CAHPS Home Health Care Survey (CMS-10275)

The Home Health Care CAHPS Survey
Part C
Appendices, including the
Home Health Care Survey Questionnaires

TABLE OF CONTENTS
Section

Page

APPENDIX A: HOME HEALTH CARE CAHPS SURVEY QUESTIONNAIRE ................1
APPENDIX B: FEDERAL REGISTER NOTICE: HOME HEALTH CARE CAHPS
SURVEY..............................................................................................................................2
APPENDIX C: MAY 7, 2007 FEDERAL REGISTER NOTICE: HOME HEALTH
CARE CAHPS, VOLUME 72, [[PAGE 25452]] ...............................................................4
APPENDIX D: HOME HEALTH CARE CAHPS MAIL SURVEY MODE
EXPERIMENT COVER LETTERS....................................................................................7
APPENDIX E: TELEPHONE INTERVIEW SCRIPT FOR THE HOME HEALTH
CARE CAHPS SURVEY: MODE EXPERIMENT ..........................................................10

i

APPENDIX A:
HOME HEALTH CARE CAHPS SURVEY QUESTIONNAIRE

®

CAHPS
Home Health Care
Mail Survey Instrument
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 XXXX-XXXX. The time required to complete this
information collection is estimated to average 12 minutes per response, including the time to
review instructions, search existing data sources, gather the data needed, and complete and
review the information collection. If you have any comments concerning the accuracy of the
time estimate(s) or suggestions for improving this form, please write to: ATTN: PRA Clearance
Officer, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mail Stop C42605, Baltimore, Maryland 21244-1850.

1

Survey Instructions

3.

Answer all the questions by checking the
box to the left of your answer.
You are sometimes told to skip over
some questions in this survey. When this
happens you will see an arrow with a
note that tells you what question to
answer next, like this:
Yes

When you first started getting home
health care from this agency, did
someone from the agency talk with you
about how to set up your home so you
can move around safely?
1
2
3

4.

If yes, go to Question 1.

No

When you started getting home health
care from this agency, did someone
from the agency talk with you about all
the prescription and over-the-counter
medicines you were taking?
1
2

Your Home Health Care
1.

According to our records, you got care
from the home health agency,
[AGENCY NAME]. Is that right?
1
2

2.

Yes
No

3

5.

If No, Please stop and
return the survey in the
envelope provided.

When you first started getting home
health care from this agency, did
someone from the agency tell you what
care and services you would get?
1
2
3

Yes
No
Do not remember

Yes
No
Do not remember

When you started getting home health
care from this agency, did someone
from the agency ask to see all the
prescription and over-the-counter
medicines you were taking?
1
2
3

As you answer the questions in this
survey, think only about your
experience with this agency.

Yes
No
Do not remember

Yes
No
Do not remember

Your Care from Home Health
Providers in the Last 2 Months
These next questions are about all the
different staff from [AGENCY NAME]
who gave you care in the last 2 months. Do
not include care you got from staff from
another home health care agency. Do not
include care you got from family or friends.
6.

In the last 2 months of care, was one of
your home health providers from this
agency a nurse?
1
2

Yes
No
2

7.

In the last 2 months of care, was one of
your home health providers from this
agency a physical, occupational, or
speech therapist?
1
2

8.

1
2

In the last 2 months of care, was one of
your home health providers from this
agency a home health or personal care
aide?
1
2

9.

Yes
No

2
3
4
5

3

Never
Sometimes
Usually
Always
I only had one provider in the last
2 months of care

1
2
3

10. In the last 2 months of care, did you and
a home health provider from this
agency talk about pain?
2

Yes
No

11. In the last 2 months of care, did you
take any new prescription medicine or
change any of the medicines you were
taking?
1
2

Yes
No

1

3

Yes
No
I did not take any new
prescription medicines or change
any medicines

15. In the last 2 months of care, how often
did home health providers from this
agency keep you informed about when
they would arrive at your home?
1
2
3

If No, Go to Question 15.

