|
Health Status (HE) Section
BOX_00
=======
----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY {HOME.RUBEGMM, HOME.RUBEGDD,
HOME.RUBEGYY, HOME.RUENDMM, HOME.RUENDDD,
HOME.RUENDYY/PERS.FULLNAME, PRND.BEGREFMM,
PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM,
PRND.ENDREFDD, PRND.ENDREFYY}
----------------------------------------------------
BOX_01
=======
----------------------------------------------------
NOTE: THIS SECTION IS ASKED FOR ALL CURRENT RU
MEMBERS AND INSTITUTIONALIZED PERSONS. DO NOT ASK
THIS SECTION FOR DECEASED PERSONS.
----------------------------------------------------
----------------------------------------------------
NOTE: QUESTIONS HE01 THROUGH HE06 ARE ASKED EVERY
ROUND.
----------------------------------------------------
----------------------------------------------------
NOTE: THROUGHOUT THE HEALTH STATUS (HE) SECTION,
AGE CATEGORIES ARE REFERENCED WHEN A TRUE AGE WAS
NOT OBTAINED. THE AGES FOR THESE AGE CATEGORIES
ARE AS FOLLOWS:
1 = LESS THAN 1 YEAR OLD
2 = 1-4
3 = 5-15
4 = 16-23
5 = 24-34
6 = 35-44
7 = 45-54
8 = 55-64
9 = 65 YEARS OLD OR OLDER
----------------------------------------------------
HE01
====
{STR-DT}
{END-DT}
{Between (START DATE) and (END DATE), did/Does} anyone
in the
family receive help or supervision using the
telephone, paying
bills, taking medications, preparing light meals,
doing laundry,
or going shopping (because of an impairment or a
physical or mental
health problem)?
YES .................................... 1
NO ..................................... 2 {HE04}
REF ................................... -7 {HE04}
DK .................................... -8 {HE04}
HELP AVAILABLE FOR DEFINITION OF IMPAIRMENT AND
HELP/SUPERVISION.
----------------------------------------------------
DISPLAY ‘Between (START DATE) and (END DATE), did’
IF ROUND 5. OTHERWISE, DISPLAY ‘Does’.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE PERSON RU,
AUTOMATICALLY CODE PERSON AS ‘RECEIVES HELP’ AT
HE02 BY CAPI AND GO TO LOOP_01
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE
WITH HE02
----------------------------------------------------
HE02
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else receive help or supervision
doing
these types of activities [such as using the
telephone, paying
bills, taking medications, preparing light meals,
doing laundry,
or going shopping]?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR > 13 YEARS
OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC
SUPPLEMENT: IADL SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
LOOP_01
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER,
ASK NAV_HE01 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 DETERMINES IF PERSONS
RECEIVE HELP OR SUPERVISION WITH INSTRUMENTAL
ACTIVITIES OF DAILY LIVING BECAUSE OF AN
IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM.
THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE
FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP WITH INSTRUMENTAL
ACTIVITIES OF DAILY LIVING (I.E., PERSON
SELECTED AT HE02)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_HE01 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------
NAV_HE01
========
SERIES: Help with Daily Activities (e.g., using phone,
paying
bills, taking medication, etc.)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP WITH INSTRUMENTAL
ACTIVITIES OF DAILY LIVING (I.E., PERSON
SELECTED AT HE02)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_01A FOR SELECTED RU MEMBER.
----------------------------------------------------
BOX_01A
=======
----------------------------------------------------
IF RU MEMBER BEING LOOPED ON IS < 13 YEARS OF AGE
OR IN CATEGORIES 1-3, CONTINUE WITH HE03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HE03A
----------------------------------------------------
HE03
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
(Do/Does) (PERSON) receive help or supervision using
the
telephone, paying bills, taking medications, preparing
light
meals, doing laundry or going shopping because of
an
impairment or a physical or mental health problem?
YES .................................... 1 {HE03A}
NO ..................................... 2 {END_LP01}
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION AND
IMPAIRMENT.
----------------------------------------------------
IF CODED ‘1’ (YES), FLAG PERSON FOR THE LTC
SUPPLEMENT: IADL SECTION.
----------------------------------------------------
HE03A
=====
{PERSON’S FIRST NAME AND LAST NAME} {STR-DT}
{END-DT}
Do you expect that (PERSON) will need help or
supervision
with these activities for at least three more months?
