Section Specifications for FQF
Round 69
Created on 5/9/2014 6:09:31 PM
Box Instructions
GO TO FQ1 - FNAMEOK.
Other Programming Instructions
Variable Name |
Assignment Instructions |
FQDISP |
If FQDISP = 7/CompleteIneligible, EMPTY, or NULL, then FQDISP = 2/NotStarted |
SPDISP |
If FQDISP = 7/CompleteIneligible and SPDISP = 11/FinalNonResp, then SPDISP = EMPTY |
FACLCERT |
FACLCERT = PreloadFQ.FACLCERT |
Design Notes
Must open PLAC array to PLACNUM = 001 and preload PLAC array from PreloadPLAC.PLACNUM = 001
Question Text
IF SP IS IN AN ADULT/GROUP HOME OR SIMILAR RESIDENCE AT ANOTHER LOCATION, CODE "2" OR "3" WITHOUT ASKING.
Before we begin, I need to verify that our information is correct. Is (PRELOAD FACILITY) the exact name of the place where (SP) (is/was) physically located [on or around (PREVIOUS INTERVIEW DATE)/on or around (ADMISSION DATE REPORTED BY A PREVIOUS SOURCE)?
Field 1: FNAMEOK
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQ1A - PLACNAME |
1 |
YES |
FQ2 - FADDROK |
2 |
DISPLAYED GROUP HOME NAME IS CORRECT |
FQ2 - FADDROK |
3 |
DISPLAYED GROUP HOME NAME IS NOT CORRECT |
FQ1A - PLACNAME |
|
Don't Know |
FQCLOSE7 - NOTRESP |
|
Refused |
FQCLOSE7 - NOTRESP |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PLACNAME |
If FQ1-FNAMEOK = 1/Yes or 2/DispHomeCorrect, then PLAC.PLACNAME = PreloadPLAC.PLACNAME |
PLACNAME |
If FQ1-FNAMEOK = 1/Yes or 2/DispHomeCorrect, then FQ.PLACNAME = PreloadPLAC.PLACNAME |
Question Text
What is the exact name of the place where (SP) (is/was) physically located [on or around (PREVIOUS INTERVIEW DATE)/on or around (ADMISSION DATE REPORTED BY A PREVIOUS SOURCE)]?
Field 1: PLACNAME
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ2 - FADDROK |
|
Don't Know |
FQ2 - FADDROK |
|
Refused |
FQ2 - FADDROK |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PLACNAME |
If FQ1A-PLACNAME <> DK, RF then PLAC.PLACNAME = FQ1A-PLACNAME. Else PLAC.PLACNAME = PreloadPLAC.PLACNAME. |
Question Text
Next,
I would like to verify the address of the place where (SP) (is/was)
physically located [on or around (PREVIOUS INTERVIEW DATE)/on or
around (ADMISSION DATE REPORTED BY A PREVIOUS SOURCE)].
I
have it listed as [READ ADDRESS BELOW]. Is this correct?
Field 1: FADDROK
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQ2A - ADDRESS |
1 |
YES |
FQ3 - FADMNOK |
|
Don't Know |
FQ3 - FADMNOK |
|
Refused |
FQ3 - FADMNOK |
Other Programming Instructions
Report Display
Report
Display Instructions:
PRELOAD ADDRESS =
PreloadPLAC.ADDRESS
PRELOAD CITY = PreloadPLAC.ADDRCITY
PRELOAD
STATE = PreloadPLAC.ADDRSTAT
PRELOAD ZIP =
PreloadPLAC.ADDRZIP
Report Header:
PREVIOUSLY
REPORTED ADDRESS:
Report Display:
(PRELOAD
ADDRESS)
(PRELOAD CITY) (PRELOAD STATE) (PRELOAD ZIP)
Background Variable Assignments
Variable Name |
Assignment Instructions |
ADDRESS |
If FQ2-FADDROK = 1/Yes then PLRoster.PLACRoster[1].ADDRESS = PreloadPLAC.ADDRESS |
ADDRCITY |
If FQ2-FADDROK = 1/Yes then PLRoster.PLACRoster[1].ADDRCITY = PreloadPLAC.ADDRCITY |
ADDRSTAT |
If FQ2-FADDROK <> 0/No then PLRoster.PLACRoster[1].ADDRSTAT = PreloadPLAC.ADDRSTAT |
ADDRZIP |
If FQ2-FADDROK = 1/Yes then PLRoster.PLACRoster[1].ADDRZIP = PreloadPLAC.ADDRZIP |
Question Text
What is the correct address of the place where (SP) (is/was) physically located [on or around (PREVIOUS INTERVIEW DATE)/on or around (ADMISSION DATE REPORTED BY A PREVIOUS SOURCE)]?
PRESS F1 FOR STATE ABBREVIATIONS.
Field 1: ADDRESS
ADDRESS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ2A - ADDRCITY |
|
Don't Know |
FQ2A - ADDRCITY |
|
Refused |
FQ2A - ADDRCITY |
Field 2: ADDRCITY
CITY
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ2A - ADDRSTAT |
|
Don't Know |
FQ2A - ADDRSTAT |
|
Refused |
FQ2A - ADDRSTAT |
Field 3: ADDRSTAT
STATE
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ2A - ADDRZIP |
|
Don't Know |
FQ2A - ADDRZIP |
|
Refused |
FQ2A - ADDRZIP |
Field 4: ADDRZIP
ZIP
Field 4 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ3 - FADMNOK |
|
Don't Know |
FQ3 - FADMNOK |
|
Refused |
FQ3 - FADMNOK |
Other Programming Instructions
Report Display
Report
Display Instructions:
PRELOAD ADDRESS =
PreloadPLAC.ADDRESS
PRELOAD CITY = PreloadPLAC.ADDRCITY
PRELOAD
STATE = PreloadPLAC.ADDRSTAT
PRELOAD ZIP =
PreloadPLAC.ADDRZIP
Report Header:
PREVIOUSLY
REPORTED ADDRESS:
Report Display:
(PRELOAD
ADDRESS)
(PRELOAD CITY) (PRELOAD STATE) (PRELOAD ZIP)
Background Variable Assignments
Variable Name |
Assignment Instructions |
ADDRESS |
If FQ2A-ADDRESS <> DK, RF, then PLAC.ADDRESS = FQ2A-ADDRESS. Else PLAC.ADDRESS = PreloadPLAC.ADDRESS. |
ADDRCITY |
If FQ2A-ADDRCITY <> DK, RF, then PLAC.ADDRCITY = FQ2A-ADDRCITY. Else PLAC.ADDRCITY = PreloadPLAC.ADDRCITY. |
ADDRSTAT |
If FQ2A-ADDRSTAT <> DK, RF, then PLAC.ADDRSTAT = FQ2A-ADDRSTAT. Else PLAC.ADDRSTAT = PreloadPLAC.ADDRSTAT. |
ADDRZIP |
If FQ2A-ADDRZIP <> DK, RF, then PLAC.ADDRZIP = FQ2A-ADDRZIP. Else PLAC.ADDRZIP = PreloadPLAC.ADDRZIP. |
Question Text
(CODE "2" WITHOUT ASKING.)
[Is (ADMINISTRATOR'S NAME)/Are you] (still) the current administrator of (FACILITY)?
Field 1: FADMNOK
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQ3A - FACRNAM1 |
1 |
YES |
FQ4 - MADDROK |
2 |
RESPONDENT CONSIDERED ADMINISTRATOR |
FQ4 - MADDROK |
|
Don't Know |
FQ4 - MADDROK |
|
Refused |
FQ4 - MADDROK |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
XFACRADM |
If FQ3-FADMNOK =
1/Yes then PLAC.XFACRADM = PreloadPLAC.XFACRADM. |
Question Text
What is the current administrator's name?
SELECT A RESPONSE BELOW OR ADD TO THE PERSON ROSTER.
Field 1: FACRNAM1
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ4 - MADDROK |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
XFACRADM |
PLAC.XFACRADM = FACRNUM added/selected on PLAC where PLACNUM = 001 |
Question Text
Next, I would like to verify your office address. I have it listed as [READ ADDRESS LISTED BELOW]. Is this correct?
Field 1: MADDROK
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQ4A - MAILADD1 |
1 |
YES |
FQ5 - FPHONOK |
|
Refused |
FQ5 - FPHONOK |
Other Programming Instructions
Report Display
Report
Display Instructions:
PRELOAD MAILING ADDRESS = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILADDR.
Else display PLAC.ADDRESS.
PRELOAD MAILING CITY = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILCITY.
Else display PLAC.ADDRCITY.
PRELOAD MAILING STATE = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILSTAT.
Else display PLAC.ADDRSTAT.
PRELOAD MAILING ZIP = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILZIP.
Else display PLAC.ADDRZIP.
Report Header:
PREVIOUSLY
REPORTED MAILING ADDRESS:
Report Display:
(PRELOAD
MAILING ADDRESS)
(PRELOAD MAILING CITY) (PRELOAD MAILING STATE)
(PRELOAD MAILING ZIP)
Background Variable Assignments
Variable Name |
Assignment Instructions |
MAILADDR |
If FQ4-MADDROK =
1/Yes or RF: |
MAILCITY |
If FQ4-MADDROK =
1/Yes or RF: |
MAILSTAT |
If FQ4-MADDROK =
1/Yes or RF: |
MAILZIP |
If FQ4-MADDROK =
1/Yes or RF: |
Question Text
What is the correct address for your office?
