Passback on the “Evaluation of the Medical Adult Day Care Services Demonstration
CMS – 10204 / 0938 - 1017
CMS appreciates OMB’s comments on the collection satisfaction survey request that were received on July 23, 2008. Below are the contractor’s response to OMB comments and questions.
________________________________________________________________________
Brandeis Answers to OMB Passback Questions:
1. The background section of the supporting statement says that this evaluation is conducting an analysis of “patient outcomes,” but this term is too broad to refer to what this particular survey is actually measuring. We recommend striking this language to make the background description more accurate.
Answer: You are correct. We agree to strike it.
2. According to Appendix A, the sampling method only includes people who are currently moving through the Demonstration sites at the time that the survey is being conducted. Why was the decision made not to include past participants and past non-participants? Wouldn’t including these people make the results more reliable, since restricting the sample to the present might skew the data for variables that have changed since last year? Also, sampling a series of every participant who moves through the sites during a given stretch of time is not probability-based random sampling, which significantly restricts the practical utility of the survey. The results cannot be generalized to the entire population of all participants and non-participants; an explanation will have to be appended to the results stating that the findings are only applicable to the group that that was sampled during the particular timeframe in question.
Answer: Regarding the question about surveying past participants, we do not believe that it is valid or reliable to mix contemporaneous judgments and experiences with services (as we propose) with recollections of experiences with services from the past. In the survey we will ask for specific details and examples with providers and settings, and these may become confused with other providers and settings as months pass. Therefore we think it would yield inferior and different data to try to survey participants and non-participants from more than a month or so prior, especially with ill and elderly Medicare beneficiaries who may experience recall deficits. Furthermore, our intention is to include a full year of experience in each of the participating sites, so as to account for seasonal differences, as well as to obtain a significant period of program operations. Using survey data from the entire sample of enrollees from day one of implementation would make it difficult to differentiate between issues pertaining to demonstration start-up periods across the sites and more recent months of a mature demonstration implementation. For that reason we have chosen to focus the evaluation survey on the final demonstration year, when the sites would have had time to work out their "growing pains." If the demonstration were scheduled to run longer, we could have included more months in the survey. Regarding the question about generalizability, it is correct that the selection for neither the demonstration sites nor the beneficiaries within them were randomized, and the results therefore cannot be generalized. We will add an explanation to the results to that effect. The design did not intend that the results of the survey would be generalized to the entire population.
3. The race/ethnicity survey questions are not in compliance with our statistical standards and must be modified. More information is available on our website at the following address: http://www.whitehouse.gov/omb/inforeg/re_app-a-update.pdf
Answer: You are correct. We have made the recommended changes on the four interview forms. The participant survey is in Attachment 1 as an example - see Questions 24 and 25. The wording is taken from the Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (Excerpt from Federal Register, October 30, 1997):
Race (select one or more):
-- American Indian or Alaska Native
-- Asian
-- Black or African American
-- Native Hawaiian or Other Pacific Islander
-- White
Ethnicity:
-- Hispanic or Latino
-- Not Hispanic or Latino
4. We recommend adding a confidentiality statement to the verbal informed consent scripts.
Answer: There is already the following brief mention of confidentiality in paragraph 2 of the "Satisfaction Survey
Verbal Informed Consent": "It will take about 15 minutes and it is completely confidential." To strengthen the message, we have added the following sentence: "After you provide your answers your name or other identifying information will not be connected to the survey responses." We have added this sentence to the scripts for the participants and decliners (Attachment 2).
Attachment 1
PARTICIPANTS
Start with introduction/consent. If yes, continue.
Before I ask you about the home health and day care programs, I have some questions about you
Please tell me who you live with? (check all that apply)
____ No one - lives alone
____ Spouse
____ Son/daughter
____ Other relative
____ Other non-relative
In thinking about how well you get around inside the house, would you say you can (start reading list at top and stop when respondent chooses)
____ Walk independently
____ Walk with a cane or walker
____ Get around in a wheelchair
____ Need to stay in bed all the time
Do you need help with any of the following activities?
