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homecare_personapproach

[p.69]


HOME CARE PAGE

Person approach

Person no. ____

Control ____

Earlier in the interview you mentioned that -- needed help of some kind here at home. I am going to read a list of different kinds of personal care some people need in the home. Please tell me if--needs help in any of the following ways.

1a. Does -- need help -

in walking up stairs or getting from room to room?
2[] No
1[] Yes
in dressing or putting on shoes?
2[] No
1[] Yes
With bathing (shaving) or other toilet activities?
2[] No
1[] Yes
In eating or having meals served in bed?
2[] No
1[] Yes
with changing bandages?
2[] No
1[] Yes
In receiving injections?
2[] No
1[] Yes
With other treatments?
2[] No
1[] Yes
If "Yes" ask: what kinds of treatment? Specify ________
In changing bed positions?
2[] No
1[] Yes
In exercising or physical therapy?
2[] No
1[] Yes
In cutting toenails?
2[] No
1[] Yes
Does-- get any other help or care here at home?
2[] No
1[] Yes
If "Yes" ask: what kind of other help or care? Specify ________

For each "Yes" answer to 1a ask:
b. Who helps --? ____

Does anyone else --? ________

[] No

If person is not receiving care: (all "No"s to question 1a) reconcile differences between answers in Q.25 or 26c and Q. 1a above or describe the situation in the footnot space below.

2. For what condition(s) does-- receive this help or care?

Specify condition(s) ________

3. How long has -- received help or care at home? Mark one box.

0[] 1 month or less
1[] Over 1 to 6 months
2[] Over 6 to 12 months
3[] Over 1 to 3 years
4[] Over 3 to 5 years
5[] Over 5 years

4. Because of --'s health, must someone be in the house with him all of the time, part of the time, or only when providing the needed help or care?

1[] All the time
2[] Part of the time
3[] Only when providing the needed help or care

For each person, other than a nurse, listed in 1b ask:
5a. Is -- a nurse, a physical therapist, or some other kind of health worker? ________
(determine the type(s) of person(s) providing the care in question 1 and mark appropriate box in column (1) of Table H).

If "Nurse" reported in Q.1b or 5a ask:
b. Is the nurse that cares for -- a registered nurse, a pratical nurse, or some other kind of nurse?
(Determine the type(s) of person(s) providing the care in question 1 and mark appropriate box in column (1) of table H). ________

[p.70]

TABLE H

1. Type of persons providing care: Non-health workers

A.B[] Related household members
B. 1[] Related persons not in household
C. 2[] Friend or neighbour
D. 3[] Other. Specify ________

2. During the past two weeks on about how many days did -- receive help or care from (relative, nurse etc)?

Days ____
XX[] Don't know

3. About how many hours a day does -- receive help or care from (relative, nurse etc)?

Hours ____
00[] Less than 1 hour
xx[] Don't know

4. Is (relative, nurse, etc) paid for these services?

1[] Yes
2[] No

Non-health workers: Health workers

E. 4[] Nurse-registered
F. 5[] Nurse-practical or other
G. 6[] Physical therapist
H. 7[] Other- specify ________

2. During the past two weeks on about how many days did -- receive help or care from (relative, nurse etc)?

Days ____
XX[] Don't know

3. About how many hours a day does -- receive help or care from (relative, nurse etc)?

Hours ____
00[] Less than 1 hour
xx[] Don't know

4. Is (relative, nurse, etc) paid for these services?

1[] Yes
2[] No

Interviewer: Mark the appropriate box before going to Q's 6-8

[] Person 65+ and "Yes" in column (4). Ask Q's 6, 7 and 8
[] Person 55-64 and "Yes" in column (4). Ask Q's 7 and 8
[] All "No's" in column (4) or only "A" checked in column (1) to table H. Skip to question 8

6. Are any of these services paid for by Medicare?

1[] Yes
2[] No
X[] Don't know

7a. Who pays (the remainder of the bill) for these services?

1[] Self or family
2[] Other relative or friend
3[] Health insurance
4[] Agency or organization (visiting nurses association etc)
5[] Welfare
6[] Other-specify ________

8a. During the past 12 months has -- received any care at home from a nurse?

[] Yes (ask 8b)
000[] No-stop

b. During the past 12 months, about how many visits did a nurse make to care for --?

Number of visits ________