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pdf2021 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
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
routing
HA1A
yes/no
IF ( SP IS IN THE SUPPLEMENTAL SAMPLE [C003]), GO BOX HA1.
ELSE GO TO HA1A-SPMOVED.
IF ANSWER IS KNOWN, CODE WITHOUT ASKING:
SPMOVED
[Have you/Has (SP)] moved since [LAST FALL ROUND DATE]?
HAINT
BOX HA1
routing
IF (SP IS IN THE SUPPLEMENTAL SAMPLE [C003]) OR (SP DID NOT RECEIVE THE HA SECTION IN THE
PREVIOUS YEAR [P_NOHA=1]) OR (SP MOVED IN THE PREVIOUS YEAR [SPMOVED=1/YES]) OR (THE
TYPE OF DWELLING REPORTED IN THE PREVIOUS YEAR WAS UNKNOWN [P_DWELLING=-7, -8, .]) OR
(MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail
[P_DWELLING=96]), GO TO HAINTRO - HAINT.
ELSE IF (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAD RAMPS AT ENTRANCES
[P_HRAMPS ^= 1]) OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAD
MODIFICATIONS TO ANY BATHROOM [P_HBATHRM ^= 1]) OR (SP DID NOT PREVIOUSLY REPORT
THAT THIS RESIDENCE HAS SPECIAL RAILINGS [P_HRAILING ^= 1]), 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
HA1- DWELLING
(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) HA20-LIVNGSIT
(-8) HA2 - HLEVELS
(-9) HA2 - HLEVELS
(01) continuous answer
HA2 - HLEVELS
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)
HLEVELS
HA2
code one
(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
(03) THREE OR MORE
AND UNFINISHED BASEMENTS AND FINISHED ATTICS. DO NOT INCLUDE UNFINISHED ATTICS OR
(-8) Don't Know
ROOF TERRACES.]
(-9) Refused
HELEVTR
HA3
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
HONELEVL
HA4
yes/no
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
HBTHLEVL
HA5
yes/no
(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.]
(01) HAINTRO2 - HAINT1
(02) HA3 - HELEVTR
(03) HA3 - HELEVTR
(-8) HA3 - HELEVTR
(-9) HA3 - HELEVTR
Page 1 of 5
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
HAQ-HOUSING CHARACTERISTICS
Question Type
Question Text/Description
BOX HA1AB
BOX HA1AB
HAINT1
HAINTRO2
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).
HAINT2
HAINTRO2A
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 [C003]) OR (SP DID NOT RECEIVE THE HA SECTION IN THE
PREVIOUS YEAR [P_NOHA=1]) OR (SP MOVED IN THE PREVIOUS YEAR [SPMOVED=1/YES]) OR (THE
TYPE OF DWELLING REPORTED IN THE PREVIOUS YEAR WAS UNKNOWN [P_DWELLING=-7, -8, .]) OR
(MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail
[P_DWELLING=96]) OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAD RAMPS AT
ENTRANCES [P_HRAMPS ^= 1]), GO TO HA6 - HRAMPS.
ELSE GO TO BOX HA1AC.
HA6
yes/no
Does [your/(SP’s)] (house/mobile home/apartment or condominium building/place of residence) have ramps at
(any of) its entrance(s)?
BOX HA1AC
HA7
HRAMPS
HBATHRM
HRAILING
HOUSTYPE
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HA1AC
routing
IF (SP IS IN THE SUPPLEMENTAL SAMPLE [C003]) OR (SP DID NOT RECEIVE THE HA SECTION IN THE
PREVIOUS YEAR [P_NOHA=1]) OR (SP MOVED IN THE PREVIOUS YEAR [SPMOVED=1/YES]) OR (THE
TYPE OF DWELLING REPORTED IN THE PREVIOUS YEAR WAS UNKNOWN [P_DWELLING=-7, -8, .]) OR
(MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail
[P_DWELLING=96]) OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAD
MODIFICATIONS TO ANY BATHROOM [P_HBATHRM ^= 1]), 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
BOX HA1AD
routing
IF (SP IS IN THE SUPPLEMENTAL SAMPLE [C003]) OR (SP DID NOT RECEIVE THE HA SECTION IN THE
PREVIOUS YEAR [P_NOHA=1]) OR (SP MOVED IN THE PREVIOUS YEAR [SPMOVED=1/YES]) OR (THE
TYPE OF DWELLING REPORTED IN THE PREVIOUS YEAR WAS UNKNOWN [P_DWELLING=-7, -8, .]) OR
(MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail
[P_DWELLING=96]) OR (SP DID NOT PREVIOUSLY REPORT THAT THIS RESIDENCE HAS SPECIAL
RAILIINGS [P_HRAILING ^= 1]), GO TO HA8 - HRAILING.
ELSE GO TO BOX HA1B.
HA8
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.]
BOX HA1B
routing
IF (THE SP IS IN THE SUPPLEMENTAL SAMPLE [C003]) OR (SP DID NOT RECEIVE THE HA SECTION IN
THE PREVIOUS YEAR [P_NOHA=1]) OR (SP MOVED IN THE PREVIOUS YEAR [SPMOVED=1/YES]) OR
(MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail
[P_DWELLING=96]) OR (THE TYPE OF HOUSING REPORTED IN THE PREVIOUS YEAR WAS
UNKNOWN [P_HOUSETYPE ^=1 or 2]), GO TO HA9 - HOUSTYPE.
