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pdf2022 MCBS Facility Instrument
Variable Name
MR Screen Name
BQ-Background Questionnaire
Question Type
Question Text/Description
Code List
Routing
(01) CONSENT OBTAINED (CONTINUE INTERVIEW)
(02) FINAL FINAL CONSENT DENIED
(03) REFUSAL CONVERTED (CONTINUE INTERVIEW)
(04) FINAL REFUSAL
(01) BQ1PRE1 - BQ1PRECT
(02) BQEND - BQENDCT
(03) BQ1PRE1 - BQ1PRECT
(04) BQEND - BQENDCT
BACKGROUND QUESTIONNAIRE SECTION SPECIFICATIONS
CRITERIA
SAMPLE TYPE= CFC, IPR
SEASON
If SAMPLE TYPE= CFC, then SEASON= ALL
If SAMPLE TYPE= IPR, then SEASON= FALL
PLACEMENT
Administered in flexible order after FQ and RH sections are completed.
BOX BQBEG
routing
IF BQDISP = 1/ConsentRequired OR BQDISP = 4/InitialRefusal, GO TO BQCONREF - CONREFFN. ELSE GO
TO BQ1PRE1 - BQ1PRECT.
CONREFFN
BQCONREF
code one
PLEASE INDICATE THE FINAL (CONSENT/REFUAL) STATUS FOR THIS SECTION.
BQ1PRECT
BQ1PRE1
no entry
The following questions are about (SP's) background including (his/her) use of long-term care, demographics,
and (his/her) immediate family. In answering some of these questions, you might find it useful to refer to various (01) CONTINUE
records. Some of these questions refer to specific points in time while others are more general in
(02) CONSENT REQUIRED
nature/background.
(03) INITIAL REFUSAL
IF THERE ARE NO CONSENT OR REFUSAL ISSUES FOR THIS SECTION, PRESS "1" TO CONTINUE.
BEFORADM
BQRH22A
code one
SHOW CARD RH1
Please look at this card and tell me what kind of place (SP) was in just before being admitted here on
(ADMISSION DATE).
PRESS F1 FOR DEFINITIONS.
BEFORAOS
BQRH22A
verbatim text
OTHER (SPECIFY)
BOX BQ3B
routing
IF BQRH22A - BEFORADM = 5/PrivateHomeOrApartment OR 91/Other, GO TO BQRH31A - BLIVEWAL.
ELSE GO TO BQ9PRE - BQ9PRECT.
(01) BQRH22A - BEFORADM
(02) BQEND - BQENDCT
(03) BQEND - BQENDCT
(01) NURSING HOME/REHAB CENTER
(02) PERSONAL CARE HOME/RESIDENTIAL CARE
FACILITY
(03) CCRC/RETIREMENT HOME/CENTER
(04) HOSPITAL
(05) PRIVATE HOME OR APARTMENT
(07) OTHER LTC FACILITY
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX BQ3B
(02) BOX BQ3B
(03) BOX BQ3B
(04) BOX BQ3B
(05) BOX BQ3B
(07) BOX BQ3B
(91) BQRH22A - BEFORAOS
(-8) BOX BQ3B
(-9) BOX BQ3B
(01) Continuous answer
BOX BQ3B
(01) BQRH31B - BLIVENUM
(02) BQRH31B - BLIVENUM
(03) BQRH31B - BLIVENUM
(04) BQ9PRE - BQ9PRECT
(-8) BQ9PRE - BQ9PRECT
(-9) BQ9PRE - BQ9PRECT
BLIVEWAL
BQRH31A
code one
Who lived with (him/her) there?
(01) RELATIVE
(02) NON-RELATIVE
(03) BOTH RELATIVE AND NON-RELATIVE
(04) ALONE
(-8) Don't Know
(-9) Refused
BLIVENUM
BQRH31B
Numeric
How many people, including relatives and non-relatives, lived with (him/her) there?
(01) Continuous answer
(-8) Don't Know
(-9) Refused
(01) BQ9PRE - BQ9PRECT
(-8) BQ9PRE - BQ9PRECT
(-9) BQ9PRE - BQ9PRECT
BQ9PRECT
BQ9PRE
code one
The next few questions are about (SP's) (level of education,) race, ethnicity, and military service.
