CMS-P-0015A Housing_Characteristics

2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

HAQ - HOUSING CHARACTERISTICS

Question Type

Question Text/Description

Code List

Routing

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

BOX HA1

(01) ONE-FAMILY, DETACHED
(02) TWO-FAMILY OR DUPLEX
(03) APARTMENT OR CONDOMINIUM BUILDING
(04) MOBILE HOME, TRAILER
(05) ROWHOUSE, TOWNHOUSE
(06) "MOTHER-IN-LAW" APARTMENT
(91) SOMETHING ELSE
(96) SP IS HOMELESS/TRANSIENT/IN JAIL OR
PRISON
(-8) Don't Know
(-9) Refused

(01) HA2 - HLEVELS
(02) HA2 - HLEVELS
(03) HA2 - HLEVELS
(04) HAINTRO2 - HAINT1
(05) HA2 - HLEVELS
(06) HA2 - HLEVELS
(91) HA1 - DWELLOS
(96) BOX HA4
(-8) HA2 - HLEVELS
(-9) HA2 - HLEVELS

HOUSING CHARACTERISTICS QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after ENS.

BOX HA

SPMOVED

HAINT

HA1A

routing

yes/no

IF ( SP IS IN THE SUPPLEMENTAL SAMPLE), GO BOX HA1.
ELSE GO TO HA1A-SPMOVED.
IF ANSWER IS KNOWN, CODE WITHOUT ASKING:
[Have you/Has (SP)] moved since [LAST FALL ROUND DATE]?

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 [SPMOVED=1/YES]) 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.

SHOW CARD HA1
DWELLING

HA1

code one

IF TYPE OF HOUSING IS OBVIOUS, CODE WITHOUT ASKING. SELECT "SP IS
HOMELESS/TRANSIENT/IN JAIL OR PRISON" WITHOUT ASKING.
[IF HOUSING TYPE IS NOT OBVIOUS, ASK:] Which of these best describes [your/(SP’s)] home?

DWELLOS

HA1

verbatim text

SOMETHING ELSE (SPECIFY)

(01) continuous answer

HA2 - HLEVELS

code one

How many levels are in [your/(SP’s)] (house/apartment or condominium building/place of residence)?
[THE NUMBER OF LEVELS REFERS TO THE TOTAL NUMBER OF FLOORS INCLUDING BOTH FINISHED
AND UNFINISHED BASEMENTS AND FINISHED ATTICS. DO NOT INCLUDE UNFINISHED ATTICS OR
ROOF TERRACES.]

(01) ONE
(02) TWO
(03) THREE OR MORE
(-8) Don't Know
(-9) Refused

(01) HAINTRO2 - HAINT1
(02) HA3 - HELEVTR
(03) HA3 - HELEVTR
(-8) HA3 - HELEVTR
(-9) HA3 - HELEVTR

yes/no

Does [your/(SP’s)] (house/apartment or condominium building/place of residence) have an elevator?
[DO NOT INCLUDE ESCALATORS, WHEELCHAIR LIFTS, OR STAIR LIFTS.]

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

HA4 - HONELEVL

HLEVELS

HELEVTR

HA2

HA3

Page 1 of 4

2019 MCBS Community Questionnaire

Variable Name

HONELEVL

HBTHLEVL

MR Screen Name

HA4

HA5

HAQ - HOUSING CHARACTERISTICS

Question Type

yes/no

yes/no

Question Text/Description

Code List

Routing

Is the living space in [your/(SP’s)] (house/own apartment or condominium/place of residence) all on one level?

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

(01) HAINTRO2 - HAINT1
(02) HA5 - HBTHLEVL
(-8) HA5 - HBTHLEVL
(-9) HA5 - HBTHLEVL

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

HAINTRO2 - HAINT1

Does [your/(SP’s)] (house/own apartment or condominium/place of residence) have either a full bathroom or a
half bathroom on all levels?
[PROBE: Bathroom facilities must contain at least a flush toilet, or a bathtub or shower.]

