15th NSOAAP COVID Module

Appendix K

COVID-19 Module Items
for the 15th NSOAAP

Participant/Client Type
HDM

Cong Meals

Case Mgmt

Transp

Homemaker

Caregiver

X

X

X

X

X

X

2. In the past 12 months, would you say that since COVID you move
around more or less (such as walking, exercising, working in the
yard)?
a. Much less
b. A little bit less
c. Same
d. A little bit more
e. A lot more

X

X

X

X

X

X

Interviewer: “I am going to read you two statements that people have
made about their food situation at home. Thinking about you and your
household, please tell me if the statements is often true, sometimes true,
or never true:”

X

X

X

X

X

X

ITEM

Core Items (1-9)
1. In the past 12 months since COVID, have you been able to
communicate with people in a virtual way? Examples are Zoom,
Skype, FaceTime, a GrandPad, or some other type of meeting over a
computer or phone?
YES or NO
If No, was the reason:
a. No computer, tablet, or cell phone
b. No internet
c. Internet, but poor connection
d. Don’t know how
e. Don’t want to
f. No one to meet or socialize with

3. Since COVID, I worry whether food would run out before more can
be bought or more can be delivered or picked up from a meals
program.
a. Often true
b. Sometimes true
c. Never true

K-1

Participant/Client Type
HDM

Cong Meals

Case Mgmt

Transp

Homemaker

Caregiver

4. Since COVID, the food that (I/we) have just didn’t last and (I/we)
didn’t have money to get more.
a. Often true
b. Sometimes true
c. Never true

X

X

X

X

X

X

5. In the past 12 months, have you lost or gained weight without trying
to lose or gain this weight?
Would you say ….. (Interviewer to read all for them to pick from)

X

X

X

X

X

X

X

X

X

X

X

X

ITEM

a.
b.
c.
d.
e.
f.
g.

Yes, I gained 10 pounds or more
Yes, I gained less than 10 pounds
No, I stayed the same
Yes, I lost 10 pounds or more
Yes, I lost less than 10 pounds
Don’t know
Yes, but I tried to lose or gain weight (if said)

6. In the past 12 months since COVID, did you need health care but
were not able to get it because of the coronavirus pandemic?
a. Yes
b. Unsure / Don’t Know
c. No
d. Not Applicable
If Yes, which types of care (interviewer will say the list):
 Urgent care for an accident or illness
 A surgical procedure
 Diagnostic or medical screening test
 Treatment for an ongoing condition
 A regular check-up
 Prescription drugs or medications
 Dental care
 Vision care
 Hearing care
Note: Medicare Current Beneficiary Survey (MCBS)1 Item

1

The MCBS COVID-19 Fall 2020 Supplement included a series of items measuring disruption to basic needs caused by the
pandemic, including ability to pay rent or mortgage and access to medication, health care, food, household supplies, and face

K-2

Participant/Client Type
Case Mgmt

Transp

Homemaker

Caregiver

a.
b.
c.
d.
e.

Cong Meals

7. In the past 12 months since COVID, have you felt more stressed or
anxious, less stressed or anxious, or about the same?2

HDM

ITEM

X

X

X

X

X

X

X

X

X

X

X

More stressed or anxious
Less stressed or anxious
About the same
Don’t know
Refused

Note: MCBS Item3
8. Thinking about support services for older adults provided by Area
Agencies on Aging, such as meals, transportation, homemaker
support, and care management, are you receiving all the help you
need?
YES or NO
If No, what is your most pressing need that is not being met?
a. Meals
b. Transportation
c. Homemaker services
d. Care management
e. Other (specify): ________________________________

masks. These items were adapted from the National Center for Health Statistics’ (NCHS) Research and Development
surveys (RANDS).
2

From the SUMMER 2020 MCBS results: Anxious/stressed was the most common of the 4 Well-Being items asked, more so
than lonely/sad, less socially connected, and less financially secure. Other studies have found the same.

3

The COVID-19 Fall 2020 Supplement included a series on impacts of the outbreak, including financial security, and feelings
of stress or anxiety, loneliness or sadness, and social connection. These items were adapted from the NCHS RANDS survey.

K-3

Participant/Client Type
Cong Meals

Case Mgmt

Transp

Homemaker

Caregiver

9. In the past 12 months since COVID, have you tried to get meals, food,
or groceries from {AAA} but were unable to?
YES or NO

HDM

ITEM

X

X

X

X

X

X

X

X

If Yes, why? (check all)
a. No response from {AAA}
b. You were put on a waiting list
c. You were told that you could not have more meals/food
d. You were told there was no more food available
e. You were told there was not enough staff
f. You were unable to pick up the meals or get to the meal pickup place
g. Other
Meal Items (10-13)
10. In the past 12 months, compared to before COVID, would you say
that how much you rely on meals or food from {AAA} has:
a. Increased
b. Stayed the same
c. Decreased
Note: Clients who didn’t use the service before COVID will not be asked
this item.

K-4

Participant/Client Type

X

Interviewer to use this table (example responses shown)
Food Received

Continue:
Check
Yes, No,
if YES
Unsure
X
Y

a. Grab-n-go service (such as pick-up, carryout, drive-through)
b. Meals delivered to your home
n/a
c. Groceries or food boxes delivered to your
X
N
home
d. Food box with random ingredients
e. Food box (containing food items to make
meals; may come with instructions)
f. Sit-down meal at a senior center or other
X
n/a
place
g. Other (specify):
______________________________
12. In the past 12 months since COVID, which type of food or meal do
you most often receive from {AAA}?
(Interviewer reads list - ask to choose one)
a.
b.
c.
d.
e.
f.