PRESS "1" TO CONTINUE.
(01) CONTINUE
(01) BOX BQ4
BOX BQ4
routing
IF HA51-BACK.HEDULEV = DK, RF, EMPTY, OR NULL GO TO BQ9 - EDLEVELF.
ELSE GO TO BQ10A - BHISPORG.
Page 1 of 4
2022 MCBS Facility Instrument
Variable Name
MR Screen Name
BQ-Background Questionnaire
Question Type
Question Text/Description
Code List
Routing
(01) NO FORMAL SCHOOLING
(02) ELEMENTARY (1ST-8TH GRADES)
(03) SOME HIGH SCHOOL (9TH-12TH GRADES)
(04) COMPLETED HIGH SCHOOL, NO COLLEGE
(05) TECHNICAL OR TRADE SCHOOL
(06) SOME COLLEGE
(07) COLLEGE GRADUATE
(08) GRADUATE DEGREE
(-8) Don't Know
(-9) Refused
(01) BQ10A - BHISPORG
(02) BQ10A - BHISPORG
(03) BQ10A - BHISPORG
(04) BQ10A - BHISPORG
(05) BQ10A - BHISPORG
(06) BQ10A - BHISPORG
(07) BQ10A - BHISPORG
(08) BQ10A - BHISPORG
(-8) BQ10A - BHISPORG
(-9) BQ10A - BHISPORG
EDLEVELF
BQ9
code one
As far as you know, what (is/was) the highest level of schooling (SP) completed?
IF DK, USE CATEGORIES AS PROBES.
BHISPORG
BQ10A
yes/no
(Is/Was) (SP) of Hispanic or Latino origin?
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BQ11A - BQRACE
(01) BQ10B - BHISPORD
(-8) BQ11A - BQRACE
(-9) BQ11A - BQRACE
(01) MEXICAN/MEXICAN AMERICAN/CHICANO(A)
(02) PUERTO RICAN
(03) CUBAN
(91) OTHER HISPANIC, LATINO/A, OR SPANISH ORIGIN
(-8) Don't Know
(-9) Refused
(01) BQ11A - BQRACE
(02) BQ11A - BQRACE
(03) BQ11A - BQRACE
(91) BQ10B - BHISPDOS
(-8) BQ11A - BQRACE
(-9) BQ11A - BQRACE
BHISPORD
BQ10B
code all
SHOW CARD BQ1AA.
Looking at this card, (is/was) (SP) Mexican, Mexican American, or
(Chicano/Chicana), Puerto Rican, Cuban, or of another Hispanic,
(Latino/Latina) or Spanish origin?
CHECK ALL THAT APPLY.
BHISPDOS
BQ10B
verbatim text
OTHER ORIGIN (SPECIFY)
(01) Continuous answer
(01) BQ11A - BQRACE
(01) AMERICAN INDIAN OR ALASKA NATIVE
(02) ASIAN
(03) BLACK OR AFRICAN AMERICAN
(04) NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
(05) WHITE
(91) ANOTHER RACE
(-8) Don't Know
(-9) Refused
(01) BOX BQ4A
(02) BOX BQ4A
(03) BOX BQ4A
(04) BOX BQ4A
(05) BOX BQ4A
(91) BQ11A - BRACEOS
(-8) BOX BQ4A
(-9) BOX BQ4A
(01) Continuous answer
(01) BOX BQ4A
(01) ASIAN INDIAN
(02) CHINESE
(03) FILIPINO
(04) JAPANESE
(05) KOREAN
(06) VIETNAMESE
(91) OTHER ASIAN GROUP
(-8) Don't Know
(-9) Refused
(01) BOX BQ4B
(02) BOX BQ4B
(03) BOX BQ4B
(04) BOX BQ4B
(05) BOX BQ4B
(06) BOX BQ4B
(91) BQ11B - BRACASOS
(-8) BOX BQ4B
(-9) BOX BQ4B
(01) Continuous answer
(01) BOX BQ4B
(01) NATIVE HAWAIIAN
(02) GUAMANIAN OR CHAMORRO
(03) SAMOAN
(91) OTHER PACIFIC ISLANDER GROUP
(-8) Don't Know
(-9) Refused
(01) BOX BQ5
(02) BOX BQ5
(03) BOX BQ5
(91) BQ11C - BRACPIOS
(-8) BOX BQ5
(-9) BOX BQ5
BQRACE
BQ11A
code all
SHOW CARD BQ1A
Please look at this card and tell me what (is/was) (SP's) race.
