0920-25-0097 0920-0943 NPALS_RCC_Final_Updated

Form Approved OMB No. 0920-0943 Exp. Date: 10/31/2025

National Post-acute and Long-term Care Study
2024 Residential Care Community Questionnaire
The Centers for Disease Control and Prevention conducts the National Post-acute and Long-term Care Study
(NPALS). Please complete this questionnaire about the residential care community at the location listed below.


If this residential care community is associated with another residential care community or is part of a
facility or campus that offers multiple levels of care, please answer only for the residential care community
portion operating at the location listed below.



Please consult records and other staff as needed to answer questions.



If you need assistance or have questions, go to https://www.cdc.gov/nchs/npals/index.htm or call
1-855-500-1435.



Thank you for taking the time to complete this questionnaire.

CASE ID
DIRECTOR’S NAME
FACILITY NAME, LICENSE NUMBER
FACILITY PHYSICAL STREET ADDRESS
CITY, ST, ZIP
care places are known by different names in different states. We refer to all of these places and
 Residential
others like them as residential care communities. Just a few terms used to refer to these places are

assisted living, personal care, and adult care homes, facilities, and communities; adult family and board and
care homes; adult foster care; homes for the aged; and housing with services establishments.

Please provide your contact information. Your information may be used for contact related to participation in
current and future NPALS waves and will be kept confidential. PLEASE PRINT
First
Last
Your name
Name
Name
Your work telephone
—
—
Ext.
number, with extension
Your work e-mail address
Your job title
Notice – CDC estimates the average public reporting burden for this collection of information as 30 minutes per
response, including the time for reviewing instructions, searching existing data/information sources, gathering and
maintaining the data/information needed, and completing and reviewing the collection of information. An agency may
not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review
Office, 1600 Clifton Road, MS H21 -8, Atlanta, GA 30333; ATTN: PRA (0920-0943). Assurance of Confidentiality – We
take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a
practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not
disclose or release responses in identifiable form without the consent of the individual or establishment in accordance
with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection
and Statistical Efficiency Act of 2018 or CIPSEA (Pub. L. No. 115-435, 132 Stat. 5529 § 302). In accordance with CIPSEA,
every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of
up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition to the above
cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 and 151 note)
which protects Federal information systems from cybersecurity risks by screening their networks.

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Background Information
1.

2.

‚

3.

What is the type of ownership of this residential
care community? MARK ONLY ONE ANSWER
Private—nonprofit
Private—for profit
Publicly traded company or limited liability
company (LLC)
Government—federal, state, county, or local

4.

Is this residential care community currently
licensed, registered, certified, or otherwise
regulated by the State?
Yes
No  Skip to question 41

‚

Number of residents

5.

‚

6.

At this residential care community, what is the
number of licensed, registered, or certified
residential care beds? Include both occupied and
unoccupied beds. If this residential care community is
licensed, registered, or certified by apartment or
unit, please count the number of single resident
apartments or units as one bed each, two bedroom
apartments or units as two beds each and so forth.
If none, enter “0.”

7.

‚

8.

If you answered “0,” skip to question 41

Does this residential care community offer at least
2 meals a day to residents?
Yes
No  Skip to question 41
Does this residential care community offer…
MARK YES OR NO IN EACH ROW

a. help with activities of daily living (ADLs),
such as help with bathing, either directly
or arranged through an outside vendor?
b. assistance with medications, such as the
administration of medications, give
reminders, or provide central storage of
medications?
 If you answered “No” to both 6a and 6b,
skip to question 41

Number of beds


What is the total number of residents currently
living in this residential care community? Include
residents for whom a bed is being held while in the
hospital. If you have respite care residents, please
include them. If none, enter “0.”

If you answered fewer than 4 beds,
skip to question 41

Yes No

Is this residential care community permitted, licensed or regulated to only serve adults with an intellectual or
developmental disability, severe mental illness, or both? Do not include Alzheimer disease or other dementias.
MARK ONLY ONE ANSWER
Yes, permitted, licensed, or regulated to serve only persons with intellectual or
developmental disability
Yes, permitted, licensed, or regulated to serve only persons with severe mental illness  Skip to
question
Yes, permitted, licensed, or regulated to serve only persons with intellectual or
41
developmental disability and severe mental illness
No, none of the above
Does this residential care community provide or arrange for any of the following types of staff to meet any
resident needs that may arise? On-site means the staff are located in the same building, in an attached building or
next door, or on the same campus. MARK ONLY ONE RESPONSE IN EACH ROW
Yes, staff are
Yes, staff are on- available as needed
No
site 24/7
or on call 24/7
a. Personal care aide or staff caregiver
b. Registered Nurse (RN), Licensed Practical Nurse
(LPN), or Licensed Vocational Nurse (LVN)
c. Director, Assistant Director, Administrator or
Operator (if they provide personal care or
nursing services to residents)

 If you answered “No” to 8a, 8b, and 8c, skip to question 41
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9.

