HOME HEALTH CARE CAHPS® SURVEY 2020

1 OMB #: 0938-1066. Expires July 31, 2026. HOME HEALTH CARE CAHPS SURVEY . 2023. SURVEY INSTRUCTIONS 3. When you first started getting home HEALTH care from this agency, did someone from the agency talk with Answer all the questions by checking the you about how to set up your home so box to the left of your answer. you can move around safely? 1. You are sometimes told to skip over Yes some questions in this SURVEY . When this 2. No happens you will see an arrow with a 3. note that tells you what question to Do not remember answer next, like this: 4.

2 When you started getting home HEALTH Yes If Yes, go to Q1 on Page 1. care from this agency, did someone No from the agency talk with you about all the prescription and over-the- counter medicines you were taking? YOUR HOME HEALTH CARE 1. Yes 2. No 1. According to our records, you got care 3. from the home HEALTH agency, Do not remember [AGENCY NAME]. Is that right? As you answer the questions in this 5. When you started getting home HEALTH SURVEY , think only about your care from this agency, did someone experience with this agency.

3 From the agency ask to see all the 1. Yes prescription and over-the-counter medicines you were taking? 2. No If No, please stop and 1. return the SURVEY in the Yes envelope provided. 2. No 3. Do not remember 2. When you first started getting home HEALTH care from this agency, did someone from the agency tell you what care and services you would get? 1. Yes 2. No 3. Do not remember 1. YOUR CARE FROM HOME 9. In the last 2 months of care, how often did home HEALTH providers from this HEALTH PROVIDERS IN THE agency seem informed and up-to-date LAST 2 MONTHS about all the care or treatment you got at home?

4 1. These next questions are about all the Never different staff from [AGENCY NAME] 2. Sometimes who gave you care in the last 2 months. Do 3. not include care you got from staff from Usually another home HEALTH care agency. Do not 4. Always include care you got from family or friends. 5. I only had one provider in the last 2 months of care 6. In the last 2 months of care, was one of your home HEALTH providers from 10. In the last 2 months of care, did you this agency a nurse? and a home HEALTH provider from this 1. Yes agency talk about pain?

5 1. 2. No Yes 2. No 7. In the last 2 months of care, was one of your home HEALTH providers from 11. In the last 2 months of care, did you this agency a physical, occupational, take any new prescription medicine or or speech therapist? change any of the medicines you were 1. Yes taking? 1. 2. No Yes 2. No If No, go to Q15. 8. In the last 2 months of care, was one of your home HEALTH providers from 12. In the last 2 months of care, did home this agency a home HEALTH or personal HEALTH providers from this agency talk care aide? with you about the purpose for taking 1.

6 Yes your new or changed prescription 2. medicines? No 1. Yes 2. No 3. I did not take any new prescription medicines or change any medicines 2. 13. In the last 2 months of care, did home 17. In the last 2 months of care, how often HEALTH providers from this agency talk did home HEALTH providers from this with you about when to take these agency explain things in a way that medicines? was easy to understand? 1 1. Yes Never 2 2. No Sometimes 3 3. I did not take any new Usually prescription medicines or 4. Always change any medicines 18.

7 In the last 2 months of care, how often 14. In the last 2 months of care, did home did home HEALTH providers from this HEALTH providers from this agency talk agency listen carefully to you? with you about the side effects of these medicines? 1. Never 1. Yes 2. Sometimes 2. No 3. Usually 3. I did not take any new 4. Always prescription medicines or change any medicines 19. In the last 2 months of care, how often did home HEALTH providers from this 15. In the last 2 months of care, how often agency treat you with courtesy and did home HEALTH providers from this respect?

8 Agency keep you informed about when 1. they would arrive at your home? Never 2. 1. Never Sometimes 3. 2. Sometimes Usually 4. 3. Usually Always 4. Always 16. In the last 2 months of care, how often did home HEALTH providers from this agency treat you as gently as possible? 1. Never 2. Sometimes 3. Usually 4. Always 3. 20. We want to know your rating of your 22. In the last 2 months of care, when you care from this agency's home HEALTH contacted this agency's office did you providers. get the help or advice you needed? 1. Yes Using any number from 0 to 10, where 0 is the worst home HEALTH care 2.

9 No If No, go to Q24. possible and 10 is the best home 3. HEALTH care possible, what number I did not contact this agency would you use to rate your care from this agency's home HEALTH providers? 23. When you contacted this agency's 0 Worst home HEALTH care office, how long did it take for you to possible get the help or advice you needed? 1. 1 Same day 2. 2 1 to 5 days 3. 3 6 to 14 days 4. 4 More than 14 days 5. 5 I did not contact this agency 6. 24. In the last 2 months of care, did you 7 have any problems with the care you 8 got through this agency?

10 1. 9 Yes 2. 10 Best home HEALTH care possible No 25. Would you recommend this agency to YOUR HOME HEALTH AGENCY your family or friends if they needed home HEALTH care? 1. Definitely no The next questions are about the office of 2. [AGENCY NAME]. Probably no 3. Probably yes 21. In the last 2 months of care, did you 4. contact this agency's office to get help Definitely yes or advice? 1. Yes 2. No If No, go to Q24. 4. ABOUT YOU 30. Are you Hispanic or Latino/Latina? 1. Yes 2. No 26. In general, how would you rate your overall HEALTH ?