SELECT ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
BRACEOS
BQ11A
verbatim text
ANOTHER RACE (SPECIFY)
BOX BQ4A
routing
IF BQ11A-BQRACE INCLUDES 2/Asian, GO TO BQ11B - BRACEASD.
ELSE GO TO BOX BQ4B.
BRACEASD
BQ11B
code all
SHOW CARD BQ1B.
Looking at this card, (is/was) (SP) Asian Indian, Chinese, Filipino,
Japanese, Korean, Vietnamese or some other Asian group?
You can choose more than one group.
CHECK ALL THAT APPLY.
BRACASOS
BRACPIDT
BQ11B
verbatim text
OTHER ASIAN GROUP (SPECIFY)
BOX BQ4B
routing
IF BQ11A-BQRACE INCLUDES 4/NativeHawaiianOrOtherPacificIslander, GO TO BQ11C - BRACPIDT.
ELSE GO TO BOX BQ5.
BQ11C
code all
SHOW CARD BQ1C.
Looking at this card, (is/was) (SP) Native Hawaiian, Guamanian
or Chamorro, Samoan, or some other Pacific Islander group?
You can choose more than one group.
CHECK ALL THAT APPLY.
Page 2 of 4
2022 MCBS Facility Instrument
BQ-Background Questionnaire
Variable Name
MR Screen Name
Question Type
Question Text/Description
Code List
Routing
BRACPIOS
BQ11C
verbatim text
OTHER PACIFIC ISLANDER GROUP (SPECIFY)
(01) Continuous answer
(01) BOX BQ5
BOX BQ5
routing
IF SP IS LESS THAN 15 YEARS OLD, GO TO BQ18PRE - BQ18PRCT.
ELSE GO TO BQ12 - BEVERAF.
BQ12
yes/no
Did (SP) ever serve on active duty in the Armed Forces?
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BQ12B - BEVERNG
(01) BQ12A - BARMEDF
(-8) BQ12B - BEVERNG
(-9) BQ12B - BEVERNG
(01) IRAQ OR AFGHANISTAN CONFLICT (2001 - Present)
(02) PERSIAN GULF WAR (Aug. 1990 - March 1991)
(03) VIETNAM ERA (Aug. 1964 - May 1975)
(04) KOREAN CONFLICT (June 1950 - Jan. 1955)
(05) WORLD WAR II (Sept. 1940 - July 1947)
(06) WORLD WAR 1 (1917 - 1918)
(07) PEACE TIME ONLY (ALL OTHER TIMES)
(-8) Don't Know
(01) BQ12B - BEVERNG
(02) BQ12B - BEVERNG
(03) BQ12B - BEVERNG
(04) BQ12B - BEVERNG
(05) BQ12B - BEVERNG
(06) DO NOT DISPLAY
(07) BQ12B - BEVERNG
(-8) BQ12B - BEVERNG
BEVERAF
SHOW CARD BQ1
Looking at this card, which time periods best describe when (SP) served in the Armed Forces?
BARMEDF
BQ12A
code all
SELECT ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
BEVERNG
BQ12B
yes/no
Was (SP) ever an active member of a National Guard or military reserve unit of the United States?
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BOX BQ5A
(01) BQ12C - BNGDUTY
(-8) BOX BQ5A
(-9) BOX BQ5A
BNGDUTY
BQ12C
yes/no
Was all of (SP's) active duty related to National Guard or military reserve training?
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BOX BQ5A
(01) BOX BQ5A
(-8) BOX BQ5A
(-9) BOX BQ5A
BOX BQ5A
routing
IF BQ12 - BEVERAF = 1/Yes OR BQ12B - BEVERNG = 1/Yes, GO TO BQ12E - BVARATE.
ELSE GO TO BQ13 - BMRJAN.
BQ12E
Numeric
What (is/was) (SP's) (current/most recent) VA disability rating?
THE VA DISABILITY RATING IS A PERCENTAGE IN MULTIPLES OF 10 (I.E., 10%, 20%, ETC.). ENTER THE
NUMBER AS A WHOLE NUMBER. DO NOT ENTER THE "%" SIGN.
(01) Continuous answer
(-8) Don't Know
(-9) Refused
(01) BQ13 - BMRJAN
(-8) BQ13 - BMRJAN
(-9) BQ13 - BMRJAN
(Is/Was) (SP) married, widowed, divorced, separated, or never married?
(01)NEVER MARRIED
(02) MARRIED
(03) WIDOWED
(04) DIVORCED
(05) SEPARATED
(-8) Don't Know
(-9) Refused
(01)BQ18PRE - BQ18PRCT
(02) BQ18PRCT BQ15 - BHWLIVES
(03) BQ18PRE - BQ18PRCT
(04) BQ18PRE - BQ18PRCT
(05) BQ18PRE - BQ18PRCT
(-8) BQ18PRE - BQ18PRCT
(-9) BQ18PRE - BQ18PRCT
SHOW CARD BQ2
Please look at this card and tell me where (SP's) spouse lives now.
(01) IN THIS FACILITY
(02) OTHER NURSING HOME/REHAB CENTER
(03) PERSONAL CARE HOME/RESIDENTIAL CARE
FACILITY
(04) CCRC/RETIREMENT HOME/CENTER
(05) HOSPITAL
(06) PRIVATE HOME OR APARTMENT
(07) SPOUSE DECEASED
(08) OTHER LTC FACILITY
(-8) Don't Know
(-9) Refused
(01) BQ18PRE - BQ18PRCT
(02) BQ18PRE - BQ18PRCT
(03) BQ18PRE - BQ18PRCT
(04) BQ18PRE - BQ18PRCT
(05)BQ18PRE - BQ18PRCT
(06) BQ18PRE - BQ18PRCT
(07) BQ18PRE - BQ18PRCT
(08) BQ18PRE - BQ18PRCT
(-8) BQ18PRE - BQ18PRCT
(-9) BQ18PRE - BQ18PRCT
(01) Continue
(01) BOX BQ10
BVARATE
BMRJAN
BQ13
code one
BHWLIVES
BQ15
code one
BQ18PRCT
BQ18PRE
code one
The next few questions are about (SP's) immediate family.
PRESS "1" TO CONTINUE.
BOX BQ10
routing
IF SP IS LESS THAN 15 YEARS OLD, GO TO BQ24 - BINCOAMT.
ELSE GO TO BQ20 - BTOTLCHI.
Page 3 of 4
2022 MCBS Facility Instrument
Variable Name
BTOTLCHI
MR Screen Name
BQ20
BQ-Background Questionnaire
Question Type
Numeric
Question Text/Description
Code List
Routing
Including natural, adopted, and stepchildren, how many living children (does/did) (SP) have?
(01) Continuous answer
(-8) Don't Know
(-9) Refused
(01) BQ24 - BINCOAMT
(-8) BQ24 - BINCOAMT
(-9) BQ24 - BINCOAMT
(01) Continuous answer
(-8) Don't Know
(-9) Refused
(01) BQ28 - DIDABBQ
(-8) BQ25 - BLESS25
(-9) BQ25 - BLESS25
(Is/Was) it less than $25,000?
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BQ27 - BHOWMORE
(01) BQ26 - BHOWLESS
(-8) BQ28 - DIDABBQ
(-9) BQ28 - DIDABBQ
Would you say it (is/was)…
(01) Less than $5,000,
(02) $5,000 - less than $10,000
(03) $10,000 - less than $15,000
(04) $15,000 - less than $20,000
(05) $20,000 - less than $25,000
(-8) Don't Know
(-9) Refused
(01) BQ28 - DIDABBQ
(02) BQ28 - DIDABBQ
(03) BQ28 - DIDABBQ
(04) BQ28 - DIDABBQ
(05) BQ28 - DIDABBQ
(-8) BQ28 - DIDABBQ
(-9) BQ28 - DIDABBQ
Would you say it (is/was)…
(01) $25,000 - less than $30,000
(02) $30,000 - less than $40,000
(03) $40,000 - less than $50,000
(04) $50,000 - less than $66,000
(05) $66,000 - less than $109,000
(06) $109,000 or more
(-8) Don't Know
(-9) Refused
(01) BQ28 - DIDABBQ
(02) BQ28 - DIDABBQ
(03) BQ28 - DIDABBQ
(04) BQ28 - DIDABBQ
(05) BQ28 - DIDABBQ
(06) BQ28 - DIDABBQ
(-8) BQ28 - DIDABBQ
(-9) BQ28 - DIDABBQ
(01) ALL
(02) MAJORITY
(03) HALF
(04) SOME
(05) NONE
(01) BQ29 - WHYABBQ
(02) BQ29 - WHYABBQ
(03) BQ29 - WHYABBQ
(04) BQ29 - WHYABBQ
(05) BQEND - BQENDCT
In studies like this, people are sometimes grouped together according to income.
SHOW CARD BQ3
BINCOAMT
BQ24
Dollar
Looking at this card, please tell me what (is/was) the total yearly income (SP) [and (his/her) spouse] received
from jobs, businesses, interest, Social Security, Railroad Retirement, Supplemental Security Income (SSI),
pensions, and any other sources of income, before taxes or any deductions.
ENTER A WHOLE DOLLAR AMOUNT FOLLOWED BY ".00"
BLESS25
BHOWLESS
BHOWMORE
BQ25
BQ26
BQ27
yes/no
code one
code one
DID YOU ABSTRACT?
DIDABBQ
BQ28
code one
TO ABSTRACT MEANS TO OBTAIN INFORMATION FROM THE BENEFICIARY'S RECORDS FOR ENTRY
INTO THE QUESTIONNAIRE. EXAMPLES OF RECORDS YOU MAY HAVE ABSTRACTED FROM INCLUDE
THE MINIMUM DATA SET (MDS), NURSES NOTES, PHYSICIANS ORDERS, AND/OR OTHER DOCUMENTS
PROVIDED BY THE FACILITY.
USE YOUR BEST JUDGMENT TO DETERMINE WHICH ANSWER IS THE MOST ACCURATE CHOICE FOR
THE AMOUNT YOU ABSTRACTED. IF THERE WAS NO ABSTRACTION AT ALL, PLEASE SELECT "NONE".
WHYABBQ
BQ29
code one
WHY DID YOU ABSTRACT?
(01) NO KNOWLEDGEABLE RESPONDENT AVAILABLE
(02) NO TIME/STAFF BURDEN TOO GREAT
(03) REFUSAL--UNWILLING TO COOPERATE
(91) OTHER
(01) BQEND - BQENDCT
(02) BQEND - BQENDCT
(03) BQEND - BQENDCT
(91) BQ29VB - WHYABBOS
WHYABBOS
BQ29VB
verbatim text
WHY DID YOU ABSTRACT?
OTHER (SPECIFY)
(01) Continuous answer
(01) BQEND - BQENDCT
BQENDCT
BQEND
code one
YOU HAVE COMPLETED THE BACKGROUND SECTION FOR THIS SP.
PRESS "1" TO RETURN TO NAVIGATION SCREEN.
(01) Continue
(1) BOX BQEND
BOX BQEND
routing
GO TO NAVIGATOR
Page 4 of 4
File Type | application/pdf |
File Title | Medicare Current Beneficiary Survey Section Specifications for BQ |
Subject | Medicare beneficiaries, MCBS facility instrument, 2022, Background Questionnaire, BQ |
Author | NORC |
File Modified | 2021-12-09 |
File Created | 2021-12-09 |