Bathing __Y __N
Dressing __Y __N
Using the toilet __Y __N
Shopping __Y __N ___ Does not shop
Figuring out what medications to take when and remembering to take them __Y __N
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1017. The time required to complete this information collection is estimated to average
10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
If help is needed on Q 3: Is there someone who helps you with these things? (check all that apply)
____ Spouse/partner
____ Son/Daughter/Son-in-law or daughter-in-law
____ Other relative
____ Friend
____ Paid helper
____ No one
(If "paid helper" is checked in #4): Do you pay for the helper or does a government program pay?
___ Program pays
___ I pay or family pays
- If self or family: How much do you pay a week?
$____ Don't know ____
Now let me ask you about the home health services you receive from (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly)
Are you still receiving services or is the episode over?
_____Still receiving
_____Episode over
Please indicate if you have you received any of the following services from (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly) and if so, whether you received them at home or in a day center?
HH Service |
Received Service (Y/N) |
In Home (check) |
In MADC (check) |
Nursing |
|
|
|
Physical Therapy |
|
|
|
Occupational Therapy |
|
|
|
Speech Therapy |
|
|
|
Home Health Aide |
|
|
|
Please tell me if (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly) provided any training or education to your primary caregiver to help them care for you? ____Y ____ N
(If receiving home health AT HOME in #6): Please tell me whether you agree with the following statements about the home health services you receive(d) at home? Would you say yes or no?
|
Yes |
No |
The nurses give good care |
|
|
The therapists give good care |
|
|
I get good information about conditions and treatments. |
|
|
They showed up when they said they would |
|
|
(If receiving home health IN THE DAY CENTER in #6): Please tell me whether you agree with the following statements about the home health services you receive(d) at home? Would you say yes or no?
|
Yes |
No |
The nurses give good care |
|
|
The therapists give good care |
|
|
I get good information about conditions and treatments. |
|
|
They showed up when they said they would |
|
|
Now let me ask you about the adult day services you receive
How often do you go (did you go) to the adult day center? (___ days a week)
What things does s/he like most about going to the day care center?
_______________________________________________________
What things does she like least?
______________________________________________________
How satisfied are you with your overall experiences in the adult day center? Would you say.....
____Very satisfied
____Somewhat satisfied
____Dissatisfied
Are you paying for any of the days attend the adult day center? __Y __N
If yes, how many days? _______
How much does it cost per day? _____
How do you get to the adult day center and back home? (check all that are mentioned)
____ Family or friends
____ Bus/van from program
____ Other ____________
How well do these transportation arrangements work for you? Would you say.....
____ very well
____ OK
____ not work very well
Do you have any costs for transportation to the day center? __Yes __No
If yes, how much per one-way trip? $ ______
I have a few more questions about the demonstration in general
Would you like to keep going to day care? ___ Y ___ N
If yes: Would you be willing to pay to go?
___ Yes
___ Yes, I already pay
___ No
___ No - a public program pays
In your own words, can you tell me how the demonstration been good for you?
Again in your own words, how could this demonstration program be improved?
I just have just a few more questions about you.
Please tell me how old you are? ____
Do you receive Medicaid assistance? ___Y ___ N
How would you describe your race? Please select one or more of the following:
___American Indian or Alaska Native
___Asian
___Black or African American
___Native Hawaiian or Other Pacific Islander
___White
25. Is your Ethnicity...
___Hispanic or Latino
___Not Hispanic or Latino
That's the end of my questions. Thanks so much for your help. Do you have any questions for me?
PARTICIPANT PROXY
Start with introduction/consent. If yes, continue.
Before I ask you about the home health and day care programs, I have some questions about you
A. Please tell me your relationship to (name of participant): ____________________
B. Are you his/her primary caregiver? __ Yes __ No
First we have some questions about your (wife/husband/father/mother,etc)
Can you tell me whom s/he lives with? (check all that apply)
____ No one - lives alone
____ Spouse
____ Son/daughter
____ Other relative
____ Other non-relative
In thinking about how s/he gets around inside the house, would you say s/he can (start reading list at top and stop when respondent chooses)
____ Walks independently
____ Walks with a cane or walker
____ Gets around in a wheelchair
____ Needs to stay in bed all the time
Does s/he need help with any of the following activities?