YES .................................... 1 {END_LP01}
NO ..................................... 2 {END_LP01}
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}
END_LP01
========
----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_01 AND CONTINUE WITH HE04
----------------------------------------------------
HE04
====
{STR-DT}
{END-DT}
{Between (START DATE) and (END DATE), did/Does} anyone
in
the family receive help or supervision with personal
care
such as bathing, dressing, or getting around the house
(because of an impairment or a physical or mental
health
problem)?
YES .................................... 1
NO ..................................... 2 {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION.
----------------------------------------------------
DISPLAY ‘between (START DATE) and (END DATE), did’
IF ROUND 5. OTHERWISE, DISPLAY ‘Does’.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS ‘RECEIVES HELP’ AT
HE05 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_02
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND MULTI-PERSON RU, CONTINUE
WITH HE05
----------------------------------------------------
HE05
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else receive help or supervision
with
personal care [such as bathing, dressing, or getting
around
the house]?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR > 13 YEARS
OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC
SUPPLEMENT: ADL SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
LOOP_02
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
NAV_HE02 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 DETERMINES IF PERSONS
RECEIVE HELP OR SUPERVISION WITH PERSONAL CARE
(I.E., ACTIVITIES OF DAILY LIVING) BECAUSE OF AN
IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM.
THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE
FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP OR SUPERVISION WITH
PERSONAL CARE (I.E., ACTIVITIES OF DAILY LIVING,
THAT IS, THE PERSON IS SELECTED AT HE05)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_02 USES NAV_HE02 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------
NAV_HE02
========
SERIES: Help with Personal Care (e.g., bathing,
dressing,
getting around the house)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP OR SUPERVISION WITH
PERSONAL CARE (I.E., ACTIVITIES OF DAILY LIVING,
THAT IS, THE PERSON IS SELECTED AT HE05)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_01B FOR SELECTED RU MEMBER.
----------------------------------------------------
BOX_01B
=======
----------------------------------------------------
IF THE RU MEMBER BEING LOOPED ON IS < 13 YEARS OF
AGE OR IN AGE CATEGORIES 1-3, CONTINUE WITH HE06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HE06A
----------------------------------------------------
HE06
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
(Do/Does) (PERSON) receive help or supervision with
personal
care such as bathing, dressing or getting around the
house
because of an impairment or a physical or mental
health
problem?
YES .................................... 1 {HE06A}
NO ..................................... 2 {END_LP02}
REF ................................... -7 {END_LP02}
DK .................................... -8 {END_LP02}
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION AND
IMPAIRMENT.
----------------------------------------------------
IF CODED ‘1’ (YES), FLAG PERSON FOR THE LTC
SUPPLEMENT: ADL SECTION.
----------------------------------------------------
HE06A
=====
{PERSON’S FIRST NAME AND LAST NAME} {STR-DT}
{END-DT}
Do you expect that (PERSON) will need help or
supervision
with personal care for at least three more months?
YES .................................... 1 {END_LP02}
NO ..................................... 2 {END_LP02}
REF ................................... -7 {END_LP02}
DK .................................... -8 {END_LP02}
END_LP02
========
----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_02 AND CONTINUE WITH BOX_02
----------------------------------------------------
BOX_02
======
----------------------------------------------------
IF ROUND 1 OR ROUND 3 OR ROUND 5, CONTINUE WITH
HE07
----------------------------------------------------
----------------------------------------------------
IF ROUND 2 OR ROUND 4, GO TO HE26
----------------------------------------------------
HE07
====
{STR-DT}
{END-DT}
{Between (START DATE) and (END DATE), did/Does} anyone
in the family
use any aids such as a walker, grab bars in the
bathtub or any other
special equipment for personal care or everyday
activities (because of
an impairment or a physical or mental health problem)?
YES .................................... 1
NO ..................................... 2 {HE09}
REF ................................... -7 {HE09}
DK .................................... -8 {HE09}
HELP AVAILABLE FOR EXAMPLES OF AIDS/SPECIAL EQUIPMENT.
