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[p.166]

Section M -- Assistive Devices

The next questions are about the use of devices to help people with physical disabilities or impairments.

1A. Does anyone in the family now use a brace of any kind?

1[] Yes
2[] No (B)
9[] DK (B)

(1) Who is this?
Mark appropriate box(es) in person's column

Ask if necessary: On what part of the body is the brace worn? Is it won on the leg or foot, arm or hand, the back, or somewhere else?

01[] Leg
02[] Foot
03[] Arm
04[] Hand
05[] Neck
06[] Back
07[] Other -- (Specify) ____

(2) Does anyone else now use a brace?

[] Yes (Reask A(1) and (2))
[] No

B. (Does anyone in the family now use) Any special equipment for getting around, such as crutches, a cane, a walker, or a wheelchair?

1[] Yes
2[] No (C)
9[] DK (C)

(1) Who is this?
Mark "Aids for getting around" box in person's column.

1[] Aids for getting around

(2) Anyone else?

[] Yes (Reask B(1) and (2))
[] No

(3) Does -- now use --

(a) Crutches?

08[] Crutches

(b) A cane for support or a walking stick?

09[] Cane or walking stick

10[] Walker

(d) A wheelchair or scooter? Which one?
If wheelchair, ask: Is it manual or electric? Mark all that apply.

11[] Manual wheelchair
12[] Electric wheelchair
13[] Scooter

(e) Any other aid for getting around? (Specify)

14[] Other mobility aid -- (Specify) ____

C. (Does anyone in the family now use) Any special equipment for hearing problems, such as a hearing aid, a special telephone, or other special equipment for hearing problems?

1[] Yes
2[] No (D)
9[] DK (D)

(1) Who is this?
Mark "Hearing equipment" box in person's column.

1[] Hearing equipment

(2) Anyone else?

[] Yes (Reask C(1) and (2))
[] No

Ask (3) (a)-(d) for each person with "Hearing equipment" in C(1).
(3) Does -- now use --

(a) A hearing aid?

15[] Hearing aid

(b) A TDD or TTY?

16[] TDD or TTY

17[] Special alarms

(d) Any other special equipment for hearing problems? (Specify)

18[] Other special equipment (Specify) ____

[p. 167]

Section M -- Assistive Devices -- Continued

D. (Does anyone in the family now use) Any special equipment for vision problems, such as a white cane, excluding eyeglasses or contact lenses?

1[] Yes
2[] No (E)
9[] DK (E)

(1) Who is this?
Mark "Vision aid" box in person's column.

1[] Vision aid

(2) Anyone else?

[] Yes (Reask D(1) and (2))
[] No

Ask (3) (a)-(b) for each person with "Vision problems" in D(1).
(3) Does -- now use --

(a) A white cane?

19[] A white cane

(b) Any other special equipment for vision problems, excluding eyeglasses or contact lenses? (Specify)

20[] Other vision equipment (Specify) ____

E. (Does anyone in the family now use) An artificial leg, foot, arm, or hand?

1[] Yes
2[] No (F)
9[] DK (F)

(1) Who is this?
Mark "Artificial limb" box in person's column.

1[] Artificial limb

(2) Anyone else?

[] Yes (Reask E(1) and (2))
[] No

Ask (3) (a)-(b) for each person with "Artificial limb" in E(1).
(3) Does -- now use --

(a) An artificial leg or foot?

21[] Artificial leg or foot

(b) An artificial arm or hand?

22[] Artificial arm or hand

F. (Does anyone in the family now use) A communications aid for speech problems?

1[] Yes
2[] No (G)
9[] DK (G)

(1) Who is this?
Mark "Speech problem aid" box in person's column.

23[] Speech problem aid

(2) Anyone else?

[] Yes (Reask F(1) and (2))
[] No

G. (Does anyone in the family now use) A typewriter or computer specially adapted for disabled persons?

1[] Yes
2[] No (H)
9[] DK (H)

(1) Who is this?
Mark "Typewriter/computer" box in person's column.

24[] Typewriter/computer

(2) Anyone else?

[] Yes (Reask G(1) and (2))
[] No

H. (Does anyone in the family now use) Any other special equipment for persons with disabilities or impairments?

1[] Yes
2[] No (Item M1)
9[] DK (Item M1)

(1) Who is this? ____
Mark "Other equipment" box in person's column.

25[] Other equipment (Specify) ____

(2) Anyone else?

[] Yes (Reask H(1) and H(2))
[] No

Item M1
Refer to 1A-H

1[] No device (NP or 5)
2[] One or more devices in 1A-H (Complete 2-4 for each device, then M1 for NP)

[p.168]

Section M -- Assistive Devices -- Continued

Enter each person number, device number and type of device for each person, then ask 2-4 separately for each device

Per No. ____
Dev. No. ____
Type ____

2. During the past month, did -- use a (device) all or most of the time, some of the time, or only occasionally?

1[] All/Most of the time
2[] Some of the time
3[] Only occasionally

Item M2
Refer to age and device in question 2 Mark first appropriate box.

1[] 65+ (3g)
2[] Brace, artificial limb, hearing aid, or white cane (3g)
8[] Other (3a)

Mark box or ask.
3a. Has -- worked or attended school in the last six months?
If "Yes," ask: Which?

