Design and Operation of

the 2010 National Survey of

Residential Care Facilities

Series 1, Number 54 November 2011
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Moss AJ, Harris-Kojetin LD, Sengupta M, et al. Design and operation of the

2010 National Survey of Residential Care Facilities. National Center for Health

Statistics. Vital Health Stat 1(54). 2011.

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Design and operation of the 2010 National Survey of Residential Care Facilities.

p. ; cm.— (DHHS publication ; no. (PHS) 2012–1330) (Vital and health

statistics. Series 1, Programs and collection procedures ; no. 54)

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(PHS) 2012–1330. 0276–4733 III. Series: Vital and health statistics. Ser. 1,

Programs and collection procedures ; no. 54.

[DNLM: 1. National Survey of Residential Care Facilities (U.S.) 2. Residential

Facilities—United States. 3. Data Collection—methods—United States. 4.

Health Care Surveys—United States. 5. Research Design—United States. 6.

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Series 1, Number 54

Design and Operation of

the 2010 National Survey of

Residential Care Facilities

Program and Collection Procedures

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

November 2011

DHHS Publication No. (PHS) 2012–1330
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

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

Division of Health Care Statistics

Clarice Brown, M.S., Acting Director
Contents
 

Acknowledgments ........................................................................................ vi 
 

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

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

Background and Purpose................................................................................... 2 
 

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

Questionnaire Development ................................................................................ 3 
 

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

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

Activities Between Pretest and National Survey ................................................................ 6 
 

Questionnaire .......................................................................................... 6 
 

Scheduling ............................................................................................ 6 
 

Contact Scripts......................................................................................... 6 
 

Respondent Contact Materials ............................................................................ 6 
 

Information for Survey Participants ....................................................................... 6 
 

Sampling Frame and Design................................................................................ 6 
 

Sampling Frame........................................................................................ 6 
 

Frame Development .................................................................................... 7 
 

Benchmarking the Sampling Frame ........................................................................ 7 
 

Facility Eligibility Criteria ............................................................................... 7 
 

Sampling Design ....................................................................................... 8 
 

National Survey Methods .................................................................................. 8 
 

Overview ............................................................................................. 8 
 

Outreach to Provider Organizations ........................................................................ 8 
 

Chain Outreach ........................................................................................ 9 
 

Recruiter Training ...................................................................................... 9 
 

Facility Recruitment .................................................................................... 9 
 

First Contact With Sampled Facility ....................................................................... 10 
 

Advance Package Mail-out ............................................................................... 10 
 

Set Appointment Call ................................................................................... 10 
 

Appointment Setting .................................................................................... 10 
 

Facility Case Transition.................................................................................. 11 
 

Interviewer Training .................................................................................... 11 
 

Data Collection Procedures and Survey Instruments............................................................. 11 
 

Reminder Call ......................................................................................... 12 
 

Reschedule Call ........................................................................................ 12 
 

Facility In-person Interview .............................................................................. 12 
 

CAPI Questionnaire Instruments .......................................................................... 12 
 

Follow-up Activities .................................................................................... 13 
 

Refusal Aversion and Conversion Strategies ................................................................. 13 
 

Follow-up With Chains .................................................................................. 13 
 

Additional Strategies to Increase Participation ............................................................... 13 
 

iii
Data Quality Assurance.................................................................................... 14 
 

Field Observation ...................................................................................... 14 
 

Verification............................................................................................ 14 
 

Production Reports ..................................................................................... 14 
 

Management Meetings .................................................................................. 14 
 

Field Memos and Calls .................................................................................. 15 
 

Data Processing .......................................................................................... 15 
 

Disclosure Risk Review ................................................................................... 15 
 

Response Rates .......................................................................................... 15 
 

Reasons for Nonresponse .................................................................................. 16 
 

Nonresponse Bias Analysis................................................................................. 16 
 

Estimation Procedures..................................................................................... 17 
 

Reliability of Survey Estimates ............................................................................. 18 
 

Confidentiality ........................................................................................... 19 
 

Data Dissemination ....................................................................................... 19 
 

References .............................................................................................. 19 
 

Appendix I. Acronyms Used in This Report ................................................................... 21 
 

Appendix II. NSRCF Technical Advisory Panel Members and Instrument Reviewers .................................. 22 
 

Appendix III. Survey Domains for the National Survey of Residential Care Facilities ................................. 23 
 

Appendix IV. Facesheet.................................................................................... 27 
 

Appendix V. NSRCF Letter of Support ....................................................................... 32 
 

Appendix VI. Provider Organizations That Supported NSRCF .................................................... 33 
 

Appendix VII. Provider Organization Newsletter Articles on NSRCF............................................... 34 
 

Appendix VIII. NSRCF Chain Package ....................................................................... 37 
 

Appendix IX. Advance Package Call Script ................................................................... 48 
 

Appendix X. Advance Package to Facilities ................................................................... 50 
 

Appendix XI. Set an Appointment Call Script.................................................................. 53 
 

Appendix XII. Frequently Asked Questions.................................................................... 56 
 

Appendix XIII. NSRCF Screener Questionnaire ................................................................ 60 
 

Appendix XIV. Pre-Interview Worksheet ...................................................................... 63 
 

Appendix XV. Interviewer Reminder Call Script ............................................................... 71 
 

Appendix XVI. Appointment Reschedule Call Script ............................................................ 73 
 

Appendix XVII. NCHS Thank You Letter..................................................................... 75 
 

Appendix XVIII. NSRCF Facility Questionnaire ............................................................... 76 
 

Appendix XIX. NSRCF Resident Selection Questionnaire ........................................................ 101 
 

Appendix XX. NSRCF Resident Questionnaire................................................................. 104 
 

Appendix XXI. Interviewer Debriefing Questionnaire ........................................................... 119 
 

Appendix XXII. Refusal Conversion Letters................................................................... 120 
 

Appendix XXIII. Schedule Appointment Reminder Letter and Postcard ............................................. 125 
 

Appendix XXIV. Closure Letter ............................................................................. 127 
 

Appendix XXV. Verification Script .......................................................................... 128 
 

Appendix XXVI. Chain Approval Report ..................................................................... 131 
 

iv
Figures

1.	 Recruiter responsibilities.............................................................................. 9 
 

2.	 Interviewer responsibilities............................................................................ 11 
 

Text Tables

A.	 Elapsed time from first appointment call to set appointment ................................................. 11 
 

B.	 Number of residential care facilities, by eligibility, response status, and selected facility characteristics:
 

National Survey of Residential Care Facilities, 2010 ....................................................... 16 
 

C.	 Percent distribution of in-scope sampled residential care facilities, by facility response status, response rates, and
 

selected facility characteristics: National Survey of Residential Care Facilities, 2010 ............................. 17 
 

D.	 Nonresponding facilities, by primary reason for nonresponse ................................................ 17 
 

v
Acknowledgments
 

The National Survey of Residential

Care Facilities (NSRCF) was made

possible through the hard work and

dedication of a number of key people

both within and outside the National

Center for Health Statistics (NCHS).

Our federal partners in this NSRCF

initiative include: Office of the Assistant

Secretary for Planning and Evaluation

(ASPE); Agency for Healthcare

Research and Quality; National Center

for Chronic Disease Prevention and

Health Promotion; National Center for

Immunization and Respiratory Diseases;

and Department of Veterans Affairs. Our

special thanks go to Emily Rosenoff

(ASPE), who provided insight,

expertise, and ongoing assistance

throughout the study. Support received

from the following organizations was

vital in achieving NSRCF’s success:

LeadingAge, formerly American

Association of Homes and Services for

the Aging; American Seniors Housing

Association (ASHA); Assisted Living

Federation of America (ALFA); National

Center for Assisted Living (NCAL); and

Board and Care Quality Forum. For

time and energy spent to improve and

promote the survey, we thank the Center

for Excellence in Assisted Living

president, Karen Love, and its board

members David Kyllo (NCAL); Stephen

Maag (LeadingAge); Rachelle

Bernstecker (ASHA); and Maribeth

Bersani (ALFA). Our appreciation also

extends to Sally Reisacher-Petro from

the Board and Care Quality Forum and

Karl Polzer (NCAL) for their valuable

assistance. We sincerely thank the

members of the NSRCF Technical

Advisory Panel whose expertise helped

guide the survey’s definition of

residential care; the sampling design; the

survey domains of importance; and the

questionnaire objectives, structure, and

refinements. We are indebted to the

dedicated staff at RTI International,

including Joshua Weiner, John Loft,

Linda Lux, Angela Greene,

Sara Zuckerbraun, Katherine Mason,

Melissa Hobbs, Timothy Flanigan, and

Julie Feldman who made significant

contributions every step of the way to

ensure the survey’s successful outcome.

Critical design, production, and analysis

assistance for this project was also

provided by Iris Shimizu and Roberto

Valverde (NCHS). Lastly, we gratefully

acknowledge the facility directors and

their staffs who allowed us to collect

these data and who were most helpful

during this process.

vi
Objectives

This methods report provides an

overview of the National Survey of

Residential Care Facilities (NSRCF)

conducted in 2010. NSRCF is a first-ever

national probability sample survey that

collects data on U.S. residential care

providers, their staffs and services, and

their residents. Included are residential

care facilities consisting of assisted living

residences; board and care homes;

congregate care; enriched housing

programs; homes for the aged; personal

care homes; and shared housing

establishments that are licensed,

registered, listed, certified, or otherwise

regulated by a state. A survey-specific

definition was used to select residential

care facilities into the study. This report

discusses the need for and objectives of

the survey, design process, survey

methods, and data availability.

Methods

In 2008, a small pilot study and a

pretest were conducted to test and refine

the survey protocol, data collection

procedures, and questionnaires. NSRCF

was conducted between March and

November 2010. The survey used a

two-stage probability sampling design in

which residential care facilities were

sampled. Then, depending on facility

size, three to six current residents were

sampled. In-person interviews were

conducted with facility directors and

designated staffs; no interviews were

conducted with residents. The survey

instrument contained a facility screening

module, facility- and resident-level

modules, a resident sampling module,

and a pre-interview worksheet.

Results

National data were collected on 2,302

facilities, and 8,094 current residents. The

first-stage facility weighted response rate

(for differential probabilities of selection)

was 81%. The second-stage resident

weighted response rate was 99%. Two

public-use files will be released. The

facility and resident files include sampling

weights to generate national estimates,

and design variables to calculate

accurate standard errors.

Keywords: assisted living • 

residential care • long-term care

Design and Operation of the

2010 National Survey of

Residential Care Facilities

by Abigail J. Moss, Lauren D. Harris-Kojetin, Ph.D., Manisha

Sengupta, Ph.D., Eunice Park-Lee, Ph.D., and Christine Caffrey,

Ph.D., National Center for Health Statistics; Emily Rosenoff, M.P.A.,

Office of the Assistant Secretary for Planning and Evaluation; and

Joshua M. Wiener, Ph.D., and Angela M. Greene, M.S.,

RTI International

Introduction

The National Survey of

Residential Care Facilities (NSRCF) is

a first-ever national data collection

effort to gather information about the

characteristics of residential care

facilities, including assisted living

residences, board and care homes,

congregate care, enriched housing

programs, homes for the aged,

personal care homes, and shared

housing establishments. To be eligible

for this study, residential care facilities

are places that are: licensed, registered,

listed, certified, or otherwise regulated

by the state; have four or more licensed,

certified, or registered beds; provide

room and board with at least two meals

a day and around-the-clock on-site

supervision; and help with personal care

such as bathing and dressing or

health-related services such as

medication management. These facilities

serve a predominantly adult population.

Facilities licensed to serve the severely

mentally ill or the developmentally

disabled populations exclusively, and

facilities that do not have any current

residents, are excluded. Nursing homes

are also excluded unless they have a

unit or wing meeting the above

definition and residents can be

separately enumerated. Appendix I lists

the acronyms used in this report.

NSRCF was conducted between

March and November 2010 by the

National Center for Health Statistics

(NCHS). Partners in this NSRCF

initiative include: Office of the Assistant

Secretary for Planning and Evaluation

(ASPE), U.S. Department of Health and

Human Services (HHS); Agency for

Healthcare Research and Quality

(AHRQ), HHS; National Center for

Chronic Disease Prevention and Health

Promotion, Centers for Disease Control

and Prevention (CDC), HHS; National

Center for Immunization and

Respiratory Diseases, CDC, HHS; and

U.S. Department of Veterans Affairs.

RTI International (RTI) collected the

data for the survey under a contract with

NCHS. ASPE also contracted with RTI

to assist with survey design and

sampling frame development. NSRCF is

legislated under the National Health

Survey Act (P.L. 84–652) of 1956.

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

Public Health Service Act authorizes

NCHS to collect statistics on health

resources and the utilization of health

care, which includes ‘‘extended care

facilities and other health

institutions’’ (1).

This report describes both the

rationale and design of NSRCF and the

planning activities and methods used to

collect and compile information on

residential care facilities and their

residents.

Page 1
Page 2 [ Series 1, No. 54

Background and

Purpose

The well-documented aging of the

U.S. population, particularly among

those aged 85 years and over, is

resulting in a significant increase in the

number of people needing long-term

care (LTC) services. By 2050, the

number of people in the United States

who will need LTC services is expected

to reach 27 million (2).

Although most people who need

LTC services receive them in their own

homes, personal care received outside

both the home and traditional nursing

facilities is an important and growing

service option. This is especially the

case for people who can no longer live

alone but do not require the skilled level

of care provided by a nursing home.

This type of care—broadly referred to

here as residential care—includes

congregate settings that provide both

housing and supportive services.

Supportive services typically include

protective oversight and help with

instrumental activities of daily living,

such as transportation, meal preparation,

and taking medications; and more basic

activities of daily living, such as eating,

dressing, and bathing.

Current national data collection

efforts are limited in their ability to

estimate the size and characteristics of

these residential care settings as well as

the number and characteristics of

residents they serve. The Medicare

Current Beneficiary Survey, the National

Long-Term Care Survey, and the Health

and Retirement Survey cover the

residential care population to varying

degrees, but their small sample sizes of

persons in residential care facilities limit

the conduct of in-depth analyses by type

of residential care setting or specific

subpopulations of residents (3).

The American Community Survey

conducted by the U.S. Census Bureau

now includes some residential care

facilities, but because it is a populationbased survey, it cannot produce national

estimates of the number of residential

care facilities in the United States.

According to data from the 2004

National Nursing Home Survey

(NNHS), there were an estimated 16,100

nursing homes with 1,492,200 residents.

However, no national data collection

effort similar to NNHS exists for

residential care settings and their

residents. NSRCF complements other

federal surveys and fills a significant

data gap about a major portion of the

long-term care population.

The primary purpose of NSRCF is

to produce a general database on

residential care facilities that researchers

and policymakers can use to address a

wide variety of LTC issues. Among the

most important specific objectives for

NSRCF are to provide national

estimates of: (1) the number of

residential care facilities operating in the

United States; (2) the number of

residents receiving care; and (3) the

characteristics of both the facilities and

their residents.

Design Process

There has been a longstanding

recognition of the need for data on the

number of residential care places and

their residents. In 2006, ASPE convened

a Technical Advisory Panel (TAP) to

discuss the government’s intent to

implement NSRCF. The group of

experts provided input on the definition

of residential care used for the study;

the sampling design, sample size, and

statistical power for both facilities and

resident surveys; the survey domains

that should be included in the

questionnaires; and the best source of

information for the data elements (4). A

subset of TAP also commented on the

questionnaires and the appropriateness

of the questions for this population and

helped refine questions and question

objectives. TAP members are listed in

Appendix II.

TAP drew heavily from a number of

other federal efforts conducted to

address data needs about residential care

facilities and residents. These efforts

provided important building blocks for

NSRCF and were used to inform and

guide the design of this survey:

+	 The first national survey of

residential care sponsored by ASPE

and conducted in 1998, the National

Study of Assisted Living for the

Frail Elderly, focused exclusively

on one component of residential

care—assisted living (5). A major

finding of that study concluded that

there was significant variability in

the assisted living industry.

+	 In 2003, NCHS, AHRQ, and ASPE

funded the Inventory of Long-Term

Care Residential Places (6). This

project developed an inventory of

residential places that provided

personal assistance. This inventory

was used to make some estimates of

the number of residential care

facilities and beds, do simulations

for the required sample sizes, define

the size strata, and help inform the

overall sampling design for NSRCF.

+	 In 2003, NCHS used state licensing

criteria and state regulations

obtained in the Inventory of

Long-Term Care Residential Places

project, a review of relevant

literature, expert opinions, and work

by Mollica and Jenkens (7)

describing state residential care and

assisted living policy to develop a

provider-based typology of LTC

places. The typology was further

refined during the course of a 2-day

meeting of experts convened by

NCHS in January 2004.

+	 In 2005, ASPE contracted with the

Urban Institute to understand how

different definitions and variations in

methodology used in national

surveys and the Decennial Census

contributed to a range of estimates

of the LTC population in residential

care (8). The definitional and

methodological issues discussed in

the report, The Size of the

Long-Term Care Population in

Residential Care: A Review of

Estimates and Methodology, 2005,

provided valuable information in

developing the survey design,

sampling frame, and questionnaires

for NSRCF (3).

+	 In 2005, AHRQ funded three

relevant projects related to assisted

living/residential care. The first

project reviewed LTC tools and

instruments developed to determine

the availability and types of services

provided in assisted living, assess

the quality of care and services
Series 1, No. 54 [ Page 3

delivered, and develop quality of life

measures that could be used or

adapted for assisted living. The

second project used a series of focus

groups of assisted living

stakeholders to determine the needs

and priorities for developing

improved consumer information and

tools. The third project reviewed

how states monitored assisted living

and disseminated information to

consumers (9).

In addition to convening TAP, in 2007

ASPE provided funding to RTI to

update a 2004 compendium on assisted

living. The compendium, Residential

Care and Assisted Living Compendium,

2007, described regulatory provisions

and Medicaid policy for residential care

settings in all 50 states and the District

of Columbia (10). The methodology for

creating the compendium was used as a

starting point for constructing a list of

LTC residential places as the sampling

frame for NSRCF.

Questionnaire

Development

The survey instruments from the

NCHS-conducted NNHS and National

Home and Hospice Care Survey

(NHHCS), as well as ASPE’s National

Study of Assisted Living for the Frail

Elderly, were used to inform the

development of the survey domains,

data elements, and questions for

NSRCF. The NNHS questionnaire is

available from the survey’s website:

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

nnhs_questionnaires.htm, and the

NHHCS questionnaire also is available

from that survey’s website:

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

nhhcs_questionnaires.htm. Proposed

survey domains and a list of suggested

facility-level and resident-level data

elements for each domain were first

compiled from a review of these

instruments (Appendix III). The TAP

then reviewed these documents and

identified what survey domains to

include. After this review, specific

questions for each domain and data

element were crafted. A subset of TAP

then reviewed and provided written

comments on the draft survey

instruments. NCHS, ASPE, and AHRQ

also provided input and guidance

throughout the questionnaire

development process.

After finalizing the content of the

facility and resident questionnaires, they

were converted into computer-assisted

personal interview (CAPI) instruments

for testing. In April and May 2007,

on-site cognitive interviews were

conducted with eight residential care

facilities across six states: two

extra-large (over 100 beds), three large

(26–100 beds), one medium (11–25

beds), and two small facilities (4–10

beds). The facilities, identified through

the use of local contacts,

recommendations from professional

associations, and word-of-mouth

contacts were chosen to achieve

diversity in size, geographic region, and

degree of urbanization. The interviewers

used pre-established probes and

spontaneous concurrent probing

techniques to assess the effectiveness of

the proposed questions. Cognitive

interviews for the facility questionnaire

(including probes) averaged 90 minutes

and for the resident questionnaire

averaged 45 minutes to complete. Each

facility was provided with a $100 cash

incentive for participation. In all cases,

directors responded to the facility

questions. A combination of facility

directors, direct care workers, activities

staff, and medical staff were respondents

for the resident questionnaires. Facilities

also were sent an Advance Data

Collection Form (ADCF) to complete

prior to the interview. The ADCF was a

self-administered questionnaire that

contained questions about the

facility—also asked during the in-person

interview—that might require consulting

records or other staff to answer

accurately, and thus enabled faster

interview completion when on-site.

Overall, facility administrators believed

completing the ADCF prior to the visit

was beneficial.

Findings from this cognitive testing

activity provided an informed

question-by-question assessment of the

facility and resident questionnaires that

then guided question item changes for

the pilot test.

Pilot Test
 

In spring 2008, a small pilot test

was conducted in which interviews were

completed with five facilities in the

greater District of Columbia

metropolitan area. The specified goals of

the pilot test were:

+	 To assess the usability of the CAPI

instruments in real-life situations.

+	 To assess the feasibility of the

questionnaire items across all

facility sizes.

Testing of recruiting procedures and

obtaining a high response rate were not

goals of the pilot test.

Twenty-four facilities were selected

from the frame and included a mix

among four size strata, urban and

nonurban areas, and chain- and

nonchain-affiliated facilities. Three

experienced interviewers were trained

over 2 days from a scripted training

guide, interviewer’s manual, and other

prepared materials. Each interviewer

completed one interview within a few

days of training and, shortly thereafter,

two interviewers completed one

additional interview.

Recruitment began with an initial

mailing to the facility that contained a

personalized letter signed by the NCHS

director, an NCHS confidentiality

brochure, and an NSRCF questions-andanswers brochure. Several days later,

phone call attempts were made to verify

receipt of the package and to gain

cooperation. Recruitment proved

difficult, with many call attempts

required to reach the facility director

and set appointments. When contact was

made with the director, a screening

instrument was used to determine

facility eligibility. If the facility was

eligible, respondents for the in-person

interview were identified and a date and

time for the interview was scheduled.

An ADCF was then mailed to the

facility. A confirmation reminder call

also was made to the director 1 to 2

days before the visit. During the

in-person interview, the interviewer first

completed the facility questionnaire. The

interviewer then randomly selected a

sample of three to nine residents from

the facility’s list of current residents—
Page 4 [ Series 1, No. 54

three residents were sampled in the

small and medium facilities, five in

large facilities, and nine in very large

facilities. Resident questionnaires were

then completed with the respondent who

was most knowledgeable about the

sampled resident.

Of the 24 sampled, a total of 13

facilities completed the entire process.

Five of the 24 were ineligible—three

because they exclusively served adults

with mental disabilities and two because

they were no longer in business—for an

ineligibility rate of 21%. An additional

six facilities firmly refused participation.

Recommendations for changes to

the questionnaires were made after the

completion of the pilot test. These

recommendations addressed redundancies in the resident questionnaire,

respondent confusion with terms and

definitions, errors in question wording

and skip patterns, and concerns about

respondent burden. Other improvements

included: increasing length of

interviewer training; finding better, more

efficient approach to recruitment of

facilities; reducing individual respondent

burden by involving other staff in

sampled facility; and streamlining

questionnaires by rewording, reordering,

and reducing the number of questions to

improve efficiency.

Pretest

In fall 2008, pretest interviews were

conducted with 72 residential care

facilities in 6 states. In addition to

further testing the questionnaire

instruments, the purpose of the pretest was

to assess the efficacy of study protocols

for the national survey. Aspects of the

protocol evaluated included:

+	 Recruitment procedures

+	 Survey administration

+	 Mode of administration (telephone

compared with in-person)

The pretest sampling frame was

constructed by accessing the licensure

lists for six states—from the Northeast,

Midwest, and South—and contained

7,256 facilities. To achieve the pretest

goal to complete interviews with 75

facilities, 150 sampled cases were

selected. Sampled facilities were

selected in order to provide a mix

among four size strata—small (4–10

beds), medium (11–25 beds), large

(26–100 beds), and extra large (more

than 100 beds)—representing both urban

and nonurban areas; provide experience

with chain-affiliated and independently

operated facilities; include both

multilevel and only assisted-living

facilities; and include for-profit and

nonprofit facilities.

Sample cases in the smallest

stratum also were used to test the

feasibility of administering the facility

questionnaire by phone instead of an

in-person visit. This was done because

the government was considering a range

of data collection protocols for the

national survey, including telephone

interviews for small facilities. One-half

of small facilities were randomly

assigned to a telephone data collection

mode and one-half to an in-person data

collection mode. Resident-level data

were not collected in the telephone

interviews.

After the sample was selected, a

limited Internet search for the facilities

was performed to determine the

following: whether Internet information

about facilities would be useful for

recruiters; if facilities were affiliated

with a chain (i.e., only facilities

affiliated with the large national chains

were previously identified on the

sampling frame); and the name, address,

and title of the chain corporate office

director. The following conclusions were

reached:

+	 Some facilities’ websites offered

plentiful information; however,

smaller facilities rarely had websites.

When the facility did not have a

website, it was difficult to determine

if the facility was affiliated with a

small or regional chain.

+	 Information found included maps of

location, facility name, name of

director, address, phone number, and

status of chain affiliation.

+	 Some facilities were affiliated with

hospital systems, rather than with

chains of other residential care

facilities.

+	 While learning about the facility

prior to field work was valuable in

some cases, some information was

difficult to find, inconsistent, or

dated and could not be used to

replace the sampling frame

information, only supplement it.

National and state residential care

provider associations in states where the

pretest was planned were also contacted

in advance of the pretest. Overall, they

were very receptive to the study and

helpful in promoting the study in their

newsletters, websites, and other

communications within the industry.

The challenges of recruiting

facilities for the pilot test suggested that

more efficient and effective staffing was

necessary to recruit facilities. Therefore,

the recruitment activity was made the

responsibility of a small number of

carefully selected field staff with

previous successful recruitment

experience. Facilities were recruited by

three experienced interviewers who

attended a 2-day recruiter training

session. Recruitment phone calls began

approximately 3 weeks prior to the start

of actual data collection. Recruiters’

responsibilities included:

+	 Contact facilities to obtain or verify

contact information for the director.

+	 Send an advance mail package.

+	 Explain the study and gain

cooperation.

+	 Administer a brief CAPI screening

instrument to determine facility

eligibility.

+	 Schedule an in-person visit or phone

call for a field interviewer to

complete the facility interview.

The advance mail package mailed

to directors was sent via Federal

Express and included the following

materials placed inside an attractive

NSRCF folder:

+	 A personalized letter from the

director of NCHS with Responses to

Frequently Asked Questions (FAQs)

printed on the back.

+	 NCHS Ethics Review Board (ERB)

approval letter.

+	 Brochure specifically about NSRCF.

+	 NCHS’ Confidentiality Brochure—

How the National Health Care

Survey Keeps Your Information

Strictly Confidential.
Series 1, No. 54 [ Page 5

+	 Letter of Support from four national

residential care provider

organizations.

+	 Publication from another NCHS

LTC provider survey.

Similar materials were also sent to

the corporate office of every chain that

had one or more facilities in the pretest

sample. However, the NCHS letter

provided additional information about

the survey and explained that one or

more of their chain facilities would be

asked to participate. Forty-two corporate

packages were sent for the pretest.

Eleven interviewers with CAPI

experience received 4 days of training.

Their pretest responsibilities included:

+	 An in-person visit or phone call to

complete the facility questionnaire.

+	 Resident sampling.

+	 Complete resident questionnaires for

a sample of residents.

The following instruments were used to

collect data for the pretest:

+	 ADCF.

+	 Facility questionnaire.

+	 Resident selection questionnaire.

+	 Resident questionnaire.

+	 Debriefing questionnaire—filled out

by interviewers after the interview

to qualitatively describe their

experience.

As with cognitive interviewing and

the pilot study, an ADCF was mailed to

the sampled facility after the recruiter

set an appointment. Directors were

encouraged to complete the ADCF at

their convenience before the interview

to minimize time and burden for them

during the interview. Fifty of the 72

facility respondents (69%) completed

the ADCF in advance. When they did,

interviewers reported that the time spent

to complete the facility questionnaire

was reduced substantially, regardless of

facility size.

The pretest facility questionnaire

took an average of 74 minutes to

complete. The facility director or their

designee completed the facility

questionnaire.

A short resident selection

questionnaire was used to determine the

total number of residents at the facility

as of midnight the day before the

in-person interview and to select

residents for the resident interviews. The

number of residents sampled depended

on facility size: small and medium

facilities—three residents; large

facilities—four residents; and extra-large

facilities—six residents.

Each resident questionnaire

averaged 18 minutes to complete.

Resident questionnaires were completed

with facility staff that referred to

resident records, usually the director or

caregiver knowledgeable about the

selected resident. No residents were

interviewed. In many cases, the same

respondent completed interviews for

multiple residents and when this

occurred, the time taken to complete

each questionnaire decreased.

Respondents received small token gifts

of a pen, ruler, and a thank-you note as

appreciation for their participation.

Interviewers who conducted facility

questionnaires by telephone reported no

difficulties in administering the

questionnaire. They used the same CAPI

facility questionnaire and Show Cards as

for the in-person interview. Show Cards

contained response categories for

questions with lengthy response options

and for question series with repetitive

response categories. However, those

respondents interviewed by phone rarely

used the Show Cards mailed to them.

Resident-level information was not

obtained for phone cases. Thank-you

notes were also mailed to facilities that

completed the questionnaire by phone.

Observers from RTI, NCHS, and

ASPE accompanied interviewers on

approximately 15 site visits during the

pretest. Overall, the CAPI instruments

worked very well and field staff

encountered few problems. Recruiters

and interviewers encountered some

resistance from facilities to participate,

primarily because of lack of time. This

was especially true for the small and

medium facilities where the director had

few supporting staff. Appointment

cancellations were also an obstacle. The

most common explanation for facility

nonresponse was the inability to ever

reach the director (25% of all

nonresponding sampled facilities).

The pretest provided an opportunity

to fully implement and assess all of the

procedures, recruitment materials, and

revised data collection questionnaires on

a small scale before they were

implemented in the national survey.

Based on results from the pretest, it was

determined that the study needed to:

+	 Improve the procedures for

identifying facilities affiliated with

chains and collecting chain contact

information.

+	 Develop a more robust appointment

system for field staff scalable to the

national level.

+	 Encourage facility directors to

complete the ADCF before the

interview to lower the questionnaire

administration time.

+	 Find ways to reduce the burden on

facility directors by encouraging

them to delegate components of the

interview, such as the resident

questionnaires, to other

knowledgeable staff.

+	 Design contacting protocols that

allow field staff more flexibility

when recruiting, instead of following

a highly scripted text.

+	 Incorporate lessons learned from the

pretest training into the national

survey supervisor, recruiter, and

interviewer trainings.

+	 Enhance recruitment materials and

outreach to improve the recruitment

rate.

The pretest results also provided a

general understanding of eligibility rates

by facility size, which helped to inform

sampling allocations for the national

survey. In addition, three sampled

facilities were out of business. The

overall pretest eligibility rate was 77%.

The eligibility rate was 95% for

extra-large facilities, 90% for large

facilities, and 79% for medium facilities.

The eligibility rate was lowest (64%)

among the small-sized facilities.

Facilities that exclusively served the

mentally retarded (MR) or

developmentally disabled (DD)

populations, or exclusively served the

severely mentally ill, accounted for

the majority (68%) of the ineligibility

cases.
Page 6 [ Series 1, No. 54

Activities Between

Pretest and National

Survey

Questionnaire

Changes made to the questionnaire

instruments included:

+	 Adding and removing some

questions.

+	 Changing question wording to

clarify the question for respondents.

+	 Changing question order to improve

questionnaire efficiency and

minimize redundancy.

+	 Adding or modifying response

categories.

+	 Adding or altering CAPI on-screen

instructions for interviewers to

improve interviewer usability.

+	 Implementing additional soft and

hard range checks and inter-item

consistency checks.

+	 Adding more Show Cards to improve

the pace of the interview.

Scheduling

The pretest also revealed need for a

centralized computer system to easily

access information about facilities,

appointments, and interviewer

availability and to better manage facility

recruitment and appointment scheduling

activities. As a result, RTI developed the

Facesheet (Appendix IV)—a Web-based

locator or appointment application—and

the Event Calendar.

The Facesheet provided:

+	 A way for recruiters and

interviewers to update findings from

the field, such as facility contact

information, chain contact

information, and notes about

appointments.

+	 A place to enter information about

mailings to facilities and chains.

+	 A place to easily view information

about a facility in a central database.

The Event Calendar allowed:

+	 Recruiters to schedule facility

appointments on behalf of

interviewers by seeing their

availability in real time.

+	 Recruiters and interviewers to

manage appointment schedules

efficiently.

The interoperability between the

Facesheet and the screener questionnaire

also ensured accurate and up-to-date

information, which was readily available

to different staff—recruiters, interviewers, and supervisors—assigned to

the same facility.

Contact Scripts

Modifications were made to the

recruiter and interviewer contacting

scripts to make them more

conversational and instructive for the

field staff and to structure them for use

with the Facesheet. The recruiter scripts

(renamed) included:

+	 Advance Package Call.

+	 Set an Appointment Call.

The interviewer scripts included:

+	 Reminder Call.

+	 Reschedule Appointment Call.

Respondent Contact

Materials

Modifications were made to the

materials sent to the facility director

before the in-person interview.

+	 A Pre-Interview Worksheet (PIW)

replaced the ADCF. It was renamed to

make its intended purpose more

transparent, better designed to

facilitate completion, and included

needed definitions and instructions.

+	 The PIW cover sheet also included

key information about the upcoming

appointment and specific instructions

for preparing the list of current

residents before the interview.

Information for Survey

Participants

NCHS developed an NSRCF website

with a section specifically dedicated to

prospective survey participants (available

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

participant.htm). This online information

included an overview of NSRCF and its

importance in providing data about

residential care providers. The website

also provided brief answers to these

frequently asked questions:

+	 What is the National Survey of

Residential Care Facilities?

+	 Why is this survey being conducted?

+	 Why should my residential care

facility participate?

+	 How was my residential care

community selected?

+	 How do I know this is a legitimate

survey?

+	 Is information on my facility kept

confidential?

+	 Does the Health Insurance

Portability and Accountability Act

(HIPAA) Privacy Rule allow my

residential care facility to participate

in this survey?

+	 Who will be collecting this

information and how long will it

take?

+	 What type of information is

collected?

+	 Who can I contact if I have

additional questions?

The link to this website appeared on

the promotional materials sent to facility

directors as well as on other related

materials used to promote the study.

Sampling Frame and

Design

Sampling Frame

The NSRCF sampling frame was

constructed from lists of licensed

residential care facilities (i.e., facilities

that are licensed, registered, listed,

certified, or otherwise regulated by the

state) acquired from the licensing

agencies in each of the 50 states and the

District of Columbia. State data on the

number of licensed beds for each

facility and the licensure categories were

used to determine the list of eligible

facilities. The individual lists of

residential care facilities from state

licensing agencies were checked for

duplicate facilities and concatenated to

form a list of all residential care
Series 1, No. 54 [ Page 7

facilities in each state. The individual

state lists were then concatenated to

form the sampling frame. The sampling

frame for NSRCF contained all of the

state-licensed residential care facilities

that were licensed for four or more beds

and, based on information obtained

during frame construction, appeared to

meet the survey definition at the time of

frame development. The rest of this

section summarizes the sampling frame

development and sampling design

activities. More information on sampling

frame construction can be found in

‘‘NSRCF Sample Frame Construction

and Benchmarking Report’’ (11), which

is available from: http://aspe.hhs.gov/

daltcp/reports/2010/sfconst.pdf.

Frame Development

Building the actual sampling frame

of individual facilities involved several

steps:

+	 Obtain state licensure lists.

+	 Convert the state files into a usable,

standardized format.

+	 Assess the completeness of the data.

+	 Clean and merge the state-level

files.

Because definitions and nomenclature regarding residential care

facilities vary widely across states, the

first sampling frame task was to identify

the licensure categories of residential

care facilities within each state that met

the study definition. To make this

determination, the following resources

were reviewed: Residential Care and

Assisted Living Compendium: 2007 (7);

Assisted Living State Regulatory Review,

2009 (12); Inventory of Long-Term Care

Residential Places (5); and the websites

of each state and their associated

regulations for the different types of

residential care. Fifty different

terminologies for these state licensure

categories were identified. Screening for

facility eligibility was also performed

during data collection because

determining whether the facility met the

study definition was not always

straightforward.

State lists, which varied in format

and degree of completeness, were

obtained from the state regulatory

agencies or, in a few cases, downloaded

from the Web. All states provided

facility licensure type and the counts

necessary to determine number of beds

per facility. Data were available on more

than 99% of facilities for street address,

city, state, ZIP code, and telephone

number. Ownership data were missing

for 57% of facilities, and a facility

contact name was missing for 28% of

facilities.

Issues concerning combining

facilities, converting units into beds, and

identifying chains were also addressed.