----------------------------------------------------
DISPLAY ‘Between (START DATE) and (END DATE),
did’ IF ROUND 5. OTHERWISE, DISPLAY ‘Does’.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS ‘USES AIDS’ AT HE08
BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE09
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE
WITH HE08
----------------------------------------------------
HE08
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else use any aids [such as a
walker,
grab bars in the bathtub or any other special
equipment]
for personal care or everyday activities?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS FOR THE LTC SUPPLEMENT:
AIDS/SPECIAL EQUIPMENT SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE09
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
HE09
====
{STR-DT}
{END-DT}
{Between (START DATE) and (END DATE), did/Does} anyone
in the family
have difficulties walking, climbing stairs, grasping
objects, reaching
overhead, lifting, bending or stooping, or standing
for long periods
of time (because of an impairment or a physical or
mental health
problem)?
YES .................................... 1
NO ..................................... 2 {HE19}
REF ................................... -7 {HE19}
DK .................................... -8 {HE19}
----------------------------------------------------
DISPLAY ‘Between (START DATE) and (END DATE),
did’ IF ROUND 5. OTHERWISE, DISPLAY ‘Does’.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS ‘HAVING DIFFICULTY’
AT HE10 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_03
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE
WITH HE10
----------------------------------------------------
HE10
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else have difficulties [walking,
climbing
stairs, grasping objects, reaching overhead, lifting,
bending
or stooping, or standing for long periods of time]?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR > 13 YEARS
OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC
SUPPLEMENT: FUNCTIONAL LIMITATIONS SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_03
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
LOOP_03
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
NAV_HE03 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS INFORMATION ON
THE LEVEL OF FUNCTIONAL LIMITATION WITH VARIOUS
PHYSICAL ACTIVITIES FOR PERSONS = OR > 13 YEARS OF
AGE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE
FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS FUNCTIONAL LIMITATIONS (I.E., PERSON
SELECTED AT HE10)
- PERSON = OR > 13 YEARS OF AGE OR IN AGE
CATEGORIES 4-9
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_03 USES NAV_HE03 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------
NAV_HE03
========
SERIES: Difficulty Moving (e.g., walking, climbing
stairs,
grasping, reaching overhead, etc.)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS FUNCTIONAL LIMITATIONS (I.E., PERSON
SELECTED AT HE10)
- PERSON = OR > 13 YEARS OF AGE OR IN AGE
CATEGORIES 4-9
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE11 FOR SELECTED RU MEMBER.
----------------------------------------------------
BOX_03
======
OMITTED.
HE11
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD HE-1.
{For these next questions, I would like you to think
about the
time when (PERSON) entered the institution and what
(PERSON)
was able to do at that time.}
Please look at this card and tell me how much
difficulty
(do/does) (PERSON) have lifting something as heavy as
10
pounds, such as a full bag of groceries? Would you say
no
difficulty, some difficulty, a lot of difficulty, or
completely unable to do it?
NO DIFFICULTY .......................... 1 {HE12}
SOME DIFFICULTY ........................ 2 {HE12}
A LOT OF DIFFICULTY .................... 3 {HE12}
COMPLETELY UNABLE TO DO IT ............. 4 {HE12}
REF ................................... -7 {HE12}
DK .................................... -8 {HE12}
[Code One]
----------------------------------------------------
DISPLAY ‘For these next questions, I would like
you to think about the time when (PERSON) entered
the institution and what (PERSON) was able to do
at that time.}’ IF PERSON BEING ASKED ABOUT CODED
AS BEING INSTITUTIONALIZED AT END DATE. IF PERSON
BEING ASKED ABOUT IS A CURRENT RU MEMBER LIVING IN
THE RU, USE A NULL DISPLAY.
----------------------------------------------------
HE12
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have walking up
10
steps without resting?
PROBE: Would you say no difficulty, some difficulty, a
lot of
difficulty, or completely unable to do it?
IF RESPONDENT VOLUNTEERS THAT PERSON IS COMPLETELY
UNABLE TO
WALK, SELECT ‘COMPLETELY UNABLE TO WALK’.
NO DIFFICULTY .......................... 1 {HE13}
SOME DIFFICULTY ........................ 2 {HE13}
A LOT OF DIFFICULTY .................... 3 {HE13}
COMPLETELY UNABLE TO DO IT ............. 4 {HE13}
COMPLETELY UNABLE TO WALK .............. 5 {HE17}
REF ................................... -7 {HE13}
DK .................................... -8 {HE13}
[Code One]
----------------------------------------------------
IF CODED ‘5’ (COMPLETELY UNABLE TO WALK),
AUTOMATICALLY CODE HE13, HE14, HE15, AND HE16 AS
‘4’ (COMPLETELY UNABLE TO DO IT) BY CAPI.