1[] Work only (3b)
2[] Attend school only (3b)
3[] Both (3b)
4[] Neither (3g)

b. Does -- use a (device) at (work/(or) school)?

1[] Yes (3c)
2[] No (3g)
3[] No longer working/attending school (3g)

Hand Card M1. Read all answer categories if telephone interview.
Card M1

1. Already installed/no payment
2. Gift
3. Self or family
4. Private health insurance
5. Medicare
6. Medicaid
7. Rehabilitation program
8. Employer
9. School system
10. VA program
11. Other private source
12. Other public source

c. Who (else) paid for the (device) -- uses at (work/(or) school)?
Mark all that apply.

01[] Already installed/no payment
02[] Gift
03[] Self or family
04[] Private health insurance
05[] Medicare
06[] Medicaid
07[] Rehabilitation program
08[] Employer
09[] School system
10[] VA program
11[] Other private source
12[] Other public source
99[] DK

If only box 01 marked in 3c, skip to 3e.
d. Did (sources in 3c) cover the total cost of the (device)?

1[] Yes
2[] No (Reask 3c and d)
9[] DK

e. Does -- also use a (device) at home or somewhere else?

1[] Yes
2[] No (4)

f. Is it the same (device) that -- uses at (work/(or) school)?

1[] Yes (4)
2[] No

Hand card M1. Read all answer categories if telephone interview.
Card M1

g. Who (else) paid for the (device) that -- uses (at home or elsewhere)?
Mark all that apply.

If only box 01 marked in 3g, skip to 4.
h. Did (sources in 3g) cover the total cost of the (device)?

1[] Yes
2[] No (Reask 3g and h)
9[] DK

4. What impairments or health conditions make it necessary for -- to use the (device)?

[] Same as device ____ (Next device or M1 for NP)
____ (Next device or M1 for NP)

After completing M1 for all persons and 2-4 for all devices, go to question 5 on page 8

[p.169]

Section M -- Assistive Devices -- Continued

Hand Card M2.
Card M2

Braces

01 Leg brace
02 Foot brace
03 Arm brace
04 Hand brace
05 Neck brace
06 Back brace
07 Other brace

Aids for Getting Around

08 Crutches
09 Cane or walking stick
10 Walker
11 Manual wheelchair
12 Electric wheelchair
13 Scooter
14 Other aid for getting around

Hearing Devices

15 Hearing aid
16 TDD or TTY
17 Special alarms
18 Other hearing equipment

Vision Devices

19 White cane
20 Other vision aid, excluding glasses and contact lenses

Artificial Limbs

21 Artificial leg or foot
22 Artificial arm or hand

Other Devices

23 Aid for speech problems
24 Specially adapted typewriter or computer
25 Other devices for disabilities

5a. Does anyone in the family need any special equipment (of this kind) that they don't have?

1[] Yes
2[] No (6)
9[] DK (6)

b. Who is this? Anyone else?
Mark "Needs equipment" box in person's column.

1[] Needs equipment

Ask 5c and d for each person with "Needs equipment" in 5b.
c. What equipment does -- need?
Anything else?

d. Why doesn't -- have (equipment in 5c)?
Mark all that apply.

1[] Can't afford it
2[] Doesn't know where to get it
3[] Not available locally
4[] Repair problems
5[] Lack of training to use equipment
6[] Can't use or install in present home
7[] Has equipment that is not satisfactory
8[] Other (Specify) ____
9[] DK

6a. Does anyone in this family now have a car or van which is specifically equipped for disabled drivers or passengers?

1[] Yes
2[] No (7)
9[] DK (7)

b. Who is the car or van equipped for?
Mark "Specially equipped car" box in person's column.

0[] Only for non-family members
1[] Specially-equipped car

c. Anyone else?

[] Yes (Reask 6b and c)
[] No (7)

Hand Card M3. Read list if telephone interview.
Card M3

1. Ramps
2. Extra wide doors or passages
3. Elevators or stair-lifts (do not include public elevators in apartment buildings)
4. Handrails or grab bars other than normal handrails on staircases
5. Raised toilet
6. Levers, push bars, or special knobs on doors
7. Lowered counters
8. Special slip-resistant floors
9. Any other special features designed for disabled persons
10. No features

7. Please tell me if this home is equipped with any special features designed for disabled persons.
Mark all that apply.

01[] Ramps
02[] Extra wide doors or passages
03[] Elevators or stairlifts (not counting public elevators)
04[] Handrails or grab bars other than normal handrails on staircases
05[] A raised toilet
06[] Levers, push bars, or special knobs on doors
07[] Lowered counters
08[] Special slip-resistant floors
09[] Any other special features designed for disabled persons (Specify) ____
10[] No features (Section N)
99[] DK (Section N)

Hand Card M1. Read all answer categories if telephone interview.
Card M1

8a. Who (else) paid for the (items in 7)?
Mark all that apply.

If only box 01 in 8a, skip to Section N.
b. Did (sources in 8a) cover the total cost of the (items in 7)?

1[] Yes
2[] No (Reask 8a and b)
9[] DK

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