Does this residential care community only serve
adults with dementia or Alzheimer disease?
Yes  Skip to question 12
No

14. Is this residential care community authorized or
otherwise set up to participate in Medicaid?
Yes
No  Skip to question 16

„10. Does this residential care community have a

„15. During the last 30 days, for how many of the

distinct unit, wing, or floor that is designated as
a dementia, Alzheimer, or memory care unit?
Yes
No  skip to question 13

residents currently living in this residential
care community did Medicaid pay for some
or all of their services received at this
community? If none, enter “0.”

‚

Number of residents

11. How many licensed beds are in the dementia,
Alzheimer, or memory care unit, wing, or
floor? If this residential care community is
licensed, registered, or certified by apartments
or units, please count the number of single
resident apartments or units as one bed each,
two bedroom apartments or units as two beds
each and so forth. If none, enter “0.”

16. An Electronic Health Record (EHR) is a
computerized version of the resident’s health and
personal information used in the management of
the resident’s health care. Other than for
accounting or billing purposes, does this residential
care community use Electronic Health Records?
Yes
No  Skip to question 18

Number of beds
12. Does this residential care community or
designated unit, wing, or floor have each of the
following? MARK YES OR NO IN EACH ROW

„17. Does this residential care community’s

Electronic Health Records system support
electronic health information exchange with
each of the following providers? Do not include
faxing. MARK YES OR NO IN EACH ROW

Yes No
a. High staff-to-resident ratios
compared to other units, wings,
or floors
b. Staff specially trained in
dementia care
c. Dementia-specific activities or
programming

Yes

No

a. Physician
b. Pharmacy
c. Hospital
d. Skilled nursing facility, nursing
home, or inpatient
rehabilitation facility
e. Other long term care provider

d. Locked exit doors
e. Doors with alarms
f. Doors with key pads/electronic
keys
g. Security cameras in common
areas
h. Personal monitoring devices for
residents who wander
i. An enclosed courtyard

18. In the last 12 months, did this residential care
community use any of the following types of
telehealth tools to assess, diagnose, monitor, or
treat residents? MARK YES, NO, OR DON’T KNOW
IN EACH ROW
Don’t
Yes
No
Know
a. Telephone audio

13. Is this residential care community owned by a
person, group, or organization that owns or
manages two or more residential care
communities? This may include a corporate chain.
Yes
No

b. Videoconference
software with audio
(e.g., Zoom, Webex,
FaceTime)
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19. Does this residential care community have the following infection control policies and practices?
MARK YES OR NO IN EACH ROW
a. Have a written Emergency Operations Plan that is specific to or includes pandemic response
b. Have a designated staff member or consultant responsible for coordinating the infection control program
c. Offer annual influenza vaccination to residents
d. Offer annual influenza vaccination to all employees or contract staff
e. Offer COVID-19 vaccination to residents
f. Offer COVID-19 vaccination to all employees or contract staff
g. Screen residents daily for infection (e.g., screen for fever or respiratory symptoms) if an outbreak occurs
h. Limit communal dining and recreational activities in common areas if an outbreak occurs
i. Impose restrictions on family, relatives, visitors, volunteers, or non-essential consultant personnel (e.g.,
barbers, delivery personnel) entering the building if an outbreak occurs
j. Masking if an outbreak occurs

Yes No

Services Offered
20. Services currently offered by this residential care community can include services offered at this physical location
or virtually (on-line or by telephone). For each service listed below… MARK ALL THAT APPLY IN EACH ROW
Provides the service by
This residential care community...
paid residential care
community employees
Does not
or
provide,
Arranges for the service
Refers residents or
arrange, or
to be provided by
family to outside service refer for this
outside service providers
providers
service
a. Hospice or palliative care services
b. Social work services—provided by licensed
social workers or persons with a bachelor’s or
master’s degree in social work, and may include
an array of services such as psychosocial
assessment, individual or group counseling,
support groups, and referral services
c. Mental or behavioral health services—target
residents’ mental, emotional, psychological, or
psychiatric well-being and may include
diagnosing, describing, evaluating, and
treating mental conditions
d. Therapy services—physical, occupational, or
speech therapies
e. Pharmacy services—including filling of or
delivery of prescriptions
f. Dietary and nutritional services
g. Skilled nursing services—must be performed
by an RN, LPN or LVN and are medical in
h. nature
Transportation services for medical or dental
appointments
i. Routine and emergency dental services by a
licensed dentist
j. Home health care—medical, therapeutic, and
other heath care services to help with postacute and chronic illnesses
k. Home care—assistance with completing selfcare, activities of daily living, and instrumental
activities of daily living such as housekeeping,
errands, and appointments
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Resident Profile
21. In the last 12 months, how many coronavirus disease
(COVID-19) cases did this residential care community
have among residents? If none, enter “0.”

