CMS-P-0015A Housing_Characteristics

2022 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

HAQ-HOUSING CHARACTERISTICS

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

SPMOVED

HAINT

HA1A

routing

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:
[Have you/Has (SP)] moved since [LAST FALL ROUND DATE]?

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)

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 AND
(03) THREE OR MORE
UNFINISHED BASEMENTS AND FINISHED ATTICS. DO NOT INCLUDE UNFINISHED ATTICS OR ROOF
(-8) Don't Know
TERRACES.]
(-9) Refused

HLEVELS

HELEVTR

HONELEVL

HA2

HA3

HA4

yes/no

yes/no

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

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

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

Page 1 of 5

2022 MCBS Community Questionnaire

Variable Name

HBTHLEVL

MR Screen Name Question Type

HA5

yes/no

HAQ-HOUSING CHARACTERISTICS

Question Text/Description

Code List

Routing

Does [your/(SP’s)] (house/own apartment or condominium/place of residence) have either a full bathroom or a half
bathroom on all levels?

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

HAINTRO2 - HAINT1

[PROBE: Bathroom facilities must contain at least a flush toilet, or a bathtub or shower.]
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).

BOX HA1AB

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.

yes/no

(01) YES
Does [your/(SP’s)] (house/mobile home/apartment or condominium building/place of residence) have ramps at (any (02) NO
of) its entrance(s)?
(-8) Don't Know
(-9) Refused

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

Does [your/(SP’s)] (house/own apartment or condominium/mobile home/place of residence) have modifications to
any bathroom such as grab bars or a shower seat?

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.

yes/no

(01) YES
Other than stair railings, does [your/(SP’s)] (house/own apartment or condominium/mobile home/place of residence) (02) NO
have special railings to help (you/him/her) move around?[DO NOT INCLUDE HANDRAILS IN BATHROOMS.]
(-8) Don't Know
(-9) Refused

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.

BOX HA1AB

HRAMPS

HA6

BOX HA1AC

HBATHRM

HA7

BOX HA1AD

HRAILING

HA8

BOX HA1B

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

BOX HA1AC

BOX HA1AD

BOX HA1B

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2022 MCBS Community Questionnaire

Variable Name

HOUSTYPE

HAQ-HOUSING CHARACTERISTICS

MR Screen Name Question Type

Question Text/Description

Code List

Routing

HA9

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

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

(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

yes/no

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

HA11 - HPERCARE

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

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

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…
prepared meals?

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

HA12 - MAIDPROB

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…
housekeeping, maid, or cleaning services?

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

HA12 - WASHPROB

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…
laundry services?

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

HA12 - HELPPROB

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…
help with medications?

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

HA12 - TRANPROB

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…
transportation?

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

HA12 - RECPROB

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

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.]
[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

HA12

HA12

HA12

HA12

HA12

HA12

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2022 MCBS Community Questionnaire

Variable Name

SERVINCL

MR Screen Name Question Type

Question Text/Description

BOX HA2

IF SP HAD ACCESS TO AT LEAST ONE PERSONAL SERVICE LISTED AT HA12, GO TO HA13 - SERVINCL.
ELSE GO TO BOX HA2A.

HA13

BOX HA2A

STAYPUT

CAREPART

REQAGE

HAQ-HOUSING CHARACTERISTICS

HA14

routing

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 (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.

yes/no

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?
[PROBE: Could [you/(SP)] stay where (you/he/she) (live/lives) now if (you/he/she) needed a much greater level of
care?]

Code List

Routing

(01) ALL INCLUDED
(02) SOME INCLUDED/SOME SEPARATE
(03) ALL SEPARATE
(-8) Don't Know
(-9) Refused

BOX HA2A

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

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

yes/no

(01) YES
(02) NO
If (you/he/she) needed substantial care, would that care be provided in another part of this same place of residence?
(-8) Don't Know
(-9) Refused

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?

BOX HA3

routing

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

HA15

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

HA16 - REQAGE

BOX HA3

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

HA17

yes/no

NBRROOMS

HA18

numeric

(01) YES
(02) NO
(-8) Don't Know
[EXPLAIN IF NECESSARY: Own bathroom facilities may be defined as the sink, flush toilet, and bathtub or shower (-9) Refused
used primarily by [you/(SP)] and is not used on a regular basis by someone not living in the household.]
[Do you/Does (SP)] have (your/his/her) own bathroom facilities?

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

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.]

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

Page 4 of 5

2022 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

HAQ-HOUSING CHARACTERISTICS

Question Text/Description

Code List

Routing

SHOW CARD HA4

LIVNGSIT

HOUSPEST

HA20

HA21

code one

grid

(01) HAVE A STEADY PLACE TO LIVE
(02) HAVE A PLACE TO LIVE TODAY, BUT WORRIED
ABOUT LOSING IT IN THE FUTURE
(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, living (-9) REFUSED
outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park.]
Which of these best describes [your/(SP’s)] living situation today? [Do you/Does (SP)] have a steady place to 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 steady
place to live?

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.

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HA21-HOUSMOLD

Mold

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HA21-HOUSLEAD

Lead paint or pipes

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HA21-HOUSHEAT

Lack of heat

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HA21-HOUSCOOL

Lack of cooling system

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HA21-HOUSOVEN

Oven or stove not working

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HA21-HOUSSMOK

Smoke detectors missing or not working

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HA21-HOUSWATR

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

BOX HA4

Pests such as bugs, ants, or mice

HOUSMOLD

HOUSLEAD

HOUSHEAT

HOUSCOOL

HOUSOVEN

HOUSSMOK

HOUSWATR

HA21

HA21

HA21

HA21

HA21

HA21

grid

grid

grid

grid

grid

grid

HA21-HOUSPEST

HA21

grid

Water leaks

BOX HA4

routing

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

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