PRESS F1 FOR STATE ABBREVIATIONS.
Field 1: MAILADD1
ADDRESS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ4A - MAILCIT1 |
|
Don't Know |
FQ4A - MAILCIT1 |
|
Refused |
FQ4A - MAILCIT1 |
Field 2: MAILCIT1
CITY
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ4A - MAILSTA1 |
|
Don't Know |
FQ4A - MAILSTA1 |
|
Refused |
FQ4A - MAILSTA1 |
Field 3: MAILSTA1
STATE
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ4A - MAILZIP1 |
|
Don't Know |
FQ4A - MAILZIP1 |
|
Refused |
FQ4A - MAILZIP1 |
Field 4: MAILZIP1
ZIP
Field 4 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ5 - FPHONOK |
|
Don't Know |
FQ5 - FPHONOK |
|
Refused |
FQ5 - FPHONOK |
Other Programming Instructions
Report Display
Report
Display Instructions:
PRELOAD MAILING ADDRESS = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILADDR.
Else display PLAC.ADDRESS.
PRELOAD MAILING CITY = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILCITY.
Else display PLAC.ADDRCITY.
PRELOAD MAILING STATE = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILSTAT.
Else display PLAC.ADDRSTAT.
PRELOAD MAILING ZIP = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILZIP.
Else display PLAC.ADDRZIP.
Report Header:
PREVIOUSLY
REPORTED MAILING ADDRESS:
Report Display:
(PRELOAD
MAILING ADDRESS)
(PRELOAD MAILING CITY) (PRELOAD MAILING STATE)
(PRELOAD MAILING ZIP)
Background Variable Assignments
Variable Name |
Assignment Instructions |
MAILADDR |
If FQ4A-MAILADDR
= DK or RF, FQ.MAILADDR = PreloadFQ.MAILADDR. |
MAILCITY |
If FQ4A-MAILCITY
= DK or RF, FQ.MAILCITY = PreloadFQ.MAILCITY. |
MAILSTAT |
If FQ4A-MAILSTAT
= DK or RF, FQ.MAILSTAT = PreloadFQ.MAILSTAT. |
MAILZIP |
If FQ4A-MAILZIP =
DK or RF, FQ.MAILZIP = PreloadFQ.MAILZIP. |
Question Text
(VERIFY PHONE NUMBER IS FOR FQ RESPONDENT. DO NOT READ ALOUD.)
Is (FACILITY AREA CODE AND PHONE NUMBER) the correct phone number for (FACILITY)?
Field 1: FPHONOK
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQ5A - ADDRAREA |
1 |
YES |
BOX FQ7 |
|
Don't Know |
BOX FQ7 |
|
Refused |
BOX FQ7 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ADDRAREA |
If FQ5-FPHONOK = 1/Yes then PLAC.ADDRAREA = PreloadPLAC.ADDRAREA |
ADDREXCH |
If FQ5-FPHONOK = 1/Yes then PLAC.ADDREXCH = PreloadPLAC.ADDREXCH |
ADDRLOCL |
If FQ5-FPHONOK = 1/Yes then PLAC.ADDRLOCL = PreloadPLAC.ADDRLOCL |
Question Text
What is the phone number?
Field 1: ADDRAREA
AREACODE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ5A - ADDREXCH |
|
Don't Know |
FQ5A - ADDREXCH |
|
Refused |
FQ5A - ADDREXCH |
Field 2: ADDREXCH
EXCHANGE
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQ5A - ADDRLOCL |
|
Don't Know |
FQ5A - ADDRLOCL |
|
Refused |
FQ5A - ADDRLOCL |
Field 3: ADDRLOCL
LOCAL
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQ7 |
|
Don't Know |
BOX FQ7 |
|
Refused |
BOX FQ7 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ADDRAREA |
If FQ5A-ADDRAREA <> DK, RF, then PLAC.ADDRAREA = FQ5A-ADDRAREA. Else PLAC.ADDRAREA = PreloadPLAC.ADDRAREA. |
ADDREXCH |
If FQ5A-ADDREXCH <> DK, RF, then PLAC.ADDREXCH = FQ5A-ADDREXCH. Else PLAC.ADDREXCH = PreloadPLAC.ADDREXCH. |
ADDRLOCL |
If FQ5A-ADDRLOCL <> DK, RF, then PLAC.ADDRLOCL = FQ5A-ADDRLOCL. Else PLAC.ADDRLOCL = PreloadPLAC.ADDRLOCL. |
Box Instructions
IF BASELINE FQ, GO TO FAINTRO1 - FAINT1TC.
IF FALL ROUND OR ANNUAL FQ, GO TO FB0PRE - ANSWERFB.
ELSE GO TO CLOSING1 - RETURNAV.
Other Programming Instructions
Variable Name |
Assignment Instructions |
FQDISP |
If
Verification FQ then FQDISP = 5/Complete. |
InterviewDate |
InterviewDate = current date |
Design Notes
Can be flagged as restart here.
Question Text
Now I have a few questions about the structure of (FACILITY) and its certification and licensing to confirm that it is eligible for this study.
PRESS "1" TO CONTINUE.
Field 1: FAINT1TC
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FA1 |
Box Instructions
IF ADULT/GROUP HOME, GO TO FA5A - EFOWNDES.
ELSE GO TO FA1 - PLACTYP1.
Variable Name |
Assignment Instructions |
PLACTYPE |
If ADULT/GROUP HOME, PLAC.PLACTYPE = 18/GroupHome. |
ELIGSTAT |
If PLAC.PLACTYPE = 18/GroupHome, then FQ.ELIGSTAT = 1/FacilityEligible. |
Question Text
SHOW CARD FA2
What type of place is (FACILITY)?
PRESS
F1 FOR PLACE DEFINITIONS.
IF RESPONDENT REPORTS CCRC OR
RETIREMENT COMMUNITY, PROBE FOR TYPE OF PLACE FOR UNIT WHERE SP
RESIDES. DO NOT ENTER "OTHER".
Field 1: PLACTYP1
Field 1 Routing
Value |
Label |
Route |
1 |
FREE STANDING NURSING HOME |
FA1A - FACHOME |
4 |
NURSING HOME UNIT WITHIN A CCRC OR RETIREMENT CENTER |
FA1A - FACHOME |
6 |
HOSPITAL |
FA2 - HOSPKIND |
7 |
HOSPITAL-BASED SNF UNIT |
FA1A - FACHOME |
8 |
ASSISTED LIVING FACILITY |
FA1A - FACHOME |
9 |
BOARD AND CARE HOME |
FA1A - FACHOME |
10 |
DOMICILIARY CARE HOME |
FA1A - FACHOME |
11 |
PERSONAL CARE HOME |
FA1A - FACHOME |
12 |
REST HOME/RETIREMENT HOME |
FA1A - FACHOME |
13 |
HOME OFFICE OR MANAGEMENT OFFICE FOR A CHAIN OR GROUP OF OFF-SITE NURSING FACILITIES |
FACLOSE5 - LVNORES |
15 |
MENTAL HEALTH CENTER/PSYCHIATRIC SETTING |
FA1A - FACHOME |
16 |
INSTITUTION FOR THE MENTALLY RETARDED/DEVELOPMENTALLY DISABLED |
FA1A - FACHOME |
17 |
REHABILITATION FACILITY |
FA1A - FACHOME |
91 |
OTHER |
FA1 - PLACTPO1 |
|
Refused |
FA1A - FACHOME |
Field 2: PLACTPO1
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FA1A - FACHOME |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PLACTYPE |
If FA1 - PLACTYP1
= 1/FreeStandingNursingHome or 4/NursingHomeUnitCCRC, then
PLAC.PLACTYPE = 4/NursingHomeorNHUnit. |
LOCCODE |
If FA1 - PLACTYP1
= 4/NursingHomeUnitCCRC or 7/HospitalBasedSNF, PLAC.LOCCODE =
2/SampledPartOfLarger. |
ELIGSTAT |
If FA1-PLACTYP1 =
13/HomeManagementOfficeForOffsiteNursing, then FQ.ELIGSTAT =
2/FacilityIneligible. |
NNHESTAT |
If FA1-PLACTYP1 = 13/HomeManagementOfficeForOffsiteNursing, then PLAC.NNHESTAT = 2/Ineligible. |
FQDISP |
If FA1-PLACTYP1 = 13/HomeManagementOfficeForOffsiteNursing, then FQ.FQDISP = 7/CompleteIneligible. Else if FQDISP = 7/CompleteIneligible, then FQDISP = 3/StartedNotComplete. |
SPDISP |
If FA1-PLACYP1 = 13/HomeManagementOfficeForOffsiteNursing, then SPDISP = 11/FinalNonResp. Else if FA1-PLACTYP1 <> 13/HomeManagementOfficeForOffsiteNursing and SPDIAP = 11/FinalNonResp, then SPDISP = EMPTY. |
PLACTPOS |
If FA1 - PLACTYP1
= 91/Other, then PLAC.PLACTPOS = FA1-PLACTPO1. |
Question Text
IF ALREADY KNOWN, CODE WITHOUT ASKING:
Do you prefer that I call (FACILITY) a home or a facility?
