Attachment C
NPALS Direct Care Worker Pilot Study Question List
Form Approved OMB No. 0920-1030
Exp. Date 02/28/2026
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Background information
1. At the facility listed on the label below, are you…. (employed--full-time or part-time, contracted from another agency--temporarily or long-term, not currently employed or contracted at this facility)? If you are no longer working at this facility please answer each question about when you were employed or contracted at this facility.
You may also work at an additional facility(s) or for another employer, but we would like you to answer only about your experiences working at the provider on the label of this survey [or at PROVIDER NAME/ ADDRESS].
2. At this facility, do you provide assistance with… (Yes No)
ADLs, or activities of daily living? By ADLs, we mean eating, dressing, bathing, transferring and toileting?
Medications, such as opening or passing medications or giving reminders to take medications?
Companionship, recreation, or social activities
Nurse delegated or assigned roles/responsibilities, such as medication administration, blood glucose monitoring, or wound care
3. Why did you initially decide to become a direct care worker? (Mark all that apply)
a. Like helping or caring for people
b. Wanted to interact with disabled or older populations
c. Family member or friend was a direct care worker
d. Wanted to work in health care
e. Provided care to a friend or relative
f. Job was steady or work hours fit schedule
g. Job available or close to home
h. Other reason, specify_________
4. How have you found jobs as a direct care worker? (Mark all that apply)
a. Family member or friend recommended it
b. Learned about it while working in other health care setting
c. Online, Newspaper, TV, Radio
d. School/job training program
e. Completed training at this facility
f. Other way
5. At this facility, do you use any of the following when providing care? (Yes No)
An Electronic Health Record (EHR) or a computerized version of a resident’s or participant’s health and personal information?
Telehealth tools to connect with other care providers, such as a smartphone or tablet with videoconference software?
A smartphone or tablet with videoconference software to connect with family members?
Training
6. About how many hours of training have you had as a direct care worker? Enter 0 if no training.
a. Initial training prior to providing care ____ (Hours) (Do not know)
b. Continuing education, on-going, or on-the-job training ____ (Hours) (Do not know)
7. Where have you received any training to work as a direct care worker? (Mark all that apply)
Facility where currently working
Facility other than where currently working
Community college, vocational, technical, or high school program
On-demand or on-line training
Apprenticeship program
Federal or state jobs program for healthcare professionals
Somewhere else, specify _______
No training
8. For which of the following specialized topics have you received training as a direct care worker? (Mark all that apply) Yes, No and for Yes, usefulness (very, somewhat, not at all)
a. Discussing care with participants’/residents’ families
b. Dementia care
c. Preventing physical harm from residents/participants
d. Preventing personal injuries at work
e. End of life issues (advance care planning, help families cope with grief)
f. Relating to participants/residents of different cultures, languages, ethnicities, or with different values, beliefs, or gender identity
g. Resident/participant rights
h. Infection control (putting on or taking off personal protective equipment, hand washing)
i. Working with persons with intellectual or developmental disabilities
j. Working with persons with specific medical or health conditions
k. Medications, side-effects or contraindications
l. Using electronic health records or telehealth technologies
m. Other training, specify _____
Benefits, Public Assistance, and Wages
9. Are you receiving any of the following benefits from this facility? (Yes, No, Not offered)
Health insurance for yourself only
Health insurance that includes family coverage
Life insurance
A retirement plan or pension, a 401(k), or a 403(b)
Paid personal time off, vacation time, or sick leave
Reimbursement for initial training
Paid childcare, childcare subsidies or assistance
Overtime pay
Dental, vision, or prescription drug benefits
Bonuses or regular pay increases
Travel reimbursements
Other, specify_____________
10. Are you enrolled or do you participate in any of the following public assistance programs? (Mark all that apply)
Government programs that pay for medical care, such as Medicare or Medicaid?
Cash welfare for families and children, also known as TANF or Temporary Assistance for Needy Families
Food assistance, like SNAP, food stamps, or WIC for food vouchers or food items
Supplemental Security Income (SSI)
Social Security Disability Insurance (SSDI)
Public housing or government rent subsidy, such as Section 8
Other public assistance program, specify_________
Do not participate in any public assistance program
11. What is your current hourly wage at this facility? ______ (Dollar amount per hour)
12. Unions negotiate a contract for workers for better workplaces, conditions, or wages. Are you represented by a union as a DCW? Yes/no
Job Satisfaction and Challenges
13. At this facility, what is your satisfaction level with the following… (Extremely satisfied, somewhat satisfied, somewhat dissatisfied, extremely dissatisfied)
Overall job
Schedule or hours
Salary or wages
Benefits
Type of work that you do
Opportunities to learn new skills
Working with your supervisor
Working with your coworkers
Opportunities for career advancement
Relationship with residents/participants
14. At this facility, do you agree or disagree with the following… (Strongly agree, somewhat agree, somewhat disagree, strongly disagree)
I am consistently assigned to care for the same residents/participants on most weeks or shifts I work
I have enough time to give individual attention to residents/participants who need assistance with dressing, bathing, transferring, or using the toilet
I have enough time to complete other duties that don’t directly involve the residents/participants
Residents/participants let me know when I am doing a good job
I am encouraged to discuss the care and well-being of residents/participants with their families.
