CMS-P-0015A Housing_Characteristics

2021 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

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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