----------------------------------------------------
HE13
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have walking
about 3
city blocks or about a quarter of a mile?
PROBE: Would you say no difficulty, some difficulty, a
lot of
difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1 {HE14}
SOME DIFFICULTY ........................ 2 {HE14}
A LOT OF DIFFICULTY .................... 3 {HE14}
COMPLETELY UNABLE TO DO IT ............. 4 {HE15}
REF ................................... -7 {HE14}
DK .................................... -8 {HE14}
[Code One]
----------------------------------------------------
IF CODED ‘4’ (COMPLETELY UNABLE TO DO IT),
AUTOMATICALLY CODE HE14 AS ‘4’ (COMPLETELY UNABLE
TO DO IT) BY CAPI.
----------------------------------------------------
HE14
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have walking a
mile?
PROBE: Would you say no difficulty, some difficulty, a
lot of
difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1 {HE15}
SOME DIFFICULTY ........................ 2 {HE15}
A LOT OF DIFFICULTY .................... 3 {HE15}
COMPLETELY UNABLE TO DO IT ............. 4 {HE15}
REF ................................... -7 {HE15}
DK .................................... -8 {HE15}
[Code One]
HE15
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have standing
for about
20 minutes?
PROBE: Would you say no difficulty, some difficulty, a
lot of
difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1 {HE16}
SOME DIFFICULTY ........................ 2 {HE16}
A LOT OF DIFFICULTY .................... 3 {HE16}
COMPLETELY UNABLE TO DO IT ............. 4 {HE16}
REF ................................... -7 {HE16}
DK .................................... -8 {HE16}
[Code One]
HE16
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have bending
down or
stooping from a standing position to pick up an object
from
the floor or tie a shoe?
PROBE: Would you say no difficulty, some difficulty, a
lot of
difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1 {HE17}
SOME DIFFICULTY ........................ 2 {HE17}
A LOT OF DIFFICULTY .................... 3 {HE17}
COMPLETELY UNABLE TO DO IT ............. 4 {HE17}
REF ................................... -7 {HE17}
DK .................................... -8 {HE17}
[Code One]
HE17
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have reaching
up
overhead, for example to remove something from a
shelf?
PROBE: Would you say no difficulty, some difficulty, a
lot of
difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1 {HE18}
SOME DIFFICULTY ........................ 2 {HE18}
A LOT OF DIFFICULTY .................... 3 {HE18}
COMPLETELY UNABLE TO DO IT ............. 4 {HE18}
REF ................................... -7 {HE18}
DK .................................... -8 {HE18}
[Code One]
HE18
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have using
fingers to
grasp or handle something such as picking up a glass
from a
table or using a pencil to write?
PROBE: Would you say no difficulty, some difficulty, a
lot of
difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1 {HE18A}
SOME DIFFICULTY ........................ 2 {HE18A}
A LOT OF DIFFICULTY .................... 3 {HE18A}
COMPLETELY UNABLE TO DO IT ............. 4 {HE18A}
REF ................................... -7 {HE18A}
DK .................................... -8 {HE18A}
[Code One]
HE18A
=====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
(Are/Is) (PERSON) expected to have difficulty with any
of these activities for at least three more months?
YES .................................... 1 {END_LP03}
NO ..................................... 2 {END_LP03}
REF ................................... -7 {END_LP03}
DK .................................... -8 {END_LP03}
END_LP03
========
----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_03 AND CONTINUE WITH HE19
----------------------------------------------------
HE19
====
{STR-DT}
{END-DT}
Is anyone in the family limited in any way in the
ability to
work at a job, do housework, or go to school
because of an
impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2 {HE22}
REF ................................... -7 {HE22}
DK .................................... -8 {HE22}
HELP AVAILABLE FOR DEFINITION OF LIMITED ABILITY
AND IMPAIRMENT.