Bathing __Yes __No
Dressing __Yes __No
Using the toilet __Yes __No
Shopping __Yes __No ___ Does not shop
Figuring out what medications to take when and remembering to take them __Yes __no
No one According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1017. The time required to complete this information collection is estimated to average
10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
_________________________________________________________________________
If help is needed on Q 3: Is there someone who helps him/her with these things? (check all that apply)
____ Spouse/partner
____ Son/Daughter/Son-in-law or daughter-in-law
____ Other relative
____ Friend
____ Paid helper
____ (If "paid helper" is checked in #4): Do you pay for the helper or does a government program pay?
___ Program pays
___ I pay or family pays
- If self or family: How much do you pay a week?
$____ Don't know ____
Now let me ask you about the home health services s/he receives from (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly)
Is s/he still receiving services or is the episode over?
_____Still receiving
_____Episode over
Please indicate if you have s/he received any of the following services from (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly) and if so, whether s/he received them at home or in a day center?
HH Service |
Received Service (Y/N) |
In Home (check) |
In MADC (check) |
Nursing |
|
|
|
Physical Therapy |
|
|
|
Occupational Therapy |
|
|
|
Speech Therapy |
|
|
|
Home Health Aide |
|
|
|
Please tell me if (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly) provided any training or education to you (as primary caregiver to help them care for him/her? ____Y ____ N
(If receiving home health AT HOME in #6): Please tell me whether you agree with the following statements about the home health services s/he receive(d) at home? Would you say yes or no?
|
Yes |
No |
The nurses give good care |
|
|
The therapists give good care |
|
|
I get good information about conditions and treatments. |
|
|
They showed up when they said they would |
|
|
(If receiving home health IN THE DAY CENTER in #6): Please tell me whether you agree with the following statements about the home health services s/he receive(d) at the day center? Would you say yes or no?
|
Yes |
No |
The nurses give good care |
|
|
The therapists give good care |
|
|
I get good information about conditions and treatments. |
|
|
They showed up when they said they would |
|
|
Now let me ask you about the adult day services you receive
How often does s/he go (did s/he go) to the adult day center? (___ days a week)
What things does s/he like most about going to the day care center?
_______________________________________________________
What things does she like least?
______________________________________________________
How satisfied is s/he with her/his overall experiences in the adult day center? Would you say.....
____Very satisfied
____Somewhat satisfied
____Dissatisfied
Are you paying for any of the days attend the adult day center? __Y __N
If yes, how many days? _______
How much does it cost per day? _____
How do you get to the adult day center and back home? (check all that are mentioned)
____ Family or friends
____ Bus/van from program
____ Other ____________
How well do these transportation arrangements work for him/her? Would you say.....
____ very well
____ OK
____ not work very well
Do you have any costs for transportation to the day center? __Yes __No
If yes, how much per one-way trip? $ ______
I have a few more questions about the demonstration in general
Would you like to keep going to day care? ___ Y ___ N
If yes: Would you be willing to pay to go?
___ Yes
___ Yes, I already pay
___ No
___ No - a public program pays
In your own words, can you tell me how the demonstration been good for you?
Again in your own words, how could this demonstration program be improved?
I just have just a few more questions about him/her.
Please tell me how old s/he is? ____
Does s/he receive Medicaid assistance? ___Y ___ N
How would you describe your race? Please select one or more of the following:
___American Indian or Alaska Native
___Asian
___Black or African American
___Native Hawaiian or Other Pacific Islander
___White
25. Is your Ethnicity...
___Hispanic or Latino
___Not Hispanic or Latino
That's the end of my questions. Thanks so much for your help. Do you have any questions for me?
DECLINER SURVEY
Start with introduction/consent. If yes, continue.
Before I ask you about the home health and day care programs, I have some questions about you
Please tell me who you live with? (check all that apply)
____ No one - lives alone
____ Spouse
____ Son/daughter
____ Other relative
____ Other non-relative
In thinking about how well you get around inside the house, would you say you can (start reading list at top and stop when respondent chooses)
____ Walk independently
____ Walk with a cane or walker
____ Get around in a wheelchair
____ Need to stay in bed all the time
Do you need help with any of the following activities?
Bathing __Y __N
Dressing __Y __N
Using toilet __Y __N
Shopping __Y __N ___ Does not go shopping
Figuring out what medications to take when and remembering to take them __Y __N
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1017. The time required to complete this information collection is estimated to average
10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
If help is needed on Q 3: Is there someone who helps you with these things? (check all that apply)
____ Spouse/partner
____ Son/Daughter/Son-in-law or daughter-in-law
____ Other relative
____ Friend
____ Paid helper
____ No one
(If "paid helper" is checked in #4): Do you pay for the helper or does a government program pay?
____ Program pays
____ I pay or family pays
- If self or family: How much do you pay a week?
$____ Don't know ____
Now let me ask you about the home health services you receive from (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly)
Are you still receiving services or is the episode over?
___Still receiving
___Episode over
Please indicate if you have you received any of the following services from (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly)?
___ Nursing
___ Physical Therapy
___ Occupational Therapy
___ Speech Therapy
___ Home Health Aide
Please tell me if (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly) provided any training or education to your primary caregiver to help them care for you? ____Y ____ N
Please tell me whether you agree with the following statements about the home health services s/he receive(d) at home? Would you say yes or no?
|
Yes |
No |
The nurses give good care |
|
|
The therapists give good care |
|
|
I get good information about conditions and treatments. |
|
|
They showed up when they said they would |
|
|
When (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly) first talked to you about home health, did they offer you the chance to get the services in an adult day care program or senior center program?
__ Yes (skip to #11)
__ No (ask question d)
__ Don't remember (ask question d)
If No or don't remember, interviewer explains the following: “An adult day program is not a nursing home. It's a program where you go in the morning to a center with other elders for social activities, games, meals, and then come back home in the afternoon.”
Have you heard of this kind of program before? __Yes __No
Would like to go to this kind of program? __Yes __No
Why didn't you go to the adult day program? ____________________________
________________________________________________________________
I just have just a few more questions about you.
Please tell me how old you are? ____
Do you receive Medicaid assistance? ___Y ___ N
How would you describe your race? Please select one or more of the following:
___American Indian or Alaska Native
___Asian
___Black or African American
___Native Hawaiian or Other Pacific Islander
___White
15. Is your Ethnicity...
___Hispanic or Latino
___Not Hispanic or Latino
That's the end of my questions. Thanks so much for your help. Do you have any questions for me?
DECLINER PROXY
Start with introduction/consent. If yes, continue.
Before I ask you about the home health and day care programs, I have some questions about you
A. Please tell me your relationship to (name of decliner): ____________________
B. Are you his/her primary caregiver? __ Yes __ No
Before I ask you about the home health and day care programs, I have some questions about (name of decliner)
Please tell me who s/he lives with? (check all that apply)
____ No one - lives alone
____ Spouse
____ Son/daughter
____ Other relative
____ Other non-relative
In thinking about how well s/he gets around inside the house, would you say s/he can (start reading list at top and stop when respondent chooses)
____ Walk independently
____ Walk with a cane or walker
____ Get around in a wheelchair
____ Need to stay in bed all the time
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1017. The time required to complete this information collection is estimated to average
10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
Does s/he need help with any of the following activities?
Bathing __Y __N
Dressing __Y __N
Using toilet __Y __N
Shopping __Y __N___ Does not go shopping
Figuring out what medications to take when and remembering to take them __Y __N
If help is needed on Q 3: Is there someone who helps her/him with these things? (check all that apply)
____ Spouse/partner
____ Son/Daughter/Son-in-law or daughter-in-law
____ Other relative
____ Friend
____ Paid helper
____ No one
(If "paid helper" is checked in #4): Do you pay for the helper or does a government program pay?
___ Program pays
___ I pay or family pays
- If self or family: How much do you pay a week?
$____ Don't know ____
Now let me ask you about the home health services s/he receives from (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly)
Is s/he still receiving services or is the episode over?
_____Still receiving
_____Episode over
Please indicate if s/he has received any of the following services from (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly)?
