Cms-p-0015a Mcbs

Medicare Current Beneficiary Survey (MCBS)

HAQ

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

OMB: 0938-0568

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Housing Characteristics (HAQ)
Variable Name

HAINT

MR Screen Name

Question type

Question text/description

BOX HA1

routing

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP DID NOT RECEIVE THE HA SECTION IN THE PREVIOUS YEAR)
OR (SP MOVED IN THE PREVIOUS YEAR) OR (THE TYPE OF DWELLING REPORTED IN THE PREVIOUS YEAR WAS
UNKNOWN) OR (MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail),
GO TO HAINTRO - HAINT.
ELSE IF (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAD RAMPS AT ENTRANCES) OR (SP DID NOT
PREVIOUSLY REPORT THAT THIS RESIDENCE HAD MODIFICATIONS TO ANY BATHROOM) OR (SP DID NOT
PREVIOUSLY REPORT THAT THIS RESIDENCE HAS SPECIAL RAILINGS), GO TO HAINTRO2A - HAINT2.
ELSE GO TO BOX HA1B.

HAINTRO

no entry

IF THE SP IS HOMELESS, IS TRANSIENT WITH NO PERMANENT HOME, OR IS IN JAIL OR PRISON, SELECT NEXT
PAGE WITHOUT READING THIS INTRODUCTION.
I would like to ask a few questions about [your/(SP’s)] housing situation or living arrangements.

Code list

DWELLING

HA1

code one

(01) ONE-FAMILY, DETACHED
(02) TWO-FAMILY OR DUPLEX
SHOW CARD HA1
(03) APARTMENT OR CONDOMINIUM BUILDING
(04) MOBILE HOME, TRAILER
IF TYPE OF HOUSING IS OBVIOUS, CODE WITHOUT ASKING. SELECT "SP IS HOMELESS/TRANSIENT/IN JAIL OR (05) ROWHOUSE, TOWNHOUSE
PRISON" WITHOUT ASKING.
(06) "MOTHER-IN-LAW" APARTMENT
[IF HOUSING TYPE IS NOT OBVIOUS, ASK:] Which of these best describes [your/(SP’s)] home?
(91) SOMETHING ELSE
(96) SP IS HOMELESS/TRANSIENT/IN JAIL OR PRISON
(-8) Don't Know

DWELLOS

HA1

verbatim text

SOMETHING ELSE (SPECIFY)

HLEVELS

HA2

code one

HELEVTR

HA3

yes/no

HONELEVL

HA4

yes/no

HBTHLEVL

HA5

yes/no

HAINT1

HAINTRO2

no entry

HAINT2

HAINTRO2A

no entry

BOX HA1AB

routing

(01) continuous answer
(01) ONE
How many levels are in [your/(SP’s)] (house/apartment or condominium building/place of residence)?
(02) TWO
[THE NUMBER OF LEVELS REFERS TO THE TOTAL NUMBER OF FLOORS INCLUDING BOTH FINISHED AND
(03) THREE OR MORE
UNFINISHED BASEMENTS AND FINISHED ATTICS. DO NOT INCLUDE UNFINISHED ATTICS OR ROOF TERRACES.] (-8) Don't Know
(-9) Refused
(01) YES
Does [your/(SP’s)] (house/apartment or condominium building/place of residence) have an elevator?
(02) NO
[DO NOT INCLUDE ESCALATORS, WHEELCHAIR LIFTS, OR STAIR LIFTS.]
(-8) Don't Know
(-9) Refused
(01) YES
Is the living space in [your/(SP’s)] (house/own apartment or condominium/place of residence) all on one
(02) NO
level?
(-8) Don't Know
(-9) Refused
Does [your/(SP’s)] (house/own apartment or condominium/place of residence) have either a full bathroom or (01) YES
a half bathroom on all levels?
(02) NO
(-8) Don't Know
[PROBE: Bathroom facilities must contain at least a flush toilet, or a bathtub or shower.]
(-9) Refused
Next, I would like to ask about access or mobility modifications that [you/(SP)] may have in (your/his/her)
(house/apartment or condominium building/mobile home/place of residence).
When we were here about a year ago, we asked about access or mobility modifications that may have been a
part of [your/(SP’s)] residence at that time. Now, I would like to update our information about such
modifications.
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP DID NOT RECEIVE THE HA SECTION IN THE PREVIOUS YEAR)
OR (SP MOVED IN THE PREVIOUS YEAR) OR (THE TYPE OF DWELLING REPORTED IN THE PREVIOUS YEAR WAS
UNKNOWN) OR (MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail)
OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAD RAMPS AT ENTRANCES ), GO TO HA6 HRAMPS.
ELSE GO TO BOX HA1AC.

Housing Characteristics (HAQ)
Variable Name

MR Screen Name

Question type

HRAMPS

HA6

yes/no

BOX HA1AC

routing

HA7

yes/no

BOX HA1AD

routing

HA8

yes/no

BOX HA1B

routing

HOUSTYPE

HA9

yes/no

HCOMUNTY

HA10

code one

HCOMUNOS

HA10

verbatim text

HAINT3

HAINTRO3

no entry

HPERCARE

HA11

yes/no

HBATHRM

HRAILING

Question text/description

Code list
(01) YES
Does [your/(SP’s)] (house/mobile home/apartment or condominium building/place of residence) have ramps (02) NO
at (any of) its entrance(s)?
(-8) Don't Know
(-9) Refused
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP DID NOT RECEIVE THE HA SECTION IN THE PREVIOUS YEAR)
OR (SP MOVED IN THE PREVIOUS YEAR) OR (THE TYPE OF DWELLING REPORTED IN THE PREVIOUS YEAR WAS
UNKNOWN) OR (MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail)
OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAD MODIFICATIONS TO ANY BATHROOM ), GO
TO HA7 - HBATHRM.
ELSE GO TO BOX HA1AD.
(01) YES
Does [your/(SP’s)] (house/own apartment or condominium/mobile home/place of residence) have
(02) NO
modifications to any bathroom such as grab bars or a shower seat?
(-8) Don't Know
(-9) Refused
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP DID NOT
RECEIVE THE HA SECTION IN THE PREVIOUS YEAR) OR (SP
MOVED IN THE PREVIOUS YEAR) OR (THE TYPE OF DWELLING
REPORTED IN THE PREVIOUS YEAR WAS UNKNOWN) OR (MOST RECENT TYPE OF DWELLING COLLECTED IN A
PREVIOUS ROUND = 96/HomelessJail) OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAS
SPECIAL RAILIINGS), GO TO HA8 - HRAILING.
ELSE GO TO BOX HA1B.
(01) YES
Other than stair railings, does [your/(SP’s)] (house/own apartment or condominium/mobile home/place of
(02) NO
residence) have special railings to help (you/him/her) move around?[DO NOT INCLUDE HANDRAILS IN
(-8) Don't Know
BATHROOMS.]
(-9) Refused
IF (THE SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP DID NOT RECEIVE THE HA SECTION IN THE PREVIOUS
YEAR) OR (SP MOVED IN THE PREVIOUS YEAR) OR (MOST RECENT TYPE OF DWELLING COLLECTED IN A
PREVIOUS ROUND = 96/HomelessJail) OR (THE TYPE OF HOUSING REPORTED IN THE PREVIOUS YEAR WAS
UNKNOWN), GO TO HA9 - HOUSTYPE.
ELSE IF TYPE OF HOUSING WAS REPORTED LAST TIME IT WAS ASKED, GO TO HAINTRO3 - HAINT3.
ELSE GO TO BOX HA4.
SHOW CARD HA2
(01) YES
Please look at this card. Is [your/(SP’s)] [house/own apartment or condominium/mobile home/place of
(02) NO
residence] a part of one of these communities?[IF A RESPONDENT EXPLAINS THAT THE PLACE OF RESIDENCE (-8) Don't Know
IS SIMILAR TO ONE LISTED ON THE CARD BUT CALLED BY ANOTHER NAME, SELECT “YES”.]
(-9) Refused
(01) RETIREMENT COMMUNITY
(02) SENIOR CITIZENS HOUSING
(03) ASSISTED LIVING FACILITY
(04) CONTINUING CARE COMMUNITY
(05) STAGED LIVING COMMUNITY
SHOW CARD HA2
(06) RETIREMENT APARTMENTS
[IF NECESSARY, ASK:] Which category best describes [your/(SP’s)] type of housing?
(07) CHURCH-PROVIDED HOUSING
(08) PERSONAL OR RESIDENTIAL CARE HOME
(91) OTHER
(-8) Don't Know
(-9) Refused
OTHER (SPECIFY)
(01) continuous answer
The type of community [you/(SP)] [live/lives] in sometimes gives its residents access to personal care services.
Next, I would like to update our records regarding [your/(SP’s)] access to such services.
SHOW CARD HA3
(01) YES
Does [your/(SP’s)] place of residence give (you/him/her) access to personal care services like any of those
(02) NO
listed on this card?
(-8) Don't Know
[THE RESPONDENT ONLY HAS TO HAVE ONE PERSONAL CARE SERVICE AVAILABLE TO HIM/HER TO QUALIFY
(-9) Refused
AS A “YES” FOR THIS QUESTION.]

Housing Characteristics (HAQ)
Variable Name
MEALPROB

MR Screen Name
HA12

Question type

Question text/description

list

We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)]
place of residence], [do you/does (SP)] have access to…
prepared meals?

MAIDPROB

HA12

list

We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)]
place of residence], [do you/does (SP)] have access to…
housekeeping, maid, or cleaning services?

WASHPROB

HA12

list

We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)]
place of residence], [do you/does (SP)] have access to…
laundry services?

list

We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)]
place of residence], [do you/does (SP)] have access to…
help with medications?

list

We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)]
place of residence], [do you/does (SP)] have access to…
transportation?

HELPPROB

TRANPROB

RECPROB

SERVINCL

HA12

HA12

HA12

list

BOX HA2

routing

HA13

code one

BOX HA2A

routing

STAYPUT

HA14

yes/no

CAREPART

HA15

yes/no

REQAGE

HA16

yes/no

BOX HA3

routing

We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)]
place of residence], [do you/does (SP)] have access to…
recreational services, such as exercise facilities, movies, activities programs, library, card rooms, pool tables,
etc.?
IF SP HAD ACCESS TO AT LEAST ONE PERSONAL SERVICE LISTED AT HA12, GO TO HA13 - SERVINCL.
ELSE GO TO BOX HA2A.

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) ALL INCLUDED
(02) SOME INCLUDED/SOME SEPARATE
Are these services included as part of the cost of [your/(SP’s)] housing or is there a separate charge for them? (03) ALL SEPARATE
(-8) Don't Know
(-9) Refused
IF (THE SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP DID NOT RECEIVE THE HA SECTION IN THE PREVIOUS
YEAR) OR (SP MOVED IN THE PREVIOUS YEAR) OR (MOST RECENT TYPE OF DWELLING COLLECTED IN A
PREVIOUS ROUND = 96/HomelessJail) OR (WHETHER OR NOT SP IS ALLOWED TO CONTINUE LIVING IN HOME
IF SUBSTANTIAL CARE IS NEEDED IS UNKNOWN), GO TO HA14 - STAYPUT.
ELSE GO TO BOX HA4.
Would the (TYPE OF HOUSING)/place where [you/(SP)] currently (live/lives) allow (you/him/her) to continue
living in (your/his/her) (house/apartment or condominium/mobile home/place of residence) if (you/he/she) (01) YES
needed substantial care?
(02) NO
(-8) Don't Know
[PROBE: Could [you/(SP)] stay where (you/he/she) (live/lives) now if (you/he/she) needed a much greater
(-9) Refused
level of care?]
(01) YES
If (you/he/she) needed substantial care, would that care be provided in another part of this same place of
(02) NO
residence?
(-8) Don't Know
(-9) Refused
(01) YES
Does the place where [you/(SP)] (live/lives) now require residents to be a certain age to live there or receive (02) NO
services?
(-8) Don't Know
(-9) Refused
IF HA5 - HBTHLEVL = 1/Yes OR HA7 - HBATHRM = 1/Yes, GO TO HA18 - NBRROOMS.
ELSE GO TO HA17 - PERSBATH.

Housing Characteristics (HAQ)
Variable Name

MR Screen Name

Question type

Question text/description
Now I have a few questions about the rooms in [your/(SP’s)] place of residence.
[Do you/Does (SP)] have (your/his/her) own bathroom facilities?

PERSBATH

HA17

yes/no
[EXPLAIN IF NECESSARY: Own bathroom facilities may be defined as the sink, flush toilet, and bathtub or
shower used primarily by [you/(SP)] and is not used on a regular basis by someone not living in the
household.]

NBRROOMS

HA18

numeric

How many rooms are there in [your/(SP’s)] (house/own apartment or condominium/mobile home/place of
residence), not counting bathrooms, hallways, or unfinished basements?
[Do you/Does (SP)] have (your/his/her) own kitchen?

PERKITCH

HA19

yes/no

BOX HA4

routing

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) continuous answer
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Own kitchen is defined as an area with a sink, non-portable cooking equipment and
(-8) Don't Know
a refrigerator used primarily by [you/(SP)] and not on a regular basis by someone not living in the household.
(-9) Refused
Also includes kitchenettes.]
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