Field 1: FACHOME
Field 1 Routing
Value |
Label |
Route |
1 |
PREFERS HOME |
BOX FA1A |
2 |
PREFERS FACILITY |
BOX FA1A |
3 |
NO PREFERENECE |
BOX FA1A |
Box Instructions
IF PLACTYP1 = 4/NursingHomeUnitCCRC or 7/HospitalBasedSNF, GO TO FA4 - PLACTYP2.
IF FA1-PLACTYP1 = 1/FreeStandingNursingHome, GO TO FA5A - EFOWNDES.
ELSE GO TO FA3 - FACLPART.
Question Text
SHOW CARD FA3
You mentioned that (FACILITY) is a hospital. Please look at this card and tell me what kind of hospital it is.
Field 1: HOSPKIND
Field 1 Routing
Value |
Label |
Route |
1 |
ACUTE CARE HOSPITAL |
FA2A - LCNDBEDS |
2 |
PRIVATE PYSCHIATRIC HOSPITAL |
FA2A - LCNDBEDS |
3 |
STATE OR COUNTY HOSPITAL FOR THE MENTALLY ILL |
FA2A - LCNDBEDS |
4 |
VA HOSPITAL, VA MEDICAL CENTER |
FA2A - LCNDBEDS |
5 |
STATE HOSPITAL FOR THE MENTALLY RETARDED |
FA2A - LCNDBEDS |
6 |
CHRONIC DISEASE, REHABILITATION, GERIATRIC, OR OTHER LONG-TERM CARE HOSPITAL |
FA2A - LCNDBEDS |
91 |
OTHER |
FA2 - HOSPKIOS |
Field 2: HOSPKIOS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FA2A - LCNDBEDS |
Question Text
Does (FACILITY) have any beds that are either certified or licensed as a nursing facility or certified or licensed as an ICF-MR (Intermediate Care Facility for the Mentally Retarded)?
PRESS F1 FOR SUGGESTED PROBES.
Field 1: LCNDBEDS
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FA2A |
1 |
YES |
FA3 - FACLPART |
|
Don't Know |
BOX FA2A |
|
Refused |
BOX FA2A |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FQDISP |
If FA2A-LCNDBEDS = 1/Yes and FQDISP = 7/CompleteIneligible, then FQDISP = 3/StartedNotComplete. |
Box Instructions
IF FA2 - HOSPKIND = 1/AcuteCareHospital, GO TO FACLOSE2 - LEAVINEL.
ELSE GO TO FA3 - FACLPART.
Variable Name |
Assignment Instructions |
FQDISP |
If FA2-HOSPKIND = 1/AcuteCareHospital and FA2A-LCNDBEDS = 0/No, DK, or RF, then FQDISP = 7/CompleteIneligible. |
ELIGSTAT |
If FA2-HOSPKIND = 1/AcuteCareHospital and FA2A-LCNDBEDS = 0/No, DK, or RF, then FQ.ELIGSTAT = 2/FacilityIneligible |
SPDISP |
If FA2-HOSPKIND = 1/AcuteCareHospital and FA2A-LCNDBEDS = 0/No, DK, or RF, then SPDISP = 11/FinalNonResp. Else if FQ.ELIGSTAT <> 2/FacilityIneligible and SPDISP = 1/FinalNonResp, then SPDISP = EMPTY. |
Question Text
Is (FACILITY) part of a larger facility or campus?
PRESS F1 FOR DEFINITION, EXAMPLES OF "LARGER" PLACES.
Field 1: FACLPART
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FA5A - EFOWNDES |
1 |
YES |
FA4 - PLACTYP2 |
|
Don't Know |
BOX FA6 |
|
Refused |
BOX FA6 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
LARGPLAC |
If FA3-FACLPART = 0/No, DK, or RF, then FQ.LARGPLAC = EMPTY. |
Question Text
SHOW CARD FA1
What type of place is (FACILITY) part of?
PRESS F1 FOR HOSPITAL DEFINITIONS.
Field 1: PLACTYP2
Field 1 Routing
Value |
Label |
Route |
3 |
CONTINUING CARE RETIREMENT COMMUNITY (CCRC) |
FA5 - LGPLCNAM |
5 |
RETIREMENT COMMUNITY |
FA5 - LGPLCNAM |
6 |
HOSPITAL |
FA5 - LGPLCNAM |
8 |
ASSISTED LIVING FACILITY |
FA5 - LGPLCNAM |
9 |
BOARD AND CARE HOME |
FA5 - LGPLCNAM |
10 |
DOMICILIARY CARE HOME |
FA5 - LGPLCNAM |
11 |
PERSONAL CARE HOME |
FA5 - LGPLCNAM |
12 |
REST HOME/RETIREMENT HOME |
FA5 - LGPLCNAM |
91 |
OTHER |
FA4 - PLACTPO2 |
|
Don't Know |
FA5 - LGPLCNAM |
|
Refused |
FA5 - LGPLCNAM |
Field 2: PLACTPO2
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FA5 - LGPLCNAM |
Question Text
What is the name of the (CATEGORY SELECTED IN FA4 - PLACTYP2/place)?
Field 1: LGPLCNAM
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FA5A - EFOWNDES |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
LARGPLAC |
FQ.LARGPLAC = FA5 - LGPLCNAM |
Question Text
SHOW CARD FA4
Which one of the categories on this card best describes the ownership of (FACILITY)?
Field 1: EFOWNDES
Field 1 Routing
Value |
Label |
Route |
1 |
FOR PROFIT (INDIVIDUAL, PARTNERSHIP, OR CORPORATION) |
BOX FA6 |
2 |
PRIVATE NONPROFIT (RELIGIOUS GROUP, NONPROFIT CORPORATION, ETC) |
BOX FA6 |
3 |
CITY/COUNTY GOVERNMENT |
BOX FA6 |
4 |
STATE GOVERNMENT |
BOX FA6 |
5 |
VETERAN'S ADMINISTRATION |
BOX FA6 |
6 |
OTHER FEDERAL AGENCY |
BOX FA6 |
91 |
OTHER |
FA5A - EFOWNDOS |
Field 2: EFOWNDOS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FA6 |
Box Instructions
GO TO BOX FA6A.
Variable Name |
Assignment Instructions |
NNHESTAT |
PLAC.NNHESTAT = 1/Eligible. |
RHPLACTY |
PLAC.RHPLACTY = 1/EligibleLTC. |
LOCCODE |
If FA5-LGPLCNAM <> EMPTY, PLAC.LOCCODE = 2/SampledPartOfLarger. Else FQ.LOCCODE = 1/SampledFac. |
COMPLEXF |
If FA3 - FACLPART = 1/Yes or (PLACTYP1 = 4 or 7), COMPLEXF = 1/Indicated. Else FQ.COMPLEXF = EMPTY. |
Box Instructions
IF FACILTIY IS ELIGIBLE, GO TO FA10 - ANSRELIG.
ELSE GO TO FACLOSE2 - LEAVINEL.
Variable Name |
Assignment Instructions |
STRUCCOMP |
If facility is eligible, then STRUCCOMP = 1/Indicated. |
Question Text
Would you be able to answer some questions about the certification status, services offered, and number of beds for (FACILITY)?
Field 1: ANSRELIG
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FA11 - FACRNAM2 |
1 |
YES |
FA12 - BEDSNUM |
|
Don't Know |
FA11 - FACRNAM2 |
|
Refused |
FA11 - FACRNAM2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
XFACRFEL |
If FA10 - ANSRELIG = 1/Yes then PLAC.XFACRFEL = FACRNUM of current respondent. |
Question Text
What is the name of the most knowledgeable person to answer questions about (FACILITY)?
SELECT A RESPONSE BELOW OR ADD TO THE PERSON ROSTER.
Field 1: FACRNAM2
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
CLOSING6 - FINOTRES |
Question Text
How many beds does (FACILITY) have?
PRESS F1 FOR EXPANDED DEFINITION OF "BEDS".
Field 1: BEDSNUM
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FA8 |
|
Don't Know |
BOX FA8 |
|
Refused |
BOX FA8 |
Other Programming Instructions
Background Variable Assignments
RHPLACTY:
If
FA12 - BEDSNUM < 3 and FA12 - BEDSNUM <> DK, RF then
RHPLACTY = 2/IneligibleLTC. Else if FA12-BEDSNUM >= 3 then:
If
FA1-PLACTYP1 = 13/HomeManagementOfficeForOffsiteNursing, then
PLAC.RHPLACTY = 4/Community.
Else if FA2-HOSPKIND =
1/AcuteCareHospital and FA2A-LCNDBEDS <> 1/Yes, then
PLAC.RHPLACTY = 3/Hospital.
Else PLAC.RHPLACTY = 1/EligibleLTC.