HAINT1

HAINT2

HAINTRO2

HAINTRO2A

BOX HA1AB

HRAMPS

HA6

BOX HA1AC

HBATHRM

HA7

BOX HA1AD

HRAILING

HA8

BOX HA1B

HOUSTYPE

HA9

no entry

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).

BOX HA1AB

no entry

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.

BOX HA1AB

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) OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE
HAD RAMPS AT ENTRANCES ), GO TO HA6 - HRAMPS.
ELSE GO TO BOX HA1AC.

yes/no

Does [your/(SP’s)] (house/mobile home/apartment or condominium building/place of residence) have ramps at
(any of) its entrance(s)?

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

BOX HA1AC

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) OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE
HAD MODIFICATIONS TO ANY BATHROOM ), GO TO HA7 - HBATHRM.
ELSE GO TO BOX HA1AD.

yes/no

(01) YES
Does [your/(SP’s)] (house/own apartment or condominium/mobile home/place of residence) have modifications (02) NO
to any bathroom such as grab bars or a shower seat?
(-8) Don't Know
(-9) Refused

BOX HA1AD

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) OR (SP DID NOT PREVIOUSLY REPORT THAT
THIS RESIDENCE HAS SPECIAL RAILIINGS), GO TO HA8 - HRAILING.
ELSE GO TO BOX HA1B.

yes/no

Other than stair railings, does [your/(SP’s)] (house/own apartment or condominium/mobile home/place of
residence) have special railings to help (you/him/her) move around?[DO NOT INCLUDE HANDRAILS IN
BATHROOMS.]

routing

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.

yes/no

SHOW CARD HA2
Please look at this card. Is [your/(SP’s)] [house/own apartment or condominium/mobile home/place of
residence] a part of one of these communities?[IF A RESPONDENT EXPLAINS THAT THE PLACE OF
RESIDENCE IS SIMILAR TO ONE LISTED ON THE CARD BUT CALLED BY ANOTHER NAME, SELECT
“YES”.]

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

BOX HA1B

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

(01) HA10 - HCOMUNTY
(02) BOX HA3
(-8) BOX HA3
(-9) BOX HA3

Page 2 of 4

2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

HAQ - HOUSING CHARACTERISTICS

Question Type

Question Text/Description

Code List

Routing
(01) HA11 - HPERCARE
(02) HA11 - HPERCARE
(03) HA11 - HPERCARE
(04) HA11 - HPERCARE
(05) HA11 - HPERCARE
(06) HA11 - HPERCARE
(07) HA11 - HPERCARE
(08) HA11 - HPERCARE
(91) HA10 - HCOMUNOS
(-8) HA11 - HPERCARE
(-9) HA11 - HPERCARE
HA11 - HPERCARE

HCOMUNTY

HA10

code one

SHOW CARD HA2
[IF NECESSARY, ASK:] Which category best describes [your/(SP’s)] type of housing?

(01) RETIREMENT COMMUNITY
(02) SENIOR CITIZENS HOUSING
(03) ASSISTED LIVING FACILITY
(04) CONTINUING CARE COMMUNITY
(05) STAGED LIVING COMMUNITY
(06) RETIREMENT APARTMENTS
(07) CHURCH-PROVIDED HOUSING
(08) PERSONAL OR RESIDENTIAL CARE HOME
(91) OTHER
(-8) Don't Know
(-9) Refused

HCOMUNOS

HA10

verbatim text

OTHER (SPECIFY)

(01) continuous answer

HAINT3

HAINTRO3

no entry

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
Does [your/(SP’s)] place of residence give (you/him/her) access to personal care services like any of those listed
on this card?
HPERCARE

HA11

yes/no

[READ IF NECESSARY: This question is asking about whether the respondent has access to these services,
not whether the respondent uses these services.]

HA11 - HPERCARE

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

(01) HA12 - MEALPROB
(02) BOX HA3
(-8) HA12 - MEALPROB
(-9) BOX HA3

[READ IF NECESSARY: THE RESPONDENT ONLY HAS TO HAVE ONE PERSONAL CARE SERVICE
AVAILABLE TO HIM/HER TO QUALIFY AS A “YES” FOR THIS QUESTION.]

MEALPROB

MAIDPROB

WASHPROB

HELPPROB

TRANPROB

RECPROB

SERVINCL

list

(01) YES
We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)] place
(02) NO
of residence], [do you/does (SP)] have access to…
(-8) Don't Know
prepared meals?
(-9) Refused

HA12 - MAIDPROB

list

(01) YES
We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)] place
(02) NO
of residence], [do you/does (SP)] have access to…
(-8) Don't Know
housekeeping, maid, or cleaning services?
(-9) Refused

HA12 - WASHPROB

list

(01) YES
We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)] place
(02) NO
of residence], [do you/does (SP)] have access to…
(-8) Don't Know
laundry services?
(-9) Refused

HA12 - HELPPROB

list

(01) YES
We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)] place
(02) NO
of residence], [do you/does (SP)] have access to…
(-8) Don't Know
help with medications?
(-9) Refused

HA12 - TRANPROB

list

(01) YES
We are interested in personal services that might be available here in addition to housing. In [your/(SP’s)] place
(02) NO
of residence], [do you/does (SP)] have access to…
(-8) Don't Know
transportation?
(-9) Refused

HA12 - RECPROB

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…
recreational services, such as exercise facilities, movies, activities programs, library, card rooms, pool tables,
etc.?

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

BOX HA2

BOX HA2

routing

IF SP HAD ACCESS TO AT LEAST ONE PERSONAL SERVICE LISTED AT HA12, GO TO HA13 - SERVINCL.
ELSE GO TO BOX HA2A.
(01) ALL INCLUDED
(02) SOME INCLUDED/SOME SEPARATE
(03) ALL SEPARATE
(-8) Don't Know
(-9) Refused

BOX HA2A

HA12

HA12

HA12

HA12

HA12

HA13

BOX HA2A

code one

Are these services included as part of the cost of [your/(SP’s)] housing or is there a separate charge for them?

routing

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 DWELLING REPORTED IN
THE PREVIOUS YEAR WAS UNKNOWN) 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.

Page 3 of 4

2019 MCBS Community Questionnaire

Variable Name

STAYPUT

CAREPART

REQAGE

MR Screen Name

HA14

HAQ - HOUSING CHARACTERISTICS

Question Type

yes/no

Question Text/Description
Would the (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) needed substantial care?

(01) YES
(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 level
(-9) Refused
of care?]

yes/no

HA16 - REQAGE

HA16

yes/no

Does the place where [you/(SP)] (live/lives) now require residents to be a certain age to live there or receive
services?

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

BOX HA3

BOX HA3

routing

IF HA5 - HBTHLEVL = 1/Yes OR HA7 - HBATHRM = 1/Yes, GO TO HA18 - NBRROOMS.
ELSE GO TO HA17 - PERSBATH.

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

HA18 - NBRROOMS

(01) continuous answer
(-8) Don't Know
(-9) Refused

HA19 - PERKITCH

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

BOX HA4

HA15

HA17

yes/no

[Do you/Does (SP)] have (your/his/her) own bathroom facilities?

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

(01) HA16 - REQAGE
(02) HA15 - CAREPART
(-8) HA16 - REQAGE
(-9) HA16 - REQAGE

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

[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

Routing

If (you/he/she) needed substantial care, would that care be provided in another part of this same place of
residence?

Now I have a few questions about the rooms in [your/(SP’s)] place of residence.
PERSBATH

Code List

HA19

yes/no

[EXPLAIN IF NECESSARY: Own kitchen is defined as an area with a sink, non-portable cooking equipment
and a refrigerator used primarily by [you/(SP)] and not on a regular basis by someone not living in the
household. Also includes kitchenettes.]

BOX HA4

routing

IF INTTYPE in(C001, C002, C003, C004, C005, C006), GO TO HIQ.

Page 4 of 4