Yes
No
I did not take any new
prescription medicines or change
any medicines

14. In the last 2 months of care, did home
health providers from this agency talk
with you about the side effects of these
medicines?
2

1

Yes
No
I did not take any new
prescription medicines or change
any medicines

13. In the last 2 months of care, did home
health providers from this agency talk
with you about when to take these
medicines?

Yes
No

In the last 2 months of care, how often
did home health providers from this
agency seem informed and up-to-date
about all the care or treatment you got
at home?
1

12. In the last 2 months of care, did home
health providers from this agency talk
with you about the purpose for taking
your new or changed prescription
medicines?

4

Never
Sometimes
Usually
Always

2

16. In the last 2 months of care, how often
did home health providers from this
agency treat you as gently as possible?
1
2
3
4

Never
Sometimes
Usually
Always

17. In the last 2 months of care, how often
did home health providers from this
agency explain things in a way that was
easy to understand?
1
2
3
4

20. We want to know your rating of your
care from this agency’s home health
providers.
Using any number from 0 to 10, where
0 is the worst home health care possible
and 10 is the best home health care
possible, what number would you use to
rate your care from this agency’s home
health providers?
0
1
2
3

Never
Sometimes
Usually
Always

4
5
6
7
8

18. In the last 2 months of care, how often
did home health providers from this
agency listen carefully to you?
1
2
3
4

2
3
4

10

Never
Sometimes
Usually
Always

19. In the last 2 months of care, how often
did home health providers from this
agency treat you with courtesy and
respect?
1

9

Never
Sometimes
Usually
Always

0 Worst home health care possible
1
2
3
4
5
6
7
8
9
10 Best home health care possible

Your Home Health Agency
The next questions are about the office of
[AGENCY NAME].
21. In the last 2 months of care, did you
contact this agency’s office to get help
or advice?
1
2

Yes
No

If No, Go to Question 24.

22. In the last 2 months of care, when you
contacted this agency’s office did you
get the help or advice you needed?
1
2
3

Yes
No If No, Go to Question 24.
I did not contact this agency

3

23. When you contacted this agency’s
office, how long did it take for you to
get the help or advice you needed?
1
2
3
4
5

Same day
1 to 5 days
6 to 14 days
More than 14 days
I did not contact this agency

About You
26. In general, how would you rate your
overall health?
1
2
3
4

24. In the last 2 months of care, did you
have any problems with the care you
got through this agency?
1
2

Yes
No

5

27. In general, how would you rate your
overall mental or emotional health?
1
2

25. Would you recommend this agency to
your family or friends if they needed
home health care?
1
2
3
4

Definitely yes
Probably yes
Probably no
Definitely no

Excellent
Very good
Good
Fair
Poor

3
4
5

Excellent
Very good
Good
Fair
Poor

28. Do you live alone?
1
2

Yes
No

29. What is the highest grade or level of
school that you have completed?
1
2

3
4
5
6

8th grade or less
Some high school, but did not
graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree

30. Are you Hispanic or Latino/Latina?
1
2

Yes
No

4

31. What is your race? Please select one or
more.
1
2
3

4
5

American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific
Islander
Black or African American
White

32. What language do you mainly speak at
home?
1
2
3

English
Spanish
Some other language:
(Please print.)

34. How did that person help you? Check
all that apply.
1
2
3
4

5

Read the questions to me
Wrote down the answers I gave
Answered the questions for me
Translated the questions into my
language
Helped in some other way:
(Please print.)

6

No one helped me complete this
survey

Thank you!
Please return the completed survey
in the postage-paid envelope.

33. Did someone help you complete this
survey?
1
2

Yes
No

If No, Please return the
completed survey in the
postage-paid envelope.

5

APPENDIX B:
FEDERAL REGISTER NOTICE: HOME HEALTH CARE CAHPS SURVEY
As part of the Department of Health and Human Services (DHHS) Transparency Initiative on
Quality Reporting, CMS plans to implement a process to measure and publicly report home
health care patient experiences through the CAHPS (Consumer Assessment of Healthcare
Providers and Systems) Home Health Care Survey. The Home Health Care CAHPS survey, as
initially discussed in the May 4, 2007 Federal Register (72 Fed. Reg. 25356, 25452), is part of a
family of CAHPS® surveys that ask patients about their health care experiences. The Home
Health Care CAHPS survey, developed by the Agency for Healthcare Research and Quality
(AHRQ), creates a standardized survey for home health patients to assess their home health care
providers and the quality of their home health care. Prior to this survey, there was no national
standard for collecting such information that would allow comparisons across all home health
agencies.
AHRQ conducted a field test to determine the length and content of the Home Health
Care CAHPS Survey. CMS has submitted the survey to the National Quality Forum (NQF) for
consideration and approval in their consensus process. NQF endorsement represents the
consensus opinion of many healthcare providers, consumer groups, professional organizations,
purchasers, federal agencies, and research and quality organizations. The final survey will also
be submitted to the Office of Management and Budget (OMB) for their approval under the
Paperwork Reduction Act (PRA) process.
The survey captures topics such as patients’ interactions with the agency, access to care,
interactions with home health staff, provider care and communication, and patient characteristics.
The survey allows the patient to give an overall rating of the agency, and asks if the patient
would recommend the agency to family and friends.
2

CMS is beginning plans for implementation of Home Health Care CAHPS Survey.
Administration of the survey will be conducted by multiple, independent survey vendors
working under contract with home health agencies to facilitate data collection and reporting.
Recruitment and training of vendors who wish to be approved to collect Home Health Care
CAHPS data will begin in 2009. Home health agencies interested in learning about the survey
and/or voluntarily participating in the survey are encouraged to view the Home Health Care
CAHPS website: http://www.homehealthCAHPS.org. Information about the project can also be
obtained by sending an email to [email protected].
Home health agency participation in the Home Health Care CAHPS Survey is currently
voluntary.

3

APPENDIX C:
MAY 7, 2007 FEDERAL REGISTER NOTICE: HOME HEALTH CARE CAHPS,
VOLUME 72, [[PAGE 25452]]

4

May 7, 2007 Federal Register Notice: Home Health CAHPS Home Health Care CAHPS,
Volume 72, [[Page 25452]]
Speech-Language Pathology...................
x1.009
x1.05
123.11

121.22

x0.958614805 ...............
--------------------------------------------------------------------------------------------------------------The estimated home health market basket update of 2.9 percent for CY 2008 is
based on Global Insight, Inc, 4th
Qtr, 2006 forecast with historical data through 3rd Qtr, 2006.
Section 1895(b)(3)(B)(v)(III) of the Act further requires that the
``Secretary shall establish procedures for making data submitted under
subclause (II) available to the public.'' Additionally, the statute
requires that ``such procedures shall ensure that a home health agency
has the opportunity to review the data that is to be made public with
respect to the agency before such data being made public.'' To meet the
requirement for making such data public, we are proposing to continue
to use the Home Health Compare Web site whereby HHAs are listed
geographically.
Currently, the 10 existing quality measures are posted on the Home
Health Compare Web site. The Home Health Compare Web site will also
include the two proposed additional measures discussed earlier.
Consumers can search for all Medicare-approved home health providers
that serve their city or zip code and then find the agencies offering
the types of services they need as well as the proposed quality
measures. See http://www.medicare.gov/HHCompare/Home.asp. HHAs
currently have access (through the Home Health Compare contractor) to
their own agency's quality data (updated periodically) and we propose
to continue this process thus enabling each agency to know how it is
performing before public posting of data on the Home Health Compare Web
site.
Over the next year, we will be testing patient level process
measures for HHAs, as well as continuing to refine the current OASIS
tool in response to recommendations from a TEP conducted to review the
data elements that make up the OASIS tool. We expect to introduce these
complementary additional measures during CY 2008 to determine if they
should be incorporated into the statutory quality measure reporting
requirements. We hope to apply these measures to the CY 2010 reporting
period. Before usage in the HH PPS, we will test and refine these
measures to determine if they can more accurately reflect the level of
quality care being provided at HHAs without being overly burdensome
with the data collection instrument. To the extent that evidence-based
data are available on which to determine the appropriate measure
specifications, and adequate risk-adjustments are made, we anticipate
collecting and reporting these measures as part of each agency's home
health quality plan. We believe that future modifications to the
current OASIS tool, refinements to the possible responses as well as
adding new process measures will be made. In all cases, we anticipate
that any future quality measures should be evidence-based, clearly
linked to improved outcomes, and able to be reliably captured with the
least burden to the provider. We are also working on developing

