CMS-10275 Home Health Care CAHPS Survey (Telephone)

TELEPHONE INTERVIEW SCRIPT
FOR THE HOME HEALTH CARE CAHPS SURVEY

INTRO1

Hello, may I please speak to [SAMPLED MEMBER’S NAME]?
1 YES Go to INTRO 2
2 NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]
3 NO [REFUSAL] Go to TERMINATE Screen,
4 MENTALLY/PHYSICALLY INCAPABLE [GO TO PROXY SCRIPT]
M MISSING/DK
IF ASKED WHO IS CALLING:
This is [INTERVIEWER NAME] calling from [ORGANIZATION]. I’d like to
speak to [SAMPLE MEMBER’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 monitored or recorded for quality improvement
purposes.
NOTE: THE LENGTH OF THE INTERVIEW WILL DEPEND ON
WHETHER THE HHA ADDS SUPPLEMENTAL QUESTIONS TO ITS
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]
M MISSING/DK

[GO TO Q_INELIG]

1

Q2_INTRO

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

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
2
3

YES
NO
DO NOT REMEMBER

M 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
2
3

YES
NO
DO NOT REMEMBER

M 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
M MISSING/DK

Q5.

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

YES
NO
DO NOT REMEMBER

M MISSING/DK

2

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
2

YES
NO

M MISSING/DK
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
2

YES
NO

M 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
M 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
2
3
4
5

Never,
Sometimes,
Usually,
Always, or
you only had one provider in the last 2 months of care?

M MISSING/DK

3

Q10.

In the last 2 months of care, did you and a home health provider from this agency
talk about pain?
1
2

YES
NO

M 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
2

YES
NO [GO TO Q15]

M MISSING/DK
Q12.

[GO TO Q15]

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
2

YES
NO

M MISSING/DK
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
2

YES
NO

M 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
2

YES
NO

M MISSING/DK

4

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
2
3
4

Never,
Sometimes,
Usually, or
Always?

M 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
2
3
4

Never,
Sometimes,
Usually, or
Always?

M 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
2
3
4

Never,
Sometimes,
Usually, or
Always?

M MISSING/DK
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?
M MISSING/DK

5

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?
M 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

M MISSING/DK
Q21_INTRO The next questions are about the office of [HOME HEALTH AGENCY].
Q21.

In the last 2 months of care, did you contact this agency’s office to get help or
advice?
1
2

YES
NO [GO TO Q24]

M MISSING/DK

[GO TO Q24]

6

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
2

YES
NO [GO TO Q24]

M MISSING/DK
Q23.

[GO TO Q24]

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
2
3
4

Same day,
1 to 5 days,
6 to 14 days, or
More than 14 days?

M MISSING/DK
Q24.

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

YES
NO

M MISSING/DK
Q25.

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

Definitely no,
Probably no,
Probably yes, or
Definitely yes?

M MISSING/DK

7

Q26_INTRO This last set of questions asks for information about you. Please listen to all
response choices before making a selection.
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?
M 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?
M MISSING/DK

Q28.

Do you live alone?
1
2

YES
NO

M MISSING/DK
Q29.

What is the highest grade or level of school that you have completed? Would you
say…
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, or
More than 4-year college degree?

M MISSING/DK

8

Q30.

Are you Hispanic or Latino/Latina?
1
2

YES
NO

M MISSING/DK
Q31.

What is your race? You may choose one or more of the following. Are you…
1
2
3
4
5

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

M MISSING/DK
Q32.

What language do you mainly speak at home? Would you say…
1
2
3

English, [GO TO Q_END]
Spanish, or [GO TO Q_END]
Some other language? [GO TO 32A]

M MISSING/DK [GO TO Q_END]
Q32A

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

9