= NO (SKIP TO El)


REPEAT D2-D4 FOR UP TO 3 STAYS


How many other stays did -- have in a nursing home or


similar place between (date) and now?


ENTER NUMBER (RANGE 1-10)


When was last admitted to a nursing home?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87,88)


How long was -- in the nursing home during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


When was -- discharged from this nursing home stay?


20= STILL THERE (SKIP TO E1)


50= DIED DURING THIS STAY (SKIP TO El)


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR- (RANGE 87,88)


IF QUESTION A4 OR C1=07 (HOSPITAL), SKIP TO E2


42 
El.	 After (date), was -- a patient in a general or short-term


hospital overnight or longer?


1= YES 

2= No (SKIP TO F) . 

IF SPEAKING TO FACILITY, TIME FRAME IS FROM DATE IN El UNTIL THE


LAST 

i 

E2 .


E2a.


E3 .


E4 .


4 

E5a.


DATE RESPONDENT KNOWS ABOUT SUBJECT


When was -- first admitted to a general or short-term


hospital after?


ENTER MONTH (RANGE 1-12) 

ENTER DAY (RANGE 1-31) 

ENTER YEAR (RANGE 86-88) 

How long was -- in the hospital during this stay?


ENTER -ER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


When was -- discharged from this hospital stay?


20= STILL THERE (SKIP TO F)


50= DIED DURING THIS STAY (SKIP TO F)


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTE~ YEAR (RANGE 86-88)


Did -- have any other stays in a general or short-term


hospital after this stay?


;= %s(f3KIP TO F)


REPEAT E2-E4 FOR UP TO 3 STAYS


How many other stays did -- have in a general or short-term


hospital between (date) and now?


ENTER NUMBER (RANGE 1-10)


43 ‘ 
--

E5b.


E5c.


E5d.


F.


Fa.


Fb.


When was -- last admitted to a general or short-term


hospital?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 87,88)


How long was -- in the hospital during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


When was -- discharged from this hospital stay?


20= STILL THERE (SKIp TO F)


50= DIED DURING THIS STAY (SKIP TO F)


ENTER MONTH (RANGE 1-12) (SKIP TO F)


ENTER DAY (RANGE 1-31) (SKIP TO F)


ENTER YEAR (RANGE 87,88) (SKIP TO F)


ASK ONLY ZF SUBJECT HAS BEEN DISCHARGED FROM A NURSING


HOME, OTHERWISE, SKIP TO G


Can you give me the name, address, and phone number of


someone or of a facility who knows about -- after -- was


discharged from your facility?


1= YES


2= NO (SKIP TO G)


What is the name?


ENTER NAME -- LIMIT 50 CHARACTERS


IF FACILITY NAME GIVEN, DO NOT ASK. ENTER ‘lFAC!ILITy!!


Fc . What”is the relationship of -- to --?


ENTER RELATIONSHIP LIMIT 20 CHARACTERS


Fd. What is the street address of --?


ENTER STREET ADDRESS -- LIMIT OF 25 CHARACTERS


44 
--

--

Fe.


Ff .


Fg . 

What is the name of the city?


ENTER NAME OF CITY -- LIMIT OF 15 CHARACTERS


What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


What is the telephone number?


ENTER TELEPHONE NUMBER -- FORMAT: (XXX) YYY-ZZZZ 

IIDKIIOR IIREII - (999) 999-9999 

G. As part of this survey, we would like to have --’s Medicare


number. - This number is n&eded to allow Medicare records to be


easily and accurately located and identified for statistical


research purposes.


The provision of --’s Medicare number is voluntary and will in


no way affect any benefits may be eligible for or -- is


receiving. This information is collected under the authority of


Section 306 of the Public Health Service Act. May I have --’s


Medicare number?


IF NUMBER ENTERED: VERIFY, CHANGE, OR RETURN THROUGH PROMPT


ENTER MEDICARE -ER AND LETTER


FORMAT : 101OO1OO1A


IF NUMBER NOT ON SCREEN, ENTER “NONE!’


H1 .	 Medicaid is a national program which pays for health care


for persons in need.


When -- was first admitted to a nursing home, was


eligible to receive Medicaid benefits for nursing home


care?


1= YES, ELIGIBLE (SKIP TO H4)


2= NO, INELIGIBLE


3= NEVER APPLIED (SKIP TO H5)


H2 . Why was -- ineligible?


1 = TOO MUCH INCOME/ASSETS


2= OWNED PROPERTY


3= AGE


4= OTHER


5= PRIVATE WAY


45 
H3 .


H4 . 

Did -- later become eligible and receive Medicaid benefits


for nursing home care?


1= YES


2= NO (SKIP TO H5)


What year did -- begin to receive Medicaid benefits for


nursing home care? –


ENTER LAST 2 DIGITS OF YEAR


(RANGE 65-88)


ASK ONLY IF THE SUBJECT IS CURRENTLY A RESIDENT OF A NURSING


HOME


H5.	 I am going to read a list of ways in which facilities are


paid for their services. Please answer ‘fyesll or !Inol!
 to


each item that may have helped pay for the care -- is


currently receiving.


1.


2.


3.


5.


6.


7.


8.


9.


10.


11.


YES NO


Own income, family support, health insurance,


retirement funds, Social Security. . . . . . . 1 . 2


Medicare. . . . . . . . . . . . . . . . . . . 1.2


Medicaid. . . . . . . .. . . . . . . . . . . . 1.2


State funded indigent care (excluding


Medicaid). . . . . . . . . . . . . . . . . . . 1.2


Other government assistance or welfare . . . . 1 . 2


Religious organization, foundations,


volunteer agencies . . . . . . . . . . . . . . 1 . 2


VA (Veterans Administration) . . . . . . . . . 1 . 2


Initial payment-life care funds. . . . . . . . 1 . 2


No charge made for care (facility assumes


cost). . . . .% . . . . . . . . . . . . . . . 1.2


Someothersource. . . . . . . . . . . . . . . 1 . 2


What other source helps pay for the care -- is currently


receiving?


ENTER RESPONSE -- LIMIT 50 CHARACTERS


46 
ASK ONLY IF ‘YES’ TO MEDICAID AS A SOURCE OF PAYMENT


H5a. You told me that Medicaid helps pay for the care -- “is


currently receiving.


Is that skilled nursing care (SNF) or intermediate nursing


care ,(ICF)?


1= SKILLED NURSING CARE


2= INTERMEDIATE NURSING CARE


3= OTHER


END


Thank you very much for answering these questions. We


appreciate your cooperation in the survey.


In case someone wants to get in touch with you to verify my


work, please give me your name.


ENTER NAME - LIMIT 50 CHAW4CTERS


IF SUBJECT, DO NOT ASK. ENTER ‘ISELFII


IF FACILITY, DO NOT ASK. ENTER “FACILITY”


What is your relationship to --?


ENTER RELATIONSHIP - LIMIT 20 CHARACTERS


Thank you again for your cooperation.


If you have questions, please feel free to call the National


Nursing Home Survey Followup, toll free.


Have a nice (day/evening).


47 

, 
I 

NNHSF Wave Ill questionnaire 

THE NATIONAL NURSING HOME SURVEY FOLLOWUP: WAVE III, 1990


QUESTIONNAIRE


Notice: All information on this questionnaire which would permit


identification of the individual will be held in strict


confidence, will be used only by persons engaged in and for the


purposes of the survey, and will not be disclosed or released to


other persons for any purpose in accordance with the Public


Health Service Act (42 USC 242m).


48 
--

--

--

NATIONAL NURSING HO~ SURVEY FOLLOWUP: WAVE IIIi 1990


I. INTRODUCTION


Hello. My name is . I’m calling from


on behalf of the United States Public Health Service in


Washington, D.C.


To make sure I have dialed correctly, is this --? 

. . 1= YES


2= NO (REDIAL)


May I please speak to --?


I= REspomEm AvAILABLE (Reintroduce YOURSELF AS NECESSARY)


2= RESPONDENT NOT AVAILABLE (mKE APPOINTMENT)


3= RESPONDENT UNABLE TO PARTICIPATE - IF RESPONDEiJT DECEASED


SAY : I’m very sorry. Maybe you will be able to help us.


Ia. TO BE USED FOR PREVIOUSLY CONTACTED RESPONDENTS “


You may remember that we spoke to you a year or so ago and asked


you some questions about --’s use of nursing homes. Your


cooperation at that time was most helpful. We are now interested


in finding out what has happened to -- with regard to any nursing


home stavs or short-term hospitalizations may have had since


then. This information is baing collected to a~sist health


planners who provide services for the elderly. (SKIP TO Id.)


Ib. TO BE USED FOR NEW RESPONDENTS


In 1988 the National Center for Health Statistics, an agency of


the U.S. Public Health Service, conducted a survey of current


and former nursing home residents. was selected at random to


take part in this study. We are now interested in finding out


what happened to -- with regard to any “nursing home stays or


short-term hospitalizations may have had since then. This


information is being collected to assist health planners who


provide services for the elderly. (SKIP TO Id.)


Ic. TO BE USED FOR FACILITY RESPONDENTS


You may remember that in 1988 your facility was contacted during


the National- Nursing Home Survey sponsored by the National Center


for Health Statistics, an agency of the U.S. Public Health


Service. We are now interested in finding out what has happened


to the sample residents who were in your facility at that time.


This information is being collected to assist health planners who


provide services for the elderly. (SKIP TO Id.)


49 
--

Id. You should have received a letter from Dr. Manninq Fei.nleib.


the Director of the National Center for Health Statistics, which


described this study. Have you received this letter?


I= YES (SKIP To Ie.) 

2= NO 

I’m sorry that you did not receive the letter. YOU should be 

receiving it shortly. Let me briefly outline its contents for 

you . 

The interviews for the 1990 National Nursing Home Survey Followup


are authorized by the Public Health Service Act, Volume 42 of the


U.S. Code, Section 242K. In accordance with this legislation,


all information on this questionnaire that would permit


identification of the individual will be held in strict


confidence, will be used only by persons engaged in and for the


purposes of the survey, and will not be disclosed or released to


other persons for any purpose.


Ie. Your participation in this survey is strictly voluntary, and


there are no penalties for your refusal to participate. You may


be assured, however, that your participation is greatly


appreciated.


If. ASK ONLY OF FACILITY RESPONDENTS


I will be asking about (READ NAME(S) FROM ASSIGNMENT LIST).


IF MORE THAN ONE: The first person I want to ask about is ---


(SKIP TO Ih.)


Ig. ASK OF PROXY RESPONDENTS


Do you feel able to answer some questions about --?


I= YES (SKIP TO Ih.)


2= NO


Igl.	Can you give me the name, address, and phone number of


someone or of a facility who knows about --?


1= YES


2= NO (SKIP TO END)


Ig2. What is,the name?


ENTER NAME - LIMIT 35 CHA.W4CTERS


Ig3. What is the relationship of -- to --?


ENTER RELATIONSHIP LIMIT OF 20 CHARACTERS


50 
.

Ig4 .


Ig5 .


Ig6 .


Ig7 .


What is the street address of --?


ENTER STREET ADDRESS -- LIMIT OF 25 CHARACTERS


What is the name of the city?


ENTER NAME OF CITY -- LIMIT OF 15 CHARACTERS


What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


What is the telephone number?


ENTER TELEPHONE NUMBER -- FORMAT: (xxx) YYY-ZZZZ


(IF ‘lDK1’
OR ‘IRE”,THANK RESPONDENT AND CALL DIRECTORY ASSISTANCE)


FINAL “DK” OR “RE” - (999) 999-9999


Thank you for your cooperation.


Good-bye. Have a nice (day/evening) .


Ih. INTERVIEWER: WHAT TYPE OF RESPONDENT WILL YOU BE


INTERVIEWING?


1= THE SUBJECT


2= PROXY


3= FACILITY OTHER THAN SAMPLE NURSING HOME


4= SAMPLE NURSING HOME


NOTE : -- denotes the name of the subject


pronoun.


SECTION A ASKED ONLY IF SUBJECT WAS


WAVE II, OTHERWISE GO TO SECTION B


Al. IF FIRST RESPONDENT:
 ,


or the appropriate


A FACILITY RESIDENT AT


At the time of our contact on (date), -- was a resident of


(facility). Is -- still a resident ?


IF SECOND RESPONDENT:


we have recently learned that -- was a resident of


(facility).


Is -- still a resident?


1= YES (SKIP TO A5)


2= NO


51 :


.


.


, 

/ 

I 
A2 .


A3 .


A4 .


After (date), in what month and year was -- first


discharged?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


Was -- alive at the time of the discharge?