25. Of the residents currently living in this residential
care community, what is the racial-ethnic
breakdown? Count each resident only once. If a nonHispanic resident falls under more than one category,
please include them in the “Two or more races”
category.
Enter “0” for any categories with no residents.
Number of
Residents

Number of COVID-19 cases
 If you answered “0,” skip to question 23
„22. Of the COVID-19 cases in your residential care

community in the last 12 months, how many
cases resulted in each of the following?
Enter “0” if none or select don’t know if you
do not know the number.
Number of
Don’t
COVID-19
Know
Cases

a. Hispanic or Latino, of any race

a. Hospitalization

b. Two or more races, not Hispanic
or Latino
c. Middle eastern or North African,
not Hispanic or Latino
d. American Indian or Alaska
Native, not Hispanic or Latino

b. Death

e. Asian, not Hispanic or Latino
f. Black, not Hispanic or Latino

23. Of the residents currently living in this residential
care community, what is the age breakdown?
Enter “0” for any categories with no residents.
Number of
Residents

g. Native Hawaiian or Other Pacific
Islander, not Hispanic or Latino
h. White, not Hispanic or Latino
i. Some other category reported in
this residential care community’s
system
j. Not reported (race and ethnicity
unknown)
TOTAL

a. Under 65 years
b. 65–74 years
c. 75–84 years

NOTE: Total should be the same as the number of
residents provided in question 4.

d. 85 years or older
TOTAL

26. Assistance refers to needing any help or supervision
from another person, or use of assistive devices. Of
the residents currently living in this residential care
community, about how many now need any
assistance in each of the following activities? Enter
“0” for any categories with no residents.
Number of
Residents
a. With transferring in and out of a
bed or chair

NOTE: Total should be the same as the number
of residents provided in question 4.
24. Of the residents currently living in this residential
care community, what is the sex breakdown?
Enter “0” for any categories with no residents.
Number of
Residents
a. Male

b. With eating, like cutting up food

b. Female

c. With dressing
d. With bathing or showering
e. With using the bathroom
(toileting)
f. With locomotion or walking—
this includes using a cane,
walker, or wheelchair and/or
help from another person

TOTAL
NOTE: Total should be the same as the number
of residents provided in question 4.

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27. Of the residents currently living in this residential
care community, about how many have been
diagnosed with each of the following conditions?
Enter “0” for any categories with no residents.
Number of
Residents
a. Alzheimer disease or other
dementias

28. As best you know, of the residents currently living
in this residential care community, about how many
were treated in a hospital emergency department in
the last 90 days? If none, enter “0.”
Number of residents
29. As best you know, of the residents currently living
in this residential care community, about how many
were discharged from an overnight hospital stay in
the last 90 days? Exclude trips to the hospital
emergency department that did not result in an
overnight hospital stay. If none, enter “0.”

b. Arthritis
c. Asthma
d. Chronic kidney disease
e. COPD (chronic bronchitis or
emphysema)

Number of residents

f. Depression

30. As best you know, of the residents currently living
in this residential care community, about how
many had a fall in the last 90 days? Include falls
that occurred in your residential care community or
off-site, whether or not the resident was injured, and
whether or not anyone saw the resident fall or
caught them. Please just count one fall per resident
who fell, even if the resident fell more than one time.
If one of your residents fell during the last 90 days,
but is currently in the hospital or rehabilitation
facility, please include that person in your count. If
no residents had a fall, enter “0.”

g. Diabetes
h. Heart disease (for example,
congestive heart failure, coronary
or ischemic heart disease, heart
attack, stroke)
i. High blood pressure or
hypertension
j. Intellectual or developmental
disability
k. Osteoporosis