Facilities were combined that had

multiple licenses or where close-by

buildings with separate licenses

appeared to be under the same

management, according to the study’s

predetermined criteria. Namely, when

facilities had addresses within two digits

of one another and the same phone

number and administrator, they were

considered combined facilities and, as

such, constituted a single case on the

sampling frame. Overall, 446 facilities

(1% of all facilities on the frame) were

flagged as combined facilities. Four

states licensed their residential care

facilities by units (i.e., rooms and

apartments) instead of beds. For these

states, the number of licensed beds was

imputed. Moreover, 16,379 facilities

(41%) were identified as being affiliated

with a chain, defined as an individual or

corporation owning two or more

facilities. Of chain-affiliated facilities,

1,381 were associated with 84 chains

identified as the largest and most

recognizable chains in the United States;

the remaining 14,998 chain-affiliated

were associated with regional or smaller

chains.

Since the sampling frame lists were

obtained from states beginning in June

2009, no list was older than 6 months at

the time the NSRCF sample was drawn

in January 2010 from the sampling

frame of 39,635 facilities.

Benchmarking the

Sampling Frame

Because there is no ‘‘gold

standard’’ list of residential care

facilities, alternative estimates of the

number of residential care facilities and

beds were identified and compared with

the number of facilities and beds on the

NSRCF sampling frame.

Four data sources were used to

make these comparisons.

+	 Using the 2002 Health and

Retirement Study, the 2002

Medicare Current Beneficiary

Survey, and the 1999 National

Long-Term Care Survey, Spillman

and Black (8) estimated the number

of older people living in residential

care facilities. These numbers were

converted to an estimated number of

residential care beds by using the

median nursing home occupancy

rates reported by the American

Health Care Association and the

proportion of nursing home residents

who are aged 65 and over from the

2004 NNHS.

+	 The Inventory of Long-Term Care

Residential Care Places (5), while

almost 7 years old, contained a

comprehensive listing of residential

care facilities against which to check

the NSRCF sampling frame.

+	 The Residential Care and Assisted

Living Compendium 2007 (7) was

used to benchmark NSRCF.

+	 The NSRCF frame was compared

with Stevenson and Grabowski’s

(13) data that utilized information in

the State Residential Care and

Assisted Living Policy: 2004 (14).

The 2009 NSRCF sampling frame

contained information for 39,635

facilities representing a total of

1,073,043 beds, which benchmarked

quite well against these other estimates.

Facility Eligibility Criteria

There is no standard federal

definition of residential care facilities.

Sampled facilities were eligible to

participate in NSRCF if they met the

following criteria:

+	 Licensed, registered, certified, listed,

or otherwise regulated by their state

within their specific licensure

category.

+	 Have four or more licensed,

certified, or registered residential

care beds.

+	 Have at least one resident currently

living in the facility.
Page 8 [ Series 1, No. 54

+	 Provide room and board with at

least two meals a day.

+	 Provide around-the-clock onsite

supervision.

+	 Provide help with activities of daily

living (e.g., bathing, eating,

dressing) or health-related services

(e.g., medication management).

+	 Serve primarily an adult population.

+	 Do not exclusively serve the

severely mentally ill, the MR/DD, or

both.

Sampling Design

Sampling for NSRCF used a

stratified two-stage probability design.

The first stage was the selection of

facilities, where the primary strata of

facilities were defined by facility bed

size (i.e., 4–10 beds, 11–25 beds,

26–100 beds, and more than 100 beds)

and geographic region (Northeast,

Midwest, South, and West). Within

primary strata, facilities were sorted by

the following characteristics: MSA

status, where MSA denotes a

metropolitan statistical area, and state.

MSA status could be ‘‘metropolitan’’ (a

county or group of contiguous counties

that contain at least one urbanized area

of 50,000 or more population; an MSA

may contain other counties that are

economically and socially integrated

with the central county, as measured by

commuting), ‘‘micropolitan’’ (a

nonmetropolitan county or group of

contiguous nonmetropolitan counties

that contains an urban cluster of

10,000–49,999 persons; surrounding

counties with strong economic ties,

measured by commuting patterns, may

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

to information available on the sampling

frame. For more information, visit:

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

inforeg_statpolicy/.

Facilities were then selected by

using systematic random sampling. This

stage yielded the final NSRCF sample

of 3,605 facilities and included 1,184

facilities with 4–10 beds, 1,038 facilities

with 11–25 beds, 1,051 facilities with

26–100 beds, and 332 facilities with

more than 100 beds. Reserve samples in

excess of the base sample of 1,184

facilities in the small stratum were also

created in case projected ineligibility

rates among small facilities were

underestimated. These cases were never

fielded, however, because targeted

numbers were reached using the base

sample alone.

The second stage was the selection

of current residents. This stage was

carried out by the interviewers during

the facility interview, with the aid of an

algorithm programmed into CAPI.

The interviewer first collected the

census list, usually from the facility

director or designee. The census list of

residents was the total number of

residents on the facility rolls as of

midnight on the day before the facility

interview. The interviewer reviewed and

cleaned the list to ensure there were no

duplicates or missing residents that

should have been on the list. The

interviewer then numbered the list and

entered the total number of residents

into the CAPI system. The CAPI

program, through systematic

randomization procedures, generated

three to six numbers, depending on

facility bed size. The interviewer then

identified which residents matched up

with these numbers. Three residents

were selected for facilities with less than

26 beds, four residents for facilities with

26–100 beds; and six residents for

facilities with more than 100 beds.

National Survey

Methods

Overview

The national survey followed an

approach similar to that for the pretest,

in which separate personnel were used

in contacting facilities: recruiters to call

facilities, determine eligibility, and set

appointments; and interviewers to

conduct the on-site interviews. Facility

recruitment began on March 16, 2010,

and continued throughout most of

the data collection period; on-site

interviewing began on April 26, 2010,

and officially ended on November 24,

2010.

Outreach to Provider

Organizations

Prior to and during NSRCF data

collection, a comprehensive outreach

strategy was carried out to effectively

spread the word about NSRCF among

prospective respondents. A joint letter of

support for NSRCF was obtained from

these provider organizations that

represent the residential care and

assisted living industries (Appendix V):

+	 LeadingAge, formerly American

Association of Homes and Services

for the Aging.

+	 American Seniors Housing

Association (ASHA).

+	 Assisted Living Federation of

America (ALFA).

+	 National Center for Assisted Living

(NCAL).

+	 Board and Care Quality Forum.

NCHS staff met several times with

the Center for Excellence in Assisted

Living (CEAL) president and board

members representing LeadingAge,

ASHA, ALFA, and NCAL (Appendix

VI). CEAL is a nonprofit collaborative

of 11 national organizations whose aim

is to promote high-quality assisted

living. The goals of the meetings were:

+	 Solicit information on best practices

for recruiting facilities to participate

in NSRCF.

+	 Identify ways to inform their

respective provider memberships

about the importance of participating

in NSRCF.

These board members agreed to raise

awareness of NSRCF using selected

communication channels with their

provider members through their

associations’ annual meetings,

newsletters, and websites. The Board

and Care Quality Forum, which caters

largely to small-sized facilities, also

agreed to promote the survey and

encourage their facilities to participate.

Before and during data collection,

short write-ups about NSRCF appeared

in the national newsletters of the

provider organizations and in the Board

and Quality Care Forum newsletter.

Survey descriptions and calls for

participation were also published in the
Series 1, No. 54 [ Page 9

newsletters of state affiliates of those

provider organizations (Appendix VII).

NSRCF brochures were distributed at their

annual meetings and the survey was

mentioned in presentations given by key

office holders in these organizations.

NCHS created an NSRCF conference

exhibit display that was used at

AHCA/NCAL’s and AAHSA’s 2009

annual meeting. NCHS staff was also

present at these exhibit booths to answer

questions about the survey and explain the

need for participation. During data

collection, follow-up requests were also

made to individual state affiliates of the

national provider organizations in states

with lower-than-expected response rates to

encourage their members to participate.

To gauge the success of these

outreach activities, respondents at the

close of the screener questionnaire were

asked: ‘‘Before you received the

package about this study, had you heard

about this study through newsletters or

other information provided by national

organizations that support it, such as

American Association of Homes and

Services for the Aging (AAHSA),

American Seniors Housing Association

(ASHA), Assisted Living Federation of

America (ALFA), National Center for

Assisted Living (NCAL), or Board and

Care Quality Forum?’’ Overall, 12% of

respondents reported hearing about the

study. The percentage was highest

among the very large facilities (22%)

and was lowest among the small

facilities (8%). Respondents representing

the large and medium-size facilities

were somewhat in between, with 22%

and 15%, respectively.

Chain Outreach

In February 2010 before data

collection began, an NSRCF information

package (Appendix VIII) was sent via

Federal Express to known chains that

had two or more affiliated facilities

included in the sample. These packages

were mailed to 122 chains with 246

sampled facilities. The purpose of this

chain outreach activity was to preempt

facility refusals or delayed participation

because chain headquarters were

unaware of the study. It enabled

recruiters to tell respondents that their

chain was previously notified about the

study whenever these facilities told

recruiters that they could not participate

without chain approval.

The chain outreach package

included the following:

+	 Letter signed by NCHS’ Director

that provided information about the

survey and explained that one or

more facilities in their organization

would be contacted.

+	 NCHS ERB approval letter.

+	 Brochure specifically about NSRCF.

+	 NCHS’ Confidentiality Brochure—

How the National Health Care

Survey Keeps Your Information

Strictly Confidential.

+	 Letter of support from five national

residential care provider

associations.

The Project Director’s name and contact

information was also provided in case

chain leadership had additional

questions about the study. Only one

national chain contacted NCHS and

refused participation on behalf of all

their facilities.

Recruiter Training

In March 2010, 16 experienced

interviewers attended and completed

31⁄2 days of recruiter training that

entailed a start-to-finish understanding

of the survey and recruitment process.

Topics included: an overview of the

study; computer applications

demonstration; recruitment scenarios;

confidentiality procedures; Facesheet

and Event Calendar system; conducting

calls to facilities; gaining cooperation;

administering the screener questionnaire;

and appointment setting. In addition,

before training began, recruiters received

a computer manual, recruiter manual,

and a home study exercise that gave

them an overview of the national survey

and their responsibilities.

Another 2-day recruiter training

session was conducted midway through

data collection after two recruiters left

the project and several others had

competing commitments. Six NSRCF

interviewers with strong refusal

conversion skills, high productivity, and

proven success of working well with

facilities were retrained as recruiters.

One recruiter was also trained to

perform interviewer duties due to the

limited number of interviewers in one

urban area.

Facility Recruitment

Facility recruitment began

approximately 5 weeks before

interviewer training to allow time for

recruiters to set initial appointments.

Each recruiter was responsible for

contacting a total of about 225 facilities;

assigned cases were released in several

batches, as recruiter workloads

diminished. Figure 1 provides an

overview of the recruiter responsibilities.

Place initial phone call to facility 

Obtain director’s 

contact information 

Verify facility name 

and mailing address 

Send advance package to facility 

Prepared by RTI Check Fedex.com 

Call facility to set appointment 

Gain cooperation Screen for eligibility Make appointment for 

in-person interview 

�

�

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities. 

Figure 1. Recruiter responsibilities
Page 10 [ Series 1, No. 54

First Contact With

Sampled Facility

As shown in Figure 1, the first

step recruiters performed was a

telephone call to the sampled facility.

The primary purpose of this call was

to confirm the facility director’s

contact information (name, title, phone

number, and e-mail address) and the

facility mailing address in order to

mail the advance package. During this

call, recruiters did not need to speak

to the director because whoever

answered the phone could usually

provide this information. In about 82% of

the sampled facilities, recruiters needed

only 1 day to complete this call. In about

6% of the cases, this process took longer

than 1 week. The primary reasons cases

took longer to complete were:

+	 Employee did not answer the call at

their main number, requiring

multiple callbacks.

+	 Recruiter was unsure whether they

had reached the sampled facility and

needed further confirmation.

+	 Telephone number was

disconnected; the correct number

needed to be identified or

determined if the facility was out of

business.

Recruiters used the Advance

Package Call Script (Appendix IX) to

guide them through the process of

making these initial calls. This

document also contained answers to

FAQs and other instructions relating to

this call. After confirming or updating

the contact information, recruiters

entered this information into the

Facesheet.

During this recruitment activity,

recruiters suspected 186 facilities as out

of business, 149 of which were later

confirmed out of business.

Advance Package Mail-out

Soon after recruiters completed the

initial call to the sampled facility,

support staff accessed the Facesheet

information and mailed out the Advance

Package (Appendix X) via Federal

Express (FedEx).

The Advance Package consisted of

an NSRCF folder that contained:

+	 A letter signed by NCHS’ Director

that provided information about the

survey, explained its importance,

and described how the survey is

conducted. The letter contained a list

of FAQs and instructions on who to

contact for more information.

+	 An NCHS ERB approval letter.

+	 A brochure specifically about

NSRCF.

+	 An NCHS Confidentiality

Brochure—How the National Health

Care Survey Keeps Your Information

Strictly Confidential.

+	 A letter of support from five

national residential care provider

associations.

Set Appointment Call

Five business days after the

Advance Package was mailed out,

recruiters began making callbacks to the

sampled facilities. The recruiter’s goals

during this call were to:

+	 Speak to the director.

+	 Confirm that the director received

the Advance Package.

+	 Answer any questions the director

had about the survey.

+	 Complete the screener questionnaire

to determine facility eligibility.

+	 Set the appointment for eligible

facilities and provide the director

with additional information about

the in-person interview.

Before placing these calls, recruiters

accessed the FedEx website for the

package tracking number, delivery date,

and person’s name who signed for it.

Then they referred to the Set an

Appointment Call Script (Appendix XI)

to guide them through these calls. Once

the director was reached, recruiters

confirmed receipt of the Advance

Package and answered any questions

about the study referring to the call

script and FAQs document (Appendix

XII). Next they administered the CAPI

screener questionnaire (Appendix XIII)

to determine whether the facility met the

survey eligibility criteria. This

questionnaire took, on average, 10

minutes to complete. The screener

questionnaire is also viewable at:

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

NCHS/Dataset_Questionnaires/nsrcf/2010/.

The most challenging part of this

activity for recruiters was reaching the

director. This challenge was more acute

in smaller facilities where directors

often provided resident care in addition

to their administrative duties, thus

ignoring phone calls and voice mails. In

other facilities, recruiters frequently

reached receptionists who acted as

gatekeepers and resisted putting their

calls through to the director. E-mail and

voicemail messages were also used to

reach the director during this process.

Appointment Setting

The CAPI screener instrument

automatically determined the facility’s

eligibility status and directed recruiters

to either end the call if the facility was

not eligible or proceed to the last

recruiter activity—setting the

appointment for the in-person interview.

Again, the Set an Appointment Call

Script and the online Event Calendar

provided recruiters with details for

scheduling an exact date and time for

the site visit that aligned with a specific

interviewer’s availability.

A higher-than-anticipated number of

eligible facilities delayed or hesitated in

setting their appointment, or refused to

do so after completing the screener

questionnaire. Of the facilities that

agreed to set an appointment during the

field period, only 68% were appointed

on the same day as they were screened.

These delays resulted in recruiters

making many callbacks as well as

employing other strategies to

successfully appoint these cases (for

more details, see ‘‘Refusal Aversion and

Conversion Strategies’’).

Recruiters also encountered many

directors who needed approval from a

supervisor or upper-level management

within their facility, organization, or

chain to participate in the study. The

process for obtaining these approvals

required some or all of these steps:

+	 Send an Advance Package to the

person who was qualified to say

whether approval was needed.
Series 1, No. 54 [ Page 11

+	 Identify the appropriate person to

provide approval.

+	 Send the Advance Package to the

person authorized to approve

participation.

+	 Obtain the approval.

+	 Convey the approval to the director

or key contact at the facility.

These recruitment activities

continued throughout data collection.

Table A shows the level of effort

expended, as measured in elapsed

days, from recruiters’ first initiating

the Set an Appointment Call to

successfully scheduling the initial

appointment.

Of the 2,422 initial appointments

made during the field period, 401

facilities (17%) rescheduled their

appointments. About 5% of appointed

cases never completed an in-person

facility interview.

Facility Case Transition

For the majority of cases, the shift

in responsibility from recruiter to

interviewer occurred after recruiters

scheduled an appointment for the

facility. Some facilities that delayed

setting appointments, however, were

transferred to the target interviewer, who

then assumed responsibility for

scheduling the appointment.

Interviewer Training

A 5-day interviewer training session

was held in April 2010 with 96

interviewers. Training consisted of

plenary sessions for all attendees and

smaller concurrent training sessions,

each with about 14 interviewers,

divided mostly according to assigned

region. The major topics covered in

training were: overview of the study;

computer applications demonstration;

confidentiality procedures; Facesheet

and Event Calendar system; reminder

call; appointment rescheduling;

maintaining cooperation; administering

the facility, resident selection, resident,

and debriefing instruments; procedures

for handling ‘‘don’t know’’ responses;

and data retrieval. In all, 86 interviewers

successfully completed training, nine

received a conditional pass, and one

failed. Those who received a conditional

pass were given specific remedial

tasks and retested, and all of these

interviewers eventually passed. The

one interviewer who failed was

dismissed, leaving a total of 95

interviewers to conduct the facility

in-person interviews.

After data collection began, some

interviewers also were trained via a

telephone training session to perform

recruiter activities during drive-by visits

to hard-to-reach facilities. Drive-bys

were used primarily to determine if the

facility was still in business, attempt to

gain cooperation, screen facilities for

eligibility, and schedule an in-person

interview, although some also included

in-person interviews.

Data Collection

Procedures and

Survey Instruments

Figure 2 provides an overview of

the interviewer responsibilities.

Before the in-person interview,

directors were mailed and asked to

complete the PIW (Appendix XIV). This

mailing provided:

+	 Interview date, time, name of

interviewer, and contact number to

call in case the appointment needed

to be rescheduled.

+	 Reminder to prepare a resident

census list before the interview.

+	 Questions asked during the

in-person interview that likely would

Table A. Elapsed time from first appointment call to set appointment

Appointed facilities

Cumulative

Elapsed time Number Percent percent

Less than 1 day ..................... 432 18 18 
 

1–7 days.......................... 450 19 36 
 

8–14 days ......................... 252 10 47 
 

15–28 days ........................ 333 14 61 
 

29–77 days ........................ 479 20 80 
 

78 days or more ..................... 478 20 100 
 

Total appointed facilities ................ 2,422 100 . . . 
 

. . . Category not applicable.

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

Place reminder call 

After checking 

Fedex.com Reschedule, if necessary Regain cooperation, if necessary 

Conduct in-person interview 

Administer facility 

questionnaire Obtain resident list Conduct 3–6 resident questionnaires 

Complete debriefing questionnaire 

After leaving facility 

�

�

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities. 

Figure 2. Interviewer responsibilities
require referring to records or

consulting other staff, and

instructions for completing the

worksheet.

About three-fourths of facilities had a

PIW filled out at the time of the

in-person interview.

Reminder Call

An interviewer’s initial task was to

contact the facility about 4 days before

the in-person interview to remind the

director of the appointment using the

Reminder Call Script (Appendix XV).

Before placing the call, interviewers

reviewed information entered in the

Facesheet by recruiters to better

understand nuances and specifics about

the facility. In most cases, the reminder

call was done by phone, but if the

facility director requested it, an e-mail

was sent. The goal of this call was to

reconfirm the appointment to reduce

no-shows and cancelled and break-off

interviews, and to remind the director to

complete the PIW and prepare a resident

census list before the interview.

Reschedule Call

During data collection, 40

previously set appointments with

directors required rescheduling because

of interviewer unavailability or for

efficiency reasons, in order to include

the case in a travel cluster assignment.

When this occurred, interviewers used

the Appointment Reschedule Call Script

(Appendix XVI) to reschedule the visit.

Thirty-six of these broken appointments

were rescheduled, three could not be

rescheduled, and one case was

ineligible.

Facility In-person

Interview

For most facilities (73%), the entire

in-person interview was conducted with

one respondent who was usually the

facility director, administrator, owner, or

operator of the facility or its residential

care component. The interview consisted

of asking questions about the facility,

conducting sampling for a preselected

number of current residents depending

on the size of the facility (three, four, or

six), and then asking questions about

those sampled residents. The in-person

interview took, on average, 2 hours and

7 minutes to complete for small and

medium facilities, 2 hours and 26

minutes to complete for large facilities,

and 3 hours and 3 minutes to complete

for very large facilities. After every

interview, interviewers gave respondents

a ruler, pen, and a thank you letter

(Appendix XVII) as tokens of

appreciation for participating in the

survey.

CAPI Questionnaire

Instruments

Data were collected using CAPI

software on laptop computers. The

CAPI system allowed interviewers to

move correctly and efficiently through

the questionnaire and use modified

question wordings based on responses to

prior questions. Only questions specific

to the individual facility or resident

were asked, skipping unnecessary

questions. CAPI included hard and soft

range checks, and hard and soft

consistency checks among question

items. Hard edits required the

interviewer to fix the discrepant data

before the interview could continue.

Soft edits resulted in a prompt for the

interviewer to either correct the data

or suppress the edit. Use of the CAPI

system also eliminated the need to

enter data from a hard-copy

questionnaire, thereby reducing this

type of data entry error. The CAPI

instrument was also programmed to

enable the interviewer to complete the

facility questionnaire or the resident

selection questionnaire in any order, to

accommodate the schedules of the

facility director and staff. In all but

43 cases, interviewers began with the

facility questionnaire.

The NSRCF CAPI instrument was

composed of four different modules

(viewable at: ftp://ftp.cdc.gov/pub/

Health_Statistics/NCHS/Dataset_

Questionnaires/nsrcf/2010/).

+ The facility instrument included

questions on facility characteristics

such as ownership, size, types of

living arrangements and amenities,

policies, staffing, services, and

general resident characteristics. The

question wordings, response options,

and accompanying skip patterns for

this questionnaire are provided in

Appendix XVIII. The facility

questionnaire took an average of 65

minutes to complete.

+ For the resident selection instrument,

interviewers entered the number of

residents currently residing at the

facility and based on the number of

beds the facility had, three, four, or

six different numbers were randomly

generated by CAPI. Interviewers

then used these numbers to identify

which residents on the census lists

to select for the resident

questionnaires. The question

wordings, response options, and

accompanying skip patterns for this

questionnaire are provided in

Appendix XIX. The resident

selection instrument took about 6

minutes to complete.

+ The resident questionnaire included

questions on the sampled residents’

demographics, living arrangements,

activities, health conditions,

cognitive and physical functioning,

and services received. The question

wordings, response options, and

accompanying skip patterns for this

questionnaire are provided in

Appendix XX. Respondents to the

resident questionnaire were those

who were most knowledgeable

about the sampled residents and had

access to their records; in addition

to directors, they were RNs, LPNs,

and personal care aides who

provided direct care services. The

resident questionnaire took an

average of 19 minutes each to

complete.

+ After leaving the facility,

interviewers also filled out a

debriefing questionnaire that

contained questions about the

interviewers’ experience, including a

personal assessment of the accuracy

of answers obtained and difficulties

encountered in conducting the

interview. These questions are

provided in Appendix XXI. The

debriefing questionnaire took on

average about 7 minutes to

complete.

Page 12 [ Series 1, No. 54
Series 1, No. 54 [ Page 13

Follow-up Activities

When a respondent needed to end

the in-person interview before all of the

required questionnaires were completed,

an attempt was usually made to

complete the interview either by phone

or in person. If only one resident

questionnaire remained, the interviewer

attempted to complete this interview by

telephone. If several components of the

survey were not completed, field

management staff decided whether the

interview was to be continued on a

revisit, by phone, or not continued at all.

Of the 119 facilities that broke off the

interview before its completion, 64 later

completed them by telephone,

34 later completed them in person

on a revisit, and 21 were never

completed.

Refusal Aversion and

Conversion Strategies

Initial refusals or resistance to

participate in NSRCF occurred at

several points during the recruiting and

interviewing phases: 1) when explaining

the study and completing the screener

questionnaire, 2) when setting the

appointment, and 3) when rescheduling

with facility respondents who cancelled

an appointment, no-showed for an

appointment, or broke off the interview

midway through the questionnaire.

Altogether, 941 facilities refused at least

once over the course of the field period.

The most prevalent reason given by

facility respondents at all phases was

that they did not have the time to

complete the interview. Other common

reasons included: not interested,

confidentiality concerns, chain or

supervisor approvals, and study

concerns.

Different strategies were employed

to convert these cases, depending on the

reason given. The study protocol

included the following approaches:

+	 Using the FAQs and knowledge of

the survey to explain the study,

address directors’ concerns, and

explain how the survey protocols

were flexible enough to handle

scheduling needs.

+	 Allowing a cooling-off period

between the refusal and attempts to

convert the refusal.

+	 Performing a drive-by visit to make

personal connection with the

respondent.

+	 Sending targeted letters (e.g.,

Having Trouble Reaching You, No

Time, Not Interested/Not if

Voluntary, Cancelled Appointment)

(Appendix XXII).

+	 Facilitating supervisor and chain

approval.

Additional strategies were also

developed during data collection to

enhance these refusal conversion efforts.

They included:

+	 Perform drive-by visits on a more

widespread basis by expanding these

visits not only to gain cooperation

but also to screen for eligibility,

appoint, and complete some

interviews on the spot.

+	 Reduce the overall length of the

interview for very large facilities, by

changing the number of required

resident interviews from six to four

residents.

+	 Offer facilities the option to

complete the last resident interview

by phone.

+	 For facilities that screened as

eligible, develop and mail a

Schedule Appointment Reminder

Letter to those that delayed or

hesitated setting their appointment;

and a Reminder Postcard, sent 3

weeks before the end of data

collection to facilities still being

actively pursued (Appendix XXIII).

Of the 269 facilities where a

drive-by visit was made, 154 (57%)

were favorably resolved; that is,

21 facilities completed the facility

interview that same day, 95 facilities

completed the interview later on, and 38

were found to be either ineligible or out

of business. About 375 facilities

received some type of conversion letter,

and of these, 156 (42%) eventually

completed the facility interview. The

Reminder Postcard was mailed late in

the data collection period and yielded

only two additional completed facility

interviews.

Follow-up With Chains

When a facility told the recruiter or

interviewer that they could not proceed

with the survey without receiving

approval from their chain office, further

efforts were made to gain the

cooperation of the chain. These steps

included:

+	 Recruiter or interviewer asked the

facility for a chain contact name.

+	 Chain Outreach package (Appendix

VIII) was mailed to the chain

contact.

+	 RTI scientific and senior staff

contacted the chain official by

telephone.

These calls began in May and continued

until November 9, 2010, during which

time the chain gave approval, denied

approval, or more commonly, stopped

communicating with NSRCF project

staff. The facilities that requested help

in obtaining chain approval resulted in

51 chains requiring follow-up. This

number corresponds to about 5% of all

chains in the sample. About one-third

(n = 16) of the 51 chains that were

called granted approval for the facility

to participate, which resulted in 49

facilities ultimately receiving chain

approval via this approach.

Additional Strategies to

Increase Participation

Several other strategies were

initiated toward the end of the data

collection period to boost the number of

final completed cases. These included:

+	 Extending the field period by 6

weeks.

+	 Reassigning cases to different

supervisors and recruiters.

+	 Changing supervisor responsibilities

to allow more time for case review

and strategizing.

+	 Using high-performing interviewers

as recruiters.

+	 Setting weekly production targets

per stratum.

+	 Offering financial payments to

interviewers and recruiters for

setting facility appointments that

resulted in a completed interview.
Page 14 [ Series 1, No. 54

+	 Assigning NSRCF project senior

staff to contact a few facilities that

were identified as being potentially

receptive to participating.

+	 Reducing the number of resident

interviews from six to four in very

large facilities.

+	 Targeting efforts on remaining cases

located in specific size strata and

geographic regions where

nonresponse was more prevalent in

order to reach survey completion

goals for these areas.

Lengthening the field period in

combination with other strategies

employed resulted in about 240

additional completed facility interviews

during the extended 6 weeks of data

collection, or about 10% of all

interviews completed in NSRCF. The

incentive program itself produced 188 of

these completed interviews.

Cases that were still in the process

of recruitment for participation after

data collection ended were sent a letter

(Appendix XXIV) to thank them and to

let them know the study had ended.

Data Quality

Assurance

Data quality assurance during the

field period was accomplished in a

variety of ways. The quality assurance

measures included field observations,

verification calls, production reports,

management meetings, and field memos

and calls. These measures were

implemented to ensure that data were

collected consistently and reliably across

the sampled facilities.

Field Observation

Between May 10 and November 3,

2010, NSRCF project staff observed a

total of 57 facility interviews conducted

by 32 interviewers. These observations

served multiple purposes. They provided

an opportunity for feedback to

interviewers on their performance,

determined whether interviewers were

administering the questionnaires

correctly so that mistakes could be

addressed, and identified those who

needed further training. In addition,

observations provided a mechanism to

evaluate the effectiveness of the survey

questions, survey protocol, responses to

questions, and respondent concerns.

When observers detected issues that

warranted clarification to field staff,

field memos were prepared. These

issues were also discussed during

weekly team meetings between

supervisors and field staff.

Verification

Verification calls served to detect

interviewer falsification and to receive

feedback from respondents regarding

interviewer performance and survey

protocol. Each interviewer’s first or

second completed interview was

selected for verification. After that,

cases were chosen using an algorithm to

achieve 10% verification of each

interviewer’s completed cases. Field

supervisors followed a script (Appendix

XXV) to conduct the telephone

verification. Almost all (95%) of the

verification calls were done with the

person who completed the facility

interview. The most common concern

raised by respondents during these calls

was that the interview was too long.

However, many respondents commented

that the interviewers were very

professional and pleasant and made the

interview experience enjoyable.

Verification calls were stopped in

November 2010 (the last month of data

collection), because they were not

revealing any new concerns and no

falsifications were found. Altogether,

about 15% of all completed interviews

were verified.

Production Reports

Weekly production reports were

reviewed to track various aspects of the

survey and its progress, including

detailed information on the following:

+	 Screener questionnaire case status

by supervisor region and strata (e.g.,

number and percentage of facilities

out of business, ineligible, refused,

eligible and complete, still pending,

and other final not complete cases).

+	 Ineligible facilities by state and

reason for ineligibility.

+	 Facility questionnaire completion

status by supervisor region and

strata.

+	 Screener and facility questionnaire

status for chain-affiliated and

independent facilities by strata and

use of gaining cooperation letters.

+	 Final case status by strata and

geographic region (i.e., ineligible;

noncompletes refusal; noncompletes

other; completed facility

questionnaire only; completed

facility questionnaire and some

resident questionnaires; and

completed facility questionnaire and

all resident questionnaires).

+	 Total appointed cases and completed

facility questionnaires by strata.

+	 Facility-specific information for

upcoming scheduled appointments.

+	 Screener Outreach report results by

strata.

In addition to monitoring production

levels and response rates across strata

and region throughout the field period,

these reports proved useful in

determining whether the hold sample of

small facilities was needed. The reports

also provided information about cases

requiring extra effort to complete, such

as very large facilities, initial refusals,

facilities requiring drive-by visits, and

cancelled appointments. Biweekly

updates on the status of efforts to gain

chain approval were also provided in the

Chain Approval Report (Appendix

XXVI). These reports provided a

progressive snapshot of the current

status of these contacts.

Management Meetings

The NSRCF project management

team held biweekly phone conference

calls throughout the field period to

review field status and developments

and to discuss and resolve issues that

arose in the field. Detailed minutes from

each meeting were used in subsequent

meetings to track progress on action

items and further guide discussion on

project activities.
Series 1, No. 54 [ Page 15

Field Memos and Calls

At three points during the field

period, field memos were sent to field

supervisors, recruiters, and

interviewers. The memos consisted of

production updates, tips for using

project materials, clarifications for

specific items in the survey

instruments, and protocol changes. In

addition, field supervisors held weekly

team meetings and one-on-one calls

with recruiters and interviewers in

their region.

Data Processing

Data processing included edits

incorporated into the CAPI

programming, which were applied

during data collection; data review and

editing post-data collection; and data

file construction. For some questions,

hard and soft edit checks were

programmed into CAPI based on the

expected range of responses for given

questions and logical consistency

between questions. Hard edits required

interviewers to correct an entry before

proceeding, whereas soft edits

prompted interviewers to verify or

correct unlikely, but possible,

responses.

Data review and editing after data

collection included a wide range of

activities. Responses were reviewed

for accuracy, logic, consistency, and

completeness. Twenty-six cases

identified as having inconsistencies in

the number of rooms and apartments

and bathrooms were contacted again

for further clarification of those

responses. Data frequencies were

examined to identify missing items

and outliers. When missing items,

outliers, or extremely implausible

responses were identified, an

explanation provided by the

interviewer in the comments attached

to specific questions or in the

debriefing questionnaire was sought.

For example, interviewers attached a

comment to a question if the actual

response was greater than the highest

value CAPI would accept. Interviewer

verbatim entries in the debriefing

questionnaire were also reviewed to

identify other needed corrections.

Corrections were also made to the data

when an interviewer error was

discovered, for example, if the

interviewer accidentally opened the

wrong case and recorded the answers

under the wrong identification number.

Problems relating to CAPI skip

patterns and recoded variables were

addressed. For example, when an

interviewer went back into CAPI to

change a response, in a few cases, this

caused a discrepancy with subsequent

questions. Labels for ‘‘select all that

apply’’ variables needed reformatting

to yes or no instead of category 1

selected or category 2 not selected.

Out-of-range data values were

identified and corrected. In addition,

‘‘other–specify’’ responses were

back-coded to existing code

categories, where appropriate. Item

nonresponse analyses that looked at

items with the highest ‘‘don’t know’’

and ‘‘refused’’ responses were

conducted. Partially completed cases

were identified and assessed as to

whether or not to include them in the

data files. For the facility file, there

was only one partially completed case

and it was included in the final file.

This case had three-fourths of the first

section of the facility questionnaire

completed. For the resident file, none

of the 36 partially completed cases

were included in the final file.

Specifications were developed for

derived variables, other recoded

variables, and creation of the final

facility and resident in-house and

public-use data files. In addition, in

order to provide a complete picture of

each sampled facility and its

disposition, a paradata file was

constructed that contained selected

variables from the event history,

preload sample file and facility,

resident selection, and resident

questionnaires. This file was used for

unit nonresponse analysis and

provided a mechanism to evaluate the

fieldwork and effectiveness of

strategies taken during the survey field

period.

Disclosure Risk

Review

NSRCF data files intended for

public-use release underwent extensive

disclosure risk review to prevent the

identity of any facilities, residents, or

persons who participated in the survey

from being made known to the public.

For unusual characteristics and

extreme and potentially recognizable

outliers, NCHS used a number of

methods such as collapsing categories

and top or bottom coding to minimize

disclosure risk associated with these

data items. Furthermore, NCHS

checked to see how prevalent certain

respondent attributes were in the

universe file, and whether they were

clustered by geography or selected

major facility characteristics. If a

given facility or resident characteristic

was relatively uncommon in the

universe file or was clustered in a

specific geographic location, NCHS

deemed there was disclosure risk.

NCHS used various methods to

perturb the data and then ensured that

the perturbation did not affect the

estimates.

Response Rates

Of the 3,605 sampled facilities

selected for NSRCF, eligibility could

not be determined for 325. Among

those for which eligibility could be

determined, 636 (19%) were ineligible

because they did not meet the survey

criteria, were out of business, or were

combined with another facility

(Table B). The ineligibility rate was

highest among small facilities (36%).

The most common reason for

ineligibility, occurring mostly among

small facilities, was that the facility

exclusively served MR/DD populations or populations with severe

mental illness. A total of 602 facilities

(17%) refused to participate in the

survey (not shown).
Page 16 [ Series 1, No. 54

Table B. Number of residential care facilities, by eligibility, response status, and selected facility characteristics: National Survey of

Residential Care Facilities, 2010

Estimated

number Estimated

Number of Estimated Number of of in-scope total

Number of Number of Number of non- Number of percent of facilities of facilities number of

sampled in-scope interviewed interviewed out-of-scope eligible unknown with unknown in-scope

Facility characteristics facilities facilities1 facilities facilities facilities2 facilities3 eligibility4 eligibility5 facilities6

All facilities ................ 3,605 2,644 2,302 342 636 80.6 325 262 2,906

Bed size

Small ................... 1,184 719 627 92 411 63.6 54 34 753

Medium .................. 1,038 775 673 102 161 82.8 102 84 859

Large ................... 1,051 871 769 102 52 94.4 128 121 992

Extra large ................ 332 279 233 46 12 95.9 41 39 318

Geographic region

Northeast ................. 645 451 404 47 145 75.7 49 37 488

Midwest .................. 1,023 716 603 113 204 77.8 103 80 796

South ................... 992 748 637 111 129 85.3 115 98 846

West .................... 945 729 658 71 158 82.2 58 48 777

Location of agency

Metropolitan statistical area ...... 2,736 2,005 1,730 275 481 80.7 250 202 2,207

Nonmetropolitan statistical area . . . 869 639 572 67 155 80.5 75 60 699

1

Facilities licensed, registered, listed, certified, or otherwise regulated by a state, and having at least four beds, providing room and board with at least two meals, providing around-the-clock on-site
 

supervision, serving an adult population, and offering help with personal care (e.g., bathing, dressing, or eating) or medication management. Personal care and health-related services may be directly
 

provided by the facility or coordinated with outside parties. In-scope status was determined via the screener questionnaire.
 

2

Facilities determined to be ineligible based on the survey definition of residential care.
 

3

Numerator is the number of known in-scope facilities; denominator is the number of facilities with known eligibility status [col b/(col b + col e)].
 

4

Facilities for which eligibility could not be assessed.
 

5

Facilities of unknown eligibility that were estimated to be eligible using the percentage of eligible facilities (col f × col g).
 

6

Sum of known in-scope facilities and estimated in-scope facilities (col b + col h).
 

With NSRCF’s two-stage sampling

design, the first-stage response rate is

the percentage of eligible facilities

that completed the facility

questionnaire. Interviews were

completed with 2,302 facilities, for a

first-stage facility weighted (for

differential probabilities of selection)

response rate of 81% (Table C). The

second-stage response rate indicates

the percentage of sampled residents

for which facility staff completed the

resident questionnaire. The secondstage resident unweighted response

rate was 98% and the resident

weighted response rate was 99% (not

shown). The overall weighted survey

response rate for NSRCF was 79%

(facility weighted response rate ×

resident weighted response rate).

Weights used in the last column of

Table C are the same weights as

provided on the NSRCF facility data

file.

Reasons for
 

Nonresponse
 

At the close of data collection, 660

remaining viable noninterview cases

were reviewed in order to determine the

predominant reason for nonresponse.

Table D shows the number and percent

distribution of these cases by primary

reason for nonresponse.

The most prevalent reason directors

gave for not participating was because

they either did not have time for the

interview or for other scheduling

reasons (30%). Another 28% of the

facilities refused as a result of not

obtaining chain or supervisor approval

to participate. Other specific reasons

given included: directors stating that

they either were not interested or would

not participate if the survey was

voluntary (16%); and recruiters and

interviewers being unable to contact the

director successfully during the field

period (9%).

Nonresponse Bias

Analysis

As previously noted, the NSRCF

facility response rate weighted by the

inverse of the probability of selection

was 81%. Table C presents the percent

distribution of selected facility

characteristics among responding and

nonresponding facilities. Using sampling

frame variables, nonresponse bias was

assessed by examining how much the

respondents and nonrespondents differed

on the survey variables of interest.

Responding and nonresponding facilities

were significantly different by size

(small, medium, large, and very large)

and geographic region (Northeast,

Midwest, South, and West), but not by

MSA status (metropolitan or

nonmetropolitan).

Table C also presents the weighted

and unweighted response rates among

facilities with different characteristics.
Series 1, No. 54 [ Page 17

Table C. Percent distribution of in-scope sampled residential care facilities, by facility response status, response rates, and selected facility

characteristics: National Survey of Residential Care Facilities, 2010

NonresponseWeighted distribution of in-scope sampled facilities1,2 Response rates

adjusted

estimates for

in-scope

Facility characteristics Total Responding Nonresponding Unweighted I

3 Unweighted II4 Weighted5 facilities6

All facilities ................. 100.0 100.0 100.0 77.5 79.2 80.6 100.0

Bed size7,8

Small9 .................... 49.9 51.4 44.3 81.1 83.2 83.1 49.1

Medium10 .................. 15.9 15.5 17.5 76.7 78.3 78.1 15.9

Large. . . . . . . . . . . . . . . . . . . . . 27.2 26.6 29.5 77.0 77.5 77.5 27.2

Extra large10 ................ 7.0 6.5 8.7 72.8 73.2 73.7 7.0

Geographic region7

Northeast .................. 8.4 8.5 8.3 80.8 82.8 80.5 8.4

Midwest9 .................. 22.3 21.0 26.9 73.6 75.7 76.9 22.3

South9 .................... 26.9 25.4 32.4 73.8 75.3 76.1 26.9

West9 .................... 42.4 45.1 32.4 83.6 84.7 85.2 42.4

Location of agency

Metropolitan statistical area ....... 81.4 81.0 83.0 76.7 78.4 80.2 81.4

Nonmetropolitan statistical area .... 18.6 19.1 17.1 80.1 81.8 82.1 18.6

1

Facilities licensed, registered, listed, certified, or otherwise regulated by a state, and having at least four beds, providing room and board with at least two meals, providing around-the-clock on-site
 

supervision, serving an adult population, and offering help with personal care (e.g., bathing, dressing, or eating) or medication management. Personal care and health-related services may be directly
 

provided by the facility or coordinated with outside parties. In-scope status was determined via the screener questionnaire.
 

2

Weights are the inverse of facility selection probabilities.
 

3

Numerator is the number of in-scope facilities that participated in the National Survey of Residential Care Facilities (NSRCF); denominator is all screened in-scope sampled facilities and facilities of
 

unknown eligibility using AAPOR Response Rate I calculation.
 

4

Numerator is the number of in-scope facilities that participated in NSRCF; denominator is all screened in-scope sampled facilities and facilities estimated to be in-scope based on an overall and
 

variable-specific eligibility rate using AAPOR Response Rate III calculation.
 

5

Numerator is the number of in-scope facilities that participated in NSRCF; denominator is all screened in-scope sampled facilities and facilities estimated to be in-scope based on an overall and
 

variable-specific eligibility rate using AAPOR Response Rate III calculation. This rate is weighted by the probability of selection.
 

6

Includes adjustment for probability of selection and adjustment for nonresponse.
 

7

Chi-square test of association is significant (p ≥ 0.01) between distribution in responding compared with nonresponding facilities in the indicated facility characteristic.
 

8

All distributions are based on the bed size strata on the frame file.
 

9

Post-hoc testing indicated that differences between responding and nonresponding facilities were significant at p ≥ 0.01.
 

10Post-hoc testing indicated that differences between responding and nonresponding facilities were significant at p ≥ 0.05.
 

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

Table D. Nonresponding facilities, by primary reason for nonresponse

Nonresponse reason Number

Percent

distribution

All cases .............................. 660 100

Scheduling or time reasons ................... 196 30

Chain or supervisor refusal ................... 186 28

Not interested/Not if voluntary ................. 107 16

Director always unavailable ................... 57 9

Unable to appoint/reappoint case—other or

no reason given ......................... 78 12

Other................................. 36 5

Higher cooperation was gained among

small facilities and facilities in the

Northeast and West. The effect of this

differential response is minimized by

using a nonresponse adjustment factor

that takes into account size, region, and

MSA status. These variables were

chosen because they were deemed

important for analysis and were also

used as estimation strata. To evaluate

the effect of nonresponse adjustments on

selected survey estimates, the last

column of Table C shows estimates

weighted by the inverse of the

probability of selection and adjusted for

nonresponse. The adjustments reflected

in the last column of Table C were

applied to reduce bias in survey

estimates.

Estimation Procedures

Because the statistics from NSRCF

are based on a sample, they differ from

the data that would have been obtained

if a complete census had been taken

using the same definitions, instructions,

and procedures. However, the

probability design of the NSRCF sample

permits the calculation of estimates and

sampling errors. The standard error of a

statistic is primarily a measure of

sampling variability that occurs by

chance because only a sample, rather

than the entire population, is surveyed.

The standard error also reflects part of

the variation that arises in the

measurement process but does not

include any systematic bias that may be

in the data, or any other nonsampling

error. The chances are about 95 in 100

that an estimate from the sample differs
Page 18 [ Series 1, No. 54

by less than twice the standard error

from the value that would be obtained

from a complete census.

Standard errors can be calculated

for facility and resident estimates by

using any statistical software package,

as long as clustering within facilities

and other aspects of the complex

sampling design are taken into account.

Software products such as SAS (15),

Stata (16), and SPSS (17) have these

capabilities. Statistics presented in

NCHS publications are computed using

the linearized Taylor series method of

approximation as applied in SUDAAN

software (18), which produces standard

error estimates for statistics from

complex sample surveys. Both of the

NSRCF public-use files (facility and

resident) include design variables that

designate each record’s stratum marker

and the first-stage unit (or cluster) to

which the record belongs.

In the facility public-use file, the

variable STRATUM indicates the

sampling stratum for bed size group and

region, and the facility indicated by the

variable FACILID is the primary

sampling unit. POPFAC represents the

total number of facilities for calculating

the finite population correction in a

stratum. The survey weight is indicated

by FACFNWT. The data dictionary for

the facility public-use file has a

‘‘Technical Notes’’ section that provides

an example of the syntax for using these

design variables to describe the

sampling design in SUDAAN. The

NSRCF data dictionary for the facility

public-use file is available from the

NSRCF website: http://www.cdc.gov/

nchs/nsrcf/nsrcf_questionnaires.htm.

The resident public-use file has two

stages. The stratum in the first stage is

indicated by the variable RSTRATUM,

in which the primary sampling unit is

the facility indicated by the variable

FACID. The variable for total facilities

needed to calculate the finite population

correction at the first stage is

RPOPFAC. In the second stage, the

sampling unit is the resident indicated

by the variable RESNUM. In the

resident public-use file, the second stage

is treated as if sampling was done with

replacement. In SUDAAN, to treat the

second stage as if sampling was with

replacement, the variable POPRES is

used and has a value of –1. Many other

statistical packages assume sampling

with replacement if no variable for the

total population at the second stage is

provided. The variable for the survey

weight is RESFNWT. The data

dictionary for the resident public-use file

has a ‘‘Technical Notes’’ section that

provides an example of the syntax for

using these design variables to describe

the sampling design in SUDAAN. The

NSRCF data dictionary for the resident

public-use file is available from the

NSRCF website: http://www.cdc.gov/

nchs/nsrcf/nsrcf_questionnaires.htm. The

resident sample represents residents

living in residential care communities on

any given day between March and

November 2010.

Because NSRCF is a sample survey,

data analyses must include survey

weights to inflate the sample numbers to

national estimates. The weight

associated with each sampled facility

and each sampled resident is constructed

to account for the multistage sampling

design. An estimatorXˆ for any given

population total X can be expressed as a

weighted sum over all sampled units,

defined as

X

^

= Σ ux(u)W(u)

where u represents a sampled unit, x(u)

is the characteristic or response of

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

survey weight for sampled unit u. The

final weight W(u) for each sampled unit

is the product of two components:

1.	 Inverse of the probability of

selection.

2.	 Nonresponse adjustment.

The first component of the weight

for each sampled unit (facility or

resident) is the inverse of the unit’s

selection probability. For the current

resident, the selection probability is the

product of two selection probabilities:

the probability of selecting the facility

to the NSRCF sample and the

probability of selecting the current

resident within the sampled NSRCF

facility. The inverse of the product of

these probabilities is used for weighting.

The first component was corrected

to account for duplicate listings of

sampled facilities in the sampling frame

when duplicates were identified after the

start of field work. To the extent that all

duplicates of sampled facilities were

identified, the corrected weights produce

unbiased estimates (i.e., estimates that

would be obtained if no facilities were

duplicated in the sampling frame).

The second component for

calculating the weight is adjustment for

nonresponse. This adjustment is made

for three types of nonresponse. The first

two types are at the facility level, and

the third is at the resident level. The

first type occurs when in-scope facilities

do not respond to NSRCF. In NSRCF,

the second type occurs when an

in-scope facility does not provide the

number of current residents within the

respective facility. The third type occurs

when the facility does not provide

information requested in the survey

about the sampled resident.

Finally, the weights described above

were smoothed within groups defined by

census region, size, and MSA status if

there were outlier sampling units whose

survey weights were somewhat larger

than those for the remaining sample in

the same group. In smoothing, total

estimates for each group were preserved.

Reliability of Survey

Estimates

Estimates published by NCHS must

meet reliability criteria based on the

relative standard error (RSE or

coefficient of variation) of the estimate

and on the number of sampled records

on which the estimate is based. RSE is a

measure of variability and is calculated

by dividing the standard error of an

estimate by the estimate itself. The

result is then converted to a percentage

by multiplying by 100. Guidelines used

by NCHS authors to determine whether

estimates should be presented in tables

of NCHS published data reports include:

+	 If the estimate is based on fewer

than 30 sampled cases, the value of

the estimate is not reported. This

is usually indicated with an

asterisk (*).

+	 If the estimate is based on 60 or

more sampled cases and the RSE
Series 1, No. 54 [ Page 19

is less than 30%, the estimate is

reported and is considered reliable.

+	 All other reported estimates should

not be assumed to be reliable.

These include estimates with an

RSE of 30% or more and estimates

based on 30–59 cases, regardless

of RSE.

Confidentiality

Participation in NCHS surveys is

strictly voluntary and information

collected on facilities and individuals is

confidential. HIPAA allows health

establishments to disclose protected

health information without patient

authorization for public health purposes

and for research that has been approved

by an institutional review board with a

waiver of patient authorization. NCHS

enforces strict procedures to prevent the

disclosure of confidential data in survey

operations and data dissemination. In

accordance with NCHS’ confidentiality

mandate [Section 308(d) of the Public

Health Service Act (42 U.S.C. 242m)],

no information collected in NSRCF may

be used for any purpose other than the

purpose for which it was collected. Such

information may not be published or

released in any form if the individual or

establishment is identifiable unless

consent to do so has been obtained in

writing from the sampled individual or

establishment. The survey data were

also collected in accordance with the

requirements specified by the

Confidential Information Protection and

Statistical Efficiency Act of 2002.

Because NSRCF does not involve

collecting protected health information

(e.g., personal identifiers such as name,

Social Security number, birth date, or

Medicare/Medicaid numbers), the survey

is not subject to the Privacy Rule

mandated by HIPAA. The NSRCF

protocol was approved by the NCHS

Research ERB. The information

provided by the facilities sampled in

NSRCF is used for statistical research

and reporting purposes only.

Data Dissemination
 

The 2010 NSRCF data are available

in public-use files from the NSRCF

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

nsrcf_questionnaires.htm. Two NSRCF

data files are being released: facility and

resident (December 2011). A limited

number of facility-level variables are

provided on the resident file (i.e.,

facility size, chain status, type of

ownership, and MSA, except for extra

large facilities). Researchers who wish

to link other facility-level data to the

resident file will need to work through

the NCHS Research Data Center (RDC).

Some data items collected during the

interview do not appear on the

public-use file because they are

restricted. Restricted variables include

indirect identifiers, such as state,

geographic region, specific numeric

variables (e.g., total number of rooms or

apartments, number of beds, number of

residents with certain health conditions),

detailed race/ethnicity, and other

sensitive variables. These indirect

identifiers could compromise the

confidentiality of survey respondents.

For other variables, response categories

were collapsed, top coded, and bottom

coded. A complete list of restricted

NSRCF variables is available from:

http://www.cdc.gov/rdc/B1dataType/

dt122.htm. RDC allows researchers

under RDC supervision to access

confidential statistical microdata files,

including restricted variables or

restricted data linkage products.

Researchers must submit a proposal for

review and approval prior to using the

RDC. Additional information on the

NCHS RDC, fees, and procedures for

access to linked data files is available

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

Questions about these data may be

directed to the NCHS Office of

Information Services, Information

Dissemination Staff, at 1–800–232–4363

or NCHSquery@cdc.gov, or to the

Long-term Care Statistics Branch at

301–458–4747.

Also available from http://

www.cdc.gov/nchs/nsrcf/nsrcf_

questionnaires.htm are NSRCF

questionnaires, data dictionaries, and

survey methodology and documentation.

The survey methodology and

documentation overview—which is

based on this methods report—briefly

describes the survey, sampling design,

sampling frame, scope of survey, data

collection procedures, estimation

procedures, and reliability of estimates.

References

1.	 National Center for Health Statistics.

Current legislative authorities of the

National Center for Health Statistics:

Enacted as of November 1999.

Hyattsville, MD. 2000. Available from:

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

legis99.pdf.

2.	 U.S. Department of Health and Human

Services and U.S. Department of Labor.

The future supply of long-term care

workers in relation to the aging baby

boom generation: Report to Congress.

Washington, DC: Office of the

Assistant Secretary for Planning and

Evaluation. 2003. Available from:

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

ltcwork.htm.

3.	 Spillman BC, Black KJ. The size of the

long-term care population in residential

care: A review of estimates and

methodology. Washington, DC: U.S.

Department of Health and Human

Services, Office of the Assistant

Secretary for Planning and Evaluation.

2005.

4.	 Weiner JM, Loft JD, Byron MZ,

Greene AM, Flanigan T. Designing a

National Survey of Residential Care

Facilities: Final design options memo.

Washington, DC: RTI International.

2006.

5.	 Hawes C, Phillips CD, Rose M. A

national study of assisted living for the

frail elderly: Final summary report.

Prepared for the U.S. Department of

Health and Human Services, Office of

the Assistant Secretary for Planning and

Evaluation, Office of Disability, Aging,

and Long-Term Care Policy. 2000.

6.	 Social and Statistical Systems, Inc.

Task 9 assess results and produce

summary report on list-building:

Inventory of long-term care residential

places. Prepared for the National

Center for Health Statistics and the

Agency for Health Care Research and

Quality. Silver Spring, MD: Social and

Statistical Systems. 2003.
Page 20 [ Series 1, No. 54

7. Mollica RL, Jenkens R. State assisted

living practices and options: A guide

for state policy makers. Princeton, NJ:

Robert Wood Johnson Foundation.

2002. Available from http://rwjf.org.

8. Spillman BC, Black KJ. The size and

characteristics of the residential care

population: Evidence from three

national surveys. Prepared for U.S.

Department of Health and Human

Services. Washington, DC. The Urban

Institute. 2006.

9. Mollica RL. Residential care and

assisted living: State oversight practices

and state information available to

consumers. AHRQ Publication No.

06–M051–EF. Rockville, MD: Agency

for Healthcare Research and Quality.

2006.

10. Mollica R, Sims-Kastelein K,

O’Keeffe J. Residential care and

assisted living compendium: 2007.

Washington, DC: U.S. Department of

Health and Human Services, Office of

the Assistant Secretary for Planning and

Evaluation. 2007. Available from:

http://aspe.hhs.gov/daltcp/reports/2007/

07alcom.htm.

11. Wiener JM, Lux L, Johnson R, Greene

AM. National Survey of Residential

Care Facilities sample frame

construction and benchmarking report.

Washington, DC: RTI International.

2010.

12. Polzer K. Assisted living state

regulatory review 2009. Washington,

DC: National Center for Assisted

Living. 2009. Available from:

http://www.ahcancal.org/ncal/resources/

Documents/2009_reg_review.pdf.

13. Stevenson DG, Grabowski DC. Sizing

up the market for assisted living.

Health Aff 29(1):35–43. 2010.

14. Mollica R, Johnson-Lamarche H,

O’Keeffe J. State Residential Care and

Assisted Living Policy: 2004. Prepared

for the U.S. Department of Health and

Human Services, Office of the Assistant

Secretary for Planning and Evaluation,

Office of Disability, Aging, and

Long-Term Care Policy. Research

Triangle Park, NC: RTI International.

2005.

15. SAS/STAT, release 9.1.3 [computer

software]. Cary, NC: SAS Institute.

2003.

16. Stata, release 9 [computer software].

College Station, TX: StataCorp. 2005.

17. SPSS for Windows, release 15.0

[computer software]. Chicago, IL:

SPSS. 2006.

18. SUDAAN, release 10.1 [computer

software]. Research Triangle Park, NC:

RTI International. 2008.
Series 1, No. 54 [ Page 21

Appendix I. Acronyms Used in This Report

AAHSA American Association of Homes and Services for the Aging

ADCF Advance Data Collection Form

AHRQ Agency for Healthcare Research and Quality

ALFA Assisted Living Federation of America

ASHA American Seniors Housing Association

ASPE Office of the Assistant Secretary for Planning and Evaluation

CAPI Computer Assisted Personal Interviewing

CDC Centers for Disease Control and Prevention

CEAL Center for Excellence in Assisted Living

ERB Ethics Review Board

FAQ Frequently Asked Questions

HHS U.S. Department of Health and Human Services

HIPAA Health Insurance Portability and Accountability Act

LTC Long-term Care

MSA Metropolitan Statistical Area

NCAL National Center for Assisted Living

NCHS National Center for Health Statistics

NHHCS National Home and Hospice Care Survey

NNHS National Nursing Home Survey

NSRCF National Survey of Residential Care Facilities

PIW Pre-Interview Worksheet

RDC Research Data Center

RSE Relative Standard Error

TAP Technical Advisory Panel
Page 22 [ Series 1, No. 54

Appendix II. NSRCF Technical Advisory Panel Members and

Instrument Reviewers

Technical Advisory Panel Members

Dr. Joan Buchanan, Harvard Medical School

Dr. Brenda Cox, Battelle Memorial Institute

Dr. Joan Hyde, CEO, Ivy Hall Senior Living

Dr. Rosalie Kane, University of Minnesota School of Public Health

Mr. David Kyllo, National Center for Assisted Living, American Health Care Association

Dr. James Lepkowski, Institute for Social Research

Dr. Nancy Mathiowetz, University of Wisconsin

Dr. Robert Mollica, National Academy for State Health Policy

Dr. Sheryl Zimmerman, Program on Aging, Disability and Long-Term Care, University of North Carolina

Instrument Reviewers

In addition to government staff at ASPE, AHRQ, and NCHS, the following experts reviewed the survey data collection

instruments.

Dr. Catherine Hawes, Department of Health Policy and Management, School of Rural Public Health, Texas A&M University

Dr. Rosalie Kane, University of Minnesota School of Public Health

Mr. David Kyllo, National Center for Assisted Living, American Health Care Association

Dr. Robert Mollica, National Academy for State Health Policy

Dr. Robert Newcomer, University of California, San Francisco

Dr. Janet O’Keeffe, RTI International

Dr. Sheryl Zimmerman, Program on Aging, Disability and Long-Term Care, University of North Carolina
Series 1, No. 54 [ Page 23

Appendix III. Survey Domains for the National Survey of Residential

Care Facilities

Survey Domains: Facility Level Data

Domain

Source

of data

Proposed

survey

domains

Final

survey

domains

Background and Demographics of Administrator

Position held Facility Staff u u

Length of time on job Facility Staff u u

Experience and training Facility Staff u u

Race of administrator Facility Staff u u

Gender of administrator Facility Staff u u

Age of administrator Facility Staff u u

Education of administrator Facility Staff u u

Facility Characteristics

How facility licensed Facility Staff u u

Ownership (for profit/not for profit) Facility Staff u u

Affiliation (chain or independent) Facility Staff u u

Multi-level campus Facility Staff u u

Length of time in operation Facility Staff u u

Number of beds/residents Facility Staff u u

Alzheimer’s Special Care Unit Facility Staff u u

Type of accommodations (e.g., private rooms, bathrooms) Facility Staff u u

Charges and reimbursement rates (amount and what it covers) Facility Staff u u

Participation in Medicaid Facility Staff u u

Waiting lists Facility Staff u u

Occupancy rates Facility Staff u u

Resident turnover: admissions/discharges Facility Staff u u

Type of staff (e.g., RNs, LPNs) Facility Staff u u

Staffing levels Facility Staff u u

Level of staff training Facility Staff u u

Staff turnover Facility Staff u u

Record keeping (types of data maintained) Facility Staff u u
Page 24 [ Series 1, No. 54

Survey Domains: Facility Level Data—Con.

Domain

Source

of data

Proposed

survey

domains

Final

survey

domains

Age of residents served Facility Staff u u

Facility Staff estimates of cognitive, functional and health status

of residents

Facility Staff u u

Facility Policies/Services

Types of services provided on site Facility Staff u u

Types of services provided by outside staff Facility Staff u u

Medication administration Facility Staff u u

Use of restraints Facility Staff u u

Admission policy (who admitted/excluded) Facility Staff u u

Discharge policy (reasons for discharge) Facility Staff u u

Linkage to health care system Facility Staff u

Greatest problem Facility Staff u
Series 1, No. 54 [ Page 25

Survey Domains: Resident Level Data

Domain

Source of data Proposed

survey

domains

Final

survey

Resident Family Staff domains 1

Demographics

Age or date of birth + + + u u

Race/ethnicity + + + u u

Gender + + + u u

Education + + u u

Marital Status + + + u u

Income + + u

Family/Social ties + + u

Previous occupation + + u

Resident Characteristics

Prior Living Arrangements + + u u

Length of time in facility/date of admission + + + u u

Reason for moving to a facility + + u

Reason for choosing a residential care facility + + u

Rate paid + + + u u

Payment source(s) (private sources/Medicaid) + + + u u

Insurance Status + + u

Health Status and Physical Functioning

Physical health/health conditions + + + u u

Cognitive status + + + u u

Health status + + + u u

Hospital stays + + + u u

Number of ER visits + + + u u

Vaccinations (flu/pneumonia) + u u

Physical functioning (ADL/IADL status) + + + u u

Psycho-social well-being + + + u u

Mental health status + + u u

Behavioral problems + + u u

Types of services used (on-site staff) + + u u
Page 26 [ Series 1, No. 54

Survey Domains: Resident Level Data—Con.

Domain

Types of services used (off-site staff)

Source of data Proposed

survey

domains

u

Final

survey

Resident domains

+

Family Staff 1

+

Autonomy and Choice

Living arrangement (lives in private room; has a

roommate; shared or private bath) + + + u u

Activity involvement + + u u

Satisfaction

Satisfaction with accommodations + + u

Satisfaction with staff + + u

Satisfaction with services received + + u

1

Staff may need to consult facility records for some of the information in this list.
Appendix IV. Facesheet

NSRCF FACESHEET

Original Preloads

CASEID:

FACILITY NAME

FACILITY STREET ADDRESS

FACILITY CITY

FACILITY STATE

FACILITY ZIPCODE

FACILITY PHONE

FACILITY STRATA

FACILITY NUMBER OF BEDS

FACILITY CONTACT NAME

ADDITIONAL PHONE NUMBERS, IF ANY

ADDITIONAL NOTES, IF ANY

Facility City:

Original Preloads Facility & Director Chain Completed Mailouts Appointment Proceed to form

CASE ID: Or

Facility Name: Or

Page 106 [ Series 1, No. 54
FACILITY & DIRECTOR

CASEID:

RECRUITER: CONFIRM/COLLECT GREEN INFORMATION DURING THE ADVANCE PACKAGE CALL. RTI WILL SEND 

THE ADVANCE PACKAGE TO THE ADDRESSEE ON THIS SCREEN.

RECRUITER AND INTERVIEWER: REVIEW THE INFORMATION ON THIS SCREEN BEFORE CALLING, SCREENING, 

APPOINTING OR INTERVIEWING FACILITY. ANY UPDATES MADE IN THE SCREENER WILL BE REFLECTED ON 

THIS SCREEN IN 24 HOURS.

FACILITY NAME:

FACILITY STRATA (PER PRELOAD):

FACILITY NUMBER OF BEDS (PER PRELOAD):

FACILITY STREET ADDRESS LINE 1*

FACILITY CITY*

FACILITY STATE*

FACILITY ZIPCODE* -

FACILITY PHONE ( ) -

MAILING ADDRESS LINE 1

MAILING ADDRESS LINE 2

FACILITY CITY*

FACILITY STATE*

FACILITY ZIPCODE*

MAILING ADDRESS (PER SCREENER)

NAME OF DIRECTOR

TITLE OF DIRECTOR

EMAIL OF DIRECTOR (ENTER REFUSED OR NONE IF 

APPLICABLE)

PHONE OF DIRECTOR ( ) -

PHONE2 OF DIRECTOR ( ) -

NOTE THAT ACCORDING TO THE COMPLETED SCREENER, THIS RESIDENTIAL CARE FACILITY...

INDEPENDENT LIVING, NURSING HOME, REHABILITATION OR HOSPITAL AT SAME LOCATION

* IF FIELD IS UPDATED, CASE MUST RECEIVE PROJECT APPROVAL BEFORE PROCEEDING

FACILITY MAILING ADDRESS IF DIFFERENT FROM THE ABOVE

Save

Facility City:

Original Preloads Facility & Director Chain Completed Mailouts Appointment

CASE ID: Or

Facility Name: Or

Proceed to form

Series 1, No. 54 [ Page 107
IS THIS FACILITY IN A CHAIN

CHAIN ID

ORGANIZATION

CONTACT NAME

ADDRESS LINE 1

ADDRESS LINE 2

CITY

STATE

ZIP

CONTACT PHONE

ORGANIZATION

CONTACT NAME

CONTACT TITLE

ADDRESS LINE 1

ADDRESS LINE 2

CITY

STATE

ZIP -

CONTACT PHONE ( ) -

NOTES FROM SCIENTIFIC STAFF

IF YOU WOULD LIKE THE CHAIN OUTREACH PACKAGE MAILED TO THE CHAIN, ENTER INFORMATION HERE:

SENT ON

CHAIN OUTREACH PACKAGE SENT PRIOR TO FIELD PERIOD

Save

NSRCF FACESHEET

CHAIN

CASE ID: A0324

Facility City:

Original Preloads Facility & Director Chain Completed Mailouts Appointment

CASE ID: Or

Facility Name: Or

Proceed to form

Page 108 [ Series 1, No. 54
DATE RTI SENT ADVANCE PACKAGE

ADVANCE PACKAGE TRACKING NUMBER

ADVANCE PACKAGE DELIVERED ON DATE

ADVANCE PACKAGE SIGNED FOR BY:

DATE RTI SENT PREFIELD CHAIN OUTREACH 

PACKAGE

CHAIN PACKAGE TRACKING NUMBER

PREFIELD CHAIN OUTREACH PACKAGE DELIVERED 

ON DATE

PREFIELD CHAIN OUTREACH PACKAGE SIGNED FOR 

BY:

DATE RTI SENT CHAIN OUTREACH PACKAGE AT 

FI REQUEST:

CHAIN OUTREACH PACKAGE AT FI REQUEST 

TRACKING NUMBER:

CHAIN OUTREACH PACKAGE FI REQUEST 

DELIVERED ON DATE:

CHAIN OUTREACH PACKAGE FI REQUEST SIGNED 

FOR BY:

DATE RTI SENT PIW

PIW TRACKING NUMBER

PIW DELIVERED ON DATE:

PIW SIGNED FOR BY:

DATE RTI SENT “TROUBLE REACHING YOU” LETTER:

DATE RTI SENT “NO TIME LETTER” LETTER:

DATE RTI SENT “NOT INTERESTED/NOT IF 

VOLUNTARY” LETTER:

DATE RTI SENT “CANCELLED APPOINTMENT” 

LETTER:

NSRCF FACESHEET

COMPLETED MAILOUTS

CASE ID:

Save

Facility City:

Original Preloads Facility & Director Chain Completed Mailouts Appointment

CASE ID: Or

Facility Name: Or

Proceed to form

Series 1, No. 54 [ Page 109
DAY OF WEEK

DATE

TIME

PRESUMED FI

CONFIRMED FI (TO BE ENTERED BY FS)

WHO TO ASK FOR WHEN ARRIVE

PARKING

APPOINTMENT NOTES

OTHER NOTES

OBSERVER

OBSERVER ORGANIZATION

OBSERVER CELL PHONE

NAME OF RESPONDENT TO FACILITY QUEX (PER 

SCREENER)

NAME OF RESPONDENT TO FACILITY QUEX (IF 

NECESSARY TO UPDATE OUTSIDE OF SCREENER)

NAME OF RESPONDENT TO SELECTION QUEX (PER 

SCREENER)

NAME OF RESPONDENT TO SELECTION QUEX (IF 

NECESSARY TO UPDATE POST-SCREENER)

NAME OF PERSON TO REMIND

EMAIL OF PERSON TO REMIND

PHONE OF PERSON TO REMIND

PHONE2 OF PERSON TO REMIND

NOTES ABOUT REMINDER CALL

Save

Facility City:

Original Preloads Facility & Director Chain Completed Mailouts Appointment

NSRCF FACESHEET

APPOINTMENT

CASE ID:

CASE ID: Or

Facility Name: Or

Proceed to form

Event Calendar

Delete Appointment

Page 110 [ Series 1, No. 54
Page 32 [ Series 1, No. 54

Appendix V. NSRCF Letter of Support

The National Survey of Residential Care Facilities (NSRCF) is the

first ever federal study of residential care/assisted living

communities designed to provide national information about these

communities and their residents. In-person interviews will be

conducted with directors and caregivers to provide information

about services, staffing, and practices, and resident health,

functional status, and payment sources. This information will help

policy makers, health care planners, and residential care/assisted

living providers better understand, plan for, and serve the future

long-term care needs of the aging population. While data from this

survey will be publicly available, all data will be confidential and

aggregated, so that the names of the communities, respondents,

and residents are not identifiable.

The study is being conducted by the National Center for Health

Statistics (NCHS), an agency of the Centers for Disease Control

and Prevention (CDC), and the Office of the Assistant Secretary

for Planning and Evaluation (ASPE) in the Department of Health

and Human Services (DHHS).

National data collection will be conducted in early 2010 following

a pretest in September and October of 2008. About 2,250

communities will be selected for the national survey and 75

communities for the pretest.

The following organizations encourage your participation in this

national research initiative:

+	 American Association of Homes and Services for the Aging

(AAHSA)

+	 American Seniors Housing Association (ASHA)

+	 Assisted Living Federation of America (ALFA)

+	 National Center for Assisted Living/American Health Care

Association (NCAL/AHCA)

+	 Board and Care Quality Forum (BCQF)
Series 1, No. 54 [ Page 33

Appendix VI. Provider Organizations That Supported NSRCF

CEAL Board of Directors and their organizations

+ Karen Love, President

+ David Kyllo, National Center for Assisted Living (NCAL)

+ Stephen Maag, American Association for Homes and Services for the Aging (AAHSA)

+ Rachelle Bernstecker, American Seniors Housing Association (ASHA)

+ Maribeth Bersani, Assisted Living Federation of America (ALFA)

Board and Care Quality Forum

+ Sally Reisacher-Petro

National Center for Assisted Living

+ Karl Polzer
Page 34 [ Series 1, No. 54

Appendix VII. Provider Organization Newsletter Articles on NSRCF

Data Collection For Federal Health Center Assisted Living Study Begins In April

The National Survey of Residential Care Facilities, a national study of assisted living and residential care communities, is

scheduled to start the data collection phase in April 2010.

The National Center for Health Statistics (NCHS), within the Centers for Disease Control and Prevention, is conducting this new

study to provide national estimates of these places and their residents, according to NCHS.

NCHS has contracted RTI International to collect information through in-person interviews about the characteristics of assisted

living and residential care communities and the people who live there. NCHS reports that about 2,250 assisted living

communities—representative of all U.S. regulated residential care and assisted living providers with four or more beds—will be

interviewed for the study. Within each residence, a random sample of three to six residents will be selected depending on the

number of beds. In-person interviews will be conducted with directors and caregivers, not with residents.

The information assisted living directors and caregivers provide will be held in the strictest of confidence, and only summary data

will be made publicly available. All published information will be presented in such a way that no individual community, staff

member, or resident can be identified. Results from this study will be presented separately by bed size (four–10 beds, 11–25 beds,

26–100 beds, and more than 100 beds). The information collected through this study will be invaluable for planning and

organizing assisted living and residential care services in the future, and NCHS seeks your support in making this possible. By

participating in this study, you can ensure that you and other similar assisted living and residential care places are well-represented

in the study.

To learn more about this study, please visit the Web site at www.cdc.gov/nchs/nsrcf.htm.

Source: National Center for Assisted Living (NCAL) Focus March 2010 Vol. 16 No. 3
Series 1, No. 54 [ Page 35

First-Ever AL Study Launches Soon

The National Survey of Residential Care Facilities (NSRCF), the first-ever national study of assisted living and residential care

communities is scheduled to start collecting data in April 2010. The National Center for Health Statistics (NCHS) is conducting

this new study to provide national estimates of these places and their residents.

‘‘ALFA has been at the table over the past several years helping to craft this survey,’’ says Maribeth Bersani, ALFA’s senior vice

president, public policy. ‘‘We encourage everyone to complete it. The results will help us provide elected officials with an accurate

snapshot of assisted living and the residents served.’’

In-person interviews will collect the information about the characteristics of assisted living and residential care communities and

the people who live there. Approximately 2,250 communities—representative of all regulated residential care and assisted living

providers with four or more units in the United States—will be interviewed for the study. Within each residence, a random sample

of three to six residents will be selected depending on the number of units. In-person interviews will be conducted with directors

and caregivers, not with residents.

The information provided will remain confidential; only summary data will be publicly available and all published information

will be presented in such a way that no individual community, staff, or residents can be identified. Study results will be presented

separately by number of units (4–10 units, 11–25 units, 26–100 units, and 100 units or more).

The data collected for this study will be invaluable for planning and organizing assisted living and residential care services in the

future, and NCHS seeks your support in making this possible. By participating in this study, you can ensure that you and other

similar assisted living communities and residential care places are well-represented in the study.

To learn more about this study, visit NSRCF online www.cdc.gov/nchs/nsrcf.htm.