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS ‘LIMITED ABILITY’ AT
HE20 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE
WITH HE20
----------------------------------------------------
HE20
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Is anyone else limited in the ability to work
at a
job, do housework, or go to school because of an
impairment or
a physical or mental health problem?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR > 5 YEARS
OLD OR IN AGE CATEGORIES 3-9 FOR THE LTC
SUPPLEMENT: WORK-HOUSEWORK-SCHOOL LIMITATIONS
SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_04
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
LOOP_04
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
NAV_HE04 - END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 COLLECTS INFORMATION ON
WORK/HOUSEWORK/SCHOOL LIMITATIONS BECAUSE OF AN
IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM
FOR PERSONS = OR > 5 YEARS OF AGE. THIS LOOP
CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS LIMITED IN ABILITY TO WORK AT A JOB,
DO HOUSEWORK, OR GO TO SCHOOL (I.E., PERSON
SELECTED AT HE20)
- PERSON = OR > 5 YEARS OF AGE OR IN AGE
CATEGORIES 3-9
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_04 USES NAV_HE04 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------
NAV_HE04
========
SERIES: Limited Ability in Working, Doing Housework,
Going to
School
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS LIMITED IN ABILITY TO WORK AT A JOB,
DO HOUSEWORK, OR GO TO SCHOOL (I.E., PERSON
SELECTED AT HE20)
- PERSON = OR > 5 YEARS OF AGE OR IN AGE
CATEGORIES 3-9
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE20A FOR SELECTED RU MEMBER.
----------------------------------------------------
BOX_04
======
OMITTED.
HE20A
=====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
Which activities (are/is) (PERSON) limited in doing
because of an
impairment or a physical or mental health problem -
working at
a job, doing housework, or going to school?
CHECK ALL THAT APPLY.
WORKING AT A JOB ...................... 1 {HE21}
DOING HOUSEWORK ....................... 2 {HE21}
GOING TO SCHOOL ....................... 3 {HE21}
REF ................................... -7 {HE21}
DK .................................... -8 {HE21}
[Code All That Apply]
HE21
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{At the time (PERSON) entered the institution,
was/(Are/Is)}
(PERSON) completely unable to {work at a job}{,/ and}
{ do housework}{ and}{ go to school}?
YES .................................... 1 {END_LP04}
NO ..................................... 2 {END_LP04}
REF ................................... -7 {END_LP04}
DK .................................... -8 {END_LP04}
----------------------------------------------------
DISPLAY ‘At the time (PERSON) entered the
institution, was’. IF PERSON BEING ASKED ABOUT
CODED AS BEING INSTITUTIONALIZED AT END DATE.
DISPLAY ‘(Are/Is)’ IF PERSON BEING ASKED ABOUT IS
A CURRENT RU MEMBER LIVING IN THE RU.
DISPLAY ‘work at a job’ IF HE20A IS CODED ‘1’
(WORKING AT A JOB), EITHER ALONE OR IN COMBINATION
WITH OTHER CODES OR IF HE20A IS CODED ‘-7’
(REFUSED) OR ‘-8’ (DON’T KNOW). IF HE20A IS NOT
CODED ‘1’, ‘-7’, OR ‘-8’, USE A NULL DISPLAY.
DISPLAY ‘,’ IF HE20A IS CODED ‘1’, ‘2’, AND ‘3’ OR
IF HE20A IS CODED EITHER ‘-7’ OR ‘-8’.
DISPLAY ‘ and’ IF HE20A IS CODED ‘1’ AND EITHER
‘2’ OR ‘3’. OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘ do housework’ IF HE20A IS CODED ‘2’
(DOING HOUSEWORK), EITHER ALONE OR IN COMBINATION
WITH OTHER CODES OR IF HE20A IS CODED ‘-7’
(REFUSED) OR ‘-8’ (DON’T KNOW). IF HE20A IS NOT
CODED ‘2’, ‘-7’, OR ‘-8’, USE A NULL DISPLAY.
DISPLAY ‘ and’ IF ONLY CODES ‘2’ AND ‘3’ ARE
SELECTED AT HE20A OR IF CODES ‘1’, ‘2’, AND ‘3’
ARE ALL SELECTED AT HE20A OR IF CODED EITHER ‘-7’
OR ‘-8’ AT HE20A. OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘ go to school’ IF HE20A IS CODED ‘3’
(GOING TO SCHOOL), EITHER ALONE OR IN COMBINATION
WITH OTHER CODES OR IF HE20A IS CODED ‘-7’
(REFUSED) OR ‘-8’ (DON’T KNOW). IF HE20A IS NOT
CODED ‘3’, ‘-7’, OR ‘-8’, USE A NULL DISPLAY.