Number of residents

Staff Profile
31. An individual is considered an employee if the residential care community is required to issue a Form W-2
federal tax form on their behalf. For each staff type below, indicate how many full-time employees and parttime employees this community currently has. Include employees who work at this physical location or virtually
(on-line or by telephone). Enter “0” for any categories with no employees.
Number of Full- Number of PartTime Employees Time Employees
a. Registered nurses (RNs)
b. Licensed practical nurses (LPNs) / licensed vocational nurses (LVNs)
c. Certified nursing assistants, nursing assistants, home health aides, home
care aides, personal care aides, personal care assistants, and medication
technicians or medication aides
d. Social workers—licensed social workers or persons with a bachelor’s or
master’s degree in social work
e. Activities directors or activities staff

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32. Contract or agency staff refer to individuals or organization staff under contract with and working at this
residential care community but are not directly employed by the community. Does this community have any
nursing, aide, social work, or activities contract or agency staff? Include contract staff who work at this physical
location or virtually (on-line or by telephone).
Yes
No Skip to question 34
„33. For each staff type below, indicate how many full-time contract or agency staff and part-time contract or

agency staff this residential care community currently has. Do not include individuals directly employed by
this residential care community. Enter “0” for any categories with no contract or agency staff.
Number of Full- Number of PartTime Contract or Time Contract or
Agency Staff
Agency Staff
a. Registered nurses (RNs)
b. Licensed practical nurses (LPNs) / licensed vocational nurses (LVNs)
c. Certified nursing assistants, nursing assistants, home health aides,
home care aides, personal care aides, personal care assistants, and
medication technicians or medication aides
d. Social workers—licensed social workers or persons with a
bachelor’s or master’s degree in social work
e. Activities directors or activities staff

34. In the last 12 months, how often was this residential care community short-staffed?
Always
Sometimes
Never
The next series of questions asks about aide employees, which includes certified nursing assistants, nursing assistants,
home health aides, home care aides, personal care aides, personal care assistants, and medication technicians or
medication aides. Contract workers are not to be included in your answers.
35. Does this residential care community offer the
following benefits to full-time aide employees?
MARK YES OR NO IN EACH ROW
Yes No
a. Health insurance for the employee
only
b. Health insurance that includes family
coverage
c. Dental, vision, or prescription drug
benefits
d. Life insurance
e. A pension, a 401(k), or a 403(b)
f. Paid childcare, childcare subsidies, or
assistance
g. Paid personal time off, vacation time,
or sick leave
h. Overtime pay
i. Bonuses or regular pay increases
j. Reimburse/pay for initial training

36. How many hours of training does this residential
care community require aide employees to have for
each of the following? If none, enter “0.”
Number of hours
a. Initial training prior to
providing care
b. Continuing education, ongoing, or on-the-job training
37. Does this residential care community provide
assistive devices, such as lifting aides, belts,
trapeze bars, or other assistive equipment, to your
aide employees when they are moving or lifting
participants who cannot move around on their
own?
Yes
No

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38. How often does this residential care community offer training to prepare aide employees for each of the
following aspects of their jobs? Include any training offered when becoming an aide and any training offered since
aides started working. MARK ONLY ONE RESPONSE IN EACH ROW
Training is
Training is
offered
Training is
always
occasionally offered rarely
offered
or as needed
or never
Don’t Know
a. Discussing resident care with residents’ families
b. Dementia care
c. Working with residents that act out or are abusive
d. Preventing personal injuries at work
e. End of life issues (advance care planning and help
families cope with grief)
f. Relating to residents of different cultures or
ethnicities, or with different values or beliefs
g. Infection control (putting on and taking off
personal protective equipment, hand washing)
These next questions ask for information to help inform planning for future waves of NPALS. The National Center for
Health Statistics (NCHS) recently conducted a Direct Care Worker (DCW) Pilot Study as part of NPALS. We asked directors
of residential care communities to sample and provide contact information for two direct care employees or contract
staff. We then invited the sampled direct care workers to complete a questionnaire by mail or web.
39. If we were to invite you to participate in a future
DCW Study, would you have access to the following
information for your direct care employees? If yes,
would you be able to provide us with this
information to contact your direct care employees?

40.

Would you have access to the following information
for your direct care contract staff? If yes, would you
be able to provide us with this information to
contact your direct care contract staff?

Have If yes Able to
Access?  Provide?

Have If yes Able to
Access?  Provide?

No Yes

No Yes

No Yes

No Yes

a. Full name



a. Full name



b. Mailing address



b. Mailing address



c. Email address



c. Email address



41. Please return your questionnaire in the enclosed return envelope or mail it to:
Cox Building (FDC Fulfillment – Data Capture)
NPALS (0219308.001)
PO Box 12194
Research Triangle Park, NC 27709-2194

Thank you for participating in the
2024 National Post-acute and Long-term Care Study.
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