Source: Assisted Living Federation of America (ALFA) News: March 2010
Page 36 [ Series 1, No. 54

Help With Data on Assisted Living and Residential Care

The National Center for Health Statistics has just launched the critical

phase of the National Survey of Residential Care Facilities, the first-ever

national study of assisted living/residential care. Approximately 3,600

communities throughout the United States have been randomly selected to

participate in the study. By law, all data collected and released will be kept

in strict confidence and used only for statistical purposes and no individual provider, staff or resident can be identified. The

interviewing process will continue through October of this year. We strongly encourage your participation in this national survey,

if you are contacted. Results from this study should be released in the first quarter of 2012. Contact: Steve Maag, (202) 508–9498.

Source: LeadingAge, formerly American Association of Homes and Services for the Aging (AAHSA)

This Week | May 10, 2010
Series 1, No. 54 [ Page 37

Appendix VIII. NSRCF Chain Package

•	 Exhibit A. NSRCF Pocket Folder

•	 Exhibit B. NCHS Letter to Chains

•	 Exhibit C. NCHS ERB Letter

•	 Exhibit D. NSRCF Brochure (available from: http://www.cdc.gov/nchs/data/nsrcf/nsrcf_brochure.pdf)

•	 Exhibit E. NCHS Confidentiality Brochure (update available from: http://www.cdc.gov/nchs/data/nhcs/

strictly_confidential_2010.pdf)

•	 NSRCF Letter of Support (Appendix V)
Page 38 [ Series 1, No. 54

Exhibit A. NSRCF Pocket Folder (front)
Series 1, No. 54

[ Page 39

Exhibit A. NSRCF Pocket Folder (back)
Page 40 [ Series 1, No. 54

Exhibit B. NCHS Letter to Chains

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

Dear_____________________:

The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) is conducting the

National Survey of Residential Care Facilities (NSRCF). This first ever national study of assisted living

communities will collect information about the characteristics of these residences and their residents. The NSRCF

data will inform researchers, long-term care providers, planners, and policymakers about residential care, which is

increasingly becoming an important part of the long-term care continuum in this country. The information that will

be requested includes facility characteristics (size, ownership, staffing, services provided, and certification status)

and resident characteristics (demographics, diagnoses, functional status, and services used).

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

NSRCF. This study includes a randomly selected nationwide sample of assisted living facilities, each of which

represents a number of similar facilities. Information will be collected primarily by personal interview with directors

and staff members. A small sample of residents will be selected, for whom one or more staff members may be

designated to answer questions. No resident will be contacted at any time.

Participation is voluntary; however, I want to emphasize that it is important that we obtain data from all sampled

communities in order to achieve accurate and complete statistics that will represent all facilities. All information

collected will be held in the strictest confidence according to Section 308(d) of the Public Health Service Act (42,

U.S. Code, 242m(d) and the Confidential Information Protection and Statistical Efficiency Act (Title 5 of PL

107–347). No resident names or social security numbers will be collected. The information that the staff of your

communities provide will be used solely for statistical research and reporting purposes. The collected information

will not be published or released in any form if the individual establishment is identifiable unless the individual or

establishment has consented to such release.

I invite your communities to participate in this study. We need their help to make this national study a success. If
 

you have any questions, please call an NSRCF representative at 1–800-334–8571 extension 2–6675. I greatly
 

appreciate your cooperation.
 

Sincerely,
 

/Edward J. Sondik, Ph.D./
 

Director, National Center for Health Statistics
 
Series 1, No. 54 [ Page 41

Exhibit C. NCHS ERB Letter

Public Health Service DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

January 5, 2010

From:	 Stephen Blumberg, Ph.D.

Chair, NCHS Research ERB

Anjani Chandra, Ph.D.
 

Vice Chair, NCHS
 

Research ERB Continuation of Protocol #2008–03 National Survey of Residential Care Facilities

To: Manisha Sengupta, Ph.D.

The NCHS Research ERB reviewed the request for approval of Continuation of Protocol #2008–03 National Survey

of Residential Care Facilities on 12/16/09. Continuation of Protocol #2008–03 is approved for the maximum

allowable period of one year.

Of Note: The advance letter sent out under Dr. Sondik’s name is considered a part of the approval and should be

included in future continuation submissions.

IRB approval of protocol #2008–03 will expire on 01/16/11.

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

submitted about 6 weeks prior to 01/16/11.

There is no grace period beyond one year from the last approval date. In order to avoid lapses in approval of your

research and the possible suspension of subject enrollment, please submit your continuation request at least six (6)

weeks before the protocol’s expiration date of 01/16/11. It is your responsibility to submit your research protocol

for continuing review.

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

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

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

official protocol file.
 

Please call or e-mail me or Verita Buie, Dr.P.H., if you have any questions.
 

/Stephen Blumberg, Ph.D. Chair,/
 

NCHS Research ERB
 

/Anjani Chandra, Ph.D./
 

Vice Chair, NCHS Research ERB
 
National Survey of 

Residential Care Facilities

National Health Care Surveys 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

Page 42 [ Series 1, No. 54
 

Exhibit D. NSRCF Brochure
Series 1, No. 54 [ Page 43

Exhibit D. NSRCF Brochure (page 2)

Introduction 

The National Survey of Residential Care Facilities (NSRCF) is a first time national 

data collection effort to gather information about the characteristics of 

residential care facilities, including assisted living residences, board and care 

homes, congregate care, enriched housing programs, homes for the aged, 

personal care homes, and shared housing establishments. 

Importance 

The number of people in the United States who need long-term care is 

expected to increase to 27 million in 2050. Although assisted living and 

residential care is an important and growing segment of the long-term care 

industry, there is an information gap about these communities and their 

residents. This study will provide for the first time a national picture of assisted 

living and residential care communities, the characteristics of the people who 

live in them, and the range of services received by residents. These data will 

help characterize how residential care and assisted living communities meet 

the needs of elders and adults with disabilities and help shape future longterm care policies. 

Residential care and assisted living 

Residential care and assisted living residences are known by different names 

in different states. To be eligible for this study, a residential care or assisted 

living residence should: 

Offer help with personal care such as bathing and dressing, or 

health-related services such as medication; 

Provide room and board with at least two meals a day; 

Provide around-the-clock onsite supervision; 

Serve an adult population; and 

Be licensed, registered, listed, certified, or otherwise regulated 

by a state. 
Page 44 [ Series 1, No. 54

Exhibit D. NSRCF Brochure (page 3)

Residences licensed to serve exclusively persons with mental illness, mental 

retardation, or developmental disabilities are ineligible. 

Interview content and process 

The NSRCF interviews will be conducted by RTI International. During the 

interviews, information will be collected on: 

Facility characteristics, such as physical structure and environment; 

types of services offered; types of staff employed; and policies on 

admission, retention, and discharge 

Resident characteristics, such as demographics, involvement in inside 

and outside activities, use of services, charges for care, health status, 

and cognitive and physical functioning 

Approximately 2,250 facilities—representative of all regulated residential care 

and assisted living providers with four or more beds in the United States—will 

be interviewed for the study. Within each residence, a random sample of 

three to six residents will be selected depending on the number of beds. 

In-person interviews will be conducted with directors and caregivers, not with 

residents. Results from this study will be presented separately by bed size 

(4–10 beds,11–25 beds, 26–100 beds, and 100 beds or more). 

Confidentiality 

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

Health Statistics (NCHS) is required by law to maintain the confidentiality of 

data it collects about facilities and persons. All data that you provide will be 

kept in strict confidence and will be used only for statistical purposes. All 

information, publications, and data files will be released in such a way that no 

individual provider, staff, or resident can be identified. Any NCHS staff, 

contractor, or agent who willfully discloses confidential information may be 

subject to a jail term or a $250,000 fine. 
Series 1, No. 54 [ Page 45

Exhibit D. NSRCF Brochure (page 4)

Intended uses of the data 

NSRCF is designed to provide national-level data that can be used by 

providers, consumers, policymakers, and researchers to: 

Describe assisted living and other residential care communities 

 and services; 

Describe functionality of residents; and 

Examine service level differences by community size and 

 geographical region. 

NSRCF partners 

NSRCF is an initiative of CDC’s NCHS in collaboration with: 

Office of the Assistant Secretary for Planning and Evaluation (ASPE), 

U.S. Department of Health and Human Services (HHS) 

Agency for Healthcare Research and Quality (AHRQ), HHS 

CDC’s National Center for Chronic Disease Prevention and Health 

Promotion (NCCDPHP), HHS 

CDC’s National Center for Immunization and Respiratory Diseases 

 (NCIRD), HHS 

U.S. Department of Veterans Affairs (VA) 

NSRCF supporters 

American Association of Homes and Services for the Aging (AAHSA)
 

American Seniors Housing Association (ASHA)
 

Assisted Living Federation of America (ALFA)
 

Board and Care Quality Forum
 

National Center for Assisted Living (NCAL)
 

To learn more about NSRCF call 

301–458–4747, or 

visit the NSRCF website: 

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

CS205492B 
ntiality Brochure

Page 46[ Series 1, No. 54
ntiality Brochure—Con.

Series 1, No. 54[ Page 47
Page 48 [ Series 1, No. 54

Appendix IX. Advance Package Call Script

ADVANCE PACKAGE CALL:

‰ OPEN FACESHEET.

‰ GO TO ORIGINAL PRELOADS TAB AND REVIEW DATA.

‰ GO TO FACILITY & DIRECTOR.

‰ PLACE CALL.

VERIFY INFORMATION:

‰	 Hello my name is_________________________. I have some information that I would like to mail to the

director of PRELOAD FACILITY NAME. (IF VERY LARGE, LARGE, OR MEDIUM: I would like to mail it to

the director who pertains to assisted living. IF THEY SAY DON’T HAVE ASSISTED LIVING, SAY: Thank

you for clarifying that for me, I will update our records. In that case, I would like to mail it to the director of

PRELOAD FACILITY NAME.)

‰	 I have the director’s name as_______________________ SPELL IF NECESSARY. Is this correct?

‰	 What is _ the name of the director? ______________________ VERIFY SPELLING.

‰ What is _ NAME OF DIRECTOR’S ___________________ title?

‰	 The number I called is PRELOAD PHONE NUMBER. Is this the correct number to reach _ NAME OF

DIRECTOR ________________________? IF THEY GIVE ANOTHER PHONE NUMBER, REPEAT IT TO

VERIFY.

‰ What is ________________________’s e-mail address? SPELL ALOUD TO VERIFY.
 

‰ May we call NAME OF DIRECTOR on his/her work cell phone, and if so, what is that number?
 

‰ I have the name of this place as ________________________ SPELL IF NECESSARY. Is this correct?
 

‰ I have the address as ____________________________. Is this correct? Is there a separate mailing
 

address you would like to give me?

‰ Thank you. I will put this information in the mail and NAME OF DIRECTOR should receive it within 3

business days. Have a good day. Good bye.

FAQS:

‰	 WHAT IS THIS (SHORT): This is a federally sponsored statistical study.

‰	 WHAT IS THIS (LONG): I’m working on the National Survey of Residential Care Facilities, a study

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

Statistics.

‰	 WHAT IS THE NSRCF: The National Survey of Residential Care Facilities is the first national study of

assisted living and residential care places and their residents.

‰	 WHY ARE YOU CALLING: I would like to mail the director some materials and am calling to verify your

mailing address.
Series 1, No. 54 [ Page 49

IF DIRECTOR/KEY PERSON ASKS ABOUT CHAINS:

‰	 We have a packet of information about the survey which we have sent to many of the national and

regional chains. I would be happy to send this information to a person within your organization. GO TO

CHAINS TAB. IF PACKAGE ALREADY MAILED: According to our records, we have sent information to a

NAME at ORGANIZATION. Would you still like us to mail this information?

‰	 To whom should we mail this information?

‰	 Thank you. They will receive this packet within 3 business days. As I mentioned before, I do have some

information about the study which I would like to mail to the director of this facility. PRELOAD FACILITY

NAME. (IF VERY LARGE, LARGE, OR MEDIUM: I would like to mail it to the director who pertains to

assisted living.) May I please verify this person’s name and title?

IF PHONE IS ANSWERED BY VOICEMAIL:

‰	 DO NOT LEAVE MESSAGE.

‰	 MAKE A NOTE WHEN TO TRY AGAIN.
Page 50 [ Series 1, No. 54

Appendix X. Advance Package to Facilities

The advance package to facilities is the same as the NSRCF package to chains except that it included the NCHS letter to facilities

with FAQs on the back, instead of the NCHS letter to chains.

‰ NCHS Letter to Facilities
 

‰ NSRCF Pocket Folder (Appendix VIII, Exhibit A)
 

‰ NCHS ERB Letter (Appendix VIII, Exhibit C)
 

‰ NSRCF Brochure (Appendix VIII, Exhibit D)
 

‰ NCHS Confidentiality Brochure (Appendix VIII, Exhibit E)
 

‰ NSRCF Letter of Support (Appendix V)
 
Series 1, No. 54 [ Page 51

NCHS Letter to Facilities

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

Dear___________________:

We are pleased to inform you that the first ever national study of assisted living and residential care will be conducted by The

Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). This study, the National Survey of

Residential Care Facilities (NSRCF), will include a representative sample of over 2,000 residential care places throughout the

United States.

The purpose of the study is to develop a comprehensive understanding of the characteristics of assisted living and residential care

communities and the needs of the residents they serve. NSRCF has received support from these national organizations:

‰ American Association of Homes and Services for the Aging (AAHSA)

‰ American Seniors Housing Association (ASHA)

‰ Assisted Living Federation of America (ALFA)

‰ Board and Care Quality Forum, and

‰ National Center for Assisted Living (NCAL)

A representative of RTI International will contact you soon to arrange an appointment for a personal, on-site interview in the
 

hopes that you will participate in this landmark study. Your participation in this national study is voluntary, but will assist greatly
 

in helping further our nation’s understanding of assisted living and the needs of people served in these communities.
 

Data collected by NSRCF is authorized by Section 306 of the Public Health Service Act (Title 42, U.S. Code 242k). As required
 

by federal law (section 308(d) of the Public Health Service Act in 42, U.S. Code, 242m(d) and the Confidential Information
 

Protection and Statistical Efficiency Act Title 5 of PL 107–347), all information collected will be used only for statistical purposes
 

and held in the strictest confidence. This study also conforms to the Privacy Rule as mandated by HIPAA, where disclosure of
 

resident data is permitted for public health purposes. If you have any questions about your rights as a participant in this research
 

study, call the Research Ethics Review Board at the National Center for Health Statistics toll-free at 1–800–223–8118.
 

If you would like to learn more about this study, please call (800) 334–8571 extension 2–5102. Leave a brief message with your
 

name and phone number and say that you are calling about Protocol #2008–03. Your call will be returned as soon as possible.
 

Thank you in advance for your help with this important endeavor.
 

Sincerely,
 

/Edward J. Sondik, Ph.D./
 

Director, National Center for Health Statistics
 
Page 52 [ Series 1, No. 54

National Survey of Residential Care Facilities (NSRCF)

Frequently Asked Questions

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

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

residential care facilities in the United States. The National Center for Health Statistics, the federal agency responsible for

providing statistical information that will guide actions and policies to improve the health of the American people, developed

this survey collaboratively with several other government agencies: Office of the Assistant Secretary for Planning and

Evaluation (DHHS), Department of Veteran Affairs and Agency for Healthcare Research and Quality.

The survey is broadly supported by industry associations, including the American Association of Homes and Services for the

Aging (AAHSA), the American Seniors Housing Association (ASHA), the Assisted Living Federation of America (ALFA),

and the National Center for Assisted Living (NCAL) (see enclosed letter of support). For more information, visit

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

What other residential care facilities are you going to visit?

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

facilities and the residents they serve.

Why can’t some other facility take our place?

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

makers who will formulate policy for the next decade. You represent other facilities like yours. If you don’t participate, there

is no guarantee that residential care facilities like yours will be adequately represented. We don’t want industry decisions

based on this survey to be made without all types of facilities, including those like yours, represented.

Will the data be held confidential?

The NSRCF is authorized by Congress in Section 306 of the Public Health Service Act (42 USC 242K). All information

collected in this survey will be held in strict confidence according to law [Section 308(d) of the Public Health Service Act

(42 United States Code 242m (d) and the Confidential Information Protection and Statistical Efficiency Act (PL 107–347)].

No information collected in this survey may be used for any purpose other than the purpose for which it was collected.

Aside from NCHS employees, the only parties that can receive your personal information are: (1) NCHS contractor(s)—

hired to conduct this survey, and (2) our designated agents—persons who work under the supervision and control of NCHS.

These parties, who will use your information for statistical research only and to carry out this survey, are bound by strong

restrictions designed to guarantee your privacy. By law we cannot release information that could identify your facility or

residents to anyone else without your consent. If any federal employee or contractor gives out confidential information not

authorized by law, he or she can be fired, fined, and/or imprisoned.

My staff is incredibly overworked right now. I need to know how much of their time will be required for this survey.

How long will this take?

We will need about an hour with you or someone you designate to answer questions about your facility. We will also collect

information about a small sample of current residents that will take approximately 20 minutes for each person sampled. The

interviewer will accommodate the schedules of your staff to complete these tasks as quickly as possible.
Series 1, No. 54 [ Page 53

Appendix XI. Set an Appointment Call Script

‰ OPEN FACESHEET TO FACILITY & DIRECTOR AND REVIEW DATA.
 

‰ PLACE CALL.
 

SPEAKING TO RECEPTIONIST:

‰ Hello, my name is FIRST AND LAST NAME. May I please speak to NAME OF DIRECTOR regarding a FedEx

package that was delivered to him/her a few days ago?

‰ Is there a better time for me to reach NAME OF DIRECTOR?

‰ Would you be able to transfer me to his/her voicemail?

‰ Is there a direct number I could call? COLLECT NUMBER. Thank you for your help.

‰ May we call NAME OF DIRECTOR on his/her work cell phone, and if so, what is that number?

SPEAKING TO DIRECTOR:

‰	 Hello, my name is FIRST AND LAST NAME. I’m working on the National Survey of Residential Care Facilities, a

study sponsored by the Centers for Disease Control and Prevention (CDC) and the National Center for Health

Statistics.

‰	 Have you had a chance to review the material that was sent to you by FedEx a few days ago?

READ MATERIALS

‰	 Do you have any questions about the materials you received?

DIDN’T READ MATERIALS

‰	 Shall I describe the survey to you now, or would you like me to call back after you (and your supervisor/national

office/etc) have reviewed the materials?

RESENDING MATERIALS (SEE MAILOUTS TAB)

‰	 There was a package sent by FedEx on DATE (that was received on DATE OF RECEIPT and signed for by

RECIPIENT). I can resend this if you would like.

‰	 Let me verify that I have the correct address. READ FACILITY ADDRESS, CORRECT AS NEEDED. Is that

correct?

‰	 We’ll send this within 2 business days. Thank you for your time. ARRANGE CALLBACK

‰	 Would you like me to call back after you have reviewed the material or would you like me to describe the survey

to you now?

DESCRIBE SURVEY

‰	 The National Survey of Residential Care Facilities is the first national study of assisted living and residential care

facilities and their residents. The purpose is to collect information about the characteristics of assisted living and

residential care facilities, the services they offer, general information on staffing, resident demographics, resident

health, and payment options from a nationally representative sample. A director is interviewed, but residents are not

interviewed. The findings will provide critical input to national issues on residential care, which is an important

component of the long-term care continuum in this country.
Page 54 [ Series 1, No. 54

CHAINS (SEE CHAINS TAB)

‰	 We have a packet of information about the survey which we have sent to many of the national and regional chains.

I would be happy to send this information to a person within your organization. GO TO CHAINS TAB. IF

PACKAGE ALREADY MAILED: According to our records, we have sent information to a NAME at

ORGANIZATION. Would you still like us to mail this information?

‰	 To whom should we mail this information?

‰	 Thank you. He/she will receive this packet within 3 business days.

VOICEMAILS—GENERAL NUMBER

‰	 This is a message for DIRECTOR NAME. I am calling regarding some materials that we sent to him/her by FedEx

a few days ago. My name is NAME OF RECRUITER and my phone number is TOLL FREE NUMBER. I will call

back at a more convenient time. Thank you.

‰	 LIMIT TO 2 MESSAGES LEFT ON GENERAL VOICEMAIL UNLESS YOU ARE PLAYING PHONE TAG.

VOICEMAIL—DIRECTOR’S DIRECT NUMBER

‰	 I am calling regarding the materials we sent to you by FedEx a few days ago for the National Survey of Residential

Care Facilities, a study sponsored by the Centers for Disease Control and Prevention and the National Center for

Health Statistics. My name is NAME OF RECRUITER and my phone number is TOLL FREE NUMBER. Please

return my call, or I will call back at a more convenient time. Thank you.

‰	 LIMIT TO 2 MESSAGES ON DIRECTOR’S LINE UNLESS YOU ARE PLAYING PHONE TAG.

E-MAIL MESSAGE

SUBJECT: NATIONAL SURVEY OF RESIDENTIAL CARE FACILITIES

Dear NAME OF DIRECTOR/ADMINISTRATOR, NAME OF FACILITY:

I am a RTI interviewer working on the National Survey of Residential Care Facilities, a federally-sponsored statistical project

conducted for the Centers for Disease Control and Prevention (CDC). This first ever national study of residential care providers

will collect information about the characteristics of these communities and their residents. Your community was randomly selected

to participate. It is important that we obtain data from all sampled communities in order to achieve accurate and complete statistics

representative of all residential care communities in the U.S.

I have tried unsuccessfully to reach you by telephone. I would like to answer any questions you may have and set an appointment

for your interview. Can you please call me toll free at RECRUITER TOLL FREE #? Or, you can reply to this email if that is

more convenient for you. I can email the study brochure and literature to you for review.

Many organizations and leaders in the long-term care community have expressed their support and join me in requesting your

participation in this meaningful study. The letter from provider associations can be found at http://www.cdc.gov/nsrcf/data/

2010NSCRFLetterofSupport.pdf.

For more information about the National Survey of Residential Care Facilities please visit http://www.cdc.gov/nchs/nsrcf.htm.

For more information about other studies of long-term care, please visit http://www.cdc.gov/nchs/nhcs.htm.

Thank you,

/RECRUITER FIRST AND LAST NAME/

RECRUITER TOLL FREE NUMBER
Series 1, No. 54 [ Page 55

COMPLETE THE SCREENER INSTRUMENT

CANNOT SET APPOINTMENT NOW

‰	 Is there a good time to reach you/RESPONDENT regarding setting the appointment to conduct the interview?

ARRANGE CALLBACK.

SET APPOINTMENT NOW

‰ TRY FOR 9:30 AM
 

‰ Would you be able to complete the interview on ___________________?
 

‰ What is a convenient time for you/RESPONDENT?
 

‰ Where should we come when we arrive?
 

‰ Who should we ask for when we arrive?
 

‰ Is there parking?
 

‰ The interviewer will show ID.
 

‰ I will send you/RESPONDENT an appointment package. It has the appointment date and time, name of your
 

interviewer, and a short worksheet to complete prior to the interview. The worksheet has factual questions about the

facility. Some answers require you to reference records. We send it in advance so you/RESPONDENT will have the

opportunity to do this before the interview. This will reduce the interview time significantly.

‰ Should you have any questions or if you need to reschedule please call my supervisor FIRST NAME, LAST

NAME, toll free, at NUMBER.

‰ Would you like her email address as well? PROVIDE EMAIL IF NEEDED.

‰ We will give a reminder call a few days before the interview. Is there a specific number or email you’d like us to

use?

‰ ASK OUTREACH QUESTION IN SCREENER.
 

‰ Are there any questions I can answer for you?
 

‰ Thank you. Good bye.
 
Page 56 [ Series 1, No. 54

Appendix XII. Frequently Asked Questions

WHO SPONSORS THIS STUDY?
 

➢ This is a federally-sponsored statistical survey.

➢	 The government agency sponsors include the Centers for Disease Control and Prevention, the Assistant Secretary for Planning

and Evaluation, and the Department of Veterans Affairs. I work for RTI International, a not-for-profit research institute located

in North Carolina. RTI is the contractor conducting the interviews.

LETTERS OF SUPPORT RECEIVED FROM THE FOLLOWING ORGANIZATIONS

➢	 National Center for Assisted Living

➢	 American Association of Homes and Services for the Aging

➢	 Assisted Living Federation of America

➢	 American Seniors Housing Association

➢	 Center for Excellence in Assisted Living

➢	 Board and Care Quality Forum

DESCRIPTION OF STUDY

➢	 The National Survey of Residential Care Facilities is the first national study of assisted living and residential care facilities and

their residents. The purpose is to collect information about the characteristics of assisted living and residential care facilities,

the services they offer, general information on staffing, resident demographics, resident health, and payment options, from a

nationally representative sample. A director and/or his/her designee is interviewed, but residents are not interviewed.

WHY STUDY IS IMPORTANT

LONG-TERM CARE POLICY (LONG ANSWERS)

➢	 Residential care and assisted living facilities are an increasingly important part of the long-term care system. According to

some studies, there may be as many as 1.0 million Americans living in residential care facilities, compared to about 1.6

million living or receiving care in nursing homes. Despite the vital role of residential care facilities, the industry and

government have little statistically accurate information about these facilities. This survey will help provide that information.

➢	 With the aging of the population, long-term care is very important. Providers and government officials need to better

understand the services that older people and younger persons with disabilities need. Currently there are no data on the broad

range of residential care facilities providing services to these individuals. This survey will provide policy makers with the data

needed to understand the role of residential care facilities in long-term care.

➢	 With the advent of a new era of health care reforms, policy makers are revisiting issues related to long-term care. Your

answers to the survey will help educate policymakers about residential care in general, and the differences between residential

care and other types of long-term care.

LONG-TERM CARE POLICY (SHORT ANSWERS)

➢	 The findings will provide critical input to national issues on residential care, which is an important component of the

long-term care continuum in this country.

➢	 This information will be used to help facility owners, operators, and health care planners understand and plan for the

long-term care needs of the U.S. population. Results will be used to understand how facilities meet the needs of elders and

adults with disabilities.

FIRST TIME COLLECTING THIS INFORMATION

➢	 This is the first ever survey conducted by the federal government to collect this type of information on a scientific, unbiased

sample of residential care facilities nationwide.

➢	 Although information on nursing homes, home health agencies, and hospitals is routinely collected, there is very little national

information on residential care and assisted living facilities. This survey will be the first nationally representative survey of

residential care facilities and their residents.
Series 1, No. 54 [ Page 57

YOUR COMMUNITY’S ANSWERS MATTER

➢	 Participation in the survey will enable facilities like yours to be properly represented in the survey so that providers and policy

makers have a better picture of what residential care facilities are like and of the residents they serve. This will be your

opportunity to tell us about how things work in your facility.

➢	 By participating in this survey, you can educate others about services you provide and challenges you face. This, in turn, will

help policy makers and other interested parties make informed decisions on issues related to residential care facilities.

➢	 It is important that your community’s voice is included in this survey’s findings. There is a critical need to know what is

happening as of 2010 in long-term care places, such as yours, and the most reliable information comes from conducting

interviews directly with the communities themselves.

➢	 With the current economic challenges facing our country, it is important that all types of communities participate in the survey.

This is an opportunity to have your community’s experiences represented in what policymakers consider in planning for the

future of long-term care.

➢	 [PARTICULARLY FOR SMALL PROVIDERS] This study has purposely included small providers like you, because it is

important that your experiences in providing for your residents be heard and understood by policymakers and others who plan

for the long-term care needs of the country.

IS IT VOLUNTARY? IS IT REQUIRED?

➢	 Your participation in this study is voluntary. However, your participation is needed to make this study a success. You represent

not just your own facility, but also others that are of the same size as yours. If your facility does not participate, its unique

qualities will be lost.

DON’T HAVE ENOUGH TIME

➢	 We will work around your schedule. We understand if there are interruptions, we will wait while you attend to your scheduled

and unscheduled responsibilities.

➢	 From the interviews we have completed thus far, we know how busy facilities are. We will wait for you. The interviewer will

remain as needed during the day of the interview and work around your schedule.

➢	 The interview can be divided among different people, such as the director and resident care staff. That way, no one person is

spending a long time.

HOW LONG WILL IT TAKE?

GENERAL TIMINGS:

➢	 It depends on the size of your facility. We understand that everyone is very busy. We are very flexible and work around your

schedule.

– If your facility has fewer than 25 residents, about 2 1⁄2 hours.

– If your facility has between 26–100 residents, about 3 hours.

– If your facility has more than 100 residents, about 3 1⁄2 hours.

➢	 We appreciate how busy facilities are. The interviewer will remain as needed and work around your schedule.

➢	 The interview can be divided among different people such as the director and resident care staff. This will lessen the time for

your staff.

TIMINGS PER QUESTIONNAIRE:

➢	 Telephone screener questionnaire: 10 minutes

➢	 Facility questionnaire: 75 minutes (1 hour, 15 minutes)

➢	 Selecting a random sample of residents: 10 minutes

➢	 Each Resident questionnaire: 20 minutes

WHY/HOW WAS THIS FACILITY SELECTED?

➢	 Your facility was chosen using a random selection process based on your state’s list of facilities that hold a license as

residential care providers.

CAN YOU USE A DIFFERENT FACILITY INSTEAD?

➢ This facility was chosen using a scientific process and cannot be replaced. If this facility does not participate, its unique

qualities will be lost and the data will overstate other facilities instead.
Page 58 [ Series 1, No. 54

WHAT’S INVOLVED?
 

➢	 The study requires an interviewer to visit your facility/place, to collect information about your facility/place and staff, and to

collect service, health, and billing information about a sample of current residents. Residents will not be interviewed.

TYPES OF QUESTIONS IN QUESTIONNAIRES

➢	 FACILITY

–	 The facility questionnaire will ask about occupancy, policies, services, costs to residents, and staffing.

–	 The facility questionnaire takes about an hour to complete.

➢	 RESIDENT

–	 The resident questionnaire will ask about the resident’s living arrangements, health status, and costs. Each resident sampled

takes about half an hour to complete. No residents are interviewed directly—we talk only with staff.

–	 We will select [FILL: 3, 4, or 6] individual residents depending on how many residents you are licensed for. Once the

residents are selected, we will need to speak to someone who is both available and familiar with each resident. This person

can be the director, a caregiver, or someone else within the facility.

CONFIDENTIALITY

➢	 (SHORT ANSWER) Confidentiality is ensured by federal law.

➢	 All data you provide are kept confidential. Although I have to know the name of you and your facility for logistical purposes

to set up the appointment, no names are included in the data, that is, not the facility name, your name, or the resident’s names.

All data will be analyzed in aggregate so your responses are never identified.

➢	 Surveys conducted by the federal government typically have a high response rate because respondents are assured about the

confidentiality of their data, and sincere efforts are made to reduce respondent burden, and provide accurate, high-quality data.

NSRCF is authorized by Congress in Section 306 of the Public Health Service Act (42 USC 242K). All information collected

in this survey will be held in strict confidence according to law [Section 308(d) of the Public Health Service Act (42 United

States Code 242m(d) and the Confidential Information Protection and Statistical Efficiency Act (PL 107–347)]. Any

government staff, contractor, or agent who willfully discloses confidential information may be subject to a jail term or a

$250,000 fine.

APPROVALS FROM IRBs/OMB

➢	 The project has received approval from these bodies: SPECIFY AS NEEDED:

–	 1. Office of Research Protection at RTI [RTI is the contractor to CDC] under Protocol #12526.

–	 2. The Research Ethics Review Board of the National Center for Health Statistics in the Centers for Disease Control and

Prevention under Protocol #2008–03.

–	 3. The U.S. Office of Management and Budget (OMB) under control number 0920–0780, expiration date 12/31/2012.

CORPORATE CHAIN

➢	 A letter and packet of information describing this survey has been sent to the corporate office of CHAIN NAME in CITY.

➢	 Would you still like us to mail information to CONTACT NAME AT CHAIN?

➢	 To whom should we mail this information?

FOR MORE INFORMATION

ABOUT THE STUDY

➢	 Visit www.cdc.gov/nchs/nsrcf.htm.

➢	 For an NSRCF Representative call (800) 334–8571 ext 2–5102.

ABOUT RIGHTS AS A RESEARCH PARTICIPANT (OR IRB INFORMATION)

➢	 You can call RTI’s Office of Research Protection at 919–316–3358 or toll free at 1–866–214–2043.

➢	 You can reach the Research Ethics Review Board at the National Center for Health Statistics toll-free at 1–800-223–8118.

Please leave a brief message with your name and phone number. Say that you are calling about Protocol #2008–03.
Series 1, No. 54 [ Page 59

WHY SHOULD I DO THIS/WHAT’S IN IT FOR ME/MY FACILITY?

LONG VERSION:

➢	 Although it’s true there are no immediate tangible benefits to you/your facility for taking this survey, your participation is a

way to help society and other facilities to benefit. Society and other facilities like yours will benefit if U.S. policymakers have

a better understanding of residential care. Right now, there are no accurate statistics on how many older adults and younger

adults with disabilities live in residential care, the types of services they typically receive, and the costs of these services.

Understanding these issues will help policymakers to plan for ways to care for the increasing numbers of older persons in the

U.S.

SHORT VERSION:

➢	 Although it’s true there are no immediate tangible benefits for taking this survey, we hope you will take the survey as a way

to help society and other facilities like yours benefit. Right now, there are no accurate statistics on how many adults need and

receive residential care. Society will benefit if policymakers understand these issues and can plan for these needs.

CONFIDENTIALITY— RESIDENTS

➢	 The project was specifically designed to not collect Personally Identifiable Information (PII) about residents. We do not collect

Medicare numbers, social security numbers or any other personal identifiers.

➢	 We will ask you to show us a list of your residents, then we will count them. The computer will randomly select 3, 4, or 6

residents depending on the number of licensed beds you have, then we will ask questions about them. We do not ever ask for

or record names of residents—we refer to them by initials or however you like—and we do not leave the facility with the

resident list. We do not ask any information which could identify the residents.

IF RECEIVED ADVANCE PACKAGE:

The brochure in your package, entitled ‘‘How the National Health Care Surveys Keep Your Data Confidential’’ describes the

technical procedures which are used to keep your survey answers confidential.
Page 60 [ Series 1, No. 54

Appendix XIII. NSRCF Screener Questionnaire

Question

number Screener question item Code categories

Facility

asked

Skip

pattern

S_I_

STATEMENT_

A

I would like to verify some information we have about

[SAMPLED FACILITY]. The questions I have right now should

take just a few minutes.

Your facility was chosen by a random selection process to

represent residential care facilities like yours. All information

you provide will be held in strict confidence and only will be

used for statistical purposes. All published information will be

presented in such a way that no individual facility, staff, or

residents can be identified. Your participation is voluntary and

there are no penalties for not participating in the survey;

however, data from your facility are necessary to accurately

portray residential care facilities.

1 CONTINUE All

facilities

S_1 Our records show that this facility is currently licensed,

registered, or certified in [STATE] as a [LICENSURE

CATEGORY].

Is this correct?

1 YES

2 NO

Single licensure

facilities

S_1_MULT Our records show that this facility has multiple [licenses/

registrations/certifications] in [STATE] as a

[LICENSE CATEGORIES].

Is this correct?

1 YES

2 NO

Multiple licensure

facilities

S_1A Is this facility licensed as...

READ THIS STATE’S LICENSE CATEGORIES TO

RESPONDENT...

IF NONE OF THE LISTED CATEGORIES APPLY TO THE

FACILITY, SELECT ‘NONE OF THE ABOVE’

SPECIFY S_1 = 2 or

S_1_MULT = 2

S_2 Does this residential care facility have 4 or more licensed,

registered, or certified beds?

1 YES

2 NO

All

sampled

facilities

S_4 Does this facility exclusively serve adults with mental

retardation or a developmental disability, such as Down

syndrome or autism?

1 YES

2 NO

3 SERVES BOTH MR/DD AND

SEVERELY MENTALLY ILL

EXCLUSIVELY

All

sampled

facilities

S_5 Does this facility exclusively serve adults with severe mental

illness, such as schizophrenia or psychosis? Please do not

include Alzheimer’s disease or other dementias.

1 YES

2 NO

3 SERVES BOTH MR/DD AND

SEVERELY MENTALLY ILL

EXCLUSIVELY

S_4 = 2

S_6 Does this facility provide or arrange for a personal care aide,

RN, or LPN to be located in the same building, in an

attached building or next door, or on the same campus 24

hours a day, 7 days a week, to meet any resident needs that

may arise? These needs can be met by the director or

assistant director, if they provide personal care or nursing

services to residents.

1 YES

2 NO

3 PROVIDED ON AN AS

NEEDED BASIS

All

sampled

facilities

S_7 Does this facility offer help with activities of daily living, such

as help with bathing, either directly or arranged through an

outside vendor?

1 YES

2 NO

All

sampled

facilities
Series 1, No. 54 [ Page 61

Question

number Screener question item Code categories

Facility

asked

Skip

pattern

S_8 Does this facility offer assistance with the administration of

medications, give reminders, or provide central storage of

medications?

1 YES

2 NO

All

sampled

facilities

S_9 Does this facility offer at least 2 meals a day to residents? 1 YES

2 NO

All

sampled

facilities

S_10 Is there at least one resident living at this residential care

facility?

1 0 RESIDENTS

2 AT LEAST ONE RESIDENT

All

sampled

facilities

S_11 Are any of the following types of places on this same

property or at this same location? By at the same location, I

mean this campus or address, not necessarily the same

building.

You may select all that apply.

Independent living or independent apartments

Nursing home

Rehabilitation subacute or postacute care unit in a nursing

home

Hospital

1 INDEPENDENT LIVING OR

INDEPENDENT APARTMENTS

2 NURSING HOME

3 REHABILITATION SUBACUTE

OR POSTACUTE CARE UNIT IN

A NURSING HOME

4 HOSPITAL

5 NONE OF THE ABOVE

All

eligible

facilities

S_12 Does this facility have a designated Alzheimer’s or dementia

special care unit that is part of the nursing home?

1 YES

2 NO

S_11 = 2 or 3

S_13 Is this a continuing care retirement community, that is, a

community that offers multiple levels of care such as

independent living, residential care, and skilled nursing care,

and gives residents the opportunity to remain in the same

community as their needs change?

1 YES

2 NO

S_11 = 1 and (S_11

= 2 or 3)

S_16 Based on your responses, your facility is eligible to

participate in our study. I would like to set up an appointment

for an in person interview. The questions about [SAMPLED

FACILITY], which will take about an hour, should be

completed by someone who is familiar with the operations of

the facility, usually the administrator or director of the facility.

In [SAMPLED FACILITY] is that you or someone else?

1 THE RESPONDENT

2 SOMEONE ELSE

3 DON’T KNOW YET

All

eligible

facilities

S_16_OTH Can you please give me his or her name? SPECIFY NAME S_16 = 2

S_17 Then we collect data about three to six residents, depending

on the size of your facility. These take about 20 minutes per

resident. We do not interview residents directly, rather we

interview the staff person most familiar with the resident and

the resident’s records. Will that be someone else on your

staff, or will you do that (as well)?

ADD IF NECESSARY: You do not need to decide now.

1 THE RESPONDENT

2 SOMEONE ELSE ON THE

STAFF

3 DON’T KNOW YET

All

eligible

facilities

S_17_OTH Can you please give me his or her name? SPECIFY NAME S_17 = 1 or 2

S_18a Let me verify that I have the correct name and address for

your facility.

Is the correct name of your facility [NAME OF SAMPLED

FACILITY]?

1 YES

2 NO

All

eligible

facilities

S_18a_NAME Please tell me the correct name of your facility. SPECIFY NAME S_18a = 2

S_18b Is your facility located at: [STREET ADDRESS OF SAMPLED

FACILITY]?

1 YES

2 NO

All

eligible

facilities

S_18B_ADD Please tell me the correct street address of your facility. SPECIFY S_18b = 2

S_18B_CITY What is the city? SPECIFY S_18b = 2
Page 62 [ Series 1, No. 54

Question

number Screener question item Code categories

Facility

asked

Skip

pattern

S_18B_STATE What is the state? SPECIFY S_18b = 2

S_18B_Zip What is the zip code? SPECIFY S_18b = 2

S_18C Is this also your mailing address? 1 YES

2 NO

All

eligible

facilities

S_18C_MAIL Please tell me the correct mailing address of your facility. STREET ADDRESS

CITY

STATE

ZIP

S_18C = 2

S_RESP_

NAME

Let me verify the spelling of the name of [RESPONDENT

NAME]

SPECIFY All

eligible

facilities

S_END CONTINUE WITH SETTING THE APPOINTMENT ON THE

FACESHEET

1 CONTINUE All

eligible

facilities

S_OUTREACH Before you received the package about this study, had you

heard about this study through newsletters or other

information provided by national organizations that support it,

such as American Association of Homes and Services for the

Aging (AAHSA), American Seniors Housing Association

(ASHA), Assisted Living Federation of America (ALFA),

National Center for Assisted Living (NCAL), or Board and

Care Quality Forum?

1 YES

2 NO

All

sampled

facilities

S_ELIG_1 INTERVIEWER: READ A CLOSING STATEMENT AS

APPROPRIATE.

(Are there any questions I can answer for you?)

(IF APPOINTMENT WAS SET: We look forward to seeing

you.)

(Thank you. Good bye.)

1 CONTINUE All

eligible

facilities

S_ELIG_2 Thank you very much for answering these questions.

Unfortunately, this facility does not qualify for our study which

is focused on facilities that are in some way regulated by the

State and provide a broader array of residential care

services. I appreciate your time today.

All

ineligible

facilities
Series 1, No. 54 [ Page 63

Appendix XIV. Pre-Interview Worksheet

OMB No. 0920–0780
 

Exp. Date 12/31/2012
 

2010 National Survey of

Residential Care Facilities 

Pre-Interview Worksheet 

Dear {NAME OF DIRECTOR} at {NAME OF FACILITY}

Thank you for agreeing to participate in the 2010 National Survey of Residential Care Facilities. The date and time of

your interview and your interviewer’s name are:

{Appointment date}
 

{Time}
 

{Interviewer’s name}
 

For reschedules, call:
 

Supervisor: {Supervisor’s name} at the Toll Free Number: 1–877–XXX–XXXX

Please fill out this worksheet prior to the interview. It should take about 15 minutes to complete.
 

It contains some of the questions that will be asked during the interview. You may need to consult facility records to
 

answer some questions. Completing this worksheet in advance will result in a shorter on-site interview.
 

If you do not have information for particular items, skip those questions; your interviewer will address them during the
 

on-site interview.
 

Also before the interview, prepare a complete list of current residents of your residential care facility as of
 

midnight before this interview date. Your interviewer will use this list to randomly select a few residents about whom
 

you will be asked to provide some information.
 

If you have questions while completing this worksheet or questions about preparing the current resident list call Sara

Zuckerbraun at: 1–800–334–8571 Ext 2–5206.

Sincerely,
 

/Angela M. Greene/
 

Project Director, RTI International
 

Information regarding Office of Management and Budget (OMB) approval,

reporting burden and data confidentiality is on the back cover.
Page 64 [ Series 1, No. 54

INSTRUCTIONS

If you need help answering any question, refer to facility records or request assistance from other staff.

The accuracy of your answers is important to this survey.

Residential care facilities are places that:

Á Are licensed, registered, listed, certified or otherwise regulated by the state;

Á	 Provide two meals a day; around-the-clock on-site supervision; help with personal care, such as bathing and

dressing; or health related services such as medication management; and

Á Include, for example, assisted living, adult care homes, personal care homes, and community-based facilities.

If your facility is part of a campus that includes other types of care, such as a nursing home, rehabilitation center,

hospital, or independent living/apartments, exclude these components in the answers you provide. Provide answers

only for the residential care portion of the campus.

A Facility B Facility Rooms and Apartments

A1. At this facility, what is the number of licensed,

registered, or certified residential care beds?

Include both occupied and unoccupied beds.

BEDS

A2. At this facility, what is the number of licensed,

registered, or certified residential care rooms or

apartments, where residents live? Exclude rooms

within apartments.

ROOMS OR

APARTMENTS

A3. What is the current number of residents living at this

residential care facility?

RESIDENTS

These next questions are about the residents’ living

quarters.

B1. How many rooms in this facility are

NUMBER

OF ROOMS

Rooms designed for one person?

Rooms designed for two persons?

Rooms designed for three or more

persons?
Series 1, No. 54 [ Page 65

B. Facility Rooms and Apartments

(continued)

B2.	 How many apartments in this facility are

NUMBER OF
 

APARTMENTS
 

Studio apartments?

1-bedroom apartments?

2-bedroom apartments?

3-bedroom apartments?

C Source of Payment

C1.	 During the last 30 days, how many of the residents

had some or all of their long-term care services

paid by Medicaid?

RESIDENTS WITH MEDICAID

D Waiting Lists

D1.	 Does this facility currently have anyone who is on a

waiting list to be admitted to this facility as soon as

a place becomes available?

M YES ➡ GO TO QUESTION D2

M NO ➡ SKIP TO E. RESIDENT TURNOVER

D2.	 What is the current number of people waiting to be

admitted to this facility as soon as a place becomes

available?

NUMBER ON WAITING LIST

D3.	 What is the average length of time that prospective

residents are waiting to be admitted to this facility?

Please respond as convenient, using months, days,

or a combination of months and days.

MONTHS DAYS

E Resident Turnover

E1. How many residents moved into this facility over

the past 12 months?

Exclude someone returning from a hospital stay if

this facility held the bed for the resident.

Count each couple as 2 residents. Residents should

be counted only once.

RESIDENTS MOVED IN

E2.	 In the last 12 months, how many residents died?

RESIDENTS DIED

E3.	 Over the last 12 months, how many residents

moved out of this facility?

Exclude someone who has moved out if the facility

is currently holding a bed for the resident.

Exclude deaths.

RESIDENTS MOVED OUT

▼

IF ‘‘0’’, SKIP TO F. STAFFING

E4.	 Where did the residents go after they moved out?

NUMBER OF
 

RESIDENTS
 

Hospital

Nursing home

Other residential care facility

Private residence

Some other place
Page 66 [ Series 1, No. 54

E. Resident Turnover (continued)

E5.	 Over the last 12 months, of those residents who

moved elsewhere, how many left because the cost

of care— including housing, meals, and services

required to meet their needs—exceeded their ability

to pay?

RESIDENTS LEFT DUE

TO COST OF CARE

F Staffing

F1.	 During the last 7 days (or last work week), how

many total hours were worked by the following paid

staff?

Include all staff that provide direct care to

residents, including full-time and part-time

employees, and contract, temporary, and agency

workers. Count hours for each staff person only

once based on their primary job title.

Direct care refers to time spent meeting the needs

of individual residents, such as helping them walk to

dinner, helping them dress, or providing them with

assistance with medications.

NUMBER OF

HOURS

WORKED

Registered Nurses (RNs)

Licensed Practical Nurses (LPNs) or

Licensed Vocational Nurses (LVNs)

Personal care aides, including

certified nursing assistants (CNAs),

and medication technicians

Activities director or Activities staff

Administrators, directors, assistant

administrators, or assistant directors.

Note: Include time meeting the

needs of residents but exclude the

time spent on the overall

management of the facility.

For these next questions, exclude contract, temporary,

or agency workers. Please count each employee only

once based upon their primary responsibilities.

F2.	 As of today, how many of the following full-time and

part-time persons are currently employed by this

facility?

NUMBER
 

CURRENTLY
 

EMPLOYED
 

Administrators, directors, assistant

administrators or assistant directors

Registered Nurses

Licensed Practical Nurses or

Licensed Vocational Nurses

Personal care aides, including

certified nursing assistants, and

medication technicians

F3.	 During the past 12 months, how many of the

following full-time and part-time employees have

resigned or been terminated from residential care?

NUMBER
 

RESIGNED OR
 

TERMINATED
 

Administrators, directors, assistant

administrators or assistant directors

Registered Nurses

Licensed Practical Nurses or

Licensed Vocational Nurses

Personal care aides, including

certified nursing assistants, and

medication technicians
Series 1, No. 54 [ Page 67

G Resident Demographics

G1. How many residents are of Hispanic, Latino, or

Spanish origin or descent?

NUMBER OF RESIDENTS

G2. How many residents are

NUMBER OF

RESIDENTS

Male?

Female?

G3. How many residents are in the following age

categories?

NUMBER OF
 

RESIDENTS
 

17 and under

18–54

55–64

65–74

75–84

Age 85 and over

G4. How many residents are

NUMBER OF
 

RESIDENTS
 

White or Caucasian?

Black or African American?

Asian?

Native Hawaiian or other Pacific
 

Islander?
 

American Indian or Alaska Native?

H Dementia / Alzheimer’s Unit

H1. Does this residential care facility have a distinct

unit, wing, or floor that is designated as a dementia

or Alzheimer’s special care unit?

M YES ➡ GO TO QUESTION H2

M NO ➡ SKIP TO NEXT PAGE SECTION

J. FACILITY CHARGES.

H2. In the dementia/Alzheimer’s special care unit, what

is the number of licensed beds?

NUMBER OF

LICENSED BEDS

H3. What is the current number of residents living in

the dementia/Alzheimer’s unit?

NUMBER OF
 

RESIDENTS
 
Page 68 [ Series 1, No. 54

I Facility Charges

The next questions are about the average monthly base

rate for rent and the services.

IF NO APARTMENTS, SKIP TO QUESTION I2.

I1.	 What is the average monthly base rate for a single

individual living ina...

(If two related people are living in the same

apartment, compute the average as if only one

person lived in the apartment.)

$ Studio apartment for a

non-Alzheimer’s unit?

$ Studio apartment for

an Alzheimer’s unit?

$ 1-bedroom apartment for

non-Alzheimer’s unit?

$ 1-bedroom apartment for

an Alzheimer’s unit?

$ 2-bedroom apartment for a

non-Alzheimer’s unit?

$ 2-bedroom apartment for

an Alzheimer’s unit?

$ 3-bedroom apartment for

non-Alzheimer’s unit?

$ 3-bedroom apartment for

an Alzheimer’s unit?

I2.	 What is the average monthly base rate for a single

individual living in a ...

IF NO ROOMS, SKIP TO END.

Room designed for one person

for a non-Alzheimer’s unit?

$

Room designed for one person

for an Alzheimer’s unit?

$

Room designed for two persons

for a non-Alzheimer’s unit?

$

Room designed for two persons

for an Alzheimer’s unit?

$

Room designed for three or more

persons for a non-Alzheimer’s unit?

$

Room designed for three or more

persons for an Alzheimer’s unit?

$
J Facility Charges

Series 1, No. 54 [ Page 69

The next questions are about the average monthly base

rate for rent and the services.

IF NO APARTMENTS, SKIP TO QUESTION J2.

J1.	 What is the average monthly base rate for a single

individual living ina...

(If two related people are living in the same

apartment, compute the average as if only one

person lived in the apartment.)

$ Studio apartment?

$ 1-bedroom apartment?

$ 2-bedroom apartment?

$ 3-bedroom apartment?

IF NO ROOMS, SKIP TO END.

J2.	 What is the average monthly base rate for a single

individual living ina...

Room designed for one

person?

$

Room designed for two

persons?

$

Room designed for three or more

persons?

$
Page 70 [ Series 1, No. 54

END

Thank you for completing this worksheet. Please retain this document to refer to during the in-person interview.

Also, please remember to prepare a list of current residents of your residential care facility as of midnight before the

interview date.

OMB No. 0920–0780
 

Exp. Date 12/31/2012
 

NOTICE—Public reporting burden of this collection of information is estimated to average 15 minutes per response,
 

including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
 

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

person is not required to respond to a collection of information unless it displays a currently valid OMB control number.
 

Send comments regarding this burden estimate or any other aspect of this collection of information, including
 

suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS D-74,
 

Atlanta, GA 30333, ATTN: PRA (0920–0780).
 

Assurance of Confidentiality—All information which would permit identification of an individual, a practice, or an
 

establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents
 

only when required and with necessary controls, and will not be disclosed or released to other persons without the
 

consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC
 

242m) and the Confidential Information Protection and Statistical Efficiency Act (PL–107–347).
 
Series 1, No. 54 [ Page 71

Appendix XV. Interviewer Reminder Call Script

REMINDER CALL

‰ OPEN FACESHEET.
 

‰ GO TO FACILITY & DIRECTOR TAB AND REVIEW DATA.
 

‰ GO TO APPOINTMENT TAB AND REVIEW DATA.
 

‰ PLACE CALL TO PRIMARY PERSON TO REMIND.
 

SPEAKING TO RECEPTIONIST

‰ Hello, this is FIRST AND LAST NAME OF INTERVIEWER. May I please speak with

____________________?

‰ Could you transfer me to his/her voicemail?

CONFIRMING WITH PRIMARY PERSON

‰ I’m calling to confirm my appointment with you and your staff at APPOINTMENT DAY OF WEEK,

APPOINTMENT DATE, APPOINTMENT TIME for the National Survey of Residential Care Facilities.

‰ Address

‰ Meeting location

‰ Parking

‰ Security/ID arrangements

‰ Anything else to be on lookout for

‰ Do you have any other questions I can answer before my visit on APPOINTMENT DATE?

‰ Thank you. I look forward to meeting you. If you have any questions, do not hesitate to call me at

INTERVIEWER’S HOME NUMBER/SUPERVISOR’S TOLL-FREE NUMBER.

REMIND OF PIW AND LIST

‰	 Did you receive the appointment package our office sent to you? It includes a letter, a worksheet,

and an NSRCF pen. I would like to ask you, if you have the time, to complete that worksheet

before the interview. I know your time is valuable, so if you can find the time to complete the

worksheet beforehand when it works with your schedule, this will more than make up for itself

because the in-person interview will be much faster and smoother. Also please print a list of

current residents (FOR CCRCs and MULTILEVELS: If you have many components of your facility,

the list should be restricted to current residents of the residential care portion, often known as

assisted living. It should not include independent apartments, nursing home, rehabilitation, or other

components you may have on your campus in the residential care portion) as of midnight before

the time interview.

‰	 IF RESPONDENT ASKS WHAT IS ON THE WORKSHEET: It is numerical data about your facility;

for example, numbers and types of staff, admissions, discharges, prices. The list of current

residents is used to select a random sample of residents.

‰	 Thank you. I look forward to meeting you. If you have any questions, do not hesitate to call me at

INTERVIEWER’S TOLL-FREE NUMBER/INTERVIEWER’S HOME NUMBER.
Page 72 [ Series 1, No. 54

IF RESPONDENT HAVING TROUBLE PROVIDING DATA REQUESTED ON PIW

‰	 Yes, some of the questions ask for a lot of data. Many facilities are like yours and do not routinely

collect this type of data. It’s okay to fill in whatever information you have.

‰	 We’ll input your answers during the site-visit. On any question, you can always pause the interview to

look up the information, ask a colleague for the information, or skip the question.

RESCHEDULE

‰	 I’m sorry that that time doesn’t work for you. Let’s reschedule to a better time.

VOICEMAIL MESSAGES

‰	 APPROPRIATE FOR PRIMARY PERSON’S DIRECT NUMBER. Hello, this if FIRST AND LAST

NAME OF INTERVIEWERS. I’m calling to confirm my appointment with you (and your staff) at

APPOINTMENT TIME on APPOINTMENT DATE for the National Survey of Residential Care

Facilities. If you have not already done so, please complete the short worksheet we sent and

prepare a list of current residents as of midnight before the interview. If you have any changes or

questions, please call me at INTERVIEWER’S HOME NUMBER ____________________.

Thank you.

‰	 APPROPRIATE FOR FACILITY GENERAL NUMBER. Hello, this is FIRST LAST NAME OF

INTERVIEWER. I’m calling to confirm my appointment with ____________________ at

APPOINTMENT DAY OF WEEK, APPOINTMENT DATE, APPOINTMENT TIME for the National

Survey of Residential Care Facilities. If ____________________ needs to reach me regarding this

appointment, please call me at INTERVIEWER HOME NUMBER. Otherwise, I look forward to

meeting her/him and his/her staff on APPOINTMENT DATE.

‰	 Our office sent appointment materials to ____________________. We hope that he/she will have

the opportunity to complete the worksheet and print the list prior to my arrival. This will make the

appointment proceed more quickly.

Again, if you have any questions or changes please call me at INTERVIEWER HOME NUMBER. Thank you.

E-MAIL MESSAGE

‰	 Dear PRIMARY PERSON. This e-mail is to confirm my appointment with you (and your staff) at

APPOINTMENT TIME on APPOINTMENT DATE for the National Survey of Residential Care

Facilities. If you have not already done so, please complete the short worksheet we sent and

prepare a list of current residents as of midnight before the interview. If you have any changes or

questions, please call me at home number ____________________. I look forward to seeing you

on APPOINTMENT DATE. Thank you. FIRST AND LAST NAME OF INTERVIEWER.
Series 1, No. 54 [ Page 73

Appendix XVI. Appointment Reschedule Call Script

RESCHEDULE CALL

‰ OPEN FACESHEET.
 

‰ GO TO FACILITY & DIRECTOR TAB AND REVIEW DATA.
 

‰ GO TO APPOINTMENT TAB AND REVIEW DATA.
 

‰ PLACE CALL TO PRIMARY PERSON TO REMIND.
 

SPEAKING TO RECEPTIONIST

‰ Hello, this is FIRST AND LAST NAME OF INTERVIEWER. May I please speak with _________________

regarding a change to the appointment we made for DATE/TIME. We will not be able to come then and

need to reschedule for another time.
 

‰ Could you transfer me to his/her voicemail?
 

‰ Is there a better time for me to reach ____________________? ARRANGE CALL BACK.
 

‰ Thank you very much for your time.
 

SPEAKING TO PRIMARY PERSON

‰ Hello, this is NAME OF INTERVIEWER. I apologize, but we will not be able to keep the appointment to

conduct your interview on DATE.

‰ Would you be available on DATE instead? SET TIME BASED ON YOUR AVAILABILITY AND

DIRECTOR’S PREFERENCES.

‰ Thank you.

IF THERE WILL BE TIME LATER TO MAKE THE REMINDER CALL

‰ A few days before your interview I will call to remind you of this appointment.

IF THERE WILL NOT BE TIME LATER TO MAKE THE REMINDER CALL, CONDUCT IT NOW

‰ Confirm address

‰ Meeting location

‰ Parking

‰ Security/ID arrangements

‰ Anything else to be on lookout for

‰ We will FedEx you an appointment package. It includes a letter and a short worksheet for you to complete

before the interview. The worksheet has factual questions about the facility. Some answers require you to

reference records. We send it in advance so you/RESPONDENT will have the opportunity to do this before

the interview. This will reduce the interview significantly.

‰ Also, please print a list of current residents as of midnight before the interview.
Page 74 [ Series 1, No. 54

‰	 FOR LARGE AND VERY LARGE FACILITIES: If you have many components of your facility, the list

should be restricted to current residents of the residential care portion, often known as assisted living. It

should not include independent apartments, nursing home, rehabilitation, or other components you may

have on your campus.

‰	 Do you have any other questions I can answer before my visit on APPOINTMENT DATE?

THANK YOU

‰	 Thank you. I look forward to meeting you on ____________________.

‰	 If you have any questions, do not hesitate to call me at INTERVIEWER’S TOLL FREE NUMBER/

INTERVIEWER’S HOME NUMBER.
Series 1, No. 54 [ Page 75

Appendix XVII. NCHS Thank You Letter

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

Thank You

I want to personally thank you for participating in the National Survey of Residential Care Facilities

and for assisting the RTI International field representative who conducted the survey in your

community. It is only through the cooperation of directors like you that we are able to conduct such

a study to produce for the first time, important national data about assisted living communities and

the care they provide. The findings will be an invaluable source of information for health care

professionals, the long-term care industry, and the general public.

Again, I appreciate the time and effort you have given in support of this study.

Sincerely,
 

/Edward J. Sondik, Ph.D./
 

Director, National Center for Health Statistics
 
Page 76 [ Series 1, No. 54

Appendix XVIII. NSRCF Facility Questionnaire

Question

number Facility question item Code categories

Facility

asked

Skip

pattern

F_A1_

Intro1

This survey is about the characteristics of residential care

facilities and the individuals who live in them.

Residential care facilities are known by many names, so just

to be clear I would like to read a definition that we are using

to describe a residential care facility that we have provided

on this card.

HAND R SHOWCARD

Residential care facilities are places that are licensed,

registered, listed, certified, or otherwise regulated by the state

and that provide room and board with at least two meals a

day, around-the-clock on-site supervision, and help with

personal care such as bathing and dressing or health related

services such as medication management. These facilities

serve a predominantly adult population. Facilities licensed to

exclusively serve the severely mentally ill or the

developmentally disabled populations are excluded.

1 CONTINUE All

facilities

F_A1_

Intro2

We are interviewing [SAMPLED FACILITY] because it is

currently licensed as a [LICENSURE CATEGORY], which is a

type of residential care facility.

READ IF MULTI-LEVEL FACILITY

[When you answer the questions, please answer only about

the residential care component of this facility.]

1 CONTINUE All

facilities

F_A1 This is the first of many questions included in the

Pre-interview Worksheet that we mailed to your facility. If you

have that form available it would be helpful to reference that

now.

At this facility, what is the number of licensed, registered, or

certified residential care beds?

Include both occupied and unoccupied beds.

0–995 BEDS All

facilities

F_A1_

CONFIRM

Does your facility have less than four beds? 1 YES

2 NO

F_A1 = 0–3

F_A1_

ABORT

I am sorry but your facility is not eligible for this study.

Thank you for your time.

1 CONTINUE F_A1_CONFIRM =

1

F_A2 At this facility, what is the number of licensed, registered or

certified residential care rooms or apartments, where

residents live?

Exclude rooms within apartments.

1–995 All

facilities

F_S14 Is this facility owned by a chain, group, or multi-facility

system?

INTERVIEWER, EXPLAIN IF NECESSARY:

A chain means more than one facility under common

ownership or management. This may include facilities

within-state or across multiple states.

1 YES

2 NO

All

facilities

F_S15 What is the type of ownership of this facility?

Private, for profit

Private Nonprofit

State, county, or local government

1 Private, for profit

2 Private Nonprofit

3 State, county, or local

government

All

facilities
Series 1, No. 54 [ Page 77

Question

number Facility question item Code categories

Facility

asked

Skip

pattern

F_S3a Does this residential care facility only serve adults with

dementia or Alzheimer’s disease?

1 YES

2 NO

All

facilities

F_A3 What is the current number of residents living at this

residential care facility?

1–995 All

facilities

F_ANEW1 HAND R SHOWCARD

The next questions are about the residents’ living quarters (in

the residential care component) at this facility.

Which of these types of living quarters does your facility offer

to residents?

Any others?

SELECT ALL THAT APPLY

1 ROOM DESIGNED FOR ONE

PERSON

2 ROOM DESIGNED FOR TWO

PERSONS

3 ROOM DESIGNED FOR

THREE OR MORE PERSONS

4 STUDIO APARTMENT

5 ONE BEDROOM APARTMENT

6 TWO BEDROOM APARTMENT

7 THREE BEDROOM

APARTMENT

All

facilities

F_ANEW2

Intro

I’ll now ask about the rooms (at/in the residential care portion of)

this facility.

1 CONTINUE F_ANEW1 = 1–3

F_ANEW2a How many rooms in this facility are designed for one person? 1–995 F_ANEW1 = 1

F_ANEW2b How many rooms in this facility are designed for two persons? 1–995 F_ANEW1 = 2

F_ANEW2c How many rooms in this facility are designed for three or more

persons?

1–995 F_ANEW1 = 3

F_ANEW3a HAND R SHOWCARD

(Does this room/do any rooms) contain any of these features?

Which ones?

SELECT ALL THAT APPLY

1 MICROWAVE

2 COOK TOP OR HOT PLATE

3 OVEN

4 REFRIGERATOR

5 KITCHEN SINK

6 NONE OF THE ABOVE

F_ANEW1 = 1–3

F_ANEW3b Do all or only some of the rooms have a microwave? 1 All

2 Some

F_ANEW 3a = 1

and Σ of

F_ANEW2a–2c ≠ 1

F_ANEW3b1 How many? 1–995 F_ANEW3b = 2

F_ANEW3c Do all or only some of the rooms have a cook top or hot plate? 1 All

2 Some

F_ANEW3a = 2 and

Σ of NEW2a–2c ≠ 1

F_ANEW3c1 How many? 1–995 F_ANEW3 c = 2

F_ANEW3d Do all or only some of the rooms have an oven? 1 All

2 Some

F_ANEW3a = 3 and

Σ of F_ANEW2a–2c

≠ 1

F_ANEW3d1 How many? 1–995 F_ANEW3d = 2

F_ANEW3e Do all or only some of the rooms have a refrigerator? 1 All

2 Some

F_ANEW3a = 4 and

Σ of F_ANEW2

a–2c ≠ 1

F_ANEW3e1 How many? 1–995 F_ANEW3e = 2

F_ANEW3f Do all or only some of the rooms have a sink in the kitchen

area?

1 All

2 Some

F_ANEW3a = 5 and

Σ of F_ANEW2a–2c

≠ 1

F_ANEW3f1 How many? 1–995 F_ANEW3f = 2

F_A7rev How many rooms have a door to the hallway that can be locked

from the inside: All, some, or none?

1 All

2 Some

3 None

F_ANEW1 = 1–3

F_A7rev1 How many? 1–995 F_ANEWF_A7rev =

2
Page 78 [ Series 1, No. 54

Question

number Facility question item Code categories

Facility

asked

Skip

pattern

F_A7_within

rev

How many rooms have a bathroom located within the room

or between rooms: All, some, or none?

1 All

2 Some

3 None

F_ANEW1 = 1–3

F_A7_within

rev1

How many? 1–995 F_A7withinrev = 2

F_A7arev How many rooms have a full bathroom including a toilet, sink,

and shower or tub located within the room or between rooms:

All, some, or none?

1 All

2 Some

3 None

F_A7_withinrev =

1–2

F_A7arev1 How many? 1–995 F_A7a rev = 2

F_A7brev How many rooms have a half-bath including a sink and toilet

located within the room or between rooms: All, some, or

none?

1 All

2 Some

3 None

F_A7a = 2–3

F_A7brev1 How many? 1–995 F_A7b rev = 2

F_ANEW4

Intro

The next questions are about this facility’s apartments. 1 CONTINUE F_ANEW1 = 4–7

F_ANEW4a How many studio apartments are there? 1–995 F_ANEW1 = 4

F_ANEW4b How many one bedroom apartments are there? 1–995 F_ANEW1 = 5

F_ANEW4c How many two bedroom apartments are there? 1–995 F_ANEW1 = 6

F_ANEW4d How many three bedroom apartments are there? 1–995 F_ANEW1 = 7

F_ANEW5a HAND R SHOWCARD

(Does this apartment/do any apartments) contain any of

these features? Which ones?

SELECT ALL THAT APPLY

1 MICROWAVE

2 COOK TOP OR HOT PLATE

3 OVEN

4 REFRIGERATOR

5 KITCHEN SINK

6 NONE OF THE ABOVE

F_ANEW1 = 4–7

F_ANEW5b Do all or only some of the apartments have a microwave?

NOTE: APARTMENT IS CONSIDERED TO HAVE A

MICROWAVE EVEN IF MICROWAVE CANNOT BE PLUGGED

IN/HAS BEEN DISABLED FOR THE RESIDENT’S SAFETY.

1 All

2 Some

F_ANEW5a = 1 and

Σ of F_ANEW4a–4d

≠ 1

F_ANEW5b1 How many? 1–995 F_ANEW5b = 2

F_ANEW5c Do all or only some of the apartments have a cooktop or hot

plate?

1 All

2 Some

F_ANEW5a = 2 and

Σ of F_ANEW4a–4d

≠ 1

F_ANEW5c1 How many? 1–995 F_ANEW5c = 2

F_ANEW5d Do all or only some of the apartments have an oven? 1 All

2 Some

F_ANEW5a = 3 and

Σ of F_ANEW4a–4d

≠ 1

F_ANEW5d1 How many? 1–995 F_ANEW5d = 2

F_ANEW5e Do all or only some of the apartments have a refrigerator? 1 All

2 Some

F_ANEW5a = 4 and

Σ of F_ANEW4a–4d

≠ 1

F_ANEW5e1 How many? 1–995 F_ANEW5e = 2

F_ANEW5f Do all or only some of the apartments have a sink in the kitchen

area?

1 All

2 Some

F_ANEW5a = 5 and

Σ of F_ANEW4a–4d

≠ 1

F_ANEW5f1 How many? 1–995 F_ANEW5f = 2

F_A7rev_apt How many apartments have a door to the hallway that can be

locked from the inside: All, some, or none?

1 All

2 Some

3 None

F_ANEW1 = 4–7
Series 1, No. 54 [ Page 79

Question

number Facility question item Code categories

Facility

asked

Skip

pattern

F_A7rev1_

apt

How many? 1–995 F_A7rev_apt = 2

F_A7_within

rev_apt

How many apartments have a bathroom located within the

apartment or between apartments: All, some, or none?

1 All

2 Some

3 None

F_ANEW1 = 4–7

F_A7_within

rev1_apt

How many? 1–995 F_A7_withinrev_apt

= 2

F_A7arev_

apt

How many apartments have a full bathroom including a toilet,

sink, and shower or tub located within the apartment or

between apartments: All, some or none?

1 All

2 Some

3 None

F_A7_withinrev_apt

= 1–2

F_A7arev1_

apt

How many? 1–995 F_A7arev_apt = 2

F_A7b_apt How many apartments have a half-bath including a sink and

toilet located within the apartment or between apartments:

All, some, or none?

1 All

2 Some

3 None

F_A7_withinrev_apt

= 1–2

F_A7b1_apt How many? 1–995 F_A7b_apt = 2

F_A8 Does the facility have a common kitchen area that any

resident can use?

1 YES

2 NO

All

facilities

F_A9 How many of the [NUMBER] residents live with a spouse or

other relative?

For example, if there is one couple who lives together, you

would report that two residents live with a spouse or relative.

0–995 All

facilities

F_A10 READ RESPONSES IF NECESSARY.

What is the total number of years this facility has been (in

operation/operating as a residential care facility)?

1 LESS THAN 5 YEARS

2 5 TO 9 YEARS

3 10 TO 19 YEARS

4 20 OR MORE YEARS

All

facilities

F_A11 Was [SAMPLED FACILITY] purposely built as a residential

care facility?

1 YES

2 NO

All

facilities

F_A12a (In the residential care portion of this facility,) how many

resident (rooms/apartments) have...

smoke detectors?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A12b (In the residential care portion of this facility,) how many

common areas have...

smoke detectors?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A12c (In the residential care portion of this facility,) how many

resident (rooms/apartments) have...

a sprinkler system?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities
Page 80 [ Series 1, No. 54

Question

number Facility question item Code categories

Facility

asked

Skip

pattern

F_A12d (In the residential care portion of this facility,) how many

common areas have...

a sprinkler system?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A12e (In the residential care portion of this facility,) how many

hallways have supported or grab rails on one or both sides?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A12f (In the residential care portion of this facility,) how many

common areas have widened hallways or doorways that can

accommodate wheelchairs?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A12g (In the residential care portion of this facility,) how many

(rooms/apartments) have an emergency call or personal

response system? This may include emergency devices worn

by residents.

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A12h (In the residential care portion of this facility,) how many

(rooms/apartments) are...

wheelchair accessible?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A12i (In the residential care portion of this facility,) how many

bathrooms have enough space for a wheelchair to enter,

about 3 ft, and turn around, about 5ft x 5ft?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A12j (In the residential care portion of this facility,) how many

bathrooms have grab bars in the shower or tub area?

Would you say...?

All

Some

None

1 All

2 Some

3 None

All

facilities

F_A15 During the past 90 days, did this residential care facility

provide any short-term respite care?

1 YES

2 NO

All

facilities

F_A16 Does this facility provide adult day health or adult day care

services to non-residents?

1 YES

2 NO

All

facilities
Series 1, No. 54 [ Page 81

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F_A17 Does this facility currently serve any persons with

developmental disabilities such as mental retardation, autism,

or Down syndrome?

1 YES

2 NO

All

facilities

F_A18 Does this facility currently serve any persons with severe

mental illness such as schizophrenia and psychosis?

Please do not include Alzheimer’s disease or other

dementias.

1 YES

2 NO

All

facilities

F_A18a HAND R SHOWCARD

Please look at this card. We would now like to ask you about

how the facility manages risky behavior by residents. By risky

behavior, we mean when residents do things that staff think

pose a risk to their health and safety—such as refusing to

take prescribed medications, not using a walker when their

balance is poor, or not complying with prescribed diets.

Some facilities use a formal written document called a

managed risk agreement or a formal negotiated risk

agreement, which documents the risky behavior, discussions

with the resident about the behavior, alternatives to the

behavior presented by staff, and agreements reached

between the facility and the resident about the behavior.

Some facilities also use these documents as liability waivers

for harm resulting from risky behavior. This document is

different from a Plan of Care or a Resident Agreement.

Does this facility develop a formal negotiated risk agreement

with any of the residents?

1 YES

2 NO

All

facilities

F_A18b Instead of a formal negotiated risk agreement, does this

facility address risky behaviors in some other formal written

document?

1 YES

2 NO

F_A18a = 2

F_A19_

Intro

The next questions ask about items residents are allowed to

bring when they move into this facility.

1 CONTINUE All

facilities

F_A19 What types of personal items or furniture may residents

bring?

Large furniture such as a couch, bed, or dining room table.

Small furniture such as a desk, bookcase, chair, lamp, or

small table.

Personal items such as pictures, bed linens, or wall

decorations.