----------------------------------------------------
END_LP04
========
----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_04 AND CONTINUE WITH HE22
----------------------------------------------------
HE22
====
{STR-DT}
{END-DT}
Besides the limitations we just talked about, is
anyone in the
family limited in participating in social,
recreational, or
family activities because of an impairment or a
physical or
mental health problem?
YES .................................... 1
NO ..................................... 2 {HE24}
REF ................................... -7 {HE24}
DK .................................... -8 {HE24}
HELP AVAILABLE FOR DEFINITION OF LIMITED IN
PARTICIPATING.
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS ‘LIMITED IN
PARTICIPATION’ AT HE23 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE24
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE
WITH HE23
----------------------------------------------------
HE23
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Is anyone else limited in participating in
social,
recreational, or family activities because of an
impairment
or a physical or mental health problem?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR > 5 YEARS
OLD OR IN AGE CATEGORIES 3-9 FOR THE LTC
SUPPLEMENT: SOCIAL LIMITATIONS SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE24
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
HE24
====
{STR-DT}
{END-DT}
Do any of the adults in the family...
YES NO
HE24_01
=======
Experience confusion
or memory loss such
that it interferes
with daily
activities? 1 2
----------------------------------------------------
REFUSED (-7) AND DON’T KNOW (-8) ALLOWED.
----------------------------------------------------
HE24_02
=======
Have problems making
decisions to the
point that it
interferes with
daily activities? 1 2
----------------------------------------------------
REFUSED (-7) AND DON’T KNOW (-8) ALLOWED.
----------------------------------------------------
HE24_03
=======
Require supervision
for their own safety? 1 2
----------------------------------------------------
REFUSED (-7) AND DON’T KNOW (-8) ALLOWED.
----------------------------------------------------
----------------------------------------------------
IF HE24_01, HE24_02, OR HE24_03 IS CODED ‘1’ (YES)
AND A SINGLE-PERSON RU, AUTOMATICALLY CODE AS
‘EXPERIENCES CONFUSION’ AT HE25 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF HE24_01, HE24_02, OR HE24_03 IS CODED ‘1’ (YES)
AND A SINGLE-PERSON RU, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
IF HE24_01, HE24_02, AND HE24_03 ARE ALL CODED ‘2’
(NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW), GO TO
BOX_10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HE25
----------------------------------------------------
HE25
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else {experience confusion or
memory loss
such that it interferes with daily activities} {{or
}have
problems making decisions to the point that it
interferes with
daily activities} {{or }require supervision for their
own
safety}?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
DISPLAY ‘experience confusion or memory loss such
that it interferes with daily activities’ IF
HE24_01 CODED ‘1’ (YES).
DISPLAY ‘{or }have problems making decisions to
the point that it interferes with daily
activities’ IF HE24_02 CODED ‘1’ (YES). DISPLAY
THE ‘or ’ ONLY IF HE24_01 IS ALSO CODED ‘1’ (YES).
DISPLAY ‘{or }require supervision for their own
safety’ IF HE24_03 IS CODED ‘1’ (YES). DISPLAY
‘or ’ ONLY IF HE24_01 AND/OR HE24_02 ARE ALSO
CODED ‘1’ (YES).
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR > 18 YEARS
OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC
SUPPLEMENT: COGNITIVE
LIMITATIONS SECTION.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
BOX_05
======
OMITTED.
BOX_05A
=======
OMITTED.
HE25A
=====
OMITTED.
HE25B
=====
OMITTED.
HE25C
=====
OMITTED.
HE26
====
{STR-DT}
{END-DT}
Does anyone in the family wear eyeglasses or contact
lenses?
YES ................................... 1 {HE27}
NO .................................... 2 {HE28}
REF ................................... -7 {HE28}
DK .................................... -8 {HE28}
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE27 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE28
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE27
----------------------------------------------------
HE27
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else wear eyeglasses or contact
lenses?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
CONTINUE WITH HE28
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
HE28
====
{STR-DT}
{END-DT}
Does anyone in the family have any difficulty
seeing{[with
glasses or contacts, if they use them]}?
