Understanding How Families Access and Use Long-Term Care Services

Form Approved

OMB No. 0990-0421

Exp. Date 07/31/2017

ATTACHMENT B: RECRUITMENT SCREENER

Understanding How Families Access and Use LTC Services

QUALITATIVE SCREENER

We are conducting research on how consumers find and choose certain types of health care services. We would like to include your thoughts and opinions. Should you qualify, we would like to invite you to participate in a focus group on the [insert dates here.] We would like to ask you a few questions to see if you qualify for the study. We assure you, we are not trying to sell you anything and you will not be contacted by a salesperson as a result of participation in this discussion.

Record gender

Male RECRUIT MIX 40%/60%

Female

Specifically, we want to understand how families make decisions about care services and providers when a family member or close friend needs care for an extended period of time due to a disability, sudden illness or as a natural consequence of the aging process. This is known as long term care. People who need help with everyday activities such as bathing and dressing, or who have problems with memory or orientation such as Alzheimer’s disease, need long term care.

1. Within the past two years, have you helped a family member or close friend find and arrange for some type of long term care services? This might have included care at home from a home health aide or nurse, care in an assisted living facility or in a nursing home.

YES…………………………………..CONTINUE

NO/UNSURE………………………..TERMINATE

2. And for how long did they need care? Did their need for care last…..

LESS THAN THREE MONTHS?..............................TERMINATE

3 months to just under a year?………………….........CONTINUE

1 to 2 years?................................................ ………..CONTINUE

More than 2 years?...................................................CONTINUE

3. Is that individual still receiving care?

YES……………………………………………….RECRUIT MIX

NO…………………………………………………RECRUIT MIX

4. Next, we need to verify that you are the right person in your household for this discussion. Thinking about your role in helping your family member or friend find care, would you say that . . .?

You were the primary decision maker _{………………………………..} CONTINUE

You jointly made decisions with someone else………….CONTINUE

Someone else was primarily responsible………………...TERMINATE AND TALLY

5. How are/were you related to the person who needed long term care services? Were they your..…..(RECRUIT MIX)

SPOUSE/PARTNER………………………………………CONTINUE

PARENT/IN-LAW or GRANDPARENT/IN-LAW………..CONTINUE

SIBLING…………………………………………………….CONTINUE

COUSIN, AUNT/UNCLE…………………………………. CONTINUE

CLOSE FRIEND……………………………………………CONTINUE

CHILD……………………………………………………….TERMINATE

6. What type of care or services did they receive? If it was more than one type, you can tell us that as well. Did they need………..[RECRUT MIX OF FACILITY/NOT FACILITY]

NURSING HOME

ASSISTED LIVING FACILITY

IN-HOME PERSONAL CARE OR THERAPY

REHABILITATION FACILITY

OTHER (describe)

7. Did their need for care arise suddenly (e.g., as a result of a fall, stroke or medical event), or was it a more gradual need such as happens when someone has dementia or Alzheimer’s and loses abilities gradually over time?

Suddenly or fairly sudden (post medical)……………….RECRUIT MIX.

Gradual need or decline………………………………….RECRUIT MIX

8. At the time that they FIRST needed care, did the person for whom you helped find care live in close proximity to you or far away? Basically, did they live……RECRUIT MIX

Close enough that you could drive back and forth to see them on the same day?

Far enough that you’d need to stay overnight when you’d visit?

9. At the time that they first needed care, how were those care expenses being paid for?

THEIR OWN RESOURCES and/or FAMILY RESOURCES

PRIVATE INSURANCE

MEDICARE [define]

MEDICAID [ define]…………………………………..TERMINATE

VETERANS BENEFITS………………………………TERMINATE

DON’T KNOW…………………………………………..?

10. Overall, how would you describe your familiarity with the process by which the care and services they received were identified and chosen? (READ LIST; RECORD)

Extremely knowledgeable………………..CONTINUE

Fairly knowledgeable……………………..CONTINUE

Somewhat knowledgeable……………….CONTINUE

Slightly Knowledgeable…………………..TERMINATE AND TALLY

Not at all knowledgeable…………………TERMINATE AND TALLY

11. Are you, or have you ever been, or is anyone in your family, employed by a company in any of the following industries? (TERMINATE AND TALLY IF ANY OF THE FOLLOWING IS MENTIONED)

Advertising, market research or public relations TERMINATE AND TALLY

Health care, hospital or nursing home TERMINATE AND TALLY

Marketing consulting or marketing department TERMINATE AND TALLY

Television, radio, newspapers, magazines

or any media company TERMINATE AND TALLY

Any kind of insurance company or agency TERMINATE AND TALLY

A branch of government* PROBE AND TERMINATE AS SPECIFIED AND TALLY

*Exclusion for those specifically associated with health care and aging services

12. When was the last time you participated in a group discussion or individual interview for

market research? (SELECT ONE)

Never CONTINUE

Longer than 6 months ago CONTINUE

Within the past 3 months TERMINATE AND TALLY

13. What is your age? (ENTER)

___________ IF AGE < 40 OR AGE >69 TERMINATE. OTHERWISE, RECRUIT MIX

14. Which of the following best describes your marital status? RECRUIT MIX

Married

Living with Significant Other

Single

Divorced

Widowed

15. Which of the following categories includes your total annual household income before taxes? (SELECT ONE AND RECRUIT MIX)

Less than $5,000 oo₁ TERMINATE AND TALLY

$5,000 to $24,999 oo₂ TERMINATE AND TALLY

$25,000 to $49,999 oo₃ CONTINUE

$50,000 to $74,999 oo₄ CONTINUE

$75,000 to $99,999 oo₅ CONTINUE

$100,000 to $199,999 oo₆ CONTINUE

$200,000 or more oo₇ CONTINUE

Refused oo₈ TERMINATE AND TALLY

16. Which of the following statements best describes your current employment situation?

(SELECT ONE AND RECRUIT MIX)

I am employed at least 32 hours per work RECRUIT MIX

I am employed part-time (less than 32 hours per week)

I am retired

Full time homemaker

I am unemployed

17. Which of the following statements best describes the highest level of education you have attained? (SELECT ONE)

Less than high school graduate RECRUIT MIX

High school graduate

Some college/trade school

College graduation

Advanced degree

ARTICULATION QUESTIONS:

If you could have dinner with anyone in history, please tell me who it would be and why.

_________________________________________

_________________________________________

_________________________________________

(SCORING ANSWER: RECRUIT ONLY IF ANSWER IS THOUGHTFUL AND ARTICULATE; DO NOT RECRUIT IF RESPONDENT HAS LANGUAGE DIFFICULTIES) PS. Don’t forget to tell them we want to know who they say just for amusement and interest purposes….

And lastly, which of the following best describes your behavior in a social situation – for example, when you are at a party or simply spending time with friends? (SELECT ONE)

I usually do a lot of the talking in the conversations that I’m in, and will often

be the one to start the conversation CONTINUE

I usually wind up doing at least half of the talking, and I’ll often initiate conversations with people………………………………………………………………… CONTINUE

I usually do no more than half the talking, and I’ll usually join other people’s conversations rather than start new ones myself……………………………. CONTINUE

I usually listen and let other people do most of the talking…… TERMINATE