5

measures of patient experience in the home health setting through the
development of the Home Health Consumer Assessment of Healthcare
Providers and Systems (CAHPS) Survey. We will be working with the
Agency for Healthcare Research and Quality (AHRQ) to field test this
instrument in summer/fall 2007. We anticipate implementing the Home
Health CAHPS Survey in late 2008 for potential application to the CY
2010 pay for reporting requirements.
III. Collection of Information Requirements
Under the Paperwork Reduction Act (PRA) of 1995, we are required to
provide 60-day notice in the Federal Register and solicit public
comment before a collection of information requirement is submitted to
the Office of Management and Budget (OMB) for review and approval. In
order to fairly evaluate whether an information collection should be
approved by OMB, section 3506(c)(2)(A) of the PRA of 1995 requires that
we solicit comment on the following issues:
The need for the information collection and its usefulness
in carrying out the proper functions of our agency.
The accuracy of our estimate of the information collection
burden.
The quality, utility, and clarity of the information to be
collected.
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
Therefore, we are soliciting public comments on each of these
issues for the information collection requirements discussed below.
To implement the OASIS changes discussed in sections II.A.(2)(a),
II.A.(2)(b), and II.A.(2)(c) of this proposed rule, which are currently
approved in Sec. 484.55, Sec. 484.205, and Sec. 484.250, a few items
in the OASIS will need to be modified, deleted, or added. The
requirements and burden associated with the OASIS are currently
approved under OMB control number 0938-0760 with an expiration date of
August 31, 2007. We are soliciting public comment on each of the
proposed changes for the information collection requirements (ICRs) as
summarized and discussed below. For the purposes of soliciting public
review and comment, we have placed a current draft of the proposed
changes to the OASIS on the CMS Web site at: http://www.cms.hhs.gov/

6

APPENDIX D:
HOME HEALTH CARE CAHPS
MAIL SURVEY MODE EXPERIMENT COVER LETTERS

7

Home Health Care CAHPS Mail Survey Mode Experiment Cover Letter, First Mailing
NAME
ADDRESS
CITY, STATE ZIP
Dear NAME:
[Home Health Agency Name] is taking part in a national survey to provide the United States
Department of Health and Human Services with information about the quality of health care delivered
to people in their homes. Our records show that you recently received health care services in your
home from [Agency Name]. You, along with a sample of other people who receive home health care,
have been selected to take part in this important survey.
The enclosed questionnaire asks for your opinions about the home health care you received. Your
help on this survey is important, as it will help us improve the quality of care provided by home
health agencies. The survey results will also be used to help people make more informed decisions
when choosing a home health care provider. We hope that you will take a few minutes to complete
and return the questionnaire in the enclosed, postage-paid envelope.
If you need help reading or answering the questions, please ask a family member or friend to
help you. It is important that your answers reflect your own opinions about the home health care you
received, so please do not ask anyone from [Agency Name] for help when completing the survey.
Your participation in this survey is voluntary and will not affect any health care or benefits you
receive. All information you give in this survey will be held in confidence and is protected by the
Privacy Act. Your answers will not be linked to your name; they will be combined with answers
from other people who take part in this survey and reported in summary form.
If you have any questions about the survey, please call Vanessa Thornburg toll-free at 1-XXXXXXX. Thank you in advance for your participation.
Sincerely,

Name
CMS Privacy Officer
Enclosures

[PRINT UNIQUE PATIENT ID NO. HERE.]

8

Home Health Care CAHPS Mail Survey Mode Experiment Cover Letter, Second Mailing

NAME
ADDRESS
CITY, STATE ZIP
Dear NAME:
Recently, we sent you a letter asking for your help on a survey to provide the United States
Department of Health and Human Services with information about the quality of health care
delivered to people in their homes. Your name was selected from a list of people who received
home health care services through [Home Health Agency Name]. As of today, we have not yet
received your completed questionnaire. If you have already returned the questionnaire, please
accept our thanks.
The enclosed questionnaire asks for your opinions about the home health care you received. Your
help on this survey is important, as it will help us improve the quality of care provided by home
health care agencies. The survey results will also be used to help people make more informed
decisions when choosing a home health care provider. If you have not completed the survey, please
take a few moments to complete the questionnaire and return it in the enclosed postage-paid
envelope.
If you need help reading or answering the questions, please ask a family member or friend to
help you. It is important that your answers reflect your own opinions about the home health care you
have received, so we ask that you do not get help from anyone from [Agency Name] when
completing the survey.
Your participation in this survey is voluntary and will not affect any health care or benefits you
receive. All information you give in this survey will be held in confidence and is protected by the
Privacy Act. Your answers will not be linked to your name; they will be combined with answers
from other people who take part in this survey and reported in summary form.
If you have any questions about the survey, please call Vanessa Thornburg toll-free at
1-XXX-XXX-XXXX. Thank you in advance for your participation.
Sincerely,
Name
CMS Privacy Officer
Enclosures

[PRINT UNIQUE PATIENT ID NO. HERE.]

9

APPENDIX E:
TELEPHONE INTERVIEW SCRIPT FOR THE HOME HEALTH CARE CAHPS
SURVEY: MODE EXPERIMENT

®

CAHPS
Home Health Care
Phone Survey
Instrument

10

Home Health Care CAHPS Survey
Telephone Interview Procedures and Script

Overview
The Home Health Care CAHPS Survey Questionnaire uses certain conventions, which
are described below, along with general telephone interview guidelines. The telephone interview
script that follows the interviewing instructions and conventions explains the purpose of the
survey and confirms required information about the sample patient.
General Interviewing Instructions and Conventions
Thoroughly familiarize yourself with the list of Frequently Asked Questions (FAQ)
that sample patients will ask about the Home Health Care CAHPS Survey before you
conduct interviews so that you are knowledgeable about the survey.
Ask every applicable question exactly as it is presented. Do not change the wording
or condense any question when reading it.
Ask the questions in the exact order in which they are presented.
Read all questions including those that may appear to be sensitive to the respondent in
the same manner with no hesitation or change in inflection.
When reading the question, emphasize all words or phrases that appear in bold or are
underlined.
Words in the questionnaire that appear in ALL CAPITAL LETTERS are never to be
read to the respondent. This includes both questions and response categories.
Ask every question specified, even when a respondent has seemingly provided the
answer as part of the response to another question. Keep in mind that the answer
received in the context of one question may not be the same answer that will be
received when the other question is asked. If it becomes cumbersome to the
respondent, remind him/her gently that you must ask all questions of all respondents
in the same way.
If the answer to a question indicates that the respondent did not understand the intent
of the question, repeat the question.
If the respondent is unable to hear well, you may attempt to set a call back on a
different day at a different time, to see if this is better for the respondent. However, if
the respondent still cannot hear, try to ask the sample member is there is someone else
in the household who can answer the questions for him or her. Terminate work on the
case if the sample member cannot hear well enough to hand the phone to a proxy
respondent or provide you with information on how to contact a proxy respondent.

11

For such cases, assign a final disposition code of ineligible: physically or mentally
incapable to the case.
Read the questions slowly, at a pace that allows them to be readily understood. It is
important to remember that the respondent has not heard these questions before and
will not have had the exposure that you have had to the questionnaire.
Read transition statements just as they are presented. Transition statements are
designed to inform the respondent of the nature of an upcoming question or a series
of questions, to define a word, or to describe what is being asked for in the question.
Do not create “transition statements” of your own, because these may unintentionally
introduce bias into the interview.
Give the respondent plenty of time to recall past events.
Do not suggest answers to the respondent. Your job as an interviewer is to read the
questions, make sure the respondent understands the questions, and then enter the
responses. Do not assist the respondent in selecting responses.
At the end of the interview, tell the sample patient that the survey is completed and
thank him or her for taking part in the survey.

12

Telephone Interview Script for the Home Health Care CAHPS Survey
INTRO1

Updated 3/20/09
Hello, may I please speak to [SAMPLED PATIENT’S NAME]?
<1> YES
Go to INTRO 2
<2>
<3>
<4>

NO, NOT AVAILABLE RIGHT NOW
[SET CALLBACK]
NO [REFUSAL]
Go to TERMINATE Screen,
MENTALLY/PHYSICALLY INCAPABLE
[GO TO PROXY SCRIPT]

MISSING/DK
IF ASKED WHO IS CALLING:
This is [INTERVIEWER NAME] calling from [ORGANIZATION]. I’d like to speak to
[SAMPLE PATIENT’S NAME] about a study about health care.
INTRO2

Hello, this is [INTERVIEWER NAME] calling on behalf of [HOME HEALTH
AGENCY]. [HOME HEALTH AGENCY] is participating in a survey about the
care people receive from their home health agencies. This survey is part of a
national effort to measure the quality of care from home health care agencies.
The survey results will be used by people when choosing a home health care
agency.
Your participation in this survey is completely voluntary and will not affect your
health care or any benefits you receive. The interview will take about 12 minutes
to complete. This call may be may monitored or recorded for quality
improvement purposes.
NOTE: THE LENGTH OF THE INTERVIEW WILL DEPEND ON
WHETHER THE HHA ADDS SUPPLEMENTAL QUESTIONS TO IS
HOME HEALTH CARE CAHPS SURVEY.

Q1

According to our records, you got care from the home health agency, [HOME
HEALTH AGENCY]. Is that right?
<1> YES
[GO TO Q2_INTRO]
<2> NO
[GO TO Q_INELIG]
MISSING/DK

Q2_INTRO

As you answer the questions in this survey, think only about your experience with
this agency.

13

Q2

When you first started getting home health care from this agency, did someone
from the agency tell you what care and services you would get?
<1> YES
<2> NO
<3> DO NOT REMEMBER
MISSING/DK

Q3

When you first started getting home health care from this agency, did someone
from the agency talk with you about how to set up your home so you can move
around safely?
<1> YES
<2> NO
<3> DO NOT REMEMBER
MISSING/DK

Q4

When you started getting home health care from this agency, did someone from
the agency talk with you about all the prescription and over-the-counter medicines
you were taking?
<1> YES
<2> NO
<3> DO NOT REMEMBER
MISSING/DK

Q5

When you started getting home health care from this agency, did someone from
the agency ask to see all the prescription over-the-counter medicines you were
taking?
<1> YES
<2> NO
<3> DO NOT REMEMBER
MISSING/DK

Q6_INTRO

These next questions are about all the different staff from [HOME HEALTH
AGENCY] who gave you care in the last 2 months. Do not include care you got
from staff from another home health care agency. Do not include care you got
from family or friends.

Q6

In the last 2 months of care, was one of your home health providers from this
agency a nurse?
<1> YES
<2> NO
MISSING/DK

14

Q7

In the last 2 months of care, was one of your home health providers from this
agency a physical, occupational, or speech therapist?
<1> YES
<2> NO
MISSING/DK

Q8

In the last 2 months of care, was one of your home health providers from this
agency a home health or personal care aide?
<1> YES
<2> NO
MISSING/DK

Q9

In the last 2 months of care, how often did home health providers from this
agency seem informed and up-to-date about all the care or treatment you got at
home? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually,
<4> Always, or
<5> you only had one provider in the last 2 months of care?
MISSING/DK

Q10

In the last 2 months of care, did you and a home health provider from this agency
talk about pain?
<1> YES
<2> NO
MISSING/DK

Q11

In the last 2 months of care, did you take any new prescription medicine or
change any of the medicines you were taking?
<1> YES
<2> NO
[GO TO Q15]
MISSING/DK

Q12

In the last 2 months of care, did home health providers from this agency talk with
you about the purpose for taking your new or changed prescription medicines?
<1> YES
<2> NO
MISSING/DK

15

Q13

In the last 2 months of care, did home health providers from this agency talk with
you about when to take these medicines?
<1> YES
<2> NO
MISSING/DK

Q14

In the last 2 months of care, did home health providers from this agency talk with
you about the side effects of these medicines?
<1> YES
<2> NO
MISSING/DK

Q15

In the last 2 months of care, how often did home health providers from this agency
keep you informed about when they would arrive at your home? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
MISSING/DK

Q16

In the last 2 months of care, how often did home health providers from this
agency treat you as gently as possible? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
MISSING/DK

Q17

In the last 2 months of care, how often did home health providers from this
agency explain things in a way that was easy to understand? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
MISSING/DK

16

Q18

In the last 2 months of care, how often did home health providers from this
agency listen carefully to you? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
MISSING/DK

Q19

In the last 2 months of care, how often did home health providers from this
agency treat you with courtesy and respect? Would you say…
<1> Never,
<2> Sometimes,
<3> Usually, or
<4> Always?
MISSING/DK

Q20_INTRO We want to know your rating of your care from this agency’s home health
providers.
Q20

Using any number from 0 to 10, where 0 is the worst home health care possible
and 10 is the best home health care possible, what number would you use to rate
your care from this agency’s home health providers?
READ RESPONSE CHOICES ONLY IF NECESSARY
<00>
<01>
<02>
<03>
<04>
<05>
<06>
<07>
<08>
<09>
<10>

0 Worst home health care possible
1
2
3
4
5
6
7
8
9
10 Best home health care possible

MISSING/DK
Q21_INTRO The next questions are about the office of [HOME HEALTH AGENCY].

17

Q21

In the last 2 months of care, did you contact this agency’s office to get help or
advice?
<1> YES
<2> NO
[GO TO Q24]
MISSING/DK

Q22

In the last 2 months of care, when you contacted this agency’s office did you get
the help or advice you needed?
<1> YES
<2> NO
[GO TO Q24]
MISSING/DK

Q23

When you contacted this agency’s office, how long did it take for you to get the
help or advice you needed? Would you say…
<1> Same day,
<2> 1 to 5 days,
<3> 6 to 14 days, or
<4> More than 14 days?
MISSING/DK

Q24

In the last 2 months of care, did you have any problems with the care you got
through this agency?
<1> YES
<2> NO
MISSING/DK

Q25

Would you recommend this agency to your family or friends if they needed home
health care? Would you say…
<1> Definitely yes,
<2> Probably yes,
<3> Probably no, or
<4> Definitely no?
MISSING/DK

18

Q26

In general, how would you rate your overall health? Would you say that it is…
<1> Excellent,
<2> Very good,
<3> Good,
<4> Fair, or
<5> Poor?
MISSING/DK

Q27

In general, how would you rate your overall mental or emotional health? Would
you say that it is…
<1> Excellent,
<2> Very good,
<3> Good,
<4> Fair, or
<5> Poor?
MISSING/DK

Q28

Do you live alone?
<1> YES
<2> NO
MISSING/DK

Q29

What is the highest grade or level of school that you have completed? Would you
say…
<1> 8th grade or less
<2> Some high school, but did not graduate
<3> High school graduate or GED
<4> Some college or 2-year degree
<5> 4-year college graduate, or
<6> More than 4-year college degree?
MISSING/DK

Q30

Are you Hispanic or Latino/Latina?
<1> YES
<2> NO
MISSING/DK

19

Q31

What is your race? You may choose one or more of the following. Are you....
<1> American Indian or Alaska Native
<2> Asian
<3> Native Hawaiian or other Pacific Islander
<4> Black or African American
<5> White
MISSING/DK

Q32

What language do you mainly speak at home? Would you say…
<1> English, [GO TO Q_END]
<2> Spanish, or [GO TO Q_END]
<3> Some other language?
[GO TO 32A]
MISSING/DK

Q32A

What other language do you mainly speak at home? (ENTER RESPONSE
BELOW).
{ALLOW UP TO 50 CHARACTERS}
MISSING/DK

Q_END

These are all the questions I have for you. Thank you for your time. Have a good
(day/evening).

INELIGIBLE SCREEN:
Q_INELIG:

Thank you for your time. Have a good (day/evening).

REFUSAL SCREEN:
Q_REF

Thank you for your time. Have a good (day/evening).

20