YES ................................... 1
NO .................................... 2 {HE33}
REF ................................... -7 {HE33}
DK .................................... -8 {HE33}
----------------------------------------------------
DISPLAY ‘ [with glasses or contacts, if they use
them]’ IF HE26 IS CODED ‘1’ (YES). OTHERWISE,
USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS ‘VISION IMPAIRED’ AT
HE29 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_05
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE29
----------------------------------------------------
HE29
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else have any difficulty
seeing{[with
glasses or contacts, if they use them]}?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
Display ‘[with glasses or contacts, if they use
them]’ IF HE26 IS CODED ‘1’ (YES). OTHERWISE, USE
A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
LOOP_05
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER,
ASK NAV_HE05 - END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS VISION
IMPAIRMENT DETAILS FOR PERSONS HAVING DIFFICULTY
SEEING. THIS LOOP CYCLES ON RU MEMBERS WHO MEET
THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY SEEING (I.E., PERSON
SELECTED AT HE29)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_05 USES NAV_HE05 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------
NAV_HE05
========
SERIES: Vision Impairment Details (e.g., blind, read
newspaper
print, see people 2-3 ft. away?)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY SEEING (I.E., PERSON
SELECTED AT HE29)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE30 FOR SELECTED RU MEMBER.
----------------------------------------------------
HE30
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
Can (PERSON) not see anything at all, that is,
(are/is) (PERSON)
blind?
YES ................................... 1 {END_LP05}
NO .................................... 2 {HE31}
REF ................................... -7 {HE31}
DK .................................... -8 {HE31}
HELP AVAILABLE FOR DEFINITION OF BLIND.
----------------------------------------------------
IF CODED ‘1’ (YES), FLAG PERSON FOR THE LTC
SUPPLEMENT: VISION SECTION.
----------------------------------------------------
HE31
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{With glasses or contacts, can/Can} (PERSON) see well
enough to
read ordinary newspaper print, even if (PERSON) cannot
read?
YES ................................... 1 {END_LP05)
NO .................................... 2 {HE32}
REF ................................... -7 {HE32}
DK .................................... -8 {HE32}
----------------------------------------------------
DISPLAY ‘With glasses or contacts, can’ IF PERSON
BEING ASKED ABOUT WAS SELECTED AT HE27, OTHERWISE
(PERSON NOT SELECTED AT HE27), DISPLAY ‘Can’.
----------------------------------------------------
HE32
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{With glasses or contacts, can/Can} (PERSON) see well
enough to
recognize familiar people if they are two or three
feet away?
YES ................................... 1 {END_LP05}
NO .................................... 2 {END_LP05}
REF ................................... -7 {END_LP05}
DK .................................... -8 {END_LP05}
----------------------------------------------------
DISPLAY ‘With glasses or contacts, can’ IF PERSON
BEING ASKED ABOUT WAS SELECTED AT HE27, OTHERWISE
(PERSON NOT SELECTED AT HE27), DISPLAY ‘Can’.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘2’ (NO), FLAG PERSON FOR THE LTC
SUPPLEMENT: VISION SECTION.
----------------------------------------------------
END_LP05
========
----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_05 AND CONTINUE WITH HE33
----------------------------------------------------
HE33
====
{STR-DT}
{END-DT}
Does anyone in the family wear a hearing aid?
YES ................................... 1
NO .................................... 2 {HE35}
REF ................................... -7 {HE35}
DK .................................... -8 {HE35}
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE34 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE35
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE34
----------------------------------------------------
HE34
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else wear a hearing aid?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS FOR THE LTC SUPPLEMENT:
HEARING SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE35
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
HE35
====
{STR-DT}
{END-DT}
Does anyone in the family have any difficulty
hearing{[with a
hearing aid, if they use one]}?
YES ................................... 1
NO .................................... 2 {BOX_10}
REF ................................... -7 {BOX_10}
DK .................................... -8 {BOX_10}
----------------------------------------------------
DISPLAY ‘ [with a hearing aid, if they use one]’
IF HE33 IS CODED ‘1’ (YES). OTHERWISE, USE A NULL
DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS ‘HEARING IMPAIRED’ AT
HE36 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_06
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE36
----------------------------------------------------
HE36
====
{STR-DT}
{END-DT}
Who is that?