___ Nursing
___ Physical Therapy
___ Occupational Therapy
___ Speech Therapy
___ Home Health Aide
Please tell me if (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly) provided any training or education to you (or another primary caregiver) to help you care for him/her? ____Y ____ N
Please tell me whether you agree with the following statements about the home health services s/he receive(d) at home? Would you say yes or no?
|
Yes |
No |
The nurses give good care |
|
|
The therapists give good care |
|
|
I get good information about conditions and treatments. |
|
|
They showed up when they said they would |
|
|
When (Metropolitan, Landmark, Aurora, Doctors Care, Neighborly) first talked to you about home health, do you remember if they offered the chance for him/her to get the services in an adult day care program or senior center program?
__ Yes (skip to #11)
__ No (ask question d)
__ Don't remember (ask question d)
If No or don't remember, interviewer explains the following: “An adult day program is not a nursing home. It's a program where you go in the morning to a center with other elders for social activities, games, meals, and then come back home in the afternoon.”
Have you heard of this kind of program before? __Yes __No
Would s/he like to go to this kind of program? __Yes __No
Why didn't s/he go to the adult day program? ____________________________
________________________________________________________________
I just have just a few more questions about (your wife/husband/mother/father).
Please tell me how old s/he is? ____
Does s/he receive Medicaid assistance? ___Y ___ N
How would you describe your race? Please select one or more of the following:
___American Indian or Alaska Native
___Asian
___Black or African American
___Native Hawaiian or Other Pacific Islander
___White
15. Is your Ethnicity...
___Hispanic or Latino
___Not Hispanic or Latino
That's the end of my questions. Thanks so much for your help. Do you have any questions for me?
Attachment 2
(Verbal) Informed Consent for
Medical Adult Day Services (MADS) Demonstration
Participants
My name is __________, and I work for Brandeis University in Massachusetts. We are working for the Medicare program to conduct an evaluation of the Medical Adult Day Services Demonstration, and I am calling to speak with (beneficiary name)....
If answerer is same gender as beneficiary: Is this Mr./Mrs. _______?
If answerer is opposite gender: Is this his wife or daughter? .... her husband or son?
(Establish if we should be interviewing the beneficiary him/herself or if the answerer will serve as a proxy.)
We understand that you are (he/she is, etc.) currently participating (or recently participated) in the Demonstration through (insert name of home health agency), and that you have received some of your home health services at (insert name of MADS if known). We are interested to learn how the Demonstration works and whether beneficiaries who are participating in the Demonstration like it. We would like to invite you to participate in a telephone survey about your satisfaction with the care you have received. It will take about 15 minutes and it is completely confidential. After you provide your answers your name or other identifying information will not be connected to the survey responses. It is also voluntary - You don't have to do this. Your Medicare and your services will not be affected if you say no.
Do you have any questions about this?
Would you like to do the survey?
If yes, proceed to the participant or participant proxy survey.
If no, thank them for their time and end the call.
Decliners
My name is __________, and I work for Brandeis University in Massachusetts. We are working for the Medicare program to conduct an evaluation of the Medical Adult Day Services Demonstration, and I am calling to speak with (benefiary name)....
If answerer is same gender as beneficiary: Is this Mr./Mrs. _______?
If answerer is opposite gender: Is this his wife or daughter? .... her husband or son?
(Establish if we should be interviewing the beneficiary him/herself or if the answerer will serve as a proxy.)
We understand that you were (he/she was, etc.) offered an opportunity to participate in the Demonstration at (insert name of home health agency) but declined to participate. We would like to invite you to participate in a telephone survey about your satisfaction with the care you have received, and also about why you declined to attend adult day services. It will take about 15 minutes and it is completely confidential. After you provide your answers your name or other identifying information will not be connected to the survey responses. It is also voluntary - You don't have to do this. Your Medicare and your services will not be affected if you say no.
Do you have any questions about this?
Would you like to do the survey?
- If yes, proceed the decliner or decliner proxy survey.
- If no, thank them for their time and end the call.
| File Type | application/msword |
| File Title | Passback on the “Evaluation of the Medical Adult Day Care Services Demonstration |
| Author | CMS |
| Last Modified By | CMS |
| File Modified | 2008-08-01 |
| File Created | 2008-08-01 |