CODE ALL THAT APPLY

1 Large furniture such as a

couch, bed, or dining room table.

2 Small furniture such as a desk,

bookcase, chair, lamp, or small

table.

3 Personal items such as

pictures, bed linens, or wall

decorations.

4 NONE OF THE ABOVE

All

facilities

F_A20 Does the facility provide a common pet such as a cat, dog, or

bird?

1 YES

2 NO

All

facilities

F_A20a Are residents ever allowed to have a personal pet such as a

cat, dog, or bird that lives at the facility?

1 YES

2 NO

All

facilities

F_A21 Is there space at this facility for residents to park their car? 1 YES

2 NO

All

facilities

F_A22_Intro The next questions ask about resident source of payment. 1 CONTINUE All

facilities

F_A22 Is this residential care facility certified or registered to

participate in Medicaid?

1 YES

2 NO

All

facilities

F_A23 During the last 30 days, how many of the residents had some

or all of their long-term care services paid by Medicaid?

0–995 F_A22 = 1

F_A24 Does this facility currently have anyone who is on a waiting

list to be admitted to this facility as soon as a place becomes

available?

1 YES

2 NO

All

facilities
Page 82 [ Series 1, No. 54

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F_A25 What is the current number of people waiting to be admitted

to this facility as soon as a place becomes available?

1–500 F_A24 = 1

F_A26 What is the average length of time that prospective residents

are waiting to be admitted to this facility?

Please respond in months and/or days.

MONTHS

DAYS

F_A24 = 1

F_A27_Intro The next questions ask about resident admission and

discharge.

1 CONTINUE All

facilities

F_A27 How many residents moved into this facility over the past 12

months?

Please count each couple as 2 residents. Also, do not include

someone returning from a hospital stay if this facility held the

bed for the resident. Residents should be counted only once.

0–500 All

facilities

F_A32 In the last 12 months, how many residents died? 0–500 All

facilities

F_A30 Over the last 12 months, how many residents moved out of

this facility?

Exclude someone who has moved out if the facility is

currently holding a bed for the resident.

Exclude deaths.

0–500 All

facilities

F_A31_

hosp

Where did the residents go after they moved out?

Hospital

0–500 F_A30 = 1–500

F_A31_

nursing

(Where did the residents go after they moved out?)

Nursing home

0–500 F_A30 = 1–500

F_A31_

otherrcf

(Where did the residents go after they moved out?)

Other residential care facility

0–500 F_A30 = 1–500

F_A31_

residence

(Where did the residents go after they moved out?)

Private residence

0–500 F_A30 = 1–500

F_A31_

other

(Where did the residents go after they moved out?)

Some other place

0–500 F_A30 = 1–500

F_A30a Over the last 12 months, of those residents who moved

elsewhere, how many left because the cost of care, including

housing, meals, and services required to meet their needs,

exceeded their ability to pay?

0–500 F_A30 = 1–500

F_A33_Intro The next questions are about facility staff. First, we will ask

how many total hours were worked in the last 7 days (or the

last work week) by paid staff (for the residential care

component of this facility).

In your calculations of staff hours, please include all staff that

provide direct care to residents, including full-time and

part-time staff employees, and contract, temporary, and

agency workers.

Direct care refers to time spent meeting the needs of

individual residents, such as helping them walk to dinner,

helping them dress, or providing them with assistance with

medications.

1 CONTINUE All

facilities

F_A33a During the last 7 days or last work week, how many total

hours were worked by the following paid staff (for the

residential care component this facility)?

Registered Nurses or RNs

0–999 All

facilities
Series 1, No. 54 [ Page 83

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F_A33b (During the last 7 days or last work week, how many total

hours were worked by the following paid staff (for the

residential care component of this facility)?)

Licensed Practical Nurses, also called an L.P.N. or Licensed

Vocational Nurses also called an LVN.

0–999 All

facilities

F_A33c (During the last 7 days or last work week, how many total

hours were worked by the following paid staff (for the

residential care component of this facility)?)

Personal care aides, including certified nursing assistants

(CNAs), and medication technicians.

0–1999 All

facilities

F_A33d (During the last 7 days or last work week, how many total

hours were worked by the following paid staff (for the

residential care component of this facility)?)

Activities director or activities staff

0–999 All

facilities

F_A33e (During the last 7 days or last work week, how many total

hours were worked by the following paid staff (for the

residential care component of this facility)?)

Administrators, directors, assistant administrators or assistant

directors—direct care time only

(Direct care time by administrators or directors refers to time

spent meeting the needs of individual residents, such as

helping them walk to dinner, helping them dress, or providing

them with medications. It does not include the time spent on

the overall management of the facility.)

0–999 All

facilities

F_A34 Does this facility use contract workers to provide direct care

to residents?

1 YES

2 NO

All

facilities

F_A35 During the past 7 days or last work week, did your facility use

any volunteers to help your residents or this facility’s staff in

any way?

1 YES

2 NO

All

facilities

F_A36 During the last 7 days or last work week, about how many

volunteer workers provided services at the facility at least

once?

0–995 F_A35 = 1

F_A36a What kinds of services do they provide?

CODE ALL THAT APPLY

General office help

Homemaker/Household services

Personal care (haircuts, nail care, massage, etc.)

Transportation services

Visiting with patients

Bereavement/family support

Religious/spiritual activities

Assist residents at Mealtime

Shopping

Social and recreational activities

Exercise

Other service

1 General office help

2 Homemaker/household

services

3 Personal care (haircuts, nail

care, massage, etc.)

4 Transportation services

5 Visiting with patients

6 Bereavement/family support

7 Religious/spiritual activities

8 Assist residents at Mealtime

9 Shopping

10 Social and recreational

activities

11 Exercise

12 Other services

F_A35 = 1

F_A36b During the last 7 days or last work week, how many of your

facility’s residents received services from any of your

volunteer workers?

0–500 F_A35 = 1

F_A37 During a typical night how many staff are on-duty and

awake? Please do not count security guards.

0–500 All

facilities
Page 84 [ Series 1, No. 54

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F_A38a These next questions ask how many full-time and part-time

persons are currently employed by this facility (for residential

care). Please count full-time and part-time employees. Do not

include contract, temporary, and agency workers. Please

count each employee only once based upon their primary

responsibilities.

As of today, how many of the following full-time and part-time

persons are currently employed by this facility (for residential

care)?

Administrators, Directors, assistant Administrators and

assistant Directors?

0–99 All

facilities

F_A38b (As of today, how many of the following full-time and

part-time staff are currently employed at this facility) (for

residential care)?

Registered Nurses or RNs

0–99 All

facilities

F_A38c (As of today, how many of the following full-time and

part-time staff are currently employed by this facility) (for

residential care)?

Licensed Practical Nurses also called LPNs or Licensed

Vocational Nurses also called LVNs

0–99 All

facilities

F_A38d (As of today, how many of the following full-time and

part-time staff are currently employed by this facility) (for

residential care)?

Personal Care Aides, including Certified Nursing Assistants

and medication technicians

0–995 All

facilities

F_A39a During the past 12 months, how many of the following

full-time and part-time employees have resigned or been

terminated (from residential care)?

Administrators, Directors, Assistant Administrators and

Assistant Directors

0–99 All

facilities

F_A39b (During the past 12 months, how many of the following

full-time and part-time employees have resigned or been

terminated) (from residential care)?

Registered Nurses or RNs

0–99 All

facilities

F_A39c (During the past 12 months, how many of the following

full-time and part-time employees have resigned or been

terminated) (from residential care)?

Licensed Practical Nurses also called LPNs or Licensed

Vocational Nurses also called LVNs

0–99 All

facilities

F_A39d (During the past 12 months, how many of the following

full-time and part-time employees have resigned or been

terminated) (from residential care)?

Personal Care Aides and nursing assistants, including CNAs

and medication technicians

0–99 All

facilities

F_A40a HAND R SHOWCARD

About what percentage of this facility’s employees received a

flu shot last flu season?

1 0%

2 1 to 20%

3 21–40%

4 41–50%

5 51–60%

6 61–80%

7 81–99%

8 100%

All

facilities
Series 1, No. 54 [ Page 85

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F_A40b HAND R SHOWCARD

Does this facility do any of the following to encourage

employees’ influenza vaccinations?

Anything else?

SELECT ALL THAT APPLY

1 VACCINATIONS

RECOMMENDED

2 VACCINATIONS OFFERED

ON SITE

3 VACCINATIONS OFFERED

FOR FREE

4 VACCINATIONS OFFERED AT

REDUCED COST

5 STAFF INCENTIVES

PROVIDED FOR VACCINATION

6 PROOF OF VACCINATION

(OR CONTRAINDICATION)

REQUIRED AS A CONDITION

OF WORK/ EMPLOYMENT

7 FURLOUGH OR PATIENT

RESTRICTION POLICY FOR

EMPLOYEES DEVELOPING

INFLUENZA—LIKE ILLNESS

8 NONE OF THE ABOVE

All

facilities

F_A40c HAND R SHOWCARD

Which vaccination program best describes what is being

used in your facility for influenza?

HELP SCREEN1

1 FACILITY-WIDE STANDING

ORDERS

2 PRE-PRINTED ADMISSION

ORDERS

3 ADVANCE PHYSICIAN/

NURSE PRACTITIONER

ORDERS FOR ALL OF THEIR

RESIDENTS

4 PERSONAL PHYSICIAN

ORDER FOR EACH RESIDENT

5 NONE OF THE ABOVE

All

facilities

F_A40d Which type of vaccination program best describes what is

being used in your facility for pneumonia?

Please select one.

HELP SCREEN2

1 FACILITY-WIDE STANDING

ORDERS

2 PRE-PRINTED ADMISSION

ORDERS

3 ADVANCE PHYSICIAN/

NURSE PRACTITIONER

ORDERS FOR ALL OF THEIR

RESIDENTS

4 PERSONAL PHYSICIAN

ORDER FOR EACH RESIDENT

5 NONE OF THE ABOVE

All

facilities

F_A40e Has this facility developed a written plan for management of

residents during an influenza pandemic?

1 NO, NOT STARTED

2 YES, IN PROGRESS

3 YES, COMPLETED

All

facilities

F_A40 Does this facility provide on-going, in-service training to

personal care aides?

1 YES

2 NO

F_A38 ≠ 0

1

Immunization Program Definitions:

1. Facility wide standing orders: An institutional policy authorizes appropriate nursing or other non-physician staff to immunize residents by institution- or

medical director-approved protocol without the need for a written or verbal order from the resident’s personal physician before administering the vaccine.

2. Pre-printed admission orders: Each resident’s personal physician signs the facility’s preprinted admission order before administering the vaccine to the

resident. The preprinted order may address the resident’s current vaccination needs as well as those in the future.

3. Advance physician/nurse practitioner orders for all of their patients: Issued by an attending physician and authorizes immunization of ALL of the

physician’s patients who are residents of the facility.

4. Personal physician order for each resident: Each resident’s personal physician is responsible for signing an individual order for every vaccine before it is

administered to the resident. 2

SEE Footnote 1.
Page 86 [ Series 1, No. 54

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F_A41 Prior to providing care to residents, how many hours of

formal training are required of personal care aides?

READ CHOICES

No formal training

Less than 75 hours of training

75 hours of training

More than 75 hours of training

1 No formal training

2 Less than 75 hours of training

3 75 hours of training

4 More than 75 hours of training

F_A38 ≠ 0

F_A43 In addition to helping with activities of daily living, such as

dressing and assistance with medications, do personal care

aides routinely perform any of the following tasks...?

Housekeeping

Janitorial services

Assistance with food preparation

Assistance with recreational activities

Resident’s personal laundry

Assistance with medications

Transportation or escort services for residents

1 Housekeeping

2 Janitorial services

3 Assistance with food

preparation

4 Assistance with recreational

activities

5 Resident’s personal laundry

6 Transportation or escort

services for residents

7 NONE OF THE ABOVE

F_A38 ≠ 0

F_A44a Does this facility offer the following to personal care aides...?

health insurance that includes family coverage

1 YES

2 NO

F_A38 ≠ 0

F_A44b (Does this facility offer the following to personal care

aides...?)

health insurance for the employee only

1 YES

2 NO

F_A38 ≠ 0 and

F_A44a = 2

F_A44c (Does this facility offer the following to personal care

aides...?)

life insurance

1 YES

2 NO

F_A38 ≠ 0

F_A44e (Does this facility offer the following to personal care

aides...?)

a pension, a 401(k), or a 403(b)

1 YES

2 NO

F_A38 ≠ 0

F_A44f (Does this facility offer the following to personal care

aides...?)

personal time off, vacation time, or sick leave

1 YES

2 NO

F_A38 ≠ 0

F_A45 Does this facility pay for more than half of the personal care

aide’s health insurance premium?

1 YES

2 NO

F_A38 ≠ 0 and

(F_A44a or

F_A44b = 1)

F_A46_Intro The next questions ask about the types of information

maintained by this facility.

1 CONTINUE All

facilities

F_A46 Before or upon admission, does this facility conduct a formal

functional assessment of residents using a standardized tool?

Functional means physical activities of daily living, such as

eating, bathing, and dressing, or cognitive functioning.

1 YES

2 NO

All

facilities

F_A47 Does this assessment include a physical assessment,

cognitive assessment, or both?

1 PHYSICAL ASSESSMENT

2 COGNITIVE ASSESSMENT

3 BOTH PHYSICAL AND

COGNITIVE ASSESSMENT

F_A46 = 1

F_A48 An individual service plan details the personalized services

needed by the resident and what will be provided to him or

her by the facility. The service plan is usually updated

regularly or as the residents’ care needs change.

Does this facility develop formal individual service plans?

1 YES

2 NO

All

facilities
Series 1, No. 54 [ Page 87

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F_A49 Other than for accounting or billing purposes, does this

facility use Electronic Health Records?

This is a computerized version of the resident’s health and

personal information used in the management of the

resident’s health care.

1 YES

2 NO

All

facilities

F_A49b Other than for accounting or billing purposes, does this

facility have a computerized system for its Resident Service

Records to keep track of the services provided to each

resident?

IF NEEDED:

Resident service records are the facility’s record of the

services being provided to each resident.

1 YES

2 NO

F_A49A = 2

F_A50 HAND R SHOWCARD

Which of the following computerized capabilities does this

facility have?

SELECT ALL THAT APPLY

1 RESIDENT DEMOGRAPHICS

2 MEDICAL PROVIDER

INFORMATION

3 FUNCTIONAL

ASSESSMENTS

4 INDIVIDUAL SERVICE PLANS

5 CLINICAL NOTES, SUCH AS

MEDICAL HISTORY AND DAILY

PROGRESS NOTES

6 PATIENT PROBLEMS LIST

7 MEDICATION

ADMINISTRATION

8 MAINTAINING LISTS OF

RESIDENT’S MEDICATIONS

9 MAINTAINING ACTIVE

MEDICATION ALLERGY LIST

10 ORDERS FOR

PRESCRIPTIONS

11 WARNING OF DRUG

INTERACTIONS OR

CONTRAINDICATIONS

12 ORDERS FOR TESTS

13 VIEWING LABORATORY/

IMAGING RESULTS

14 REMINDERS FOR

GUIDELINE BASED

INTERVENTIONS OR

SCREENING TESTS

15 DISCHARGE and

TRANSFER SUMMARIES

16 PUBLIC HEALTH

REPORTING

17 NONE OF THE ABOVE

All

facilities

F_A51 HAND R SHOWCARD

Does this facility’s computerized system support electronic

health information exchange with any of the following—for

example, sending electronic records from this facility to a

hospital?

SELECT ALL THAT APPLY

1 PHYSICIAN

2 NURSING HOME

3 HOSPITAL

4 PHARMACY

5 LABORATORY/TESTS

6 OTHER HEALTH OR

LONG-TERM CARE PROVIDER

7 RESIDENT’S PERSONAL

HEALTH RECORD

8 PUBLIC HEALTH REPORTING

9 CORPORATE OFFICE

10 ELECTRONIC

INFORMATION IS NOT

EXCHANGED

F_A50 ≠ 17
Page 88 [ Series 1, No. 54

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F_A51a Does this facility’s staff use any system for Electronic Point of

Care Documentation? This includes PDA’s (Personal Digital

Assistants), Notebook PCs, or other portable hand held

devices.

1 YES

2 NO

All

facilities

F_A52a_

Intro

The next questions involve resident demographics. 1 CONTINUE All

facilities

F_A53 As of midnight last night, how many residents are of

Hispanic, Latino, or Spanish origin or descent?

0–999 All

facilities

F_A52_male As of midnight last night, what is the total number of male

residents living at this facility?

0–995 All

facilities

F_A52_

female

As of midnight last night, what is the total number of female

residents living at this facility?

0–995 All

facilities

F_A52a_1 As of midnight last night, how many residents are in the

following age categories?

17 and under

0–999 All

facilities

F_A52a_2 (As of midnight last night, how many residents are in the

following age categories?)

18–54

0–999 All

facilities

F_A52a_3 (As of midnight last night, how many residents are in the

following age categories?)

55–64

0–999 All

facilities

F_A52a_4 (As of midnight last night, how many residents are in the

following age categories?)

65–74

0–999 All

facilities

F_A52a_5 (As of midnight last night, how many residents are in the

following age categories?)

75–84

0–999 All

facilities

F_A52a_6 (As of midnight last night, how many residents are in the

following age categories?)

Age 85 and over

0–999 All

facilities

F_A54_1 As of midnight last night, how many residents are...?

White or Caucasian

0–999 All

facilities

F_A54_2 (As of midnight last night, how many residents are...?)

Black or African American

0–999 All

facilities

F_A54_3 (As of midnight last night, how many residents are...?)

Asian

0–999 All

facilities

F_A54_4 (As of midnight last night, how many residents are...?)

Native Hawaiian or other Pacific Islander

0–999 All

facilities

F_A54_5 (As of midnight last night, how many residents are...?)

American Indian or Alaska Native

0–999 All

facilities

F_A55_Intro The next questions ask about the cognitive, functional, and

health status of residents (in the residential care component

of this facility)

1 CONTINUE All

facilities
Series 1, No. 54 [ Page 89

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F_A55 During the last 7 days, how many of this facility’s current

residents had short-term memory problems or seemed

disoriented all or most of the time?

This includes, for example, residents who are not able to

remember things after a short while and residents who have

difficulty remembering where their room is, or difficulty

recognizing staff names or faces.

0–500 All

facilities

F_A56a HAND R SHOWCARD

(What percentage of the residents...)

have had an episode of urinary incontinence during the last

7 days?

1 100%

2 75–99%

3 50–74%

4 25–49%

5 11–24%

6 1–10%

7 0%

All

facilities

F_A56b (What percentage of the residents...)

are confined to a bed or chair because of health problems?

1 100%

2 75–99%

3 50–74%

4 25–49%

5 11–24%

6 1–10%

7 0%

All

facilities

F_A56c (What percentage of the residents...)

use a wheelchair or electric scooter to get around in the

facility?

1 100%

2 75–99%

3 50–74%

4 25–49%

5 11–24%

6 1–10%

7 0%

All

facilities

F_A56d (What percentage of the residents...)

currently receive assistance in transferring in and out of bed

or a chair?

1 100%

2 75–99%

3 50–74%

4 25–49%

5 11–24%

6 1–10%

7 0%

All

facilities

F_A56e (What percentage of the residents...)

currently receive assistance in eating, like cutting up food?

1 100%

2 75–99%

3 50–74%

4 25–49%

5 11–24%

6 1–10%

7 0%

All

facilities

F_A57a (For what percentage of the residents do you...)

manage, supervise or store medications or provide

assistance with self-administration of medications?

1 100%

2 75–99%

3 50–74%

4 25–49%

5 11–24%

6 1–10%

7 0%

All

facilities

F_A57b (For what percentage of the residents do you...)

provide or arrange assistance with locomotion, that is,

helping the resident walk or wheel him/herself around the

facility?

1 100%

2 75–99%

3 50–74%

4 25–49%

5 11–24%

6 1–10%

7 0%

All

facilities
Page 90 [ Series 1, No. 54

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F_A57c (For what percentage of the residents do you...?)

provide or arrange assistance using the bathroom? This

includes reminders to use the toilet, scheduled toileting,

getting on or off the toilet, cleaning him/herself, arranging

clothing, and changing adult incontinence supplies.

1 100%

2 75–99%

3 50–74%

4 25–49%

5 11–24%

6 1–10%

7 0%

All

facilities

F_A58 Does this residential care facility have a distinct unit, wing, or

floor that is designated as a Dementia or Alzheimer’s Special

Care Unit?

1 YES

2 NO

F_S3a ≠ 1

F_A59_Intro The next set of questions is about the Dementia or

Alzheimer’s unit, floor, or wing. When answering these

questions, please answer only for that unit.

1 CONTINUE F_A58 = 1

F_A59a In the Dementia or Alzheimer’s Special Care unit, please tell

me the number of licensed beds.

0–500 F_A58 = 1

F_A60 What is the current number of residents living in the

Dementia/Alzheimer’s unit?

0–500 F_A58 = 1

F_A61 HAND R SHOWCARD

Which of the following features does this (facility/Dementia or

Alzheimer’s Special Care Unit) have?

1 LOCKED EXIT DOORS

2 DOORS WITH ALARMS

3 DOORS WITH KEY

PADS/ELECTRONIC KEYS

4 CLOSED CIRCUIT TV

MONITORING

5 PERSONAL MONITORING

DEVICES

6 AN ENCLOSED

COURTYARD

7 HIGHER STAFF-TORESIDENT RATIOS

COMPARED TO OTHER UNITS

8 SPECIALLY TRAINED STAFF

9 DEMENTIA-SPECIFIC

ACTIVITIES AND

PROGRAMMING

F_A58 = 1 or

F_S3a = 1

F_BIntro The next questions will be about policies and services

provided (at FACILITY NAME/by the residential care

component of this facility).

1 CONTINUE All

facilities

F_B1a In terms of this facility’s admission policy, do you admit a

resident who...?

Is unable to leave the facility in an emergency without help

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3a In terms of this facility’s discharge policy, do you discharge a

resident who...?

Is unable to leave the facility in an emergency without help

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1a = 2 or 3

F_B1b In terms of this facility’s admission policy, do you admit a

resident who...?

Has moderate to severe cognitive impairment, that is, the

resident does not know who they are

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3b In terms of this facility’s discharge policy, do you discharge a

resident who...?

Has moderate to severe cognitive impairment, that is, the

resident does not know who they are

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1b = 2 or 3
Series 1, No. 54 [ Page 91

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F_B1c In terms of this facility’s admission policy, do you admit a

resident who...?

Exhibits problem behavior such as wandering, temper

outbursts, or combative behavior to other residents

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3c In terms of this facility’s discharge policy, do you discharge a

resident who...?

Exhibits problem behavior such as wandering, temper

outbursts, or combative behavior to other residents

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1c = 2 or 3

F_B1d In terms of this facility’s admission policy, do you admit a

resident who...?

Needs skilled nursing care on a regular basis

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3d In terms of this facility’s discharge policy, do you discharge a

resident who...?

Needs skilled nursing care on a regular basis

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1d = 2 or 3

F_B1e In terms of this facility’s admission policy, do you admit a

resident who...?

Needs daily monitoring for a health condition like assistance

taking insulin or monitoring blood sugar

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3e In terms of this facility’s discharge policy, do you discharge a

resident who...?

Needs daily monitoring for a health condition like assistance

taking insulin or monitoring blood sugar

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F _B1e = 2 or 3

F_B1f In terms of this facility’s admission policy, do you admit a

resident who...?

Is regularly incontinent of urine

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3f In terms of this facility’s discharge policy, do you discharge a

resident who...?

Is regularly incontinent of urine

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F B1f = 2 or 3

F_B1g In terms of this facility’s admission policy, do you admit a

resident who...?

Is regularly incontinent of feces

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3g In terms of this facility’s discharge policy, do you discharge a

resident who...?

Is regularly incontinent of feces

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1g = 2 or 3

F_B1h In terms of this facility’s admission policy, do you admit a

resident who...?

Is regularly incontinent of urine and feces

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities
Page 92 [ Series 1, No. 54

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F_B3h In terms of this facility’s discharge policy, do you discharge a

resident who...?

Is regularly incontinent of urine and feces

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1h = 2 or 3

F_B1i In terms of this facility’s admission policy, do you admit a

resident who...?

Needs two people to help them get in and out of bed or

needs a Hoyer lift to get in and out of bed

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3i In terms of this facility’s discharge policy, do you discharge a

resident who...?

Needs two people to help them get in and out of bed or

needs a Hoyer lift to get in and out of bed

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1i = 2 or 3

F_B1j In terms of this facility’s admission policy, do you admit a

resident who...?

Has a history of drug or alcohol abuse

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3j In terms of this facility’s discharge policy, do you discharge a

resident who...?

Abuses drugs or alcohol

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1j = 2 or 3

F_B1k In terms of this facility’s admission policy, do you admit a

resident who...?

Requires end of life care?

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

All

facilities

F_B3k_ In terms of this facility’s discharge policy, do you discharge a

resident who...?

Requires end of life care?

1 YES

2 NO

3 NO SPECIFIC POLICY—WE

MAKE DECISIONS ON A CASE

BY CASE BASIS

F_B1k = 2 or 3

F_B2 Are there any (other) reasons for which you would refuse to

admit someone?

1 YES

2 NO

All

facilities

F_B2sp What are these other reasons you would refuse to admit

someone?

SPECIFY F_B2 = 1

F_B4 Are there any (other) reasons for which you would discharge

someone?

1 YES

2 NO

All

facilities

F_B4sp What are those (other) reasons you would discharge

someone?

SPECIFY F_B4 = 1

F_B5Intro Does this facility provide any of the following services to

residents...?

1 CONTINUE All

facilities

F_B5a (Does this facility provide any of the following services to

residents...?)

Special diets

1 YES

2 NO

All

facilities

F_B5a1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5a = 1
Series 1, No. 54 [ Page 93

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F_B5b Does this facility provide...?

Assistance with activities of daily living

1 YES

2 NO

All

facilities

F_B5b1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5b = 1

F_B5c Does this facility provide...?

Assistance with a bath or shower at least once a week

1 YES

2 NO

All

facilities

F_B5c1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5c = 1

F_B5d Skilled nursing services are services that must be performed

by a registered nurse (RN), or a licensed practical nurse

(LPN) and are medical in nature.

Does this facility provide...?

Skilled nursing services

1 YES

2 NO

All

facilities

F_B5d1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5d = 1

F_B5e Does this facility provide...?

Basic health monitoring, such as blood pressure and weight

checks.

1 YES

2 NO

All

facilities

F_B5e1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5e = 1

F_B5f Does this facility provide...?

Social and recreational activities within the facility

1 YES

2 NO

All

facilities

F_B5f1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5f = 1

F_B5g Does this facility provide...?

Social and recreational activities outside the facility

1 YES

2 NO

All

facilities

F_B5g1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5g = 1

F_B5h Does this facility provide...?

Incontinence care

1 YES

2 NO

All

facilities

F_B5h1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5h = 1

F_B5i Does this facility provide...?

Transportation to medical or dental appointments

1 YES

2 NO

All

facilities
Page 94 [ Series 1, No. 54

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pattern

F_B5i1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5i = 1

F_B5j Does this facility provide...?

Transportation to stores and elsewhere

1 YES

2 NO

All

facilities

F_B5j1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5j = 1

F_B5k Does this facility provide...?

Personal laundry

1 YES

2 NO

All

facilities

F_B5k1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5k = 1

F_B5l Does this facility provide...?

Linen laundry services

1 YES

2 NO

All

facilities

F_B5l1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5l = 1

F_B5m Social services counseling is counseling related to obtaining

and keeping benefits provided by programs such as

Supplemental Security income, Social Security, and Medicaid.

Does this facility provide...?

Social services counseling

1 YES

2 NO

All

facilities

F_B5m1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5m = 1

F_B5n Case management is generally a process of assessment,

planning, and facilitation of options and services for an

individual. Does this facility provide...?

Case management

1 YES

2 NO

All

facilities

F_B5n1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5n = 1

F_B5o Does this facility provide...?

Occupational therapy

1 YES

2 NO

All

facilities

F_B5o1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5o = 1

F_B5p Does this facility provide...?

Physical therapy

1 YES

2 NO

All

facilities

F_B5p1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5p = 1
Series 1, No. 54 [ Page 95

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F_B5q Does this facility provide...?

Transportation to a sheltered workshop, work training

program or supported employment

1 YES

2 NO

All

facilities

F_B5q1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5q = 1

F_B5r Does this facility provide...?

Transportation to an education program

1 YES

2 NO

All

facilities

F_B5r1_1 Is this service provided by paid facility employees, other

types of workers, or both?

1 FACILITY EMPLOYEES

2 OTHER TYPES OF

WORKERS

3 BOTH

F_B5r = 1

F_B5_cable Does this facility offer...?

Cable TV access in resident (rooms/apartments/rooms and

apartments).

1 YES

2 NO

All

facilities

F_B5_tele Does this facility offer...?

A landline telephone in resident (rooms/apartments/rooms

and apartments).

1 YES

2 NO

All

facilities

F_B5_int Does this facility offer...?

Internet access in resident (rooms/apartments/rooms and

apartments).

1 YES

2 NO

All

facilities

F_B5s Does this facility have public internet access elsewhere in the

facility?

1 YES

2 NO

All

facilities

F_B5_

assist_a

HAND R SHOWCARD

Do any of the residents use...?

An amplifier for the telephone. Please do not include a

hearing aid.

1 YES

2 NO

All

facilities

F_B5_

assist_b

A telecommunications device for the deaf, or TDD, is an

electronic device for text communication via a telephone line,

used when one or more of the parties has hearing or speech

difficulties. It is also referred to as a TTY or teletype. Do any

of the residents use...?

TDD, TTY or teletype? Please do not include a hearing aid.

1 YES

2 NO

All

facilities

F_B5_

assist_c

Do any of the residents use...?

Any other types of assistive listening devices. Please do not

include a hearing aid.

1 YES

2 NO

All

facilities

F_B5_

assist_d

Do any of the residents use...?

Signaling devices—that is, devices that can visually alert the

hearing impaired person to auditory signals that may not be

heard.

1 YES

2 NO

All

facilities

F_B5_

assist_e

A communication board is another type of device sometimes

used by individuals with speech or hearing impairments. They

can be plain boards that you erase or have pictures or words

on them that the individual points to as a means of

communication.

Do any of the residents use...?

A communication board

1 YES

2 NO

All

facilities
Page 96 [ Series 1, No. 54

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F_B5_

assist_f

Do any of the residents use...?

Other equipment for people with hearing or speech

impairments? Please do not include a hearing aid.

1 YES

2 NO

All

facilities

F_B7a HAND R SHOWCARD

Do you or other staff assist residents with medications in any

of the following ways? Please tell me the numbers that apply

from this card.

1 PROVIDING A CENTRAL

LOCATION WHERE

MEDICATIONS ARE STORED

PRIOR TO ADMINISTRATION

TO RESIDENTS

2 PROVIDING MEDICATION

REMINDERS, FOR EXAMPLE,

PROMPTING THAT IT IS TIME

TO TAKE MEDICATIONS

3 DELIVERING PREPACKAGED UNIT DOSES

4 HELPING WITH,

ADMINISTRATION FOR

EXAMPLE, OPENING THE

BOTTLE AND HANDING THE

RESIDENT THE CORRECT

DOSE

5 HELPING THE RESIDENT

TAKE THE MEDICINE, FOR

EXAMPLE, PUTTING IT IN

THEIR MOUTH AND HANDING

THE RESIDENT A GLASS OF

WATER

6 PROVIDING OVERSIGHT

AND CUEING TO MAKE SURE

THE RESIDENT ACTUALLY

TAKES THE MEDICATION

7 ADMINISTERING DROPS,

TOPICAL OINTMENTS, ETC.

8 ADMINISTERING IV

MEDICATIONS

9 ADMINISTERING

INJECTIONS

10 OTHER TYPE OF

ASSISTANCE

11 FACILITY DOES NOT

ASSIST RESIDENTS WITH

MEDICATIONS

All

facilities

F_B7b HAND R SHOWCARD

Who passes or hands the residents their prescription

medications?

Passing medications includes the delivery of pre-packaged

doses or opening the bottle and handing the resident the

correct dose. Please tell me the numbers that apply from this

card.

1 RN

2 LPN

3 CERTIFIED MEDICATION

AIDE, MEDICATION

SUPERVISOR, OR

MEDICATION TECHNICIAN

4 PERSONAL CARE AIDE

5 OWNER, DIRECTOR,

ASSISTANT DIRECTOR, OR

MANAGER

6 OTHER

F_B7a = 3 or 4
Series 1, No. 54 [ Page 97

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F_B8 Who administers prescription medications to the residents?

Administering medications includes placing the medication in

residents’ mouths and handing them glasses of water, giving

injections, giving IV medications, or applying prescription

topical ointments and creams. Please tell me the numbers

that apply from this card.

1 RN

2 LPN

3 CERTIFIED MEDICATION

AIDE, MEDICATION

SUPERVISOR, OR

MEDICATION TECHNICIAN

4 PERSONAL CARE AIDE

5 OWNER, DIRECTOR,

ASSISTANT DIRECTOR, OR

MANAGER

6 OTHER

F_B7a = 5, 7, 8, or

9

F_B8_lic (Is this person a licensed nurse, certified medication aide,

medication supervisor, or medication technician/Are each of

these individuals licensed nurses,certified medication aides,

medication supervisor, or medication technician)?

1 YES

2 NO

(F_B8 is not only 1,

not only 2, and not

only 1 and 2) AND

(F_B7a = any

selection of 5, 7, 8

or 9.)

F_B9 Does the facility have a pharmacist or doctor, either on staff

or through a contract with an outside service provider, review

the medications that residents receive for appropriateness?

1 YES

2 NO

All

facilities

F_B10 Does this (residential care) facility ever use physical

restraints such as lap buddies, posey restraint, bed rails, or

Gerry chairs?

1 YES

2 NO

All

facilities

F_B11 Do facility staff regularly give drugs to any resident to control

behavior or to reduce agitation?

This includes drugs prescribed by a physician or other

medical provider.

1 YES

2 NO

All

facilities

F_B12Intro The next series of questions are about charges to the

resident.

1 CONTINUE All

facilities

F_B12a How is the base rate structured? Does this facility offer a flat

base rate or is there a rate that varies by disability or

services received? Do not include variations in charges by

room type or size.

1 FLAT BASE RATE

2 BASE RATE VARIES BY

DISABILITY

All

facilities

F_B12b Can the residents obtain additional services, beyond the base

rate, on a fee-for-service basis?

1 YES

2 NO

All

facilities

F_B13 Is a security deposit required? 1 YES

2 NO

All

facilities

F_B14 Does this facility charge an entrance fee prior to moving in? 1 YES

2 NO

All

facilities

F_B15Intro The next questions are about the average monthly base rate

for (the room/the apartment/both the room and apartment)

rent and the services.

IF NEEDED: If two people are living in the same room and

are related, please compute the average as if only one

person lived in the room.

1 CONTINUE All

facilities

F_B15a1 What is the average monthly base rate for a single individual

living in a studio apartment (for a regular, non-Alzheimer’s

unit)?

0–9995 F_ANEW1=4&

F_S3a = 2

F_B15a2 What is the average monthly base rate for a single individual

living in a studio apartment for an Alzheimer’s unit?

0–9995 F_ANEW1=4&

F_S3A or

F_A58 = 1

F_B15b1 What is the average monthly base rate for a single individual

living in a 1-bedroom apartment (for a regular, nonAlzheimer’s unit)?

0–9995 F_ANEW1=5&

F_S3a = 2
Page 98 [ Series 1, No. 54

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F_B15b2 What is the average monthly base rate for a single individual

living in a 1-bedroom apartment for an Alzheimer’s unit?

0–9995 F_ANEW1=5&

F_S3A or

F_A58 = 1

F_B15c1 What is the average monthly base rate for a single individual

living in a 2-bedroom apartment (for a regular, nonAlzheimer’s unit)?

0–9995 F_ANEW1=6&

F_S3a = 2

F_B15c2 What is the average monthly base rate for a single individual

living in a 2-bedroom apartment for an Alzheimer’s unit?

0–9995 F_ANEW1=6&

F_S3A or

F_A58 = 1

F_B15c3 What is the average monthly base rate for a single individual

living in a 3-bedroom apartment (for a regular, nonAlzheimer’s unit)?

0–9995 F_ANEW1=7&

F_S3a = 2

F_B15c4 What is the average monthly base rate for a single individual

living in a 3-bedroom apartment for an Alzheimer’s unit?

0–9995 F_ANEW1=7&

F_S3A or F_A58 =

1

F_B15d1 What is the average monthly base rate for a single individual

living in a room designed for one person (for a regular,

non-Alzheimer’s unit)?

0–9995 F_ANEW1 = 1&

F_S3a = 2

F_B15d2 What is the average monthly base rate for a single individual

living in a room designed for one person for an Alzheimer’s

unit?

0–9995 F_ANEW = 1 &

F_S3A or F_A58 =

1

F_B15e1 What is the average monthly base rate for a single individual

living in a room designed for two persons (for a regular,

non-Alzheimer’s unit)?

0–9995 F_ANEW1=2&

F_S3a = 2

F_B15e2 What is the average monthly base rate for a single individual

living in a room designed for two persons for an Alzheimer’s

unit?

0–9995 F_ANEW = 2 &

F_S3A or F_A58 =

1

F_B15f1 What is the average monthly base rate for a single individual

living in a room for three or more residents (for a regular,

non-Alzheimer’s unit)?

0–9995 F_ANEW1=3&

F_S3a = 2

F_B15f2 What is the average monthly base rate for a single individual

living in a room for three or more residents for an Alzheimer’s

unit?

0–9995 F_ANEW = 3 &

F_S3A or F_A58 =

1

F_B16Intro HAND R SHOWCARD

For the next questions, please tell me if the following services

provided by this facility are included in the base rate or

provided at an extra charge.

1 CONTINUE All

facilities

F_B16b Is assistance with activities of daily living included in the base

rate or provided at an extra charge?

1 INCLUDED IN BASE RATE

2 PROVIDED AT EXTRA

CHARGE

F_B5b = 1

F_B16c Is assistance with a bath or shower at least once a week

included in the base rate or provided at an extra charge?

1 INCLUDED IN BASE RATE

2 PROVIDED AT EXTRA

CHARGE

FB5c = 1

F_B16d Are skilled nursing services included in the base rate or

provided at an extra charge?

1 INCLUDED IN BASE RATE

2 PROVIDED AT EXTRA

CHARGE

FB5d = 1

F_B16h Is incontinence care included in the base rate or provided at

an extra charge?

1 INCLUDED IN BASE RATE

2 PROVIDED AT EXTRA

CHARGE

F_B5h = 1

F_B16i Is transportation to medical or dental appointments included

in the base rate or provided at an extra charge?

1 INCLUDED IN BASE RATE

2 PROVIDED AT EXTRA

CHARGE

F_B5i = 1
Series 1, No. 54 [ Page 99

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F_B16o Is occupational therapy included in the base rate or provided

at an extra charge?

CODE ALL THAT APPLY

1 INCLUDED IN BASE RATE

2 PROVIDED AT EXTRA

CHARGE

F_B5o = 1

F_B16p Is physical therapy included in the base rate or provided at

an extra charge?

CODE ALL THAT APPLY

1 INCLUDED IN BASE RATE

2 PROVIDED AT EXTRA

CHARGE

F_B5p = 1

F_B17 Are privately hired nurses, aides, or private duty nurses

permitted to provide services to residents?

1 YES

2 NO

All

facilities

F_B18 How many meals are included in the base rate? 1 ONE MEAL PER DAY

2 TWO MEALS PER DAY

3 THREE MEALS PER DAY

4 NO MEALS PROVIDED

All

facilities

F_B19 Are residents required to eat during a scheduled meal time? 1 YES

2 NO

All

facilities

F_B20 Are residents required to eat meals in a specific location like

a dining room?

1 YES

2 NO

All

facilities

F_B21 Does this facility have residents who speak limited or no

English?

1 YES

2 NO

All

facilities

F_B22 How do staff communicate with these residents? 1 CAREGIVERS ALSO SPEAK

THEIR LANGUAGE

2 RELY ON FAMILY MEMBERS

TO TRANSLATE

3 USE A TRANSLATION

SERVICE

4 NON-VERBAL CUEING/HAND

SIGNS/GESTURES

5 OTHER METHOD

F_B21 = 1

F_C1_Intro INTERVIEWER:

ARE YOU SPEAKING WITH THE...?

1 HIGHEST RANKING

ADMINISTRATOR OR

DIRECTOR OF THE

RESIDENTIAL CARE PORTION

OF THIS FACILITY

2 SOMEONE OTHER THAN

THE HIGHEST RANKING

ADMINISTRATOR OR

DIRECTOR OF THE

RESIDENTIAL CARE PORTION

OF THIS FACILITY

All

facilities

F_C1 How long have you worked at this facility as the administrator

or director? Please include the total time worked even if you

have left the facility and then returned.

YEARS

MONTHS

F_C1_Intro = 1

F_C2 How long, in total, have you worked at this and other

residential care facilities or nursing homes in an

administrative position?

YEARS

MONTHS

F_C1_Intro = 1

F_C3 Do you have a certificate or license related to managing

facilities for older people?

1 YES

2 NO

All

facilities

F_C4 HAND R SHOWCARD

What position(s) do you hold at this facility?

1 Owner or Operator

2 Administrator, Manager, or

Director

3 Supervisor-in-charge

4 Wellness Director

5 Director of Nursing

6 Other

F_C1_Intro = 2

F_C4_OTH What other position do you hold at this facility? SPECIFY F_C3 = 6
Page 100 [ Series 1, No. 54

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asked

Skip

pattern

F_C5 How long has the director or administrator worked at this

facility as the administrator? Please include the cumulative

time worked even if they have left the facility and then

returned.

SPECIFY F_C1_Intro = 2

F_C6 Does the director or administrator have a certificate or license

related to managing facilities for older people?

1 YES

2 NO

F_C1_Intro = 2

F_D1_Intro Please answer the last few questions about the highest

ranking administrator or director of this residential care

facility.

1 CONTINUE All

facilities

F_D1 What is the gender of the director or administrator? 1 MALE

2 FEMALE

All

facilities

F_D2 HAND R SHOWCARD

Please look at this card and tell me which range includes the

administrator or director’s age.

1 18–29

2 30–39

3 40–49

4 50–59

5 60–69

6 70 or older

All

facilities

F_D3 Is the administrator or director of Hispanic, Latino, or Spanish

origin or descent?

1 YES

2 NO

All

facilities

F_D4 HAND R SHOWCARD

Which of these groups best describes the administrator or

director?

You may select more than one category.

1 WHITE OR CAUCASIAN

2 BLACK OR AFRICAN

AMERICAN

3 ASIAN

4 NATIVE HAWAIIAN OR

OTHER PACIFIC ISLANDER

5 AMERICAN INDIAN OR

ALASKA NATIVE

All

facilities

F_D5 What is the highest grade or level of education the

administrator or director completed?

Less than high school

High school graduate or GED

Vocational, trade school, or technical school graduate

Some college

College graduate

Post graduate

1 Less than high school

2 High school graduate or GED

3 Vocational, trade school, or

technical school graduate

4 Some college

5 College graduate

6 Post graduate

All

facilities

F_D6a In the near future you may receive a telephone call from my

supervisor at RTI International. This call is designed to verify

the quality of my work and will only take a few minutes of

your time.

1 CONTINUE All

facilities

F_D6 Thank you, those are all the questions for this Facility section

of the interview.

1 CONTINUE All

facilities
Series 1, No. 54 [ Page 101

Appendix XIX. NSRCF Resident Selection Questionnaire

Question

number Resident selection question item Code categories

Facility

asked

Skip

pattern

P_CHECK INTERVIEWER:

ENTER WHAT STAGE YOU HAVE REACHED IN

INTERVIEWING THIS FACILITY.

1 STARTED/COMPLETED

FACILITY QUESTIONNAIRE

—WROTE DOWN # OF BEDS

2 STARTED/COMPLETED

FACILITY QUESTIONNAIRE

—DID NOT WRITE DOWN # OF

BEDS

3 HAVE NOT STARTED THE

FACILITY QUESTIONNAIRE

All

facilities

P_FA1 I will now re-ask a question I asked earlier. This is because

the information is needed for this next part of the interview.

At this facility, what is the number of licensed, registered, or

certified residential care beds? Include both occupied and

unoccupied beds.

1–995

NUMBER OF BEDS

IF P_CHECK = 2

INTERVIEWER:

IF YOU WROTE DOWN THE NUMBER OF LICENSED,

REGISTERED, OR CERTIFIED RESIDENTIAL CARE BEDS

WHEN ADMINISTERING THE FACILITY QUESTIONNAIRE

(F_A1), RECORD THE NUMBER OF BEDS HERE. YOU DO

NOT NEED TO ASK THE QUESTION FOR P_FA1

1–995

NUMBER OF BEDS

IF P_CHECK = 1

At this facility, what is the number of licensed, registered, or

certified residential care beds? Include both occupied and

unoccupied beds.

1–995

NUMBER OF BEDS

IF P_CHECK = 3

P_FA1a ASK ONLY IF P_FA1 = DK (CAN’T ANSWER IN BEDS

BECAUSE FACILITY IS LICENSED BY THE NUMBER OF

ROOMS /APARTMENTS)

Thank you. In that case, at this facility what is the number of

licensed, registered or certified rooms or apartments where

residents live? Exclude rooms within apartments.

1–995

NUMBER OF ROOMS/

APARTMENTS

IF P_FA1 = DK

P_FA1_

CONFIRM

You reported that this facility has less than 4 beds. Is this

correct?

[If NO, CORRECT P_FA1]

1 YES

2 NO

If P_FA1<4

P_FA1_

ABORT

I am sorry but your facility is not eligible for this study. Thank

you for your time.

If P_FA1_

CONFIRM = 1

P_INTRO_A To help make a random selection of residents for our resident

interviews, can you tell me the number of residents living in

this residential care facility as of midnight yesterday?

A MINIMUM OF ONE (1) RESIDENT IS REQUIRED TO

CONTINUE.

1–995

NUMBER OF RESIDENTS

IF P_CHECK = 1

P_INTRO_B I will be able to complete the interviews about the residents

now and come back to complete the facility information later.

I’ll need your help for a few more minutes right now.

What is the current number of residents living at this

residential care facility as of midnight yesterday?

A MINIMUM OF ONE (1) RESIDENT IS REQUIRED TO

CONTINUE.

1–995

NUMBER OF RESIDENTS

IF P_CHECK = 2
Page 102 [ Series 1, No. 54

Question

number

P_INTRO_C

P_INTRO_

Resident selection question item

In order to obtain national level data about the residents of

residential care facilities such as this one, we are collecting

information from a sample of current residents. I will be

asking questions about the background, health status, and

charges for each sampled resident. I will need your help for a

few minutes right now.What is the current number of

residents living at this residential care facility as of midnight

yesterday?

A MINIMUM OF ONE (1) RESIDENT IS REQUIRED TO

CONTINUE.

The next process is sampling the residents. In order to

Code categories

1–995

NUMBER OF RESIDENTS

1 YES

Facility

asked

Skip

pattern

IF P_CHECK = 3

If SCREENER.S_

OTHER

P_INTRO_

protect the confidentiality of your residents, I will need to

work with someone who can best assist with selecting the

sample from a list and locating staff who are familiar with the

sampled residents. Are you the best person to help WITH the

resident sampling process?

INTERVIEWER:

ASK FOR A SUBSTITUTE IF ONE IS AVAILABLE, TO

ANSWER THESE QUESTIONS.

We’ll begin by selecting a sample of your residents. Because

2 NO

1 CONTINUE All

17 = 2

START this is a statistical survey, I will need to follow procedures to

do this. To start, I will ask you to provide a list of the current

residents as of midnight yesterday. The sampling procedures

do not require the full name of the residents. I will only record

the initials of each resident. Each resident should be listed on

a separate line.

Then, I will briefly review the list with you. Finally after I enter

the total number of current residents, the computer program

will randomly choose which residents we will include in the

sample.

eligible

facilities

P_CONFIRM

P_ENUME

INTERVIEWER:

WHEN YOU GET THE LIST FROM THE RESPONDENT,

READ:

I just need to confirm that this is a complete list of all the

residents as of midnight yesterday.

INTERVIEWER:

LOOK AT THE LIST TOGETHER WITH THE RESPONDENT.

Please take a moment to check for anyone on the list who

was not a resident as of midnight yesterday or who is

younger than 18 years old. Also check for new residents who

might not be on the list but were admitted before midnight

yesterday.

To the best of your knowledge, is this list complete and

accurate?

INTERVIEWER:

IF NO, ASK THE RESPONDENT TO MAKE ANY

ADJUSTMENTS NECESSARY TO THE LIST. YOU WILL

NOT BE ABLE TO PROCEED UNTIL THE LIST IS

CORRECT AND THE RESPONSE IS YES.

NUMBER THE RESIDENTS BEGINNING WITH 1. IF THERE

1 YES

2 NO

1 CONTINUE

All

eligible

facilities

All

RATE ARE MULTIPLE PAGES OF RESIDENTS, THEN CONTINUE

NUMBERING THE NEXT PAGE WHERE YOU LEFT OFF.

THE PROGRAM WILL MAKE A RANDOM SELECTION

WHICH WILL REFER TO YOUR PERSON-LEVEL

NUMBERING.

eligible

facilities
Series 1, No. 54 [ Page 103

Question

number

P_ASK_R

Resident selection question item

I have counted {in line} on the list. Would you say that is an

accurate number of residents?

INTERVIEWER:

IF THE RESPONSE IS NO THEN CORRECT AND

RENUMBER THE LIST BEFORE ENTERING YES TO

CONTINUE.

Code categories

1 YES

2 NO

Facility

asked

All

eligible

facilities

Skip

pattern

P_NUM_R ENTER THE TOTAL NUMBER OF RESIDENTS ON THE

CONFIRMED LIST.

IF THE TOTAL NUMBER OF RESIDENTS IS 0, BREAKOFF

THE INTERVIEW.

1–995

NUMBER OF RESIDENTS

All

eligible

facilities

P_End PRESS ‘‘1’’ TO CONTINUE. 1 CONTINUE All

eligible

facilities

S_Start

S_CHOOSE_

R

S_RESIDENT

ID

S_THANKU

PRESS ‘‘1’’ TO SELECT RESIDENTS AT THIS FACILITY.

INTERVIEWER:

THIS DISPLAY TELLS YOU WHICH ARE YOUR SELECTED

CASES.

NOW SAY TO YOUR RESPONDENT:

The computer program has identified the following residents

[READ RESIDENTS SELECTED]. To complete interviews

about these selected residents, I would like to speak with a

caregiver who knows about them. Our Resident

Questionnaire asks about services provided to the resident

and a little about his or her background. I can interview

different caregivers for different residents. I would like your

help arranging to speak with the caregiver in a private place

or some place where we won’t be disturbed. The Resident

Questionnaire takes about 20 minutes for each selected

resident.

It will also be helpful if the resident records for each of the

residents selected could be retrieved before we begin these

interviews.

Here I will record a description of our selected residents.

INTERVIEWER:

ENTER THE FIRST AND LAST INITIALS OF THE SAMPLED

RESIDENTS. NO OTHER INFORMATION ABOUT THE

RESIDENTS SHOULD BE ENTERED HERE.

Thank you, now we can proceed with the Resident portion of

the study.

1 CONTINUE

1 CONTINUE

RESIDENT INITIALS

1 CONTINUE

All

eligible

facilities

All

eligible

facilities

All

eligible

facilities

All

eligible

facilities
Page 104 [ Series 1, No. 54

Appendix XX. NSRCF Resident Questionnaire

Question

number Question item Code categories

Resident

asked

Skip

pattern

R_A_INTRO1 In order to obtain national level data about the residents of

residential care facilities such as this one, we are collecting

information from a sample of current residents. I will be

asking questions about the background, health status, and

charges for each sampled resident. The information you

provide will be held in strict confidence and will be used only

by persons involved in the survey and only for the purpose of

the survey. The interview for each of the selected residents

should take about 20 minutes to complete.

1 CONTINUE All

residents

R_A_INTRO

1A

Now I am going to ask questions about the following

resident—[RESIDENT INITIALS].

1 CONTINUE All

residents

R_A_INTRO

2

Do you have the resident records for [RESIDENT INITIALS]?

(You may want to use the resident file in answering a few of

the questions in this survey. If you have not retrieved the

records and would like to do so now, I can wait a few

minutes while you obtain them.)

1 RECORD OBTAINED

2 RECORD NOT OBTAINED

All

residents

R_A1 Please tell me [RESIDENT INITIALS] gender? 1 MALE

2 FEMALE

All

residents

R_A3 Is [RESIDENT INITIALS] of Hispanic, Latino, or Spanish

origin or descent?

1 YES

2 NO

All

residents

R_A2 Please tell me [RESIDENT INITIALS] age? 0–120 All

residents

ENDINT I am sorry but our survey is about residents that are 18 or

older.

Since this person is not eligible, I won’t complete an interview

for this particular resident. I need to check my records for any

other selected residents for whom you were identified as a

caregiver.

1 CONTINUE R_A2 = < 18

R_A4 HAND R SHOWCARD

Which one or more of the following would you say is

[RESIDENT INITIALS] race?

SELECT ALL THAT APPLY

1 WHITE/CAUCASIAN

2 BLACK OR AFRICAN

AMERICAN

3 ASIAN

4 HAWAIIAN OR OTHER

PACIFIC ISLANDER

5 AMERICAN INDIAN OR

ALASKA NATIVE

All

residents

R_A5 What is the highest grade or level of education [RESIDENT

INITIALS] completed...?

High school or less or

Some college or more

1 High school or less

2 Some college or more

All

residents

R_A6 Is [RESIDENT INITIALS] currently married, divorced, legally

separated, widowed, or never married?

1 Married

2 Divorced

3 Legally separated

4 Widowed

5 Never married

All

residents
Series 1, No. 54 [ Page 105

Question

number Question item Code categories

Resident

asked

Skip

pattern

R_A7 How well does [RESIDENT INITIALS] speak English...?

Excellent

very well

well

fair

poor or not at all

1 Excellent

2 Very well

3 Well

4 Fair

5 Poor or not at all

6 DOES NOT SPEAK BECAUSE

OF A DISABILITY, OR SEVERE

DEMENTIA

All

residents

R_A8a Overall, is [RESIDENT INITIALS] health...?

Excellent

very good

good

fair or

poor

1 Excellent

2 Very Good

3 Good

4 Fair

5 Poor

All

residents

R_A9 HAND R SHOWCARD

Which of these places best describes [RESIDENT INITIALS]

living quarters?

1 ROOM DESIGNED FOR ONE

PERSON

2 ROOM DESIGNED FOR TWO

PERSONS

3 ROOM DESIGNED FOR

THREE OR MORE PERSONS

4 STUDIO APARTMENT

5 ONE BEDROOM APARTMENT

6 TWO BEDROOM

APARTMENT

7 THREE BEDROOM

APARTMENT

All

residents

R_A10 Does [RESIDENT INITIALS] currently share this (room/

apartment) with another person?

1 YES

2 NO

All

residents

R_A11 Is this person [RESIDENT INITIALS] spouse or other

relative?

1 YES

2 NO

If R_A10 = 1

R_A12 How many other residents not counting [RESIDENT

INITIALS] live in the (room/apartment)?

1 ONE OTHER PERSON

2 TWO OR MORE OTHER

PERSONS

If R_A10 = 1

R_A13 Does [RESIDENT INITIALS] live in a Dementia/Alzheimer’s

Special Care Unit?

1 YES

2 NO

3 FACILITY DOES NOT HAVE

DEMENTIA/ ALZHEIMERS UNIT

All

residents

New question HAND R SHOWCARD

Which of the following are located inside [RESIDENT

INITIALS] (room/apartment)?

SELECT ALL THAT APPLY

1 MICROWAVE

2 COOK TOP OR HOT PLATE

3 OVEN

4 REFRIGERATOR

5 KITCHEN SINK

6 NONE OF THE ABOVE

All

residents

R_A15 Does [RESIDENT INITIALS] (room/apartment) have a door to

the hallway that can be locked from the inside?

1 YES

2 NO

All

residents

R_A15A Does [RESIDENT INITIALS] (room/apartment) have a

bathroom located inside the (room/apartment) or between

(rooms/apartments)?

1 YES

2 NO

All

residents

R_A15Bath HAND R SHOWCARD

Which type of bathroom is in [RESIDENT INITIALS]

(room/apartment)

1 FULL BATHROOM

INCLUDING A TOILET, SINK,

AND SHOWER OR TUB

2 HALF-BATH INCLUDING A

SINK AND TOILET

If R_A15A = 1
Page 106 [ Series 1, No. 54

Question

number Question item Code categories

Resident

asked

Skip

pattern

R_A16 HAND R SHOWCARD

Please read this list of activities and tell me whether

[RESIDENT INITIALS] regularly participates in any of these

at least twice a month, regardless of whether or not it is

arranged by the facility.

SELECT ALL THAT APPLY

1 CARDS, BOARD GAMES,

BINGO, PUZZLES

2 ARTS OR CRAFTS, SUCH AS

SEWING, KNITTING, PAINTING,

QUILTING, FLOWER

ARRANGING

3 EXERCISE OR SPORTS

4 PLAYING OR LISTENING TO

MUSIC, OR SINGING

5 READING OR WRITING

6 SPIRITUAL OR RELIGIOUS

ACTIVITIES

7 SHOPPING OR TRIPS

8 WATCHING TELEVISION

9 LEAVING THE FACILITY

GROUNDS

10 TALKING WITH FRIENDS

OR RELATIVES

11 GOING OUT TO THE

MOVIES, DINING OUT OR

OTHER SOCIAL ACTIVITIES

12 GARDENING

13 TAKING CARE OF PETS

14 OTHER HOBBIES OR

ACTIVITIES

15 NONE OF THE ABOVE

All

residents

R_A16_ HAND R SHOWCARD 1 WORK AT A JOB FOR PAY All

outside Does [RESIDENT INITIALS] go outside the facility to do any

of the following activities?

SELECT ALL THAT APPLY

2 PARTICIPATE IN A

SHELTERED WORKSHOP

3 PARTICIPATE IN A WORK

TRAINING PROGRAM

4 ATTEND DAY PROGRAMS

FOR SOCIAL OR

RECREATIONAL ACTIVITIES

5 ATTEND AN EDUCATIONAL

PROGRAM

6 ATTEND AN ADULT DAY

CARE PROGRAM

7 NONE OF THE ABOVE

residents

R_A17 Does [RESIDENT INITIALS] still drive? 1 YES

2 NO

All

residents

R_A18 How often does [RESIDENT INITIALS] drive? 1 Daily or every other day If R_A17 = 1

Daily or every other day 2 Once or twice a week

Once or twice a week or

Less than once per week

3 Less than once per week

R_B1Month When did [RESIDENT INITIALS] first move into this facility? 1 January All

MONTH 2 February residents

3 March

4 April

5 May

6 June

7 July

8 August

9 September

10 October

11 November

12 December

R_B1Year (When did [RESIDENT INITIALS] first move into this facility?)

YEAR

1970–2010 All

residents
Series 1, No. 54 [ Page 107

Question

number Question item Code categories

Resident

asked

Skip

pattern

R_B1Range HAND R SHOWCARD

Please look at this card and tell me approximately how long it

has been since [RESIDENT INITIALS] first moved into this

facility?

1 0 TO 3 MONTHS

2 MORE THAN 3 MONTHS TO

6 MONTHS

3 MORE THAN 6 MONTHS TO

1 YEAR

4 MORE THAN 1 YEAR TO 3

YEARS

5 MORE THAN 3 YEARS TO 5

YEARS

6 MORE THAN 5 YEARS

If R_B1Year = DK

R_B2 When [RESIDENT INITIALS] first moved into this facility, was

(he/she) directly admitted from a short-term stay at a:

READ CHOICES

hospital

rehabilitation facility

nursing home

1 Hospital

2 Rehabilitation facility

3 Nursing home

4 NONE OF THE ABOVE

All

residents

R_B3 HAND R SHOWCARD

Where did (he/she) live prior to (his/her) (moving to this

facility/stay at the (hospital/rehabilitation facility/nursing

home))?

1 PRIVATE HOME,

APARTMENT, RENTED ROOM,

OR FAMILY RESIDENCE

2 DIFFERENT RESIDENTIAL

CARE, ASSISTED LIVING, OR

GROUP HOME FACILITY

3 RETIREMENT OR

INDEPENDENT LIVING

COMMUNITY

4 NURSING HOME (THIS

EXCLUDES SHORT NURSING

HOME STAYS FOR

REHABILITATION)

5 PSYCHIATRIC FACILITY

6 JAIL

7 HOMELESS

8 OTHER

All

residents

R_B4 For last month, what was the total charge for [RESIDENT

INITIALS] to live in this facility? Include the basic monthly

charge and charges for any additional services.

0–8000 All

residents

R_B5 During the last 30 days did [RESIDENT INITIALS] have any

of (his/her) long-term care services at this facility paid by

Medicaid?

1 YES

2 NO

All

residents

R_B6 Is [RESIDENT INITIALS] a veteran of U.S. Military service? 1 YES

2 NO

All

residents

R_B6a Is [RESIDENT INITIALS] the spouse, or widow/widower, of a

veteran of U.S. Military service?

1 YES

2 NO

All

residents

R_C_INTRO The next questions are about [RESIDENT INITIALS] health

status and physical functioning.

1 CONTINUE All

residents
Page 108 [ Series 1, No. 54

Question

number Question item Code categories

Resident

asked

Skip

pattern

R_C1 HAND R SHOWCARD

As far as you know, has a doctor or other health professional

ever diagnosed [RESIDENT INITIALS] with any of the

following conditions? Please tell me the numbers that apply

from this card.

SELECT ALL THAT APPLY

1 ALZHEIMER’S DISEASE OR

OTHER DEMENTIA

2 ANEMIA

3 ARTHRITIS OR RHEUMATOID

ARTHRITIS

4 ASTHMA

5 CANCER OR MALIGNANT

NEOPLASM OF ANY KIND

6 CEREBRAL PALSY

7 CHRONIC BRONCHITIS

8 CONGESTIVE HEART

FAILURE

9 COPD

10 CORONARY HEART

DISEASE

11 DEPRESSION

12 DIABETES

13 EMPHYSEMA

14 GLAUCOMA

15 GOUT, LUPUS, OR

FIBROMYALGIA

16 HEART ATTACK

(MYOCARDIAL INFARCTION)

17 HIGH BLOOD PRESSURE

OR HYPERTENSION

18 INTELLECTUAL OR

DEVELOPMENTAL

DISABILITIES SUCH AS

MENTAL RETARDATION,

SEVERE AUTISM, OR DOWN

SYNDROME

19 KIDNEY DISEASE

20 MACULAR DEGENERATION

21 MUSCULAR DYSTROPHY

22 NERVOUS SYSTEM

DISORDERS, INCLUDING

MULTIPLE SCLEROSIS,

PARKINSON’S DISEASE, AND

EPILEPSY

23 OSTEOPOROSIS

24 OTHER MENTAL,

EMOTIONAL OR NERVOUS

CONDITION

25 PARTIAL OR TOTAL

PARALYSIS

26 SERIOUS MENTAL

PROBLEMS SUCH AS

SCHIZOPHRENIA OR

PSYCHOSIS

27 SPINAL CORD INJURY

28 STROKE

29 TRAUMATIC BRAIN INJURY

30 ANY OTHER KIND OF

HEART CONDITION OR HEART

DISEASE (OTHER THAN

LISTED ABOVE)

31 OTHER

32 NONE OF THESE

All

residents

R_C1OTH Specify other condition. SPECIFY R_C1 = 31
Series 1, No. 54 [ Page 109

Question

number Question item Code categories

Resident

asked

Skip

pattern

R_C1_Cancer What kind of cancer?

SELECT ALL THAT APPLY

1 BLADDER

2 BLOOD

3 BONE

4 BRAIN

5 BREAST

6 CERVIX

7 COLON

8 ESOPHAGUS

9 GALLBLADDER

10 KIDNEY

11 LARYNX, WINDPIPE

12 LEUKEMIA

13 LIVER

14 LUNG

15 LYMPHOMA

16 MELANOMA

17 MOUTH, TONGUE, OR LIP

18 OVARY

19 PANCREAS

20 PROSTATE

21 RECTUM

22 SKIN, NON-MELANOMA

23 SKIN, DON’T KNOW WHAT

KIND

24 SOFT TISSUE (MUSCLE OR

FAT)

25 STOMACH

26 TESTIS

27 THROAT, PHARYNX

28 THYROID

29 UTERUS

30 OTHER

R_C1 = CANCER

R_C1FLU1 HAND R SHOW CARD

Please look at this card and tell me which category best

describes [RESIDENT INITIALS] documented vaccination

status for a flu shot during the past 12 months.

1 VACCINATED WHILE

RESIDING AT THIS FACILITY

2 VACCINATED BEFORE

ADMISSION TO THIS FACILITY

3 NOT VACCINATED IN PAST

12 MONTHS—NO RECORD OF

DOCTOR’S ORDER OR OF

VACCINATION OFFERED

4 NOT VACCINATED IN PAST

12 MONTHS—VACCINATION

MEDICALLY

CONTRAINDICATED

5 NOT VACCINATED IN PAST

12 MONTHS—RESIDENT/

FAMILY REFUSED

VACCINATION

6 NOT VACCINATED IN PAST

12 MONTHS—OTHER REASON

7 NOT VACCINATED IN PAST

12 MONTHS—REASON

UNKNOWN

8 DID NOT RESIDE IN THE

FACILITY DURING THE MOST

RECENT FLU SEASON

All

residents
Page 110 [ Series 1, No. 54

Question

number Question item Code categories

Resident

asked

Skip

pattern

R_C1FLU2 HAND R SHOW CARD

Which statement on this card best describes the documented

vaccination status for whether [RESIDENT INITIALS] has

ever had a pneumococcal vaccine?

1 VACCINATED WHILE

RESIDING AT THIS FACILITY

2 VACCINATED BEFORE

ADMISSION TO THIS FACILITY

3 NEVER VACCINATED—NO

RECORD OF DOCTOR’S

ORDER OR OF VACCINATION

OFFERED

4 NEVER VACCINATED—

VACCINATION MEDICALLY

CONTRAINDICATED

5 NEVER VACCINATED—

RESIDENT/FAMILY REFUSED

VACCINATION

6 NEVER VACCINATED—

OTHER REASON

7 NEVER VACCINATED—

REASON UNKNOWN

All

residents

R_C1_

impair_4

HAND R SHOWCARD

Which statement on this card best describes [RESIDENT

INITIALS] hearing without a hearing aid?

1 HEARING IS GOOD

2 HAS A LITTLE TROUBLE

HEARING

3 HAS A LOT OF TROUBLE

HEARING

4 DEAF

All

residents

R_C1_

impair_6

Is [RESIDENT INITIALS] blind in both eyes or unable to see? 1 YES

2 NO

All

residents

R_C1_

impair_5

Does [RESIDENT INITIALS] have any trouble seeing even

when wearing glasses or contact lenses

1 YES

2 NO

R_C1_impair_

6=2

R_C2a These next questions refer to the (past 12 months/# of

months since [RESIDENT INITIALS] moved into this

residential care facility).

During this time, has [RESIDENT INITIALS] been treated in a

hospital emergency room?

1 YES

2 NO

All

residents

R_C2b (This question refers to the (past 12 months/# of months

since [RESIDENT INITIALS] moved into this residential care

facility).)

During this time, has [RESIDENT INITIALS] been a patient in

a hospital overnight or longer (excluding trips to the

emergency room that did not result in a hospital stay)?

1 YES

2 NO

All

residents

R_C2c (This question refers to the (past 12 months/# of months

since [RESIDENT INITIALS] moved into this residential care

facility).)

During this time has [RESIDENT INITIALS] had a stroke?

1 YES

2 NO

All

residents

R_C2d (This question refers to the (past 12 months/# of months

since [RESIDENT INITIALS] moved into this residential care

facility).)

During this time has [RESIDENT INITIALS] had a heart

attack?

1 YES

2 NO

All

residents

R_C2e (This question refers to the (past 12 months/# of months

since [RESIDENT INITIALS] moved into this residential care

facility).)

During this time has [RESIDENT INITIALS] had a fall that

caused a hip fracture?

1 YES

2 NO

All

residents
Series 1, No. 54 [ Page 111

Question

number Question item Code categories

Resident

asked

Skip

pattern

R_C2f (This question refers to the (past 12 months/# of months

since [RESIDENT INITIALS] moved into this residential care

facility).)

During this time has [RESIDENT INITIALS] had a fall that

caused an injury other than a hip fracture?

1 YES

2 NO

All

residents

R_C2g (This question refers to the (past 12 months/# of months

since [RESIDENT INITIALS] moved into this residential care

facility).)

During this time has [RESIDENT INITIALS] had a stay in a

nursing home?

1 YES

2 NO

All

residents

R_C2i During the (past 12 months/# months since [RESIDENT

INITIALS] moved into this residential care facility).

During this time, has [RESIDENT INITIALS] had a stay in a

rehabilitation facility?

1 YES

2 NO

All

residents

R_C3 During the (past 12 months/# months since [RESIDENT

INITIALS] moved into this residential care facility).

How many times has [RESIDENT INITIALS] been treated in

a hospital emergency room over this period?

1–35 R_C2a = 1

R_C4 HAND R SHOWCARD

Does [RESIDENT INITIALS] currently use any of the items

listed on this card?

SELECT ALL THAT APPLY

1 DENTURES, INCLUDING A

PARTIAL PLATE

2 GLASSES OR CONTACT

LENSES

3 HEARING AID

4 CANE, INCLUDING A TRIPOD

CANE

5 WALKER

6 MANUAL WHEEL CHAIR

7 ELECTRIC OR MOTORIZED

WHEEL CHAIR OR SCOOTER

8 OXYGEN

9 COMMUNICATION BOARD

OR OTHER APPLIANCE TO

COMMUNICATE

10 ARTIFICIAL LIMB

11 NONE OF THE ABOVE

All

residents

R_C4a Does [RESIDENT INITIALS] currently use telescopic lenses,

Braille, readers, a guide dog, white cane, or any other

equipment for people with severe visual impairments?

1 YES

2 NO

R_C1_impair_ 6 =

1

R_C5a Is [RESIDENT INITIALS] limited in any way because of

difficulty remembering or because [RESIDENT INITIALS]

experiences periods of confusion?

1 YES

2 NO

All

residents

R_C5 During the last 7 days, has [RESIDENT INITIALS] given

evidence of a problem with short-term memory, such as

difficulty remembering what (he/she) had for breakfast or

something you told (he/she) a few minutes earlier?

1 YES

2 NO

All

residents

R_C6 During the last 7 days, has [RESIDENT INITIALS] given

evidence of a problem with long-term memory, such as

forgetting how old (he/she) is or forgetting that (he/she) was

married?

1 YES

2 NO

All

residents
Page 112 [ Series 1, No. 54

Question

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Resident

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pattern

R_C7 During the last 7 days, has [RESIDENT INITIALS] had any of

the following problems with orientation, such as:

Knowing the location of (his/her) bedroom?

Recognizing staff names or faces?

Knowing that (he/she) is in a facility?

Knowing what the season of the year it is?

READ CHOICES. SELECT ALL THAT APPLY

1 Knowing the location of

(his/her) bedroom

2 Recognizing staff names or

faces

3 Knowing that (he/she) is in a

facility

4 Knowing what the season of

the year it is

5 NONE OF THE ABOVE

All

residents

R_C8 HAND R SHOWCARD

The next question refers to the resident’s actual performance

in making everyday decisions about the tasks or activities of

daily living.

During the last 7 days, which of these answers best

describes [RESIDENT INITIALS] decision-making about such

things as what to wear, how to organize (his/her) day, etc?

1 INDEPENDENT—DECISIONS

WERE CONSISTENT,

REASONABLE

2 MODIFIED

INDEPENDENCE—HE/SHE

HAD SOME DIFFICULTY IN

NEW SITUATIONS

3 MODERATELY IMPAIRED—

HIS/HER DECISIONS WERE

POOR; CUES AND

SUPERVISION WERE

REQUIRED

4 SEVERELY IMPAIRED—HE/

SHE NEVER OR RARELY

MADE DECISIONS

All

residents

R_C9 HAND R SHOWCARD

During the last 7 days, which of these answers best

describes [RESIDENT INITIALS] ability to make (himself/

herself) understood by others?

1 ALWAYS UNDERSTOOD BY

OTHERS

2 USUALLY UNDERSTOOD—

DIFFICULTY FINDING WORDS

OR FINISHING THOUGHTS

3 SOMETIMES UNDERSTOOD—

ABILITY IS LIMITED TO

MAKING CONCRETE

REQUESTS

4 RARELY OR NEVER

UNDERSTOOD

All

residents

R_C9a Is [RESIDENT INITIALS] difficulty in making (himself/herself)

understood by others due to a severe speech impairment or

other disability?

1 YES

2 NO

R_C9 = 2–4

R_C10 Next, I would like to ask about everyday activities and

whether [RESIDENT INITIALS] receives any assistance in

doing them.

By assistance, I mean help from special equipment, another

person or both.

1 CONTINUE

R_c10a Does [RESIDENT INITIALS] currently receive assistance in

bathing or showering? This includes standby assistance.

1 YES

2 NO

All

residents

R_c10a1 Does [RESIDENT INITIALS] bathe or shower with the help

of:

Special Equipment

Another Person

1 Special Equipment

2 Another Person

R_c10a = 1

R_c10b Does [RESIDENT INITIALS] currently receive assistance in

dressing?