Variable Name |
Assignment Instructions |
ELIGSTAT |
If FA12 - BEDSNUM < 3 and FA12 - BEDSNUM <> DK, RF then FQ.ELIGSTAT = 2/FacilityIneligible. Else if FA12-BEDSNUM >= 3, then FQ.ELIGSTAT = 1/FacilityEligible |
NNHESTAT |
If FA12 - BEDSNUM < 3 and FA12 - BEDSNUM <> DK, RF then PLAC.NNHESTAT = 2/Ineligible. |
SPDISP |
If FA12-BEDSNUM < 3 and FA12-BEDSNUM <> DK, RF, then SPDISP = 11/FinalNonResp. Else if FQ.ELIGSTAT <> 2/FacilityIneligible and SPDISP = 11/FinalNonResp then SPDISP = EMPTY |
Box Instructions
IF FA12 - BEDSNUM < 3 AND FA12-BEDSNUM <> DK,RF, GO TO FACLOSE2 - LEAVINEL.
ELSE IF PLAC.PLACTYPE = 4/NursingHomeorNHUnit, 7/HospitalBasedSNF, OR 17/RehabilitationFacility, GO TO FA13 - CAIDCRT1.
ELSE IF PLAC.PLACTYPE = 16/InstitutionForMentallyRetarded OR FA2 - HOSPKIND = 3/StateCountyHospitalForMentallyIll OR 5/StateHospitalForMentallyRetarded OR 6/ChronicDiseaseLongTermHospital, GO TO FA15 - CAIDICF.
ELSE GO TO FA18 - HDEPTPCH.
Question Text
Does
(FACILITY) have any beds certified by [(PREFERRED NAME(S) FOR
MEDICAID)/MEDICAID] as Nursing Facility (NF) beds?
[READ
IF NECESSARY: We are concerned only with the place where (SP) is
physically located.]
IF
R MENTIONS:
ICF-MR (INTERMEDIATE CARE FACILITY--MENTAL
RETARDATION), SAY THAT YOU WILL ASK ABOUT THOSE IN A MOMENT.
Field 1: CAIDCRT1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FA14 - CARECRT1 |
1 |
YES |
FA14 - CARECRT1 |
|
Don't Know |
FA14 - CARECRT1 |
|
Refused |
FA14 - CARECRT1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
CAIDCERT |
FQ.CAIDCERT = FA13 - CAIDCRT1 |
Question Text
Does (FACILITY) have any beds certified by Medicare as SNF beds?
Field 1: CARECRT1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FA15 - CAIDICF |
1 |
YES |
FA15 - CAIDICF |
|
Don't Know |
FA15 - CAIDICF |
|
Refused |
FA15 - CAIDICF |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
CARECERT |
FQ.CARECERT = FA14 - CARECRT1 |
Question Text
Does (FACILITY) have any beds certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as ICF-MR (Intermediate Care Facility for the Mentally Retarded) beds?
Field 1: CAIDICF
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FA16 - HDEPTLIC |
1 |
YES |
FA16 - HDEPTLIC |
|
Don't Know |
FA16 - HDEPTLIC |
|
Refused |
FA16 - HDEPTLIC |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FMRCERT |
FQ.FMRCERT = FA15 - CAIDICF |
Question Text
Does (FACILITY) have any beds that are [not certified by (Medicaid and Medicare/Medicare/Medicaid) but are] licensed as nursing home beds by the (STATE) State Health Department or by some other State or Federal Agency?
Field 1: HDEPTLIC
Field 1 Routing
Value |
Label |
Route |
0 |
NO, NOT LICENSED |
FA18 - HDEPTPCH |
1 |
YES, LICENSED BY STATE HEALTH DEPARTMENT |
FA18 - HDEPTPCH |
2 |
YES, LICENSED BY SOME OTHER AGENCY |
FA16 - HDEPTLOS |
|
Don't Know |
FA18 - HDEPTPCH |
|
Refused |
FA18 - HDEPTPCH |
Field 2: HDEPTLOS
OTHER AGENCY (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FA18 - HDEPTPCH |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
HDLICEN |
FQ.HDLICEN = FA16 - HDEPTLIC |
HDLICOS |
FQ.HDLICOS = FA16 - HDEPTLOS |
Question Text
Does (FACILITY) have any beds licensed as personal care, board and care, assisted living, or domiciliary care beds by the (STATE) State Health Department or by some other state or local government agency?
Field 1: HDEPTPCH
Field 1 Routing
Value |
Label |
Route |
0 |
NO, NOT LICENSED |
FA19 - NORMCARE |
1 |
YES, LICENSED BY STATE HEALTH DEPARTMENT |
FA19 - NORMCARE |
2 |
YES, LICENSED BY SOME OTHER AGENCY |
FA18 - HDEPTPOS |
|
Don't Know |
FA19 - NORMCARE |
|
Refused |
FA19 - NORMCARE |
Field 2: HDEPTPOS
OTHER AGENCY (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FA19 - NORMCARE |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PCHLICEN |
FQ.PCHLICEN = FA18 - HDEPTPCH |
PCHLICOS |
FQ.PCHLICOS = F18 - HDEPTPOS |
Question Text
In addition to room and board, does (FACILITY) routinely provide…
Field 1: NORMCARE
nursing or medical care?
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FA19 - SUPRMEDI |
1 |
YES |
FA19 - SUPRMEDI |
|
Don't Know |
FA19 - SUPRMEDI |
|
Refused |
FA19 - SUPRMEDI |
Field 2: SUPRMEDI
supervision over medications?
Field 2 Routing
Value |
Label |
Route |
0 |
NO |
FA19 - HELPBATH |
1 |
YES |
FA19 - HELPBATH |
|
Don't Know |
FA19 - HELPBATH |
|
Refused |
FA19 - HELPBATH |
Field 3: HELPBATH
help with bathing?
Field 3 Routing
Value |
Label |
Route |
0 |
NO |
FA19 - HELPDRES |
1 |
YES |
FA19 - HELPDRES |
|
Don't Know |
FA19 - HELPDRES |
|
Refused |
FA19 - HELPDRES |
Field 4: HELPDRES
help with dressing?
Field 4 Routing
Value |
Label |
Route |
0 |
NO |
FA19 - HELPSHOP |
1 |
YES |
FA19 - HELPSHOP |
|
Don't Know |
FA19 - HELPSHOP |
|
Refused |
FA19 - HELPSHOP |
Field 5: HELPSHOP
help with correspondence or shopping?
Field 5 Routing
Value |
Label |
Route |
0 |
NO |
FA19 - HELPWALK |
1 |
YES |
FA19 - HELPWALK |
|
Don't Know |
FA19 - HELPWALK |
|
Refused |
FA19 - HELPWALK |
Field 6: HELPWALK
help with walking?
Field 6 Routing
Value |
Label |
Route |
0 |
NO |
FA19 - HELPEAT |
1 |
YES |
FA19 - HELPEAT |
|
Don't Know |
FA19 - HELPEAT |
|
Refused |
FA19 - HELPEAT |
Field 7: HELPEAT
help with eating?
Field 7 Routing
Value |
Label |
Route |
0 |
NO |
FA19 - HELPCOMM |
1 |
YES |
FA19 - HELPCOMM |
|
Don't Know |
FA19 - HELPCOMM |
|
Refused |
FA19 - HELPCOMM |
Field 8: HELPCOMM
help with communications?
Field 8 Routing
Value |
Label |
Route |
0 |
NO |
BOX FA13 |
1 |
YES |
BOX FA13 |
|
Don't Know |
BOX FA13 |
|
Refused |
BOX FA13 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PROVHELP |
If FA19 - NORMCARE = 1/Yes or FA19 - SUPPMEDI = 1/Yes or FA19 - HELPBATH = 1/Yes or FA19 - HELPDRES = 1/Yes or FA19 - HELPSHOP = 1/Yes or FA19 - HELPWALK = 1/Yes or FA19 - HELPEAT = 1/Yes or FA19 - HELPCOMM = 1/Yes then FQ.PROVHELP = 1/Indicated |
Box Instructions
IF FA13 - CAIDCRT1, FA14 - CARECRT1, OR FA15 - CAIDICF = 1/Yes, GO TO FA20 - CARESUP.
ELSE GO TO FA19A - RNLPNSUP.
Question Text
Does (FACILITY) provide 24-hour a day, on-site supervision by an RN or LPN 7 days a week?
Field 1: RNLPNSUP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FA16A |
1 |
YES |
BOX FA16A |
|
Don't Know |
BOX FA16A |
|
Refused |
BOX FA16A |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
NURSSUP |
FQ.NURSSUP = FA19A - RNLPNSUP |
Question Text
Does (FACILITY) provide 24-hour a day, on-site supervision by a caregiver 7 days a week?
Field 1: CARESUP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FA16A |
1 |
YES |
BOX FA16A |
|
Don't Know |
BOX FA16A |
|
Refused |
BOX FA16A |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
CGIVSUP |
FQ.CGIVSUP = FA20 - CARESUP |
Box Instructions
GO TO BOX FA16.
Other Programming Instructions
Background Variable Assignments
REASSIGN
ELIGSTAT AS DESCRIBED BELOW:
If FA13-CAIDCRT1 = 1/Yes or
FA14-CARECRT1 = 1/Yes or FA16 - HDEPTLIC = 1/YesStateHealthDept or
2/YesOtherAgency or FQ.PROVHELP = 1/Indicated or FA19A - RNLPNSUP =
1/Yes or FA20-CARESUP = 1/Yes, then FQ.ELIGSTAT =
1/FacilityEligible.