I participate as a member of a care team
15. In the past year, did you miss any time from work at this facility because of…. (Mark all that apply).
Problems with transportation or traveling to job
Problems with childcare arrangements
Having to take care of a family member, relative, or friend
Injury while working at your current job
COVID-19 illness
Health issues or illness, other than COVID-19
Scheduling issue because of another job
Other, specify____________
Did not miss any time from work in the past year
16. How often have you experienced any of the following at this facility? (often, sometimes, rarely, never)
Communication problems with staff or residents/participants
Difficult behavior from residents/participants or their family members
Unpleasant coworkers or supervisor
Low pay
Limited benefits
Workload too little
Workload too much
Inability to take sufficient time off for COVID-19 illnesses
Difficulty dealing with COVID-19-related regulations or restrictions
Shortages of personal protection equipment (PPE), such as gloves or face masks
Discrimination in the workplace
Sexual harassment in the workplace
17. How often is this facility short-staffed? (Select one) (Never, Sometimes, Often , Always)
18. This question is about your supervisor at this facility. This is the person to whom you report about your day-to-day activities. Please remember this survey is confidential. For each statement, do you strongly agree, somewhat agree, somewhat disagree, strongly disagree.
a. My supervisor provides clear instructions when assigning work
b. My supervisor is supportive of progress in my career, such as further training
c. My supervisor listens to me when I am worried about a resident’s/participant’s care
d. My supervisor tells me when I am doing a good job
19. How long do you think you will continue to work at this facility? Please remember this survey is confidential. (Select one)
a. Less than 6 months
b. 6 months – 1 year
c. More than 1 year
d. Don’t know/unsure
e. No longer work at this facility
20. If you were to leave your job at this facility, what would be the reasons why? If you have left already, what were the reasons why? Please remember this survey is confidential. (Mark all that apply)
a. Retirement
b. Relocation
c. Better Pay
d. Better benefits package
e. Family reasons
f. Work stress or burnout
g. Lack of career growth opportunities
h. Other job or position in another field
i. Injury or the possibility of being injured
j. Views others have about the job
k. Other job or position available as a direct care worker
l. Other reason
Health and Workplace Safety
21. In the last 12 months, have you…. (Yes No)
Received a flu shot?
Received a COVID-19 shot or booster?
22. In the past 12 months, as a direct care worker, how many times have you been hurt or injured, such as broken bones or pulled back muscles, human bites, scratches, open wounds, or cuts, black eyes or other types of bruising, or burns? Include only work-related injuries that you reported to a facility, that required medical attention, or that caused you to miss work. Number. Enter 0 if none. (Add Skip for 0)
23. How did these injuries happen?
1 Lifting, repositioning, bathing or handling residents/participants
2 Slips, trips, falls
3 Aggression or violence by residents/participants
4 Bumping into, hitting, or using equipment
5 Performing janitorial tasks
6 Some other way, specify _______
24. Since you started your job at this facility, have you ever used assistive devices, such as lifting aides, belts, trapeze bars, or other assistive equipment, when moving or lifting residents/participants who cannot move around on their own? Yes, No
25. How often are assistive devices available to you at this facility when they are needed? Would you say . . . always, sometimes, or never?
26. Overall, how prepared are you to care for residents/participants at this facility if there were to be an emergency, such as a pandemic, weather event, or environmental disaster? (not prepared at all, somewhat prepared, extremely prepared)
Demographics
27. Are you a direct care worker at any other facilities? (Yes No)
If yes: How many hours a week do you work at another facility/other facilities? ____ (Number of hours)
28. What is your age in years? _____
29. Are you of Hispanic, Latino, or Spanish origin or descent? (Yes No)
30. Which one or more of the following would you say is your race? (Mark all that apply)
__ American Indian or Alaska Native
__ Asian
__ Black
__ Native Hawaiian or other Pacific Islander
__ White
__ Other, specify___________
31. What is your current gender identity? (Mark all that apply)
1. Female
2. Male
3. Transgender, non-binary, or another gender
32. What is your current relationship status? (Mark all that apply)
__ Married
__ With a partner
__ Separated
__ Divorced
__ Widowed
__ Single
__ Never married
__ Other
32. This next question is about you and the people living with you in your household. All of your answers will be kept confidential. Please do not include yourself and only count people who normally stay with you for at least 2 nights per week. How many people in your household are….
Children, age 17 or younger
Adults, age 18-64 years
Adults, age 65 and older
33. What is the highest level of education or degree you have achieved to date? (Select one)
__Some high school or less
__High school diploma or equivalent (GED)
__ Some vocational/technical training (after high school)
__Some college
__College graduate
__Some graduate school
__Graduate degree
34. Were you born outside of the United States? Please remember this survey is confidential. (Yes No)
35. What languages do you speak fluently? (Mark all that apply)
__ English
__ Spanish
__ Other language, Specify ______________________
36. In the following box, please share any feedback with us.
For example:
Is there anything we asked, we should not have?
Anything we did not ask, but should have?
Were there questions that were difficult to answer?
Was there a better way for us to contact you?
How much time would you be willing to spend on this survey?
Anything else?
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| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |