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 HE25 ARE ASKED IN
ROUNDS 1, 3, AND 5. QUESTIONS HE26 THROUGH HE43
ARE ASKED IN ROUNDS 2 AND 4.
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
IF ROUND 1 OR ROUND 3 OR ROUND 5, CONTINUE WITH
HE01
IF ROUND 2 OR ROUND 4, GO TO HE26
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)
- PERSON IS <13 YEARS OF AGE OR IN AGE
CATEGORIES 1-3
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)
- PERSON IS <13 YEARS OF AGE OR IN AGE
CATEGORIES 1-3
CONTINUE WITH HE03 FOR SELECTED RU MEMBER.
HE03
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{Do/Does} {you/{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 {END_LP01}
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.
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 {HE07}
REF ................................... -7 {HE07}
DK .................................... -8 {HE07}
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)
- PERSON IS <13 YEARS OF AGE OR IN AGE
CATEGORIES 1-3
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)
- PERSON IS <13 YEARS OF AGE OR IN AGE
CATEGORIES 1-3
CONTINUE WITH HE06 FOR SELECTED RU MEMBER.
HE06
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{Do/Does} {you/{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 {END_LP02}
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.
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 HE07
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.
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
{you/{PERSON}} entered the institution and what
{you/he/she} was able to
do at that time.}
Please look at this card and tell me how much
difficulty {do/does}
{you/{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 {you/{PERSON}}
entered the institution and what {you/he/she} 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} {you/{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} {you/{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} {you/{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} {you/{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} {you/{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} {you/{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} {you/{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 {END_LP03}
SOME DIFFICULTY ........................ 2 {END_LP03}
A LOT OF DIFFICULTY .................... 3 {END_LP03}
COMPLETELY UNABLE TO DO IT ............. 4 {END_LP03}
REF ................................... -7 {END_LP03}
DK .................................... -8 {END_LP03}
[Code One]
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.
HE20A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
Which activities {are/is} {you/{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 {you/{PERSON}} entered the institution,
was/{Are/Is}}
{you/{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 {you/{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.
HE26
With this next set of questions we want to learn about
people who
have physical, mental, or emotional conditions that
cause serious
difficulties with their daily activities.
{Please answer the next few questions for family
members age 1 or
older.}
Is anyone in the family deaf or does anyone have
serious difficulty
hearing?
YES .................................... 1
NO ....,................................ 2 {HE29}
REF ................................... -7 {HE29}
DK .................................... -8 {HE29}
DISPLAY THE SENTENCE ‘Please answer ... age 1 or
older.’ IF ANY RU MEMBERS ARE < 1 YEAR OF AGE OR
IN AGE CATEGORY 1. OTHERWISE, USE A NULL DISPLAY.
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
LOOP_05
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE27
HE27
Who is that?
PROBE: Anyone else?
[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 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 ONLY RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS > OR = 1 YEAR OF AGE OR IN AGE
CATEGORIES 2-9
LOOP_05
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER,
ASK NAV_HE05 - END_LP05
LOOP DEFINITION: LOOP_05 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 HE27)
NAVIGATOR DETAILS: LOOP_05 USES NAV_HE05 TO
CONTROL THE FLOW OF THE LOOP.
NAV_HE05
SERIES: Hearing Impairment Details (e.g., deaf?)
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 HE27)
CONTINUE WITH HE28 FOR SELECTED RU MEMBER
HE28
Can {you/{PERSON}} not hear any speech at all, that
is, {are/is}
{you/{PERSON}} deaf?
YES .................................... 1 {END_LP05}
NO ..................................... 2 {END_LP05}
REF ................................... -7 {END_LP05}
DK .................................... -8 {END_LP05}
HELP AVAILABLE FOR DEFINITION OF DEAF.
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 HE29
HE29
Is anyone in the family blind or does anyone have
serious difficulty
seeing, even when wearing glasses?
YES .................................... 1
NO ..................................... 2 {HE32}
REF ................................... -7 {HE32}
DK .................................... -8 {HE32}
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE30 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 HE30
HE30
Who is that?
PROBE: Anyone else?
[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 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 ONLY RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS > OR = 1 YEAR OF AGE OR IN AGE
CATEGORIES 2-9
LOOP_06
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
NAV_HE06 - END_LP06
LOOP DEFINITION: LOOP_06 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 HE30)
NAVIGATOR DETAILS: LOOP_06 USES NAV_HE06 TO
CONTROL THE FLOW OF THE LOOP.
NAV_HE06
SERIES: Vision Impairment Details (e.g., blind?)
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 HE30)
CONTINUE WITH HE31 FOR SELECTED RU MEMBER
HE31
Can {you/{PERSON}} not see anything at all, that is,
{are/is}
{you/{PERSON}} blind?
YES .................................... 1 {END_LP06}
NO ..................................... 2 {END_LP06}
REF ................................... -7 {END_LP06}
DK .................................... -8 {END_LP06}
HELP AVAILABLE FOR DEFINITION OF BLIND.
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 CONTINUE WITH HE32
HE32
{Please answer the next few questions for family
members age 5 or
older.}
Because of a physical, mental, or emotional condition,
does anyone in
the family have serious difficulty concentrating,
remembering, or
making decisions?
YES .................................... 1
NO ..................................... 2 {HE34}
REF ................................... -7 {HE34}
DK .................................... -8 {HE34}
DISPLAY THE SENTENCE ‘Please answer ... age 5 or
older.’ IF ANY RU MEMBERS ARE < 5 YEARS OF AGE OR
IN AGE CATEGORIES 1 OR 2. OTHERWISE, USE A NULL
DISPLAY.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE33 BY CAPI.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE34
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE33
HE33
Who is that?
PROBE: Anyone else?
[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 HE34
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 ONLY RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS > OR = 5 YEARS OF AGE OR IN AGE
CATEGORIES 3-9
HE34
Does anyone in the family have serious difficulty
walking or climbing
stairs?
YES .................................... 1
NO ..................................... 2 {HE36}
REF ................................... -7 {HE36}
DK .................................... -8 {HE36}
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE35 BY CAPI.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE36
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE35
HE35
Who is that?
PROBE: Anyone else?
[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 HE36
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 ONLY RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS > OR = 5 YEARS OF AGE OR IN AGE
CATEGORIES 3-9
HE36
Does anyone in the family have difficulty dressing or
bathing?
YES .................................... 1
NO ..................................... 2 {HE38}
REF ................................... -7 {HE38}
DK .................................... -8 {HE38}
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE37 BY CAPI.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE38
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE37
HE37
Who is that?
PROBE: Anyone else?
[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 HE38
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 ONLY RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS > OR = 5 YEARS OF AGE OR IN AGE
CATEGORIES 3-9
HE38
{Please answer the next few questions for family
members age 15 or
older.}
Because of a physical, mental, or emotional condition,
does anyone
in the family have difficulty doing errands alone such
as visiting
a doctor’s office or shopping?
YES .................................... 1
NO ..................................... 2 {HE40}
REF ................................... -7 {HE40}
DK .................................... -8 {HE40}
DISPLAY THE SENTENCE ‘Please answer ... age 15 or
older.’ IF ANY RU MEMBERS ARE < 15 YEARS OF AGE OR
IN AGE CATEGORIES 1 - 3. OTHERWISE, USE A NULL
DISPLAY.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE39 BY CAPI.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE40
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE39
HE39
Who is that?
PROBE: Anyone else?
[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 HE40
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 ONLY RU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS > OR = 15 YEARS OF AGE OR IN AGE
CATEGORIES 4-9
HE40
{Please answer the next few questions for family
members of all ages.}
Does anyone in the family wear a hearing aid?
YES .................................... 1
NO ..................................... 2 {HE42}
REF ................................... -7 {HE42}
DK .................................... -8 {HE42}
DISPLAY THE SENTENCE ‘Please answer ... of all
ages.’ IF ANY RU MEMBERS ARE <15 YEARS OF AGE OR
IN AGE CATEGORIES 1-3. OTHERWISE, USE A NULL
DISPLAY.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE41 BY CAPI.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
HE42
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE41
HE41
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]
CONTINUE WITH HE42
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.
HE42
Does anyone in the family wear eyeglasses or contact
lenses?
YES .................................... 1
NO ..................................... 2 {BOX_10}
REF ................................... -7 {BOX_10}
DK .................................... -8 {BOX_10}
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AT HE43 BY CAPI.
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, GO TO
BOX_10
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU,
CONTINUE WITH HE43
HE43
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 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_10
GO TO NEXT QUESTIONNAIRE SECTION
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