Else if FA13-CAIDCRT1 = 0/No, EMPTY
and FA14-CARECRT1 = 0/No, EMPTY and FA15-CAIDICF = 0/No, EMPTY and
FA16-HDEPTLIC = 0/NoNotLicensed, EMPTY and FA18-HDEPTPCH =
0/NoNotLicensed, EMPTY and FA19-NORMCARE = 0/No and FA19-SUPRMEDI=
0/No and FA1-HELPBATH = 0/No and FA19-HELPWALK = 0/No and
FA19-HELPEAT = 0/No and FA19-HELPCOMM = 0/No and FA19-RNLPNSUP =
0/No, EMPTY, and FA20-CARESUP = 0/No, EMPTY, then
FQ.ELIGSTAT=2/FacilityIneligible.
Else FQ.ELIGSTAT =
3/Undetermined.
Box Instructions
IF FQ.ELIGSTAT = 1/FacilityEligible, GO TO FA22 - ANSRFACQ.
ELSE IF FQ.ELIGSTAT = 2/FacilityIneligible, GO TO FACLOSE2 - LEAVINEL.
ELSE GO TO FA11 - FACRNAM2.
Other Programming Instructions
Variable Name |
Assignment Instructions |
ELIGCOMP |
If FQ.ELIGSTAT = 1/FacillityEligible, then ELIGCOMP = 1/Indicated |
SPDISP |
If FQ.ELIGSTAT = 2/FacilityIneligible, then SPDISP = 11/FinalNonResp. Else if FQ.ELIGSTAT <> 2/FacilityIneligible and SPDISP = 11/FinalNonResp, then SPDISP = EMPTY. |
Design Notes
To be deemed eligible, the facility must (1) Have three or more beds, and (2) Be certified by Medicaid or Medicare or be licensed as a nursing home or other long-term care facility, or provide at least one personal care service, or provide 24 hour, 7 day a week supervision by a caretaker.
Question Text
The next questions are about the number of nursing beds and residents by payer type and staffing. Can you answer these questions about (FACILITY)?
Field 1: ANSRFACQ
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FA23 - FACRNAM3 |
1 |
YES |
BOX FA17 |
|
Don't Know |
BOX FA17 |
|
Refused |
FA23 - FACRNAM3 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
XFACRFAQ |
If FA22-ANSRFACQ = 1/Yes, then PLAC.XFACRFAQ = FACRNUM of current respondent |
Question Text
Who would be the best person to answer questions about (FACILITY)?
SELECT A RESPONSE BELOW OR ADD TO THE PERSON ROSTER.
Field 1: FACRNAM3
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
CLOSING6 - FINOTRES |
Box Instructions
IF FA12 - BEDSNUM <> DK OR RF, GO TO FA24PRE - FA24PRCT.
ELSE GO TO FA24 - ANYBEDUL.
Question Text
From
information I collected earlier, I understand that (FACILITY) has a
total of (NUMBER OF BEDS IN FACILITY) beds.
[IF NECESSARY:
We are concerned only with the place where (SP) is physically
located.]
PRESS "1" TO CONTINUE.
Field 1: FA24PRCT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
FA24 - ANYBEDUL |
Question Text
Does (FACILITY) have any beds that are not licensed or certified or otherwise identified as nursing or other long-term care beds?
PRESS F1 FOR DEFINITION OF "OTHERWISE IDENTIFIED".
Field 1: ANYBEDUL
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FA18 |
1 |
YES |
FA25 - ULBEDS |
|
Don't Know |
BOX FA18 |
|
Refused |
BOX FA18 |
Question Text
How many beds are not licensed or certified or otherwise identified as nursing or other long-term care beds?
Field 1: ULBEDS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FA18 |
|
Don't Know |
BOX FA18 |
|
Refused |
BOX FA18 |
Box Instructions
IF FACILITY CERTIFIED BY BOTH MEDICAID AND MEDICARE, GO TO FA26 - MANDMBED.
ELSE IF FACILITY IS CERTIFIED BY MEDICAID, GO TO FA27 - MCAIDBED.
ELSE GO TO BOX FA20.
Variable Name |
Assignment Instructions |
TOTELBED |
If FA12-BEDSNUM =
DK,RF or FA25-ULBEDS = DK,RF then FQ.TOTELBED = DK. |
BEDSLEFT |
TEMP.BEDSLEFT = FQ.TOTELBED |
Question Text
I have recorded that (FACILITY) contains beds that are certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as Nursing Facility beds and by Medicare as Skilled Nursing Facility beds. How many beds are dually certified (that is, certified by both)?
Field 1: MANDMBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FA27 - MCAIDBED |
|
Don't Know |
FA27 - MCAIDBED |
|
Refused |
FA27 - MCAIDBED |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BEDSLEFT |
If BEDSLEFT <> DK, RF and FA26-MANDMBED <> DK, RF, then BEDSLEFT = BEDSLEFT - FA26-MANDMBED |
Question Text
I have recorded that (FACILITY) contains beds that are certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as Nursing Facility beds. How many beds are certified under [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] (only)?
Field 1: MCAIDBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FA20 |
|
Don't Know |
BOX FA20 |
|
Refused |
BOX FA20 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BEDSLEFT |
If BEDSLEFT <> DK, RF and FA27-MCAIDBED <> DK, RF, then BEDSLEFT = BEDSLEFT - FA27-MCAIDBED |
Box Instructions
IF FA14 - CARECRT1 = 1/Yes, GO TO FA28 - MCAREBED.
ELSE GO TO BOX FA21.
Question Text
I have recorded that (FACILITY) contains beds that are certified by Medicare as Skilled Nursing Facility beds. How many beds are certified under Medicare (only)?
Field 1: MCAREBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FA21 |
|
Don't Know |
BOX FA21 |
|
Refused |
BOX FA21 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BEDSLEFT |
If BEDSLEFT <> DK, RF and FA28-MCAREBED <> DK, RF, then BEDSLEFT = BEDSLEFT - FA28-MCAREBED |
Box Instructions
IF FA16 - HDEPTLIC = 1/YesStateHealthDept OR 2/YesOtherAgency, GO TO FA29 - MNORMBED.
ELSE GO TO BOX FA22.
Question Text
I have recorded that (FACILITY) contains beds that are licensed as nursing facility beds but not certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] or Medicare. How many beds are licensed but not certified as nursing home beds (only)?
Field 1: MNORMBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FA22 |
|
Don't Know |
BOX FA22 |
|
Refused |
BOX FA22 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BEDSLEFT |
If BEDSLEFT <> DK, RF and FA29-MNORMBED <> DK, RF, then BEDSLEFT = BEDSLEFT - FA29-MNORMBED |
Box Instructions
IF FA15 - CAIDICF = 1/Yes, GO TO FA30 - ICFMRBED.
ELSE GO TO BOX FA23.
Question Text
I have recorded that (FACILITY) contains beds that are certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as ICF-MR (Intermediate Care Facility for the Mentally Retarded) beds. How many beds are certified as ICF-MR beds (only)?
Field 1: ICFMRBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FA23 |
|
Don't Know |
BOX FA23 |
|
Refused |
BOX FA23 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BEDSLEFT |
If BEDSLEFT <> DK, RF and FA30-ICFMRBED <> DK, RF, then BEDSLEFT = BEDSLEFT - FA30-ICFMRBED |
Box Instructions
IF FA18 - HDEPTPCH = 1/YesStateHealthDept OR 2/YesOtherAgency, GO TO FA31 - OTLTCBED.
ELSE GO TO BOX FA24.
Question Text
I recorded earlier that (FACILITY) contains beds that are licensed as personal care, board and care, assisted living, domiciliary care, or other type of long-term care beds. How many beds are licensed as one of these types of long-term care (only)?
Field 1: OTLTCBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FA24 |
|
Don't Know |
BOX FA24 |
|
Refused |
BOX FA24 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BEDSLEFT |
If BEDSLEFT <>
DK, RF and FA31-OTLTCBED <> |
Box Instructions
IF CANNOT CALCULATE NUMBER OF REMAINING BEDS, GO TO FA35 - MIDNTRES.
ELSE, GO TO FA32 - NHBEDCOR.
Variable Name |
Assignment Instructions |
NLTCBEDS |
FQ.NLTCBEDS = BEDSLEFT |
Question Text
So,
there are a total of (TOTAL # LTC BEDS) LTC beds in the
(facility/home).
[REVIEW NUMBER OF BEDS BY TYPE.]
That
leaves (NUMBER OF BEDS LEFT) long-term care beds that are neither
certified or licensed as nursing home or other long-term care beds.
Is that correct?
Field 1: NHBEDCOR
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FA32VB - NHBEDEX |
1 |
YES |
FA35 - MIDNTRES |
Other Programming Instructions
Report Display
Report
Display Instructions:
In first fill for TOTAL # LTC BEDS,
display TOTELBED.
If FA26- MANDMBED > 0, display second
clause and fill with number in FA26 - MANDMBED.
If FA27 -
MCAIDBED > 0, display third clause and fill with number in FA27 -
MCAIDBED.
If FA28 - MCAREBED > 0, display fourth clause and
fill with number in FA28 - MCAREBED.