ELSE IF TYPE OF HOUSING WAS REPORTED LAST TIME IT WAS ASKED [P_HOUSETYPE=1], GO TO
HAINTRO3 - HAINT3.
ELSE GO TO HA20-LIVNGSIT.
HA9
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 5
2021 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 [you have/(SP) has] access to these services,
not whether [you use/(SP) 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
[THE RESPONDENT ONLY HAS TO HAVE ONE PERSONAL CARE SERVICE AVAILABLE TO HIM/HER TO
QUALIFY AS A “YES” FOR THIS QUESTION.]
MEALPROB
HA12
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
MAIDPROB
HA12
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
WASHPROB
HA12
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
HELPPROB
HA12
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
TRANPROB
HA12
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
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.?
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.
HA13
code one
(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
SERVINCL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HA2A
Page 3 of 5
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
HAQ-HOUSING CHARACTERISTICS
Question Type
Question Text/Description
BOX HA2A
routing
IF (SP IS IN THE SUPPLEMENTAL SAMPLE [C003]) OR (SP DID NOT RECEIVE THE HA SECTION IN THE
PREVIOUS YEAR [P_NOHA=1]) OR (SP MOVED IN THE PREVIOUS YEAR [SPMOVED=1/YES]) OR (THE
TYPE OF DWELLING REPORTED IN THE PREVIOUS YEAR WAS UNKNOWN [P_DWELLING=-7, -8, .]) OR
(MOST RECENT TYPE OF DWELLING COLLECTED IN A PREVIOUS ROUND = 96/HomelessJail
[P_DWELLING=96]) OR (WHETHER OR NOT SP IS ALLOWED TO CONTINUE LIVING IN HOME IF
SUBSTANTIAL CARE IS NEEDED IS UNKNOWN [P_STAYPUT = -7, -8, .]), GO TO HA14 - STAYPUT.
ELSE GO TO HA20-LIVNGSIT.
STAYPUT
HA14
yes/no
CAREPART
HA15
yes/no
REQAGE
HA16
yes/no
BOX HA3
routing
Code List
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?]
(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
Routing
(01) HA16 - REQAGE
(02) HA15 - CAREPART
(-8) HA16 - REQAGE
(-9) HA16 - REQAGE
HA16 - REQAGE
BOX HA3
IF HA5 - HBTHLEVL = 1/Yes OR HA7 - HBATHRM = 1/Yes, GO TO HA18 - NBRROOMS.
ELSE GO TO HA17 - PERSBATH.
Now I have a few questions about the rooms in [your/(SP’s)] place of residence.
PERSBATH
HA17
yes/no
[Do you/Does (SP)] have (your/his/her) own bathroom facilities?
[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
PERKITCH
HA19
yes/no
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?
[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.]
(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
HA20 - LIVNGSIT
SHOW CARD HA4
LIVNGSIT
HA20
code one
HOUSPEST
HA21
grid
(01) HAVE A STEADY PLACE TO LIVE
Which of these best describes [your/(SP’s)] living situation today? [Do you/Does (SP)] have a steady place to
(02) HAVE A PLACE TO LIVE TODAY, BUT
live, have a place to live today but [are/is] worried about losing it in the future, or [do you/does (SP)] not have a WORRIED ABOUT LOSING IT IN THE FUTURE
steady place to live?
(03) DO NOT HAVE A STEADY PLACE TO LIVE
(-8) DON'T KNOW
[IF NEEDED: Not having a steady place to live includes temporarily staying with others, in a hotel, in a shelter, (-9) REFUSED
living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park.]
Think about the place [you/(SP)] [live/lives]. [Do you/does (SP)] have problems with any of the following?
Please indicate yes or no to each one.
Pests such as bugs, ants, or mice
HA21 - HOUSPEST
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HA21 - HOUSMOLD
HOUSMOLD
HA21
grid
Mold
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HA21 - HOUSLEAD
HOUSLEAD
HA21
grid
Lead paint or pipes
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HA21 - HOUSHEAT
Page 4 of 5
2021 MCBS Community Questionnaire
HAQ-HOUSING CHARACTERISTICS
Variable Name
MR Screen Name
Question Type
Question Text/Description
Code List
Routing
HOUSHEAT
HA21
grid
Lack of heat
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HA21 - HOUSCOOL
HOUSCOOL
HA21
grid
Lack of cooling system
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HA21 - HOUSOVEN
HOUSOVEN
HA21
grid
Oven or stove not working
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HA21 - HOUSSMOK
HOUSSMOK
HA21
grid
Smoke detectors missing or not working
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HA21 - HOUSWATR
HOUSWATR
HA21
grid
Water leaks
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HA4
BOX HA4
routing
IF INTTYPE in (C001, C002, C003, C004, C005, C006), GO TO HIQ.
Page 5 of 5
File Type | application/pdf |
File Title | HAQ.xlsx |
Author | Wishart-Marisa |
File Modified | 2020-11-10 |
File Created | 2020-11-10 |