1= YES


2= NO (SKIP TO B2)


Where was -- discharged to? (AFTER THIS QUESTION, SKIP TO


A9 )


(IF “HOSPITAL”, PROBE FOR SPECIFIC TYPE OF HOSPITAL)


1= 

2=


3=


4=


5=


6=


7=


8=


9=


10=


11=


12=


., 

OWN HOME OR APARTMENT


RELATIVE’S HOME OR APARTMENT


OTHER PRIVATE HOME OR APARTMENT


RETIREMENT HOME


BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


ANOTHER NURSING HOME


GENERAL OR SHORT-TERM HOSPITAL


MENTAL HOSPITAL


CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


HOSPICE


SOME OTHER PLACE


GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


A5 .


A6 .


A7 .


A% .


52 

Has -- been a resident continuously in (facility) since


(date)? .


I= ms (SKIP To E1) 

2= NO 

When was -- first discharged after (date)?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


When was -- next admitted to this nursing home?


ENTER MOiTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


Was -- disch&ged from that stay?


1= YES


2= NO (SKIP TO Dl) “


REPEAT A6-A8 FOR UP TO 4 STAYS

--

--

A8a.


A8b .


A9 .


AlO.


All .


A12 .


A13 .


How many more times was -- admitted between (date) and now?


ENTER NUMBER OF TIMES (RANGE 1-10)


When was -- last admitted to this nursing home?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


Was -- ever readmitted to (facility) after (date)?


1= YES


2= NO (SKIP TO Bl)


When was -- first admitted after (date)?


ENTER MONTH (RANGE 1-12) 

ENTER DAY (RANGE 1-31) 

ENTER YEAR (RANGE 88-90) 

When was -- discharged from that stay?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


Was -- alive at discharge?


1= YES


2= NO (SKIP TO B2)


Was -- readmitted after that stay?


1= YES


2= NO (SKIP TO B1)


REPEAT A1O-A13 FOR UP TO 3 STAYS


A13a. How many other times was -- admitted between (date) and


A14 .


A15 .


now?


ENTER NUMBER OF TIMES (RANGE 1-10)


When was last admitted to this facili-ty?


ENTER MONTH (WGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


When was last discharged from this facility?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90) 53

--

--

--

A16 .


B1 .


B2 .


B3 .


B4 .


cl.


Was -- alive at discharge?


1= YES


2= NO (SKIP TO B2)


(ASK ONLY IF NOT KNOWN)


Is alive?


1= YES (SKIP TO Cl)


2= NO


On what date did -- die?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (liANGE 88-90)


In what State did -- die?


ENTER 2-LETTER STATE ABBREVIATION


OC=OTHER COUNTRY


During the last 6 months before --’s death, that is, from


(date) to (date), did -- receive hospice care either at


home, in a hospital, in a nursing home, or in a


freestanding hospice?


1= YES (SKIP TO Dl)


2= NO (SKIP TO DI)


Where is staying now?


(IF THE RESPONSE TO THIS QUESTION IS 7, ASK c2; OTHERWISE,


AFTER THIS QUESTION SKIP TO Dl)


(IF “HOSPITAIJ”, PROBE FOR SPECIFIC TYPE OF HOSPITAL)


1=


2=


=
 3


4=


5=


6=


7=


8=


9=


10=


11=


12=


OWN HOME OR APARTMENT


RELATIVE’S HOME OR APARTMENT


OTHER PRIVATE HOME OR APARTMENT


RETIREMENT HOME


BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


NURSING HOME


GENERAL OR SHORT-TERM HOSPITAL


MENTAL HOSPITAL


CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


HOSPICE


SOME OTHER PLACE


GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


What place is that?


ENTER VERBATIM RESPONSE LIMIT OF 50 CH?!JWCTERS


54 
--

--

--

--

--

--

--

C2 . Where was living before being admitted to the hospital?


1= 

2=


3=


4=


5=


6=


7=


8=


9=


10=


11=


12=


OWN HOME OR APARTMENT


RELATIVE’S HOME OR APARTMENT


OTHER PRIVATE HOME OR APARTMENT


RETIREMENT HOME


BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


NURSING HOME


GENE~L OR SHORT-TERM HOSPITAL


MENTAL HOSPITAL


CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


HOSPICE


SOME OTHER PLACE


GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


C3a.


I 

C3b .


C3C.
 1 

C3d.
 I 

C3e.


,, 

“, 

D1 .


What place was that?


ENTER VERBATIM RESPONSE LIMIT OF 50 CHARACTERS


What is the name of the nursing home?


1= (facility name)


IF NAME GIVEN IS THAT SHOWN ABOVE, ENTER “1”; OTHERWISE


ENTER NAME OF NURSING HOME LIMIT 50 C~CTERS


What is the street address of the home?


ENTER STREET ADDRESS LIMIT OF 25 C_CTERS


What is the name of the city?


ENTER NAME OF CITY LIMIT OF 15 CHARACTERS


What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


What is the telephone number?


ENTER TELEPHONE NUMBER FORMAT: (xxx) YYY-ZZZZ


IIDKM OR IIREII _ (999) 999-9999 

(Other than the stays you have told me about) , did have


any stays in a nursing home or similar place after (date)?


1= YES


2= NO (SKIP TO E1)


55 

I 
IF SPEAKING TO FACILITY, TIME FRAME IS FROM DATE IN D1 UNTIL THE 

LAST DATE RESPONDENT KNOWS ABOUT SUBJECT 

D2 . When was -- first admitted to a nursing home after (date)?


NOTE: IF DISCHARGED TO NH, DATE WILL BE DISCHARGE DATE


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


D2a. How long was -- in the nursing home during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


D3 . When was -- discharged from this nursing home stay?


20= STILL THERE (SKIP TO El)


50= DIED DURING THIS STAY (SKIP TO El)


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


D4 .	 Did -- have any other stays in a nursing home or similar


place after this stay?


1= YES


2= NO (SKIP TO El)


REPEAT D2-D4 FOR UP TO 3 STAYS


D5a. How many other stays did -- have in a nursing home or


similar place between (date) and now?


ENTER NUMBER (RANGE 1-10)


D5b. When was -- last admitted to a nursing home?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


56 
D5c.


D5d .


How long was -- in the nursing home during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


When was -- discharged from this nursing home stay?


20= sTILL THERE (SKIp TO E1)


50= DIED DURING THIS STAY (SKIP TO El)


ENTER MONTH (RANGE 1-12)


ENTER DAy (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


IF QUESTION A4 OR c1=07 (HOSPITAL), mm To m 

El.	 After (date), was -- a patient in a general or short-term


hospital overnight or longer?


1= YES


2= NO (SKIP TO F)


IF SPEAKING TO FACILITY, TIME FRAME IS FROM DATE IN El UNTIL THE


LAST DATE RESPONDENT KNOWS ABOUT SUBJECT


E2 .	 When was -- first admitted to a general or short-term


hospital after?


ENTER MONTH (RANGE 1-12)


ENTER DAY (-GE 1-31)


ENTER YEAR (RANGE 88-90)


E2a. How long was -- in the hospital during this stay?


ENTER NUMBER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


57 
--

E3.


E4.


E5a.


E5b.


E5c.


E5d.


When was -- discharged from this hospital stay?


20= STILL THERE (SKIP TO F)


50= DIED DURING THIS STAY (SKIP TO F)


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


Did have any other stays in a general or short-term


hospital after this stay?


1= YES


2= NO (SKIP TO F)


REPEAT E2-E4 FOR UP TO 3 STAYS


How many other stays did -- have i.na general or short-term


hospital between (date) and now?


ENTER NUMBER (RANGE 1-10)


When was -- last admitted to a general or short-tezn


hospital?


ENTER MONTH (RANGE 1-12)


ENTER DAY (RANGE 1-31)


ENTER YEAR (RANGE 88-90)


How long was -- in the hospital during this stay?


ENTER -ER (RANGE 1-365)


ENTER CODE: CONVERT AS NECESSARY


1= DAYS


2= WEEKS


3= MONTHS


4= YEARS


When was -- discharged from this hospital stay?


20= STILL THERE (SKIP TO F)


50= DIED DURING THIS STAY (SKIP TO F)


ENTER MO~H (RANGE 1-12) (SKIP TO F)


ENTER DAY -(RANGE1-31) (f3KIPTO F)


ENTER YEAR (RANGE 88-90) (SKIP To F)


58 
--

i 

F.	 ASK ONLY IF SUBJECT HAS BEEN DISCHARGED FROM A NURSING


HOME, OTHERWISE, SKIP TO G


Fa.	 Can you give me the name, address, and phone number of


someone or of a facility who knows about -- after -- was


discharged from your facility?


1= YES 

2= NO (SKIP TO G) 

Fb. What is the name?


ENTER NAME -- LIMIT 50 CHARACTERS


IF FACILITY NAME GIVEN, DO NOT ASK. ENTER ‘lFACILITYII


Fc. What is the relationship of -- to --?


ENTER RELATIONSHIP LIMIT 20 CHARACTERS


Fd. What is the street address of --?


ENTER STREET ADDRESS -- LIMIT OF 25 CHARACTERS


Fe. What is the name of the city?


ENTER NAME OF CITY -- LIMIT OF 15 CHARACTERS


Ff. What State is that in?


ENTER 2-LETTER STATE ABBREVIATION


Fg. What is the telephone number?


ENTER TELEPHONE NUMBER -- FORMAT: (xxx) YYY-ZZZZ


IIDKII OR IIREI1
- (999) 999-9999


59

G. As part of this survey, we would like to have --’s Medicare 

number. This number is needed to allow Medicare records to be 

easily and accurately located and identified for statistical 

research purposes. 

The provision of --’s Medicare number is voluntary and will in


no way affect any benefits -- may be eligible for or -- is


receiving. This information is collected under the authority of


Section 306 of the Public Health Service Act. May I have --’s


Medicare number?


IF NUMBER ENTERED: VERIFY, CHANGE, OR RETURN THROUGH PROMPT


HI.


H2.


H3.


H4.


ENTER MEDICARE NUMBER AND LETTER


FORMAT: 101OO1OO1A


IF NUMBER NOT ON SCREEN, ENTER l’NONE”


Medicaid is a national program which pays for health care


for persons in need.


When -- was first admitted to a nursing home, was --


eligible to receive Medicaid benefits for nursing home


care?


I= YES, ELIGIBLE (SKIP TO H4)


2= NO, INELIGIBLE


3= NEVER APPLIED (SKIP TO H5)


Why was -- ineligible?


1 = TOO MUCH INCOME/ASSETS


2= OWNED PROPERTY


3= AGE


4= OTHER


5= PRIVATE WAY


Did -- later become eligible and receive Medicaid benefits


for nursing home care?


1= YES


2= NO (SKIP TO H5)


WhaE.year did -- begin to receive Medicaid benefits for


nursing home care?


ENTER LAST 2 DIGITS OF YEAR


(RANGE 65-90)


60 
ASK ONLY IF THE SUBJECT IS CURRENTLY A RESIDENT OF A NURSING


HOME


H5 . I am going to read a list of ways in which facilities are


paid for their services. Please answer liyes~f or ‘Inolf
to


each item that may have helped pay for the care -- is


currently receiving.


YES NO


1. 

2.


3.


5.


6.


7.


8.


9.


10.


11.


own income, family support, health insurance,


retirement- funds,-Socbl Security . . . .


Medicare. . . . . . . . . . . . . . . . .


Medicaid. . . . . . . . . . . . . . . . .


State funded indigent care (excluding


Medicaid) . . . . . . . . . . . . . . . .


Other government assistance or welfare. .
 Religious organization, foundations,


volunteer agencies. . . . . . . . . . . .


VA (Veterans Administration) . . . . . . .
 Initial payment-life care funds . . . . .


No charge made for care (facility assumes


cost) . . . . . . . . . . . . . . . . . .


Some other source . . . . . . . . . . . .


. . 

. . 

. . 

. . 

. . 

. . 

. . 

. . 

. . 

. . 

. . 

1.2


1.2


1.2


1 .2


1.2


1.2


1.2


1.2


1 .2


1.2


1.2


What other source helps pay for the care -- is currently


receiving?


ENTER RESPONSE -- LIMIT 50 CHARACTERS


ASK ONLY IF ‘YES’ TO MEDICAID AS A SOURCE OF PAYMENT


H5a. You told me that Medicaid helps pay for the care -- is


currently receiving.


Is that skilled nursing care (SNF) or intermediate nursing


care (ICF)?


1= SKILLED NURSING CARE


2= INTERMEDIATE NURSING CARE


3= OTHER


I 

61

END


Thank you very much for answering these questions. We


appreciate your cooperation in the survey.


In case someone wants to get in touch with you to verify my


work, please give me your name.


ENTER NAME - LIMIT 50 CHARACTERS


IF SUBJECT, DO NOT ASK. ENTER IISELFII


IF FACILITY, DO NOT ASK. ENTER l’FACILITYII


What is you relationship to --?


ENTER RELATIONSHIP - LIMIT 20 CHAFUACTERS


Thank you again for your cooperation.


If you have questions, please feel free to call the National


Nursing Home Survey Followup, toll free.


Have a nice (day/evening).


62

--

SECTION J


I. INTRODUCTION


In 1985, the National Center for Health Statistics, an agency of


the U.S. Public Health Service, conducted a nationwide sample


survey of current and former nursing home residents. was


selected at random to take part in this study.


INTERVIEWER: IS THE PERSON YOU ARE SPEAKING TO A PREVIOUS


RESPONDENT?


1= YES 

2= NO (SKIP) 

You may recall that shortly after that survey, we called you to


obtain some additional information about ---


Since that time, we have conducted two followup surveys to update


the information of the sample residents. We are now conducting a


third followup and would like to ask you a few questions to


supplement the information.


This will take just a few minutes of your time.


1. Do you feel able to answer some questions about --? 

1= YES


2= NO (END OF SECTION J)


IF SUBJECT DECEASED, SKIP TO J3


J1. What is --’s marital status?


1= MARRIED


2= WIDOWED (SKIP To J3)


3= DIVORCED OR SEP-TED (SKIP TO J3)


4= NEVER MARRIED (SKIP To J3)


8= DON’T KNOW (SKIP TO J3)
 . 9= REFUSED (SKIP To J3) 

. 

63 
—- --- . --- . . !32. wnere 1s --’s spouse currently living?


(IF “HOSPITAL”, PROBE FOR SPECIFIC TYPE OF HOSPITAL)


1= OWN HOME OR APARTMENT


2= RELATIVE’S HOME OR APARTMENT


3= OTHER PRIVATE HOME OR APARTMENT


4= RETIREMENT HOME


5= BOARDING HOUSE, ROOMING HOUSE, OR RENTED ROOM


6= NURSING HOME


7= GENERAL OR SHORT-TERM HOSPITAL


8= MENTAL HOSPITAL


9= CHRONIC DISEASE OR OTHER LONG-TERM CARE HOSPITAL


10= HOSPICE


11= SOME PLACE OTHER THAN CODES 1-10 AND CODE 12


12= GROUP HOME, FOSTER HOME, BOARD AND CARE, ETC.


98= DON’T KNOW


J3 . Did -- ever own a home?


1= YES


2= NO (END OF SECTION J)


8= DON’T KNOW (END OF SECTION J)


9= REFUSED (END OF SECTION J)


J4 .	 Did -- own a home during the two years prior to --’s first


nursing home stay?


$ 

1= YES 

2= NO (END OF SECTION J)


8= DON’T KNOW (END OF SECTION J)


9= REFUSED (END OF SECTION J)


IF SUBJECT DECEASED, SKIP TO J6


J5 . Does -- still own that home?


1= YES (END OF SECTION J)


2= NO


8= DON’T KNOW (END OF SECTION J)


J6”. Did -- sell that home?
 I 

1= YES , 

2= NO (5KII? TO J8) i 

8= DON’T KNow (5KIP TO J8) , 

1 

J7 . Did -- use any of the proceeds from the sale of --’s home 1 

to pay for nursi,ng home care?


1= YES (END OF SECTION J)


2= NO (END OF SECTION J)


8= DON’T KNOW (END OF SECTION J) i 

9= REFUSED (END OF SECTION J) I 

.64 

,1 
* 

J8 .	 Did -- transfer that home to relatives other than --’s


spouse ?


1= YES (END OF SECTION J)


2= NO


8= DON’T KNOW (END OF SECTION J)


9= REFUSED (END OF SECTION J)


J9 . What happened to the home?


1= STILL OWNED BY SPOUSE


2= TRANSFERRED FOR NURSING HOME CARE


3= WILLED TO RELATIVES


4= SOLD BY SPOUSE OR RELATIVE


5= PART OF ESTATE


6= TAKEN BY MORTGAGE HOLDER


7= DESTROYED OR CONDEMNED


END


, s- . .. 

, .,,. 

‘U.S,GoifernrrrentPrhrllngOWce: 1993-242-227/80013 65 
Vital and Health Statistics 

series descriptions 

1, SERIES 1. Programs and Collection Procedure –These reports 

I describe the data collection programs of the National Center 

for Health Statistics. They include 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 –These reports 

are studies of new statistical methods and include analytical 

techniques, objective evaluations of reliability of collected 

data, and contributions to statistical theory. These studies 

also include experimental tests of new suwey methods and 

comparisons of U.S. methodology with those of other 

countries. 

SERIES 3. Analytical and Epidemiological Studies–These reports 

present analytical or interpretive studies based on vital and 

health statistics.These reports carry the analyses further than 

the expository types of reports in the other series. 

SERIES 4. Documents and Committee Reports–These are final 

reports of major committees concerned with vital and health 

statistics and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

SERIES 5. International Vital snd Health Statistics Reports-These 

reports are analytical or descriptive reports that compare U.S. 

vital and health statistics with those of other countries or 

present other international data of relevance to the health 

statistics system of the United States. 

SERIES 6. Cognition and Survey Measurement–These reports are 

from the National Laboratory for Collaborative Research in 

Cognition and Survey Measurement. They use methods of 

cognitive science to design, evaluate, and test survey 

instruments. 

SERIES 10. Data From the National Health Interview Survey-These 

reports contain statistics on illness; unintentional injuries; 

dlsabili~ use of hospital, medical, and other health serviceq 

and a wide range of special current health topics covering 

many aspects of health behaviors, health status, and health 

care utilization. They are based on data collected in a 

i continuing national household interview survey. 

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

National Health and Nutrition Examination Surveys, and 

1 the Hispanic Health and Nutrition Examination Survey– 

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 cfktributionsof 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 12.	 Data From the Institutionalized Population Surveya– 

Discontinued in 1975. Reports from these surveys are 

included in Series 13. 

SERIES 13. Dats From the National Health Care Survey–These 

reports contain statisticson 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 14. 

SERIES 15. 

SERIES 16. 

SERIES 20. 

SERIES 21. 

SERIES 22. 

SERIES 23. 

SERIES 24. 

Data on Health Resources: Manpower and Facilities– 

Discontinued in 1990. Reports on the numbers, geographic 

distribution, and characteristics of health resources are now 

included in Series 13. 

Data From Special Surveys–These reports contain 

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. 

Compilations of Advance Data From Vital and Health 

Statistics –Advance Data Reports provide early release of 

information from the ‘Nationai Center for Health Statistics’ 

health and demographic surveys. They are compiled in the 

order in which they are published. Some of these releases 

may be followed by detailed reports in Series 10–13. 

Data on Mortality –These reports contain statistics on 

mortalitythat 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. 

Data on Natality, Marriage, and Divorce–These reports 

contain 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. 

Data From the National Mortality and Natality Surveys– 

Discontinued in 1975. Reports from these sample surveys, 

based on vital records, are now published in Series 20 or 21. 

Data From the National Survey of Famiiy Growth –These 

reports contain statistics on factors that affect birth rates, 

including contraception, infertility, cohabitation, marriage, 

divorce, and remarriage; adoption; use of medical care for 

family planning and infertili~ and related maternal and infant 

health topics. These statistics are based on national surveys 

of childbearkg age. 

Compilations of Data on Natality, Mortality, Marriage, 

Divorce, and Induced Terminations of Pregnancy– 

These include advance reports of births, deaths, marriages, 

and divorces based on final data from the National Vital 

Statistics System that were published as supplements to the 

Month/y Vital .9atkfics Report (MVSR). These r?Potis provide 

highlights and summaries of detailed data subsequently 

published in Vita/ Statistics of the United States. Other 

supplements to the MVSR published here provide selected 

findings based on final data from the National Vital Statistics 

System and may be followed by detailed repoRs in Series 20 

or 21. 

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

in these series, contact 

Data Dissemination Branch 

National Center for Health Statistics 

Centers for Disease Control and Prevention 

Public Health Service 

6525 Belcrest Road, Room 1064 

Hyattsville, MD 20782 

(301) 436-8500 
DEPARTMENT OF


HEALTH &HuMAN SERVICES


Public Health Service


Centera for Disease Control and Prevention


National Center forJiealth Statistics


6525 Belcrest Road “


Hyattsville, Maryland 20782


OFFICIAL BUSINESS


PENALTY FOR PRIVATE USE, $300


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PERMIT NO, G-281 

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DHHS Publication No. (PHS) 93-1306, Series 1, No. 30 

. . . . ., .,