If FA29 - MNORMBED > 0,
display fifth clause and fill with number in FA29 - MNORMBED.
If
FA30 - ICFMRBED > 0, display sixth clause and fill with number in
FA30 - ICFMRBED.
If FA31 - OTLTCBED > 0, display seventh
clause and fill with number in FA31 - OTLTCBED.
If there
are PREFERRED NAME(S) FOR MEDICAID, display "(PREFERRED NAME(S)
FOR MEDICAID)".
Else display "MEDICAID".
Always
display "(s)" in parentheses.
Report
Display:
TOTAL # OF BEDS: (TOTAL # LTC BEDS)
[(# DUALLY
CERTIFIED BEDS) dually certified nursing bed(s)]
[(# CERTIFIED
MEDICAID BEDS) certified by [(PREFERRED NAME(S) FOR
MEDICAID)/MEDICAID] as nursing bed(s) (only)]
[(# CERTIFIED
MEDICARE BEDS) certified as nursing bed(s) by Medicare (only)]
[(#
NOT CERTIFIED MEDICARE/MEDICAID BEDS) not certified by Medicare or
[(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] but licensed as
nursing bed(s)]
[(# CERTIFIED MEDICAID ICF-MR BEDS) certified by
[(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as ICF-MR bed(s)]
[(#
LICENSED LONG-TERM BEDS) licensed as personal care, assisted living,
or other type of long-term care bed(s)]
Question Text
PLEASE ENTER A BRIEF EXPLANATION:
Field 1: NHBEDEX
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FA35 - MIDNTRES |
Question Text
How many residents were in (FACILITY) altogether at midnight last night?
Field 1: MIDNTRES
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FR1PRE - FR1PRECT |
|
Don't Know |
FR1PRE - FR1PRECT |
|
Refused |
FR1PRE - FR1PRECT |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
QUESCOMP |
QUESCOMP = 1/Indicated |
HOSPKIND |
If PLAC.PLACTYPE = 6/Hospital, PLAC.HOSPKIND = FA2-HOSPKIND. |
HOSPKIOS |
If PLAC.PLACTYPE = 6/Hospital, PLAC.HOSPKIOS = FA2-HOSPKIOS. |
Question Text
Would you be able to answer some questions about the certification status, services offered, and the number of beds for (FACILITY)?
Field 1: ANSWERFB
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FB19 - FACRNAM4 |
1 |
YES |
FB1PRE - FB1PRECT |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Question Text
I would like to review with you some information that I collected about (FACILITY) the last time I was here.
PRESS "1" TO CONTINUE.
Field 1: FB1PRECT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FB1 |
Box Instructions
IF PreloadFQ.CAIDCERT = EMTPY, GO TO BOX FB3.
ELSE GO TO FB2 - CAIDCERT.
Question Text
Is (FACILITY) (still) certified by Medicaid as a Nursing Facility (NF)?
Field 1: CAIDCERT
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FB5 - CARECERT |
1 |
YES |
FB5 - CARECERT |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
CAIDCERT |
FQ.CAIDCERT = FB2 - CAIDCERT |
Question Text
Is (FACILITY) (still) certified by Medicare as a Skilled Nursing Facility (SNF)?
Field 1: CARECERT
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FB3 |
1 |
YES |
BOX FB3 |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
CARECERT |
FQ.CARECERT = FB5 - CARECERT |
Box Instructions
IF PreloadFQ.FMRCERT <> EMPTY, GO TO FB9 - FMRCERT.
ELSE GO TO BOX FB4.
Question Text
Is (FACILITY) (still) certified by Medicaid as an Intermediate Care Facility for the Mentally Retarded (ICF-MR)?
Field 1: FMRCERT
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FB4 |
1 |
YES |
BOX FB4 |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FMRCERT |
FQ.FMRCERT = FB9 - FMRCERT |
Box Instructions
IF PreloadFQ.HDLICEN <> EMPTY, GO TO FB11 - HDLICEN.
ELSE GO TO FB14 - PCHLICEN.
Question Text
Does (FACILITY) (still have/have any) beds that are [not certified by (Medicaid and Medicare/Medicare/Medicaid) but are] licensed as nursing (facility/home) beds by the (STATE) State Health Department or by some other State or Federal agency?
Field 1: HDLICEN
Field 1 Routing
Value |
Label |
Route |
0 |
NO, NOT LICENSED |
FB14 - PCHLICEN |
1 |
YES, LICENSED BY STATE HEALTH DEPARTMENT |
FB14 - PCHLICEN |
2 |
YES, LICENSED BY SOME OTHER AGENCY |
FB11 - HDLICOS |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Field 2: HDLICOS
OTHER AGENCY (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FB14 - PCHLICEN |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
HDLICOS |
FQ.HDLICOS = FB11 - HDLICOS |
HDLICEN |
FQ.HDLICEN = FB11 - HDLICEN |
Question Text
Is (FACILITY) (still) licensed as a personal care home, board and care home, assisted living facility, domiciliary care home or rest home by the (STATE) State Health Department or by some other state or local government agency?
Field 1: PCHLICEN
Field 1 Routing
Value |
Label |
Route |
0 |
NO, NOT LICENSED |
FB15 - NURSCARE |
1 |
YES, LICENSED BY STATE HEALTH DEPARTMENT |
FB15 - NURSCARE |
2 |
YES, LICENSED BY SOME OTHER AGENCY |
FB14 - PCHLICOS |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Field 2: PCHLICOS
OTHER AGENCY (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FB15 - NURSCARE |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PCHLICOS |
FQ.PCHLICOS = FB14 - PCHLICOS |
PCHLICEN |
FQ.PCHLICEN = FB14 - PCHLICEN |
Question Text
In addition to room and board, does (FACILITY) routinely provide…
Field 1: NURSCARE
nursing or medical care?
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FB15 - MEDISUPR |
1 |
YES |
FB15 - MEDISUPR |
|
Don't Know |
FB15 - MEDISUPR |
|
Refused |
FB15 - MEDISUPR |
Field 2: MEDISUPR
supervision over medications?
Field 2 Routing
Value |
Label |
Route |
0 |
NO |
FB15 - BATHHELP |
1 |
YES |
FB15 - BATHHELP |
|
Don't Know |
FB15 - BATHHELP |
|
Refused |
FB15 - BATHHELP |
Field 3: BATHHELP
help with bathing?
Field 3 Routing
Value |
Label |
Route |
0 |
NO |
FB15 - DRESHELP |
1 |
YES |
FB15 - DRESHELP |
|
Don't Know |
FB15 - DRESHELP |
|
Refused |
FB15 - DRESHELP |
Field 4: DRESHELP
help with dressing?
Field 4 Routing
Value |
Label |
Route |
0 |
NO |
FB15 - SHOPHELP |
1 |
YES |
FB15 - SHOPHELP |
|
Don't Know |
FB15 - SHOPHELP |
|
Refused |
FB15 - SHOPHELP |
Field 5: SHOPHELP
help with correspondence or shopping?
Field 5 Routing
Value |
Label |
Route |
0 |
NO |
FB15 - WALKHELP |
1 |
YES |
FB15 - WALKHELP |
|
Don't Know |
FB15 - WALKHELP |
|
Refused |
FB15 - WALKHELP |
Field 6: WALKHELP
help with walking?
Field 6 Routing
Value |
Label |
Route |
0 |
NO |
FB15 - EATHELP |
1 |
YES |
FB15 - EATHELP |
|
Don't Know |
FB15 - EATHELP |
|
Refused |
FB15 - EATHELP |
Field 7: EATHELP
help with eating?
Field 7 Routing
Value |
Label |
Route |
0 |
NO |
FB15 - COMMHELP |
1 |
YES |
FB15 - COMMHELP |
|
Don't Know |
FB15 - COMMHELP |
|
Refused |
FB15 - COMMHELP |
Field 8: COMMHELP
help with communications?
Field 8 Routing
Value |
Label |
Route |
0 |
NO |
BOX FB5AA |
1 |
YES |
BOX FB5AA |
|
Don't Know |
BOX FB5AA |
|
Refused |
BOX FB5AA |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PROVHELP |
If FB15-NURSCARE or FB15-MEDISUPR or FB15-BATHHELP or FB15-DRESHELP or FB15-SHOPHELP or FB15-WALKHELP or FB15-EATHELP or FB15-COMMHELP = 1/Yes, then FQ.PROVHELP = 1/Indicated. |
Box Instructions
IF ANY ITEM IN FB15 = DK OR RF, GO TO FB19 - FACRNAM4.
ELSE GO TO BOX FB5.
Box Instructions
IF FB2-CAIDCERT = 1/Yes OR FB5-CARECERT = 1/Yes OR FB9-FMRCERT = 1/Yes, GO TO FB16 - CGIVSUP.
ELSE GO TO FB15A - NURSSUP.
Question Text
Does (FACILITY) provide 24-hour a day, on-site supervision by an RN or LPN 7 days a week?
Field 1: NURSSUP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FB8 |
1 |
YES |
BOX FB8 |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
NURSSUP |
FQ.NURSSUP = FB15A - NURSSUP |
Question Text
Does (FACILITY) provide 24-hour a day, on-site supervision by a caregiver 7 days a week?