This includes standby assistance.

1 YES

2 NO

All

residents

R_c10b1 Does [RESIDENT INITIALS] dress with the help of:

Special Equipment, such as zipper pulls or button hook aids,

or another person, or both?

1 Special Equipment

2 Another Person

R_c10b = 1

R_c10c Does [RESIDENT INITIALS] currently receive assistance in

eating, such as cutting up food, or cueing?

1 YES

2 NO

All

residents
Series 1, No. 54 [ Page 113

Question

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Resident

asked

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pattern

R_c10c1 Does [RESIDENT INITIALS] eat with the help of:

Special Equipment

Another Person

1 Special Equipment

2 Another Person

R_c10c = 1

R_C10d Is [RESIDENT INITIALS] confined to bed by health

problems?

1 YES

2 NO

All

residents

R_C10e Is [RESIDENT INITIALS] confined to a chair by health

problems?

1 YES

2 NO

R_C10d = 2

R_C10f Does [RESIDENT INITIALS] currently receive any assistance

in transferring in and out of bed or a chair?

1 YES

2 NO

R_C10e = 2

R_C10f1 Does [RESIDENT INITIALS] transfer in or out of a bed or a

chair with the help of:

Special Equipment

Another Person

1 Special Equipment

2 Another Person

R_C10f = 1

R_C10g Does [RESIDENT INITIALS] currently receive any assistance

in walking?

1 YES

2 NO

R_C10d = 2 and

R_C10e = 2

R_C10g1 Does [RESIDENT INITIALS] walk with the help of:

Special Equipment

Another Person

1 Special Equipment

2 Another Person

R_C10g = 1

R_C10h Does [RESIDENT INITIALS] currently receive any assistance

going outside the grounds of this facility?

1 YES

2 NO

3 DOES NOT GO OUTSIDE

FACILITY GROUNDS

R_C10d = 2 and

R_C10e = 2

R_C10h1 When [RESIDENT INITIALS] goes outside the grounds does

[RESIDENT INITIALS] require the help of:

Special Equipment

Another Person

1 Special Equipment

2 Another Person

R_C10h = 1

R_C10i Does [RESIDENT INITIALS] have an ostomy, an indwelling

catheter or similar device?

1 YES

2 NO

All

residents

R_C10i1 Does [RESIDENT INITIALS] receive any help from another

person in caring for this device?

1 YES

2 NO

R_C10i = 1

R_C10j Does [RESIDENT INITIALS] currently receive any assistance

using the bathroom?

1 YES

2 NO

3 DOES NOT USE TOILET (AN

OSTOMY PATIENT, CHAIRFAST,

ETC.)

All

residents

R_C10j1 When [RESIDENT INITIALS] uses the bathroom, does

[RESIDENT INITIALS] require the help of:

Special equipment

Another person

1 Special equipment

2 Another person

R_C10j = 1

R_C10k Has [RESIDENT INITIALS] had any episode of bowel

incontinence during the last 7 days?

1 YES

2 NO

3 NOT APPLICABLE (E.G., HAD

A COLOSTOMY, ILEOSTOMY)

All

residents

R_C10l Has [RESIDENT INITIALS] had any episode of urinary

incontinence during the last 7 days?

1 YES

2 NO

3 NOT APPLICABLE (E.G., HAS

AN INDWELLING CATHETER,

HAD A UROSTOMY)

All

residents

R_C10m Is [RESIDENT INITIALS] able to get out of the facility without

the help of another person in case of an emergency?

1 YES

2 NO

R_C10d≠1 and

R_C10e≠1
Page 114 [ Series 1, No. 54

Question

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Resident

asked

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pattern

R_C11 HAND R SHOWCARD

For the next questions, please tell me whether or not

[RESIDENT INITIALS] needs help from another person or

does not perform this activity.

1 CONTINUE

R_C11a Does [RESIDENT INITIALS] currently need help from another

person with:

Going shopping for personal items, such as toilet items or

medicine.

If the only help [RESIDENT INITIALS] needs is for

transportation to and from the store, choose ‘‘No.’’

1 YES, NEEDS HELP

2 NO, DOES NOT NEED HELP

3 DOES NOT PERFORM THIS

ACTIVITY

All

residents

R_C11b (Does [RESIDENT INITIALS] currently need help from

another person with:)

Managing money, such as keeping track of expenses or

paying bills?

1 YES, NEEDS HELP

2 NO, DOES NOT NEED HELP

3 DOES NOT PERFORM THIS

ACTIVITY

All

residents

R_C11c Does [RESIDENT INITIALS] currently need help from another

person or a special device with:

Using the telephone? This includes TTY or dialing out.

1 YES, NEEDS HELP

2 NO, DOES NOT NEED HELP

3 DOES NOT PERFORM THIS

ACTIVITY

All

residents

R_C11c_1 Does [RESIDENT INITIALS] receive help using the telephone

from another person or a special device?

1 ANOTHER PERSON

2 SPECIAL DEVICE

3 BOTH

R_C11c = 1

R_C11d Does [RESIDENT INITIALS] currently need help from another

person with:

Doing light housework, like straightening up (his/her) room or

apartment?

1 YES, NEEDS HELP

2 NO, DOES NOT NEED HELP

3 DOES NOT PERFORM THIS

ACTIVITY

All

residents

R_C11e (Does [RESIDENT INITIALS] currently need help from

another person with:)

Taking medication—this includes opening the bottle,

remembering to take medication on time, and taking the

prescribed dosage?

1 YES, NEEDS HELP

2 NO, DOES NOT NEED HELP

3 DOES NOT PERFORM THIS

ACTIVITY

All

residents

R_C12a Does [RESIDENT INITIALS] now use an amplifier for the

telephone, a TDD, TTY or teletype, closed caption TV,

assistive listening or signaling devices, an interpreter, or any

other equipment for people with hearing or speech

impairments?

1 YES

2 NO

All

residents

R_C13 Does [RESIDENT INITIALS] have a landline telephone or

cellular telephone in (his/her) room?

1 YES

2 NO

All

residents

R_C12 HAND R SHOWCARD

Over the last 30 days, how often did [RESIDENT INITIALS]

receive one or more outside visitors?

1 EVERY DAY

2 AT LEAST SEVERAL TIMES A

WEEK

3 ABOUT ONCE A WEEK

4 SEVERAL TIMES DURING

THE PAST 30 DAYS BUT LESS

THAN EVERY WEEK

5 AT LEAST ONCE IN THE

LAST 30 DAYS

6 NOT AT ALL IN THE LAST 30

DAYS

All

residents

R_C12a1 HAND R SHOWCARD

Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...

Walk a quarter mile, about three city blocks?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

R_C10d and

R_C10e≠1
Series 1, No. 54 [ Page 115

Question

number Question item Code categories

Resident

asked

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pattern

R_C12a2 Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...

Walk up 10 steps without resting?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

R_C10d≠1 and

R_C10e≠1

R_C12a3 Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...

Stand or be on feet for about two hours?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

R_C10d≠1 and

R_C10e≠1

R_C12a4 (Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS]...)

Sit for about two hours?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

All

residents

R_C12a5 (Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...)

Stoop, bend, or kneel?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

R_C10d≠1 and

R_C10e≠1

R_C12a6 (Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...)

Reach up over head?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

All

residents

R_C12a7 (Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...)

Use fingers to grasp or handle small objects?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

All

residents

R_C12a8 (Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...)

Lift or carry something as heavy as 10 pounds, such as a

bag of groceries?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

All

residents
Page 116 [ Series 1, No. 54

Question

number Question item Code categories

Resident

asked

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pattern

R_C12a9 (Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...)

Push or pull a large object like a living room chair?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

All

residents

R_C12a10 (Without assistance and without equipment, how difficult is it

for [RESIDENT INITIALS] to...)

Go out to do things like shopping, movies, or sporting

events?

1 NOT AT ALL DIFFICULT

2 ONLY A LITTLE DIFFICULT

3 SOMEWHAT DIFFICULT

4 VERY DIFFICULT

5 CAN’T DO AT ALL—HEALTH

REASON

6 DOES NOT DO—OTHER

REASON

R_C10d≠1 and

R_C10e≠1

R_C14 In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?

1 CONTINUE

R_C14a HAND R SHOWCARD

(In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Refusing to take prescribed medicines at the appropriate time

or in the prescribed dosage

1 OFTEN

2 SOMETIMES (INCLUDES 1

TIME)

3 NEVER

4 RESIDENT DOES NOT TAKE

ANY PRESCRIBED

MEDICATIONS

5 FACILITY DOES NOT

HANDLE RESIDENTS’

MEDICATIONS

All

residents

R_C14c (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Creating disturbances or being excessively noisy by knocking

on doors or yelling or being verbally abusive?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents

R_C14cc (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Wandering or moving aimlessly about in the building or on

the grounds?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents

R_C14d (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Refusing to bathe or clean (himself/herself)?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents

R_C14e (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Rummaging through or taking other people’s belongings?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents

R_C14f (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Damaging or destroying property?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents

R_C14g (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Verbally threatening other persons including staff or other

residents?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents

R_C14h (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Being physically aggressive towards other persons including

staff or other residents?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents
Series 1, No. 54 [ Page 117

Question

number Question item Code categories

Resident

asked

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pattern

R_C14i (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Removing clothing in public?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents

R_C14j (In the past 30 days, how often has [RESIDENT INITIALS]

exhibited any of the following behaviors?)

Making unwanted sexual advances towards staff or other

residents?

1 Often

2 Sometimes (INCLUDES 1

TIME)

3 Never

All

residents

R_C15 Does a physician ever prescribe medications to help control

[RESIDENT INITIALS] behavior or to reduce agitation?

1 YES

2 NO

R_C14a-j = 1 or 2

in any of these

questions

R_C16 HAND R SHOWCARD

The following services may be offered by facility staff or

provided at the facility by non-facility staff.

Please look at this Showcard and tell me if [RESIDENT

INITIALS] uses any of these services.

SELECT ALL THAT APPLY

1 SPECIAL DIETS

2 ASSISTANCE WITH

ACTIVITIES OF DAILY LIVING

3 ASSISTANCE WITH A BATH

OR SHOWER AT LEAST ONCE

A WEEK

4 SKILLED NURSING

SERVICES

5 BASIC HEALTH MONITORING

SUCH AS BLOOD PRESSURE

AND WEIGHT CHECKS

6 SOCIAL AND RECREATIONAL

ACTIVITIES WITHIN THE

FACILITY

7 SOCIAL AND RECREATIONAL

ACTIVITIES OUTSIDE THE

FACILITY

8 INCONTINENCE CARE

9 TRANSPORTATION TO

MEDICAL APPOINTMENTS

10 TRANSPORTATION TO

STORES AND ELSEWHERE

11 PERSONAL LAUNDRY

12 LINEN LAUNDRY SERVICES

13 SOCIAL SERVICES

COUNSELING

14 NONE OF THE ABOVE

All

residents

R_C17a HAS THIS RESPONDENT ALSO COMPLETED EITHER THE

FACILITY QUESTIONNAIRE OR ANOTHER RESIDENT’S

QUESTIONNAIRE?

1 YES

2 NO

R_C17 The next few questions are about you.

How long have you worked at this facility?

1 6 MONTHS OR LESS

2 MORE THAN 6 MONTHS BUT

LESS THAN ONE YEAR

3 AT LEAST ONE YEAR TO

LESS THAN TWO YEARS

4 TWO YEARS OR MORE

R_C17a = 2
Page 118 [ Series 1, No. 54

Question

number Question item Code categories

Resident

asked

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pattern

R_C18 HAND R SHOWCARD

Please look at this card and tell me which best describes

your position at this facility.

1 RN

2 LPN

3 CERTIFIED MEDICATION

AIDE

4 NURSING ASSISTANT/CNA/

PERSONAL CARE AIDE

5 ACTIVITY DIRECTOR OR

STAFF

6 OWNER, ADMINISTRATOR,

EXECUTIVE DIRECTOR,

ASSISTANT DIRECTOR,

DIRECTOR OF OPERATIONS,

OR MANAGER

7 SOME OTHER POSITION

R_C17a = 2

R_CEND Thank you. These are all the questions I have for you

regarding this resident. Now I need to check my records if

there are any other selected residents for whom you were

identified as a caregiver.

1 CONTINUE
Series 1, No. 54 [ Page 119

Appendix XXI. Interviewer Debriefing Questionnaire

1.	 DID THE ADMINISTRATOR HAVE THE PRE-INTERVIEW WORKSHEET FILLED OUT?

YES
 

NO (please explain)
 

2.	 DID RESPONDENT(S) HAVE ANY SPECIFIC DIFFICULTIES ANSWERING ANY QUESTIONS?

YES
 

NO (please explain)
 

3.	 DO YOU FEEL RESPONDENTS WERE ACCURATE IN THEIR ANSWERS?

YES
 

NO (please explain)
 

4.	 WERE THERE ANY QUESTIONS ON THE FACILITY QUESTIONNAIRE WHERE THE RESPONDENT

PROVIDED SOME ANSWERS FOR ONLY PART OF THE FACILITY AT THIS LOCATION? THIS MAY OCCUR

WHEN THE FACILITY HAS TWO OR MORE LICENSES TO CARE FOR RESIDENTS WITH SIGNIFICANTLY

DIFFERENT LEVELS OF DISABILITY, SUCH AS REGULAR ASSISTED LIVING AND ALZHEIMER’S DISEASE

CARE.

YES
 

NO (please explain)
 

5.	 PLEASE BRIEFLY DESCRIBE ANY DIFFICULTY THE RESPONDENT HAD ANSWERING THE QUESTIONS.

6.	 HOW MANY RESPONDENTS WERE NEEDED TO COMPLETE THE FACILITY QUESTIONNAIRE? PLEASE
 

EXPLAIN WHY MORE THAN ONE RESPONDENT WAS NEEDED.
 

7.	 HOW LONG WERE YOU AT THIS FACILITY, FROM THE TIME YOU ARRIVED UNTIL THE TIME YOU LEFT OR

WILL LEAVE?

8.	 PLEASE DESCRIBE ANY DIFFICULTY STAFF HAD OBTAINING RESIDENT RECORDS. IF NO DIFFICULTY,
 

ENTER ‘‘NONE.’’
 

9.	 PLEASE DESCRIBE ANY DIFFICULTY STAFF HAD FINDING OR LOCATING INFORMATION WITHIN
 

RESIDENT RECORDS.
 

10.	 PLEASE DESCRIBE ANY DIFFICULTY IN LOCATING THE CORRECT STAFF PERSON TO COMPLETE THE

INTERVIEW.

11.	 ENTER OTHER COMMENTS ABOUT THIS FACILITY, RESPONDENTS, OR DATA COLLECTED

NOT MENTIONED ABOVE. IF NO OTHER COMMENTS, ENTER ‘‘NONE.’’
Page 120 [ Series 1, No. 54

Appendix XXII. Refusal Conversion Letters

• Exhibit A. Having trouble reaching you letter

• Exhibit B. No time letter

• Exhibit C. Not interested/not if voluntary letter

• Exhibit D. Cancelled appointment letter
Series 1, No. 54 [ Page 121

Exhibit A. Having trouble reaching you letter

Public Health Service DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

DATE

NAME

FACILITY

ADDRESS

CITY/STATE/ZIP

Dear :

We keep missing you!

We have been trying to reach you about participating in the National Survey of Residential Care Facilities (NSRCF).

‰ This first-time national study collects information about the characteristics of residential care communities, the types of

services they provide, and the characteristics of people who live in these communities.

‰ All responses are confidential and protected by federal privacy laws.

‰ Only a small number of communities in STATE will be included in this study, so your responses are very important to

provide accurate information on long-term care in the United States.
 

‰ Please see the attached brochure for more information.
 

We understand that you are very busy. Our attempts to reach you have been unsuccessful. We’d like to tell you more about the

study at a time that’s convenient to your schedule. To reduce the time commitment of any one person, you can designate portions

of the interview to be completed by different people on your staff.

In a few days you will receive a call from our field office to discuss this study. If you prefer, you may call FIELD SUPERVISOR

toll-free at 1–866–XXX–XXXX or send an e-mail to FS EMAIL ADDRESS. An NSRCF staff member will respond promptly.

Sincerely,

/Lauren Harris-Kojetin/

Chief, Long-Term Care Statistics Branch

National Center for Health Statistics

Attachment: NSRCF brochure and related information

For more information about the National Survey of Residential Care Facilities and other studies of long-term care, please visit

www.cdc.gov/nchs/nhcs.htm
Page 122 [ Series 1, No. 54

Exhibit B. No time letter

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

DATE

NAME

FACILITY

ADDRESS

CITY/STATE/ZIP

Dear:

When we contacted you recently about participating in the National Survey of Residential Care Facilities (NSRCF),

you expressed concern about spending the time necessary to complete the interview.

This first-time national study collects information about the characteristics of residential care communities and the types of

services they provide. Only a small number of communities in STATE will be included in this study, so your responses are

very important to provide accurate information on long-term care in the United States.

We understand that you are very busy.

‰ The interviewer will accommodate your schedule and your needs in order to complete the interview.
 

‰ Should you need to pause the interview in order to attend to other duties, your interviewer will be happy to do so.
 

‰ To reduce the time commitment of any one person, you can designate portions of the interview to be completed by
 

different people on your staff. The facility portion of the interview averages 1 hour, while the resident portion of
 

the interview averages 20 minutes per selected resident. (Residents are not interviewed directly.)
 

‰ This survey is conducted via a laptop computer which enhances the ease and speed of administration.
 

Many organizations and leaders in the long-term care community, including the American Association of Homes and Services

for the Aging (AAHSA), the American Seniors Housing Association (ASHA), the Assisted Living Federation of America (ALFA),

and the National Center for Assisted Living (NCAL) join me in urging your participation in this meaningful study.

We hope you will consider participating in this important research study. In a few days, you will receive a call from our

field office to discuss the specific concerns that you had. If you prefer, you may call FIELD SUPERVISOR toll-free at

1–866–XXX–XXXX or send an e-mail to FS EMAIL ADDRESS. An NSRCF staff member will respond promptly.

Sincerely,

/Lauren Harris-Kojetin/

Chief, Long-Term Care Statistics Branch

National Center for Health Statistics

Attachment: NSRCF brochure and related information

For more information about the National Survey of Residential Care Facilities and other studies of long-term care, please visit

http://www.cdc.gov/nchs/nhcs.htm
Series 1, No. 54 [ Page 123

Exhibit C. Not interested/not if voluntary letter

Public Health Service DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

DATE

NAME

FACILITY

ADDRESS

CITY/STATE/ZIP

Dear:

When we contacted you recently about participating in the National Survey of Residential Care Facilities (NSRCF),

you expressed concern about completing the interview.

This first-time national study collects information about the characteristics of residential care communities and the types of

services they provide. Only a small number of communities in STATE will be included in this study, so your responses are

very important to provide accurate information on long-term care in the United States.

‰ All responses are confidential and protected by federal privacy laws.
 

‰ The interviewer will accommodate your schedule and your needs in order to complete the interview.
 

‰ Should you need to pause the interview in order to attend to other duties, your interviewer will be happy to do so.
 

‰ To reduce the time commitment of any one person, you can designate parts of the interview to be completed by
 

other people on your staff.
 

‰ This survey is conducted via a laptop computer which enhances the ease and speed of administration.
 

Many organizations and leaders in the long-term care community, including the American Association of Homes and Services

for the Aging (AAHSA), the American Seniors Housing Association (ASHA), the Assisted Living Federation of America (ALFA),

and the National Center for Assisted Living (NCAL) join me in urging your participation in this meaningful study.

We hope you will consider participating in this important national study. In a few days, you will receive a call from our

field office to discuss the specific concerns that you had. If you prefer, you may call FIELD SUPERVISOR toll-free at

1–866–XXX–XXXX or send an e-mail to FS EMAIL ADDRESS. An NSRCF staff member will respond promptly.

Sincerely,

/Lauren Harris-Kojetin/

Chief, Long-Term Care Statistics Branch

National Center for Health Statistics

Attachment: NSRCF brochure and related information

For more information about the National Survey of Residential Care Facilities and other studies of long-term care, please visit

http://www.cdc.gov/nchs/nhcs.htm
Page 124 [ Series 1, No. 54

Exhibit D. Cancelled appointment letter

Public Health Service DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

DATE

NAME

FACILITY

ADDRESS

CITY/STATE/ZIP

Dear:

Sorry we missed you!

We had an appointment on: DATE, TIME to complete the surveys for the National Survey of Residential Care Facilities

(NSRCF). We hope to speak with you soon to reschedule a date and time that is convenient for you. As a reminder, here are some

features of this study:

‰ This first-time national study collects information about the characteristics of residential care communities, the types of

services they provide, and the characteristics of people who live in these communities.

‰ All responses are confidential and protected by federal privacy laws.

‰ Only a small number of communities in STATE will be included in this study, so your responses are very important to

provide accurate information on long-term care in the United States.

We understand that you are very busy. We can find a time to meet that is convenient to your schedule. To reduce the time

commitment of any one person, you can designate portions of the interview to be completed by different people on your staff.

In a few days you will receive a call from our field office. If you prefer, you may call FIRST NAME LAST NAME toll-free at

1–XXX–XXX–XXXX or send an e-mail to NSRNMut1@nsr.rti.org. An NSRCF staff member will respond promptly.

Sincerely,

/Lauren Harris-Kojetin/

Chief, Long-Term Care Statistics Branch

National Center for Health Statistics

Attachment: NSRCF brochure and related information

For more information about the National Survey of Residential Care Facilities and other studies of long-term care, please visit

http://www.cdc.gov/nchs/nhcs.htm
Series 1, No. 54 [ Page 125

Appendix XXIII. Schedule Appointment Reminder Letter and Postcard

Exhibit A. Schedule appointment reminder letter

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

DATE:

Dear

It’s time to schedule your appointment!

Thank you for agreeing to participate in the National Survey of Residential Care Facilities (NSRCF). It is the first

ever national study of assisted living and residential care, and it is being conducted by the Centers for Disease

Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) and the Assistant Secretary for

Planning and Evaluation (ASPE).

When we spoke earlier to complete the screening interview, you asked that I contact you at another time to set up

your appointment for the on-site visit. Our interviewers are flexible and will accommodate your schedule.

I will give you a call in a few days to schedule an appointment time that is convenient for you. Or, please feel free

to call me toll free at 1–_____–_____–________ or email me at ______________________.

I look forward to speaking with you again.

Sincerely,

/recruiter name/

Recruiter
Page 126 [ Series 1, No. 54

Exhibit B. Postcard

National Survey of Residential Care Facilities

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

National study being conducted by U.S. Centers for Disease Control and Prevention (CDC),

National Center for Health Statistics and Assistant Secretary of Planning and Evaluation

Interviewing conducted by RTI International

If you have participated in the National Survey of Residential Care Facilities (NSRCF) in the past few weeks, thank you so much!

If you haven’t completed the survey, please consider scheduling an appointment to do so. We understand that you are very busy;

however, we can find a time to meet that is convenient to your schedule. This first-time national study collects information about

the characteristics of residential care communities and the types of services they provide. Your responses are very important to

provide accurate information on long-term care in the United States.

In a few days you will receive a call from our field office to discuss this study. If you prefer, you may call ___________________

toll-free at 866–____–______ or send an e-mail to _______________@rti.org. An NSRCF staff member will respond promptly.

Thank you in advance for your help with this important endeavor.
Series 1, No. 54 [ Page 127

Appendix XXIV. Closure Letter

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road 

Hyattsville, Maryland 20782 

[DATE]
 

[DIRECTOR]
 

[FACILITY NAME]
 

[ADDRESS]
 

[CITY, STATE ZIP]
 

Dear [FIRST NAME LAST NAME OF DIRECTOR]:
 

On behalf of the National Survey of Residential Care Facilities (NSRCF), we want to thank you for considering
 

participation in this study. We have completed the 2010 study and will no longer attempt to contact you.
 

This NSRCF will provide a national picture of assisted living and residential care communities and the services they
 

provide. These findings will help characterize how residential care and assisted living communities meet the needs
 

of elders and adults with disabilities and help shape future long-term care policies.
 

Again, we appreciate the time and effort you have given in support of this study.
 

Sincerely,
 

/Lauren Harris-Kojetin/
 

Chief, Long-Term Care Statistics Branch
 

National Center for Health Statistics
 

For more information about the National Survey of Residential Care Facilities and other studies of long-term care,

please visit http://www.cdc.gov/nchs/nhcs.htm
20

Page 128 [ Series 1, No. 54

Appendix XXV. Verification Script

OMB No. 0920–0780

Exp. Date ____/____/_______

VERIFICATION SCRIPT

November 5, 2009

INSTRUCTIONS: Refer to this hardcopy script to administer all verification cases. Type answers in

Verif_WeekX_RegionX.xls. Refer to Project FAQs if necessary to answer questions from facility.

READ IF NECESSARY

NOTICE—Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the

time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and

reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a

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

or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports

Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920–0780).

Assurance of Confidentiality—All information which would permit identification of an individual, a practice, or an establishment

will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and

with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or

establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information

Protection and Statistical Efficiency Act (PL–107–347).

INTRODUCTION: Hello, my name is ______________________. I’m a supervisor with RTI International. May I speak with

(DIRECTOR’S NAME/NAME OF RESPONDENT TO FACILITY QUESTIONNAIRE, SOMEONE ELSE)?

I am calling to verify the work of one of our interviewers, FI NAME, who conducted a recent interview at this facility for the

National Survey of Residential Care Facilities.

IF DOING VERIFICATION WITH DIRECTOR

(OR RESPONDENT TO FACILITY INTERVIEW)

USE THIS COLUMN

F

1. Did you complete an in-person interview with FI NAME on

DATE?

a. YES, I COMPLETED IT.

b. NO, I DID NOT COMPLETE AN INTERVIEW

c. I DON’T REMEMBER IF I COMPLETED AN INTERVIEW

IF DOING VERIFICATION WITH SOMEONE ELSE

USE THIS COLUMN

NOTE THE PERSON’S NAME

F

AND POSITION:

1. Did someone at FACILITY complete an in-person interview with

FI NAME on DATE?

a. YES, FACILITY COMPLETED IT.

b. NO, FACILITY DID NOT COMPLETE AN INTERVIEW.

c. I DON’T KNOW IF FACILITY COMPLETED AN

INTERVIEW
Series 1, No. 54 [ Page 129

2. Were you [IF Q1=DON’T REMEMBER OR NO: You would

have been] asked questions about NAME OF FACILITY, such as

the number of residents and rooms, the services you offer, and

general information on staffing?

a. YES, I WAS ASKED THESE QUESTIONS

b. NO, I WAS NOT ASKED THESE

QUESTIONS

➔ PROBLEM.

➔ IF Q1 = YES, PROCEED TO Q3

➔ IF Q1 = NO OR DON’T REMEMBER, SKIP

TO Q7.

c. DON’T REMEMBER IF I WAS ASKED THESE

QUESTIONS.

➔ PROBLEM.

➔ IF Q1 = YES, PROCEED TO Q3.

➔ IF Q1 = NO OR DON’T REMEMBER, SKIP

TO Q7.

3. Did the interviewer ask you to provide a list of residents?

a. YES

b. NO

➔ PROBLEM.

➔ SKIP TO Q5.

c. DON’T REMEMBER

4. And did the interviewer ask a series of questions about

(3,3,4,6) residents?

a. YES

b. NO ➔ PROBLEM

c. DON’T REMEMBER.

5. How long was the interviewer at your facility?

__________Hours

__________Minutes

***FIGURES ASSUME ALL RESIDENT

INTERVIEWS WERE COMPLETED***

Small and 0–45 MINUTES ➔ PROBLEM

Medium 45 MINUTES – 3 HOURS ➔ OK

Facilities 3 OR MORE HOURS ➔ PROBLEM

Large 0–1 HOUR ➔ PROBLEM

Facilities 1 HOUR – 3 1⁄2 HOURS ➔ OK

3 1⁄2 OR MORE HOURS ➔ PROBLEM

Very Large 0–1 HOURS ➔ PROBLEM

Facilities 1 1⁄2 – 4 HOURS ➔ OK

4+ HOURS ➔ PROBLEM

Respondent is EXPLAIN

unsure of time

2. Was someone at FACILITY [IF Q1 = NO OR DON’T KNOW:

Someone at FACILITY would have been] asked questions about

the facility, such as the number of residents and rooms, the

services you offer, and general information on staffing?

a. YES, FACILITY WAS ASKED THESE QUESTIONS

b. NO, FACILITY WAS NOT ASKED THESE

QUESTIONS

➔ PROBLEM.

➔ IF Q1 = YES, PROCEED TO Q3

➔ IF Q1 = NO OR DON’T KNOW, SKIP

TO Q7.

c. DON’T KNOW IF FACILITY WAS ASKED THESE

QUESTIONS.

➔ PROBLEM.

➔ IF Q1 = YES, PROCEED TO Q3.

➔ IF Q1 = NO OR DON’T KNOW, SKIP

TO Q7.

3. Did the interviewer ask for a list of residents?

a. YES

b. NO

➔ PROBLEM

➔SKIP TO Q5.

c. DON’T KNOW

4. And did the interviewer ask a series of questions about

(3,3,4,6) residents?

a. YES

b. NO ➔ PROBLEM

c. DON’T KNOW.

5. How long was the interviewer at your facility?

__________Hours

__________Minutes

***FIGURES ASSUME ALL RESIDENT

INTERVIEWS WERE COMPLETED***

Small and

Medium

Facilities

0–45 MINUTES ➔ PROBLEM

45 MINUTES – 3 HOURS ➔ OK

3 OR MORE HOURS ➔ PROBLEM

Large

Facilities

0–1 HOUR ➔ PROBLEM

1 HOUR – 3 1⁄2 HOURS ➔ OK

3 1⁄2 OR MORE HOURS ➔ PROBLEM

Very Large

Facilities

0–1 HOURS ➔ PROBLEM

1 1⁄2 – 4 HOURS ➔ OK

4+ HOURS ➔ PROBLEM

Respondent is

unsure of time

EXPLAIN
Page 130 [ Series 1, No. 54

6. We would like you to assess the overall performance of the

interviewer FI NAME. Would you say (his/her) performance

was excellent, very good, good, fair or poor?

a. EXCELLENT

b. VERY GOOD

c. GOOD

d. FAIR➔ PROBLEM

e. POOR➔ PROBLEM

f. DON’T REMEMBER.

7. Did you have any concerns about the interview or

data collection procedures?

a. YES (DESCRIBE)

b. NO

c. DON’T REMEMBER.

CONCLUSION: Thank you very much for your time.

Goodbye!

DESCRIBE ANY PROBLEMS NOTED ABOVE:

ADDITIONAL COMMENTS:

6. N/A

7. Did you have any concerns about the interview or

data collection procedures?

a. YES (DESCRIBE)

b. NO

c. DON’T REMEMBER.

CONCLUSION: Thank you very much for your time.

Goodbye!

DESCRIBE ANY PROBLEMS NOTED ABOVE:

ADDITIONAL COMMENTS:
Series 1, No. 54 [ Page 131

Appendix XXVI. Chain Approval Report

Preload

1 Number of facilities linked to chains(a) 1,455

2 Number of chains(a) 1,062

Chain Approval Needed/Requested

3 Number of chains where approval needed(b) 74

4 Number of chains in line 3 who contacted NCHS to refuse(c) 1

Request rate (rows 3+4/row 2) 7.0%

Current Status of Scientific Staff Efforts

Pending cases

3a Chain is new; has not been worked yet by scientific staff 8

3b Chain approval unnecessary; scientific staff stopped work(d) 23

3c Scientific staff not yet contacted chain 0

3d Scientific staff contact to chain is in process 12

3d_1 Scientific staff contact to chain is not being pursued due to risk of a chain-wide refusal that

would impact multiple other facilities in the chain

4

3e Chain is consulting corporate counsel 0

Final cases

3f Final: Chain refused to participate 8

4f Among line 4 chains 0

3g Final: Chain agreed to participate 16

4g Among line 4 chains 0

3h Final: Chain was never reached by scientific staff 3

4h Among line 4 chains 0

Agreement rate (row3g/(row 3-row 3b)) 31.4%

Facilities Linked to Chains

Total Facilities in

Sample Linked

to Chains(e)

Actual Number

of Impacted

Facilities(f)

3a.1 Facilities linked to 3a 18 11

3c.1 Facilities linked to 3c 0 0

3d.1 Facilities linked to 3d 31 21

3d.1_1 Facilities linked to 3d_1 64 16

3e.1 Facilities linked to 3e 0 0

3f.1 Facilities linked to 3f 53 53

3g.1 Facilities linked to 3g 80 49

3h.1 Facilities linked to 3h 7 6

4.1 Facilities linked to 4 9 9

4f.1 Facilities linked to 4f 0 0

4g.1 Facilities linked to 4g 0 0

4h.1 Facilities linked to 4h 0 0

5 Sum 3a.1, 3c.1, 3d.1, 3e.1, 3f.1, 3g.1, 3h.1 262 165

Notes:

(a)Based on information from preload frame.

(b)Requested by recruiter, interviewer, NCHS, or chain.

(c)This reflects a national chain that, immediately after recruiters began making phone calls, contacted NCHS to refuse participation for all their facilities. They provided a list of all facilities in their chain

that we cross-referenced to 24 facilities in the sample. These 24 facilities were put on hold. Although the project director contacted this chain to explain the study, the chain never took his calls. The 24

facilities were not pursued or completed.

(d)Scientific staff did not pursue these chains because (a) the approval required was for an offsite administrator rather than a chain, so the recruiter was able to follow up, or (b) the facility decided to

participate before scientific staff contacted the chain office.

(e)Based on manual examination, not based on preload.

(f)Impacted facilities are fewer for some categories compared to total facilities in the sample linked to chains because some affiliated facilities did not report needing chain approval.
Vital and Health Statistics

Series Descriptions

ACTIVE SERIES

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

describes the data collection programs of the National Center

for Health Statistics. Series 1 includes descriptions of the

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

other material necessary for understanding the data.

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

report concerns statistical methods and includes analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. Also included are

experimental tests of new survey methods, comparisons of

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

2009, studies of cognition and survey measurement, and final

reports of major committees concerning vital and health

statistics measurement and methods.

Series 3.	 Analytical and Epidemiological Studies—This type of

report presents analytical or interpretive studies based on vital

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

studies based on surveys that are not part of continuing data

systems of the National Center for Health Statistics and

international vital and health statistics reports.

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

type of report contains statistics on illness; unintentional

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

services; and a wide range of special current health topics

covering many aspects of health behaviors, health status, and

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

this continuing national household interview survey.

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

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

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

and measurement on representative samples of the civilian

noninstitutionalized population provide the basis for (1)

medically defined total prevalence of specific diseases or

conditions in the United States and the distributions of the

population with respect to physical, physiological, and

psychological characteristics, and (2) analyses of trends and

relationships among various measurements and between

survey periods.

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

report contains statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

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

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

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

demographic variables, and geographic and trend analyses

are included.

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

report contains statistics on natality, marriage, and divorce

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

Special analyses by health and demographic variables and

geographic and trend analyses are included.

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

reports contain statistics on factors that affect birth rates,

including contraception and infertility; factors affecting the

formation and dissolution of families, including cohabitation,

marriage, divorce, and remarriage; and behavior related to

the risk of HIV and other sexually transmitted diseases.

These statistics are based on national surveys of women and

men of childbearing age.

DISCONTINUED SERIES

Series 4.	 Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents. The last Series 4 report was

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

in Series 2 or another appropriate series, depending on the

report topic.

Series 5.	 International Vital and Health Statistics Reports—This

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

those of other countries or presents other international data of

relevance to the health statistics system of the United States.

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

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

depending on the report topic.

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

uses methods of cognitive science to design, evaluate, and

test survey instruments. The last Series 6 report was

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

in Series 2.

Series 12.	 Data From the Institutionalized Population Surveys—

The last Series 12 report was published in 1974. Reports

from these surveys are included in Series 13.

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

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

health resources are included in Series 13.

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

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics. The last

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

based on these surveys are included in Series 3.

Series 16.	 Compilations of Advance Data From Vital and Health

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

All reports are available online, and so compilations of

Advance Data reports are no longer needed.

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

The last Series 22 report was published in 1973. Reports

from these sample surveys, based on vital records, are

published in Series 20 or 21.

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

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

All reports are available online, and so compilations of reports

are no longer needed.

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

in these series, contact:

Information Dissemination Staff

National Center for Health Statistics

Centers for Disease Control and Prevention

3311 Toledo Road, Room 5412

Hyattsville, MD 20782

1–800–232–4636

E-mail: cdcinfo@cdc.gov

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

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

MEDIA MAIL
 

POSTAGE & FEES PAID
 

CDC/NCHS
 

PERMIT NO. G-284
 

CS226530

DHHS Publication No. (PHS) 2012–1230, Series 1, No. 54