PROBE: Does anyone else have any difficulty
hearing{[with a
hearing aid, if they use one]}?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
DISPLAY ‘[WITH A HEARING AID, IF THEY USE ONE]’ IF
HE33 IS CODED ‘1’ (YES). OTHERWISE USE A NULL
DISPLAY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_06
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU
MEMBERS.
----------------------------------------------------
LOOP_06
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
NAV_HE06 - END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS HEARING
IMPAIRMENT DETAILS FOR PERSONS HAVING DIFFICULTY
HEARING. THIS LOOP CYCLES ON RU MEMBERS WHO MEET
THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY HEARING (I.E., PERSON
SELECTED AT HE36)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_06 USES NAV_HE06 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------
NAV_HE06
========
SERIES: Hearing Impairment Details (e.g., deaf, hear
any speech,
hear some things?)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY HEARING (I.E., PERSON
SELECTED AT HE36)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE37 FOR SELECTED RU MEMBER.
----------------------------------------------------
HE37
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
Can (PERSON) not hear any speech at all, that is,
(are/is)
(PERSON) deaf?
YES ................................... 1 {END_LP06}
NO .................................... 2 {HE38}
REF ................................... -7 {HE38}
DK .................................... -8 {HE38}
HELP AVAILABLE FOR DEFINITION OF DEAF.
----------------------------------------------------
IF CODED ‘1’ (YES), FLAG PERSON FOR THE LTC
SUPPLEMENT: HEARING SECTION.
----------------------------------------------------
HE38
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{With a hearing aid, can/Can} (PERSON) hear most
of the things
people say?
YES ................................... 1 {END_LP06}
NO .................................... 2 {HE39}
REF ................................... -7 {HE39}
DK .................................... -8 {HE39}
----------------------------------------------------
DISPLAY ‘With a hearing aid, can’ IF PERSON
BEING ASKED ABOUT WAS SELECTED AT HE34. OTHERWISE
(PERSON NOT SELECTED AT HE34), DISPLAY ‘Can’.
----------------------------------------------------
HE39
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{With a hearing aid, can/Can} (PERSON) hear some
of the things
people say?
YES ................................... 1 {END_LP06}
NO .................................... 2 {END_LP06}
REF ................................... -7 {END_LP06}
DK .................................... -8 {END_LP06}
----------------------------------------------------
DISPLAY ‘With a hearing aid, can’ IF PERSON
BEING ASKED ABOUT WAS SELECTED AT HE34. OTHERWISE
(PERSON NOT SELECTED AT HE34), DISPLAY ‘Can’.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘2’ (NO), FLAG PERSON FOR THE LTC
SUPPLEMENT: HEARING SECTION.
----------------------------------------------------
END_LP06
========
----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_06 AND GO TO BOX_10
----------------------------------------------------
BOX_06A
=======
OMITTED.
BOX_06
======
OMITTED.
HE40
====
OMITTED.
HE41
====
OMITTED.
LOOP_07
=======
OMITTED.
HE42
====
OMITTED.
HE43
====
OMITTED.
HE44
====
OMITTED.
HE44OV
======
OMITTED.
END_LP07
========
OMITTED.
BOX_07
======
OMITTED.
LOOP_08
=======
OMITTED.
HE45
====
OMITTED.
HE46
====
OMITTED.
HE47
====
OMITTED.
HE48
====
OMITTED.
HE49
====
OMITTED.
HE49A
=====
OMITTED.
END_LP08
========
OMITTED.
BOX_08
======
OMITTED.
LOOP_09
=======
OMITTED.
HE50
====
OMITTED.
HE51
====
OMITTED.
HE52
====
OMITTED.
HE52OV
======
OMITTED.
HE52A
=====
OMITTED.
HE52B
=====
OMITTED.
HE52BOV
=======
OMITTED.
HE53
====
OMITTED.
HE54
====
OMITTED.
HE54OV
======
OMITTED.
END_LP09
========
OMITTED.
BOX_09
======
OMITTED.
LOOP_10
=======
OMITTED.
HE55
====
OMITTED.
HE55_01
=======
OMITTED.
HE55_02
=======
OMITTED.
HE55_03
=======
OMITTED.
HE56
====
OMITTED.
HE56_01
=======
OMITTED.
HE56_02
=======
OMITTED.
HE57
====
OMITTED.
HE57_01
=======
OMITTED.
HE57_02
=======
OMITTED.
END_LP10
========
OMITTED.
BOX_10
======
----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------
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