Field 1: CGIVSUP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FB8 |
1 |
YES |
BOX FB8 |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
CGIVSUP |
FQ.CGIVSUP = FB16 - CGIVSUP |
Box Instructions
IF FB2-CAIDCERT = 1/Yes OR FB5-CARECERT = 1/Yes OR FB9-FMRCERT = 1/Yes OR FB11-HDLICEN = 1/YesStateHealthAgency OR 2/YesOtherAgency OR FB14-PCHLICEN = 1/YesStateHealthAgency OR 2/YesOtherAgency OR FQ.PROVHELP = 1/Indicated OR FB15A-NURSSUP = 1/Yes OR FB16-CGIVSUP = 1/Yes, GO TO BOX FB9.
ELSE GO TO FBCLOSE2 - LEVINEL2.
Other Programming Instructions
Background Variable Assignments
Set
ELIGSTAT using the following logic:
ELIGSTAT:
If
(FB2-CAIDCERT or FB5-CARECERT or FB9-FMRCERT = 1/Yes) or
(FB11-HDLICEN or FB14-PCHLICEN = 1/YesStateHealthAgency or
2/YesOtherAgency) or FQ.PROVHELP = 1/Indicated or (FB15A-NURSSUP or
FB16-CGIVSUP = 1/Yes), then FQ.ELIGSTAT = 1/FacilityEligible.
Else
FQ.ELIGSTAT = 2/FacilityIneligible.
Variable Name |
Assignment Instructions |
FQDISP |
If FQ.ELIGSTAT = 2/FacilityIneligible, then FQDISP = 7/CompleteIneligible |
SPDISP |
If FQ.ELIGSTAT = 2/FacilityIneligible, then SPDISP = 11/FinalNonResp. Else if FQ.ELIGSTAT <> 2/FacilityIneligible and SPDISP = 11/FinalNonResp, then SPDISP = EMPTY. |
Box Instructions
IF PreloadFQ.TOTELBED = DK, RF, GO TO FB18 - TOTELBED.
ELSE GO TO FB17 - SAMEBEDS.
Question Text
I have recorded that (FACILITY) has [PREVIOUS TOTAL # LTC BEDS] beds that provide long-term care. Is this still the number of beds providing long-term care in (FACILITY)?
Field 1: SAMEBEDS
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FB18 - TOTELBED |
1 |
YES |
BOX FB11 |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
TOTELBED |
If FB17-SAMEBEDS = 1/Yes, then FQ.TOTELBED = PreloadFQ.TOTELBED |
Question Text
How
many beds does (FACILITY) have that provide long-term care?
[PROBE:
Do not count "independent living" beds or those that don't
provide 24-hour a day assistance or supervision with daily living
activities.]
Field 1: TOTELBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FB11 |
|
Don't Know |
FB19 - FACRNAM4 |
|
Refused |
FB19 - FACRNAM4 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ELIGSTAT |
If FB18-TOTELBED < 3, and FB18-TOTELBED <> DK,RF, then FQ.ELIGSTAT = 2/FacilityIneligible. ELSE FQ.ELIGSTAT = 1/FacilityEligible |
FQDISP |
If FQ.ELIGSTAT = 2/FacilityIneligible then FQDISP = 7/CompleteIneligible |
SPDISP |
If FQ.ELIGSTAT = 2/FacilityIneligible, then SPDISP = 11/FinalNonResp. Else if FQ.ELIGSTAT <> 2/FacilityIneligible and SPDISP = 11/FinalNonResp, then SPDISP = EMPTY. |
TOTELBED |
If FB18 - TOTELBED >= 3, then FQ.TOTELBED = FB18 - TOTELBED |
Question Text
Who would be the best person to answer these questions about (FACILITY)?
SELECT A RESPONSE BELOW OR ADD TO THE PERSON ROSTER.
Field 1: FACRNAM4
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
CLOSING6B - FINOTRSB |
Box Instructions
IF FQ.ELIGSTAT = 2/FacilityIneligible, GO TO FBCLOSE2 - LEVINEL2.
ELSE IF FB2-CAIDCERT = 1/Yes AND FB5-CARECERT = 1/Yes, GO TO FB20 - CANDCBED.
ELSE GO TO BOX FB12.
Variable Name |
Assignment Instructions |
FBBEDS |
FBBEDS = FQ.TOTELBED |
FBELIG |
FBELIG = 1/Indicated |
Question Text
I have recorded that (FACILITY) contains beds that are certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as Nursing Facility beds and by Medicare as Skilled Nursing Facility beds. How many beds are dually certified (that is, certified by both)?
Field 1: CANDCBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FB12 |
|
Don't Know |
BOX FB12 |
|
Refused |
BOX FB12 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FBBEDS |
If FB20-CANDCBED <> DK, RF, then FBBEDS = FBBEDS - FB20-CANDCBED |
Box Instructions
IF FB2-CAIDCERT = 1/Yes, GO TO FB21 - CAIDBEDS.
ELSE GO TO BOX FB13.
Question Text
[I have recorded that (FACILITY) contains beds that are certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as Nursing Facility beds.] How many beds are certified under [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] (only)?
Field 1: CAIDBEDS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FB13 |
|
Don't Know |
BOX FB13 |
|
Refused |
BOX FB13 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FBBEDS |
If FB21-CAIDBEDS <> DK, RF, then FBBEDS = FBBEDS - FB21-CAIDBEDS |
Box Instructions
IF FB5-CARECERT = 1/Yes, GO TO FB22 - CAREBEDS.
ELSE, GO TO BOX FB14.
Question Text
[I have recorded that (FACILITY) contains beds that are certified by Medicare as Skilled Nursing Facility beds.] How many beds are certified under Medicare (only)?
Field 1: CAREBEDS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FB14 |
|
Don't Know |
BOX FB14 |
|
Refused |
BOX FB14 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FBBEDS |
If FB22-CAREBEDS <> DK, RF, then FBBEDS = FBBEDS - FB22-CAREBEDS |
Box Instructions
IF FB11-HDLICEN = 1/YesStateHealthAgency or 2/YesOtherAgency, GO TO FB23 - HDLICBED.
ELSE GO TO BOX FB15.
Question Text
I have recorded that (FACILITY) contains beds that are licensed as nursing facility beds but not certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] or Medicare. How many beds are licensed but not certified as nursing home beds (only)?
Field 1: HDLICBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FB15 |
|
Don't Know |
BOX FB15 |
|
Refused |
BOX FB15 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FBBEDS |
If FB23-HDLICBED <> DK, RF, then FBBEDS = FBBEDS - FB23-HDLICBED |
Box Instructions
IF FB9-FMRCERT = 1/Yes, GO TO FB24 - FMRBEDS.
ELSE GO TO BOX FB16.
Question Text
I have recorded that (FACILITY) contains beds that are certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as ICF-MR (Intermediate Care Facility for the Mentally Retarded) beds. How many beds are certified as ICF-MR beds (only)?
Field 1: FMRBEDS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FB16 |
|
Don't Know |
BOX FB16 |
|
Refused |
BOX FB16 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FBBEDS |
If FB24-FMRBEDS <> DK, RF, then FBBEDS = FBBEDS - FB24-FMRBEDS |
Box Instructions
IF FB14-PCLICEN = 1/YesStatHealthDept OR 2/YesOtherAgency, GO TO FB25 - PCHBED.
ELSE GO TO BOX FB17.
Question Text
I recorded earlier that (FACILITY) contains beds that are licensed as personal care, board and care, assisted living, domiciliary care, or other type of long-term care beds. How many beds are licensed as one of these types of long-term care (only)?
Field 1: PCHBED
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FB17 |
|
Don't Know |
BOX FB17 |
|
Refused |
BOX FB17 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FBBEDS |
If FB25-PCHBED <> DK, RF, then FBBEDS = FBBEDS - FB25-PCHBED |
Box Instructions
IF CANNOT CALCULATE NUMBER OF REMAINING BEDS, GO TO FB27 - MIDNTCNT.
ELSE GO TO FB26 - FBBEDCOR.
Variable Name |
Assignment Instructions |
OTHERBED |
FQ.OTHERBED = FBBEDS |
FBCOMP |
If cannot calculate remaining beds, then FQ.FBCOMP = 1/Indicated |
Question Text
So,
there are a total of (TOTAL # LTC BEDS) LTC beds in the
(facility/home).
[REVIEW NUMBER OF BEDS BY TYPE.]
Is
that correct?
Field 1: FBBEDCOR
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FB26VB - FBBEDEX |
1 |
YES |
FB27 - MIDNTCNT |
Other Programming Instructions
Report Display
Report
Display Instructions:
In first fill, for TOTAL # LTC BEDS
display FQ.TOTELBED.
If FB20 - CANDCBED > 0, display second
clause and fill with number in FB20 - CANDCBED.
If FB21 -
CAIDBEDS > 0, display third clause and fill with number in FB21 -
CAIDBEDS.
If FB22 - CAREBEDS > 0, display fourth clause and
fill with number in FB22 - CAREBEDS.
If FB23 - HDLICBED >
0, display fifth clause and fill with number in FB23 - HDLICBED.
If
FB24 - FMRBEDS > 0, display sixth clause and fill with number in
FB24 - FMRBEDS.