A hot meal
A cold meal like a sandwich or submarine
A frozen meal that needs to be heated up and/or microwaved
Shelf-stable – unopened food in their original can, jar, or box.
Delivery of groceries that you ordered
Food box (containing food items to make meals; may come
with instructions)
g. Food box with random ingredients

K-5

Caregiver

X

If they say YES to a, c, d, or e (i.e., new services) ask:
“Would you like for this to continue to be available to you after the
pandemic is over?”

Homemaker

X

Transp

X

Case Mgmt

Cong Meals

11. In the past 12 months since COVID, how have you been receiving
meals or food from {AAA}:
(List options, Record all that apply)

HDM

ITEM

Participant/Client Type

If No, what have you missed the most about the in-person meal
program?
a. Eating a good meal
b. Seeing friends, peers, staff
c. Someplace to go and get out of the house
d. Socializing in general
e. The feeling of being supported by others.
f. Accessing other programming: classes, activities
g. Other, specify: _________________________
If yes, how? Specify: ____________________
Transportation Items (14-15)
14. In the past 12 months since COVID, how have you been receiving
transportation services from {AAA}?
(check all that apply)
a.
b.
c.
d.
e.

X

Car
Voucher for taxi, Uber, etc.
Voucher for public transportation
Shuttle bus or van
Other, specify: ____________________

15. In the past 12 months, compared to before COVID, would you say
that how much you rely on transportation from {AAA} has:
a. Increased
b. Stayed the same
c. Decreased
Note: Clients who didn’t use the service before COVID will not be asked
this item.

K-6

X

Caregiver

X

Homemaker

Transp

Case Mgmt

13. In the past 12 months since COVID, have you eaten any of your
{AAA}-provided meals in an in-person group setting?
YES or NO

Cong Meals

HDM

ITEM

Participant/Client Type

Case Management Items (16-17)
16. In the past 12 months since COVID, how have you been receiving
case management from {AAA}?
a.
b.
c.
d.
e.

X

Scheduled and/or routine phone calls with case manager
Non-scheduled check-in calls from case manager
Virtual meetings from case manager
Group virtual meetings
Case manager comes to home

17. In the past 12 months, compared to before COVID, would you say
that how much you rely on case management from {AAA} has:

X

a. Increased
b. Stayed the same
c. Decreased
Note: Clients who didn’t use the service before COVID will not be
asked this item.
Homemaker Item (18)
18. In the past 12 months since COVID, which homemaker services have
you received from {AAA}?
Interviewer will choose all that apply from response:
a.
b.
c.
d.
e.

Light housekeeping
Shopping
Laundry
Paying bills
Other, specify: ______________

K-7

X

Caregiver

Homemaker

Transp

Case Mgmt

Cong Meals

HDM

ITEM

Participant/Client Type
Caregiver

Homemaker

Transp

Case Mgmt

Cong Meals

HDM

ITEM

Caregiver Items (19-22)
19. Caregiver support organizations offer help to family caregivers
through services such as caregiver education, training, counseling,
respite care from a home health aide, help finding resources, home
equipment, or a day-care program. Thinking about these services, as
a caregiver, are you receiving all the help you need?
YES or NO?

X

If No, what is the one, most pressing need that is not being met?
Interviewer to listen and pick from this list or document in Other
(specify):
a. Education and information
b. Training
c. Counseling
d. Support groups
e. Respite care (i.e., getting a break)
f. Day care for care recipient
g. Home equipment
h. Help finding resources
i. Other (specify): _______________________________
20. In the past 12 months, compared to before COVID, would you say
that how much you use caregiver support services has:
a. Increased
b. Stayed the same
c. Decreased
Note: Clients who didn’t use the service before COVID will not be
asked this item.

K-8

X

Participant/Client Type

21. In the past 12 months since COVID, have you used any caregiver
support services that were provided by phone, online (also called
“virtual”), or in a socially distant manner, and if so, would you like for
this type of support to continue to be available to you after the
pandemic is over?

Caregiver

Homemaker

Transp

Case Mgmt

Cong Meals

HDM

ITEM

X

Interviewer to use this table (example responses shown)
Continue:
Service Received (for Caregiver unless
Check
Yes, No,
stated CR)
if YES
Unsure
h. Virtual support group(s)
X
Y
i. Education or training class/program
j. Fun activity online or socially distant
X
N
k. Package or fun activity mailed or
dropped off
l. Class or program with CR (i.e., memory
café)
m. Fun activity for CR (online or socially
X
U
distant)
n. Other (specify):
______________________
22. In the past 12 months since COVID, have you used any support
services that allowed for you to have a break in caregiving? This does
not include visits from family members or friends.

X

If Yes, what type of support services did you use?
a. in-home respite, where someone comes into the home to
care for {Care Recipient} and you feel comfortable enough
that you could take a nap or leave the home while that
person is there?
b. adult daycare, where {Care Recipient} goes to a facility for
care during the day?
c. overnight respite care in a facility?
d. overnight respite in the home?
e. some other kind of respite care?
TOTAL ITEMS BY PARTICIPANT/CLIENT TYPE

12

K-9

13

11

11

10

12