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fl
[p. 171-172]

Section P. FUNCTIONAL LIMITATIONS (FL)

P1
Refer to age of all family members

[] Persons 65+ in family (Enter person number and first name of EACH person on separate FL page.)
[] No persons 65+ in family (Section Q)
FL1 [3-4]

Person No. ____
First name ____
[] Callback required (Hhld. page, THEN NP) [] Available
[] Noninterview (Footnotes, THEN NP)

Read to respondent:
The next questions are about how well you are able to do certain activities -- by yourself and without using special equipment.


1. Because of a health or physical problem, do you have ANY difficulty -
Ask if "Doesn't do":
Is this because of a HEALTH or PHYSICAL problem?
If "Yes," mark box 1; if "No," mark box 3


(1) Bathing or showering?
1 [] Yes
2 [] No
3 [] Doesn't do for other reason


(2) Dressing?
Ask if "Doesn't do":
Is this because of a HEALTH or PHYSICAL problem?
If "Yes," mark box 1; if "No," mark box 3
1 [] Yes
2 [] No
3 [] Doesn't do for other reason


(3) Eating?
Ask if "Doesn't do":
Is this because of a HEALTH or PHYSICAL problem?
If "Yes," mark box 1; if "No," mark box 3
1 [] Yes
2 [] No
3 [] Doesn't do for other reason


(4) Getting in and out of bed or chairs?
1 [] Yes
2 [] No
3 [] Doesn't do for other reason


(5) Walking?
1 [] Yes
2 [] No
3 [] Doesn't do for other reason


(6) Getting outside?
1 [] Yes
2 [] No
3 [] Doesn't do for other reason


(7) Using the toilet, including getting to the toilet?
1 [] Yes
2 [] No
3 [] Doesn't do for other reason


2. By yourself and without using special equipment, how much difficulty do you have (activity), some, a lot, or are you unable to do it?


(1) Bathing or showering
1 [] Some
2 [] A Lot
3 [] Unable


(2) Dressing

1 [] Some
2 [] A Lot
3 [] Unable


(3) Eating

1 [] Some
2 [] A Lot
3 [] Unable


(4) Getting in and out of bed or chairs

1 [] Some
2 [] A Lot
3 [] Unable


(5) Walking

1 [] Some
2 [] A Lot
3 [] Unable


(6) Getting outside

1 [] Some
2 [] A Lot
3 [] Unable


(7) Using the toilet, including getting to the toilet

1 [] Some
2 [] A Lot
3 [] Unable


3. Do you receive help from anyone in (activity)?


(1) Bathing or showering
1 [] Yes
2 [] No (5)


(2) Dressing
1 [] Yes
2 [] No (5)


(3) Eating
1 [] Yes
2 [] No (5)


(4) Getting in and out of bed or chairs
1 [] Yes
2 [] No (5)


(5) Walking
1 [] Yes
2 [] No (5)


(6) Getting outside
1 [] Yes
2 [] No (5)


(7) Using the toilet, including getting to the toilet
1 [] Yes
2 [] No (5)


4a. Who gives this help?
Anyone else? ____


(1) Bathing or showering

Source of help
HH member
1 [] Relative
2 [] Non-relative


Non-HH member
3 [] Relative
4 [] Non-relative


(2) Dressing
Source of help
HH member
1 [] Relative
2 [] Non-relative


Non-HH member
3 [] Relative
4 [] Non-relative


(3) Eating
Source of help
HH member
1 [] Relative
2 [] Non-relative


Non-HH member
3 [] Relative
4 [] Non-relative


(4) Getting in and out of bed or chairs
Source of help
HH member
1 [] Relative
2 [] Non-relative


Non-HH member
3 [] Relative
4 [] Non-relative


(5) Walking
Source of help
HH member
1 [] Relative
2 [] Non-relative


Non-HH member
3 [] Relative
4 [] Non-relative


(6) Getting outside
Source of help
HH member
1 [] Relative
2 [] Non-relative


Non-HH member
3 [] Relative
4 [] Non-relative


(7) Using the toilet, including getting to the toilet
Source of help
HH member
1 [] Relative
2 [] Non-relative


Non-HH member
3 [] Relative
4 [] Non-relative


Mark the S/C/P box without asking if ONLY help is from spouse/children/parents.
b. Is this help paid for?
Ask if necessary:
Which helpers are paid?


(1) Bathing or showering
0 [] S/C/P (5)

[HH member -- Relative]
1 [] Yes
2 [] No

[HH member -- non-relative]
1 [] Yes
2 [] No

[Non-HH member -- Relative]
1 [] Yes
2 [] No

[Non-HH member -- Non-relative]
1 [] Yes
2 [] No


(2) Dressing
0 [] S/C/P (5)

[HH member -- Relative]
1 [] Yes
2 [] No

[HH member -- non-relative]
1 [] Yes
2 [] No

[Non-HH member -- Relative]
1 [] Yes
2 [] No

[Non-HH member -- Non-relative]
1 [] Yes
2 [] No


(3) Eating
0 [] S/C/P (5)

[HH member -- Relative]
1 [] Yes
2 [] No

[HH member -- non-relative]
1 [] Yes
2 [] No

[Non-HH member -- Relative]
1 [] Yes
2 [] No

[Non-HH member -- Non-relative]
1 [] Yes
2 [] No


(4) Getting in and out of bed or chairs
0 [] S/C/P (5)

[HH member -- Relative]
1 [] Yes
2 [] No

[HH member -- non-relative]
1 [] Yes
2 [] No

[Non-HH member -- Relative]
1 [] Yes
2 [] No

[Non-HH member -- Non-relative]
1 [] Yes
2 [] No


(5) Walking
0 [] S/C/P (5)

[HH member -- Relative]
1 [] Yes
2 [] No

[HH member -- non-relative]
1 [] Yes
2 [] No

[Non-HH member -- Relative]
1 [] Yes
2 [] No

[Non-HH member -- Non-relative]
1 [] Yes
2 [] No


(6) Getting outside
0 [] S/C/P (5)

[HH member -- Relative]
1 [] Yes
2 [] No

[HH member -- non-relative]
1 [] Yes
2 [] No

[Non-HH member -- Relative]
1 [] Yes
2 [] No

[Non-HH member -- Non-relative]
1 [] Yes
2 [] No


(7) Using the toilet, including getting to the toilet
0 [] S/C/P (5)

[HH member -- Relative]
1 [] Yes
2 [] No

[HH member -- non-relative]
1 [] Yes
2 [] No

[Non-HH member -- Relative]
1 [] Yes
2 [] No

[Non-HH member -- Non-relative]
1 [] Yes
2 [] No


5a. Do you use any special equipment or aids in (activity)?


(1) Bathing or showering

1 [] Yes
2 [] No (2 for next activity with "Yes" in 1)


(2) Dressing
1 [] Yes
2 [] No (2 for next activity with "Yes" in 1)


(3) Eating
1 [] Yes
2 [] No (2 for next activity with "Yes" in 1)


(4) Getting in and out of bed or chairs
1 [] Yes
2 [] No (2 for next activity with "Yes" in 1)


(5) Walking
1 [] Yes
2 [] No (2 for next activity with "Yes" in 1)


(6) Getting outside
1 [] Yes
2 [] No (2 for next activity with "Yes" in 1)


(7) Using the toilet, including getting to the toilet
1 [] Yes
2 [] No (6)


b. What special equipment for aids do you use? ____
Anything else? ____


(1) Bathing or showering

Special equipment or aids
_______
_______


(2) Dressing
Special equipment or aids
_______
_______


(3) Eating
Special equipment or aids
_______
_______


(4) Getting in and out of bed or chairs
Special equipment or aids
_______
_______


(5) Walking
Special equipment or aids
_______
_______


(6) Getting outside
Special equipment or aids
_______
_______


(7) Using the toilet, including getting to the toilet
Special equipment or aids
_______
_______


6a. Do you have difficulty controlling your bowels?

1 [] Yes
2 [] No (6c)




b. How frequently do you have this difficulty -- daily, several times a week, once a week, or less than once a week?

1 [] Daily
2 [] Several times a week
3 [] Once a week
4 [] Less than once a week
9 [] DK


c. Do you have a colostomy or a device to help control bowel movements?

1 [] Yes
2 [] No (7)


d. Do you need help from anyone in taking care of this device?

1 [] Yes
2 [] No


7a. Do you have difficulty controlling your urination?

1 [] Yes
2 [] No (7c)


b. How frequently do you have this difficulty -- daily, several times a week, once a week, or less than once a week?

1 [] Daily
2 [] Several times a week
3 [] Once a week
4 [] Less than once a week
9 [] DK


c. Do you have a urinary catheter or a device to help control bowel movements?

1 [] Yes
2 [] No (P2)


d. Do you need help from anyone in taking care of this device?

1 [] Yes
2 [] No


P2
Mark first appropriate box

1 [] Respondent is a proxy (8)
2 [] Person has only been seen in a bed or chair (8)
3 [] Telephone interview (8)
4 [] All other (Page 10)

Mark if known
8. Because of a health or physical problem, do you usually:

a. Stay in bed all or most of the time?
1 [] Yes (Page 10)
2 [] No
b. Stay in a chair all or most of the time?
1 [] Yes
2 [] No

[p. 173-174]

Section P. FUNCTIONAL LIMITATIONS (FL), Continued

Read to respondent - Now I will ask you about some other activities. Tell me about doing them by yourself.


9. Because of a health or physical problem, do you have ANY difficulty -
Ask if "Doesn't do":
Is this because of a HEALTH or PHYSICAL problem?
If "Yes," mark box 1; if "No," mark box 3


(1) Preparing your own meals?
1[] Yes
2[] No
3[] Doesn't do for other reason


(2) Shopping for personal items, (such as toilet items or medicines)?
1[] Yes
2[] No
3[] Doesn't do for other reason


(3) Managing your money, (such as keeping track of expenses or paying bills)?
1[] Yes
2[] No
3[] Doesn't do for other reason


(4) Using the telephone?
1[] Yes
2[] No
3[] Doesn't do for other reason


(5) Doing heavy housework, (such as scrubbing floors, or washing windows)?
1[] Yes
2[] No
3[] Doesn't do for other reason


(6) Doing light housework, (such as doing dishes, straightening up, or light cleaning)?
1[] Yes
2[] No
3[] Doesn't do for other reason


Ask 10-12 for each activity marked "Yes" in 9.
10. By yourself and without using special equipment, how much difficulty do you have (activity), some, a lot, or are you unable to do it?


(1) Preparing your own meals
1 [] Some
2 [] A Lot
3 [] Unable


(2) Shopping for personal items
1 [] Some
2 [] A Lot
3 [] Unable


(3) Managing your money
1 [] Some
2 [] A Lot
3 [] Unable


(4) Using the telephone
1 [] Some
2 [] A Lot
3 [] Unable


(5) Doing heavy housework
1 [] Some
2 [] A Lot
3 [] Unable


(6) Doing light housework
1 [] Some
2 [] A Lot
3 [] Unable


11. Do you receive help from anyone in (activity)?


(1) Preparing your own meals
1 [] Yes (12)
2 [] No (10 for next activity with "Yes" in 9 )


(2) Shopping for personal items
1 [] Yes (12)
2 [] No (10 for next activity with "Yes" in 9 )


(3) Managing your money
1 [] Yes (12)
2 [] No (10 for next activity with "Yes" in 9 )


(4) Using the telephone
1 [] Yes (12)
2 [] No (10 for next activity with "Yes" in 9 )


(5) Doing heavy housework
1 [] Yes (12)
2 [] No (10 for next activity with "Yes" in 9 )


(6) Doing light housework
1 [] Yes (12)
2 [] No (P3 )


12a. Who gives this help? Anyone else?


(1) Preparing your own meals
HH member
1 [] Relative
2 [] Nonrelative
Non-HH member
3 [] Relative
4 [] Nonrelative


(2) Shopping for personal items
HH member
1 [] Relative
2 [] Nonrelative
Non-HH member
3 [] Relative
4 [] Nonrelative


(3) Managing your money
HH member
1 [] Relative
2 [] Nonrelative
Non-HH member
3 [] Relative
4 [] Nonrelative


(4) Using the telephone
HH member
1 [] Relative
2 [] Nonrelative
Non-HH member
3 [] Relative
4 [] Nonrelative


(5) Doing heavy housework
HH member
1 [] Relative
2 [] Nonrelative
Non-HH member
3 [] Relative
4 [] Nonrelative


(6) Doing light housework
HH member
1 [] Relative
2 [] Nonrelative
Non-HH member
3 [] Relative
4 [] Nonrelative

Mark the S/C/P box without asking if ONLY help is from spouse/children/parents, THEN 10 for next activity marked "Yes" in 9.
b. Is this help paid for?
Ask if necessary: Which helpers are paid?

(1) Preparing your own meals
0 [] S/C/P

[HH member - Relative]
1 [] Yes
2 [] No
[HH member - Nonrelative]
1 [] Yes
2 [] No


(2) Shopping for personal items
0 [] S/C/P

[HH member - Relative]
1 [] Yes
2 [] No
[HH member - Nonrelative]
1 [] Yes
2 [] No


(3) Managing your money
0 [] S/C/P

[HH member - Relative]
1 [] Yes
2 [] No
[HH member - Nonrelative]
1 [] Yes
2 [] No


(4) Using the telephone
0 [] S/C/P

[HH member - Relative]
1 [] Yes
2 [] No
[HH member - Nonrelative]
1 [] Yes
2 [] No


(5) Doing heavy housework
0 [] S/C/P

[HH member - Relative]
1 [] Yes
2 [] No
[HH member - Nonrelative]
1 [] Yes
2 [] No


(6) Doing light housework
0 [] S/C/P

[HH member - Relative]
1 [] Yes
2 [] No
[HH member - Nonrelative]
1 [] Yes
2 [] No

P3

1 [] 13 and 14 filled on another FL page (15)
8 [] Other (13)

13a. Is it NECESSARY to go up or down a step to get into this (house/apartment) from the outside?

1 [] No

Yes - If not mentioned ask: Is it one step or more than one step?
2 [] 1 step
3 [] More than 1 step


b. Counting basements and stepdown living areas as separate levels, does this (house/apartment) have more than one floor or level?

1 [] Yes
2 [] No (14b)


14a. Does this [house/apartment] have a bathroom, bedroom, and kitchen ALL on the SAME floor or level?

1 [] Yes
2 [] No


b. Does this [house/apartment] have a walk-in shower, that is, where you don't step over the side of the tub to get into the shower?

1 [] Yes
2 [] No


15a. Because of a health or physical problem, do YOU NEED a bathroom, bedroom, and kitchen all on the same floor or level?

1 [] Yes
2 [] No


b. Because of a health of physical problem, do YOU NEED a walk-in shower?

1 [] Yes
2 [] No