If FB25 - PCHBED > 0, display seventh clause
and fill with number in FB25 - PCHBED.
If FB2-CAIDCERT =
1/Yes, display standard Medicaid display.
If FB2-CAIDCERT =
1/Yes and FB5-CARECERT = 1/Yes, display "only".
Display
"care" in third clause with underline.
Display all
instances of "only" with underline if displayed.
Always
display "(s)" in parentheses.
If there are
PREFERRED NAME(S) FOR MEDICAID, display "(PREFERRED NAME(S) FOR
MEDICAID)".
Else display "MEDICAID".
Report
Display:
TOTAL # OF BEDS : (TOTAL # LTC BEDS)
[(# DUALLY
CERTIFIED BEDS) dually certified nursing bed(s)]
[(# CERTIFIED
MEDICAID BEDS) certified by [(PREFERRED NAME(S) FOR
MEDICAID)/MEDICAID] as nursing bed(s) (only)]
[(# CERTIFIED
MEDICARE BEDS) certified as nursing bed(s) by Medicare (only)]
[(#
NOT CERTIFIED MEDICARE/MEDICAID BEDS) not certified by Medicare or
[(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] but licensed as nursing
bed(s)]
[(# CERTIFIED MEDICAID ICF-MR BEDS) certified by
[(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as ICF-MR bed(s)]
[(#
LICENSED LONG-TERM BEDS) licensed as personal care, assisted living,
or other type of long-term care bed(s)]
Question Text
PLEASE ENTER A BRIEF EXPLANATION:
Field 1: FBBEDEX
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FB27 - MIDNTCNT |
Question Text
How
many residents were in (FACILITY) altogether at midnight last
night?
Field 1: MIDNTCNT
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FR1PRE - FR1PRECT |
|
Don't Know |
FR1PRE - FR1PRECT |
|
Refused |
FR1PRE - FR1PRECT |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
FBCOMP |
FQ.FBCOMP = 1/Indicated. |
Question Text
Next,
I'd like to get some information on the basic rates residents in
(FACILITY) are charged. Most facilities have one or more set rates
they charge their residents for room and board and basic services.
Usually this rate includes basic nursing services and sometimes it
includes medical services as well. I'm interested in the basic rates
charged by (FACILITY) for [(PREFERRED NAME(S) FOR
MEDICAID)/MEDICAID], Medicare, and private pay/[(PREFERRED NAME(S)
FOR MEDICAID)/MEDICAID] and private pay/Medicare and private
pay/private pay) residents.
[IF NECESSARY: We are
concerned only with the place where (SP) is physically located.]
PRESS "1" TO CONTINUE.
Field 1: FR1PRECT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
FR2 - RATEPRB |
Question Text
Do you have more than one basic rate?
Field 1: RATEPRB
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FR5 - SINGRATE |
1 |
YES |
FR3 - HIGHRATE |
|
Don't Know |
FR3 - HIGHRATE |
Question Text
What is the highest rate you bill for residents' basic care?
ENTER A WHOLE DOLLAR AMOUNT FOLLOWED BY A DECIMAL AND CENTS ".00" TO ".99".
Field 1: HIGHRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FR3 - HIGHPER |
|
Don't Know |
BOX FR2 |
|
Refused |
BOX FR2 |
Field 2: HIGHPER
HIGH RATE UNIT
Field 2 Routing
Value |
Label |
Route |
1 |
DAY |
FR4 - LOWRATE |
2 |
WEEK |
FR4 - LOWRATE |
3 |
MONTH |
FR4 - LOWRATE |
91 |
OTHER |
FR3 - HIGHPROS |
Field 3: HIGHPROS
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FR4 - LOWRATE |
Question Text
What is the lowest rate you bill for residents' basic care?
ENTER A WHOLE DOLLAR AMOUNT FOLLOWED BY A DECIMAL AND CENTS ".00" TO ".99".
Field 1: LOWRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FR4 - LOWPER |
|
Don't Know |
BOX FR2 |
|
Refused |
BOX FR2 |
Field 2: LOWPER
LOW RATE UNIT
Field 2 Routing
Value |
Label |
Route |
1 |
DAY |
BOX FR2 |
2 |
WEEK |
BOX FR2 |
3 |
MONTH |
BOX FR2 |
91 |
OTHER |
FR4 - LOWPEROS |
Field 3: LOWPEROS
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FR2 |
Question Text
What is the rate you bill for residents' basic care?
ENTER A WHOLE DOLLAR AMOUNT FOLLOWED BY A DECIMAL AND CENTS ".00" TO ".99".
Field 1: SINGRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FR5 - SINGPER |
|
Don't Know |
BOX FR2 |
|
Refused |
BOX FR2 |
Field 2: SINGPER
SINGLE RATE UNIT
Field 2 Routing
Value |
Label |
Route |
1 |
DAY |
BOX FR2 |
2 |
WEEK |
BOX FR2 |
3 |
MONTH |
BOX FR2 |
91 |
OTHER |
FR5 - SINGPEROS |
Field 3: SINGPEROS
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FR2 |
Box Instructions
GO TO CLOSING1 - RETURNAV.
Variable Name |
Assignment Instructions |
FRCOMP |
FQ.FRCOMP = 1/Indicated |
FACLCERT |
FACLCERT = current round |
Question Text
Thank you. Those are all the questions I have for you at the moment. Someone from my office may call you to verify some of the data I have collected. We appreciate your help on this important study.
THE
FACILITY-LEVEL QUESTIONS FOR THIS CASE ARE COMPLETE FOR THIS ROUND.
PRESS "1" TO RETURN TO FACILITY NAVIGATION
SCREEN.
Field 1: RETURNAV
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FACEND |
Other Programming Instructions
Background Variable Assignments
Assign
FQDISP as described below.
FQDISP:
If Baseline FQ:
If FQ1A-PLACNAME <> DK,RF and
If FQ2-FADDROK <>
DK,RF and
If FQ3-FADMNOK <> DK,RF and
If
FQ4-MADDROK <> RF and
If FQ5-FPHONOK <> DK,RF
and
If FA1-PLACTYP1 <> RF and
If
FA12-BEDSNUM <> DK,RF and
If FA13-CAIDCRT1 <>
DK,RF and
If FA14-CARECRT1 <> DK,RF and
If
FA15-CAIDICF <> DK,RF and
If (FA16-HDEPTLIC <>
DK,RF or (FA16-HDEPTLIC = DK,RF and (FA13-CAIDCRT1 = 1/Yes or
FA14-CARECRT1 = 1/Yes or FA15-CAIDICF = 1/Yes))) and
If
FA18-HDEPTPCH <> DK,RF and
If FQ.ELIGCOMP =
1/Indicated and
If FQ.STRUCCOMP = 1/Indicated and
If FQ.QUESCOMP = 1/Indicated and
If FQ.FRCOMP =
1/Indicated, then FQ.FQDISP = 5/Complete.
Else FQ.FQDISP =
4/MissingData
Else if (Fall Round or Annual FQ) and FBELIG
= 1/Indicated and FBCOMP = 1/Indicated and FRCOMP = 1/Indicated, then
FQDISP = 5/Complete.
Else if Verification FQ and FQDISP =
3/StartedNotComplete,
then FQDISP = 5/Complete
Question Text
YOU
ARE ABOUT TO LEAVE FQ BECAUSE THE FACILITY IS INELIGIBLE.
IF
THIS IS NOT RIGHT, BACK UP TO MAKE APPROPRIATE CORRECTIONS.
OTHERWISE, ENTER 1.
Field 1: LEAVINEL
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FACEND |
Question Text
YOU ARE ABOUT TO LEAVE FQ BECAUSE THE FACILITY IS INELIGIBLE.
Field 1: LEVINEL2
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FACEND |
Question Text
YOU
ARE ABOUT TO LEAVE FQ BECAUSE THIS IS A "HOME OFFICE" WITH
NO RESIDENTS.
IF THIS IS NOT RIGHT, BACK UP TO MAKE
APPROPRIATE CORRECTIONS. OTHERWISE, COLLECT FACILITY CONTACT
INFORMATION FOR FACILITY WHERE SP IS LOCATED.
Field 1: LVNORES
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FACEND |
Question Text
Thank you. Those are all the questions I have for you at the moment. Right now, I need to make arrangements to speak to (NAMED RESPONDENT).
PRESS "1" TO RETURN TO FACILITY NAVIGATION SCREEN.
Field 1: FINOTRES
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FACEND |
Question Text
Thank you. Those are all the questions I have for you at the moment. Right now, I need to make arrangements to speak to (NAMED RESPONDENT).
PRESS "1" TO RETURN TO FACILITY NAVIGATION SCREEN.
Field 1: FINOTRSB
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FACEND |
Question Text
YOU
ARE ABOUT TO LEAVE FQ BECAUSE THE RESPONDENT IS NOT ABLE TO VERIFY
INFORMATION ABOUT THE FACILITY.
IF THIS IS NOT RIGHT,
BACK UP TO MAKE APPROPRIATE CORRECTIONS. OTHERWISE, PRESS "1"
TO RETURN TO FACILITY NAVIGATION SCREEN.
Field 1: NOTRESP
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FACEND |
Box Instructions
GO TO NAVIGATOR
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ryan Hubbard |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |