C2. Functional limitations and helpers

Module C2. Functional limitations and helpers of survey KLoSAw4

Start of C2. Functional limitations and helpers
 
C201

Do you have difficulties with dressing, including taking clothes out of a closet and buttoning or zipping up? Do you need someone to help you with that?

DO YOU HAVE DIFFICULTIES WITH DRESSING, INCLUDING TAKING CLOTHES OUT OF A CLOSET AND BUTTONING OR ZIPPING UP? DO YOU NEED SOMEONE TO HELP YOU WITH THAT?
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C202

Do you have difficulties in washing your face and hair and brushing your teeth? Do you need someone to help you with that?

DO YOU HAVE DIFFICULTIES IN WASHING YOUR FACE AND HAIR AND BRUSHING YOUR TEETH? DO YOU NEED SOMEONE TO HELP YOU WITH THAT?
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C203

Do you have difficulties with bathing or showering (You may not scrub your back alone.)? Do you need someone to help you with that?

DO YOU HAVE DIFFICULTIES WITH BATHING OR SHOWERING (YOU MAY NOT SCRUB YOUR BACK ALONE.)? DO YOU NEED SOMEONE TO HELP YOU WITH THAT?
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C204

Do you have difficulties with eating (You may use forks or other tools.)? Do you need someone to help you with that?

DO YOU HAVE DIFFICULTIES WITH EATING (YOU MAY USE FORKS OR OTHER TOOLS.)? DO YOU NEED SOMEONE TO HELP YOU WITH THAT?
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C205

Do you have difficulties in getting out of bed and walking out of the room (You may use equipment or devices to get up.)? Do you need someone to help you with that?

DO YOU HAVE DIFFICULTIES IN GETTING OUT OF BED AND WALKING OUT OF THE ROOM (YOU MAY USE EQUIPMENT OR DEVICES TO GET UP.)? DO YOU NEED SOMEONE TO HELP YOU WITH THAT?
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C206

Do you have difficulties in using the toilet (including taking off clothes and cleaning oneself after defecating or urinating. You may use a portable toilet.). Do you need someone to help you with that?

DO YOU HAVE DIFFICULTIES IN USING THE TOILET (INCLUDING TAKING OFF CLOTHES AND CLEANING ONESELF AFTER DEFECATING OR URINATING. YOU MAY USE A PORTABLE TOILET.). DO YOU NEED SOMEONE TO HELP YOU WITH THAT?
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C207

Do you have difficulties in controlling urination and defecation (You may use a catheter (conduit) or a pouch by yourself.)? Do you need someone to help you with that?

DO YOU HAVE DIFFICULTIES IN CONTROLLING URINATION AND DEFECATION (YOU MAY USE A CATHETER (CONDUIT) OR A POUCH BY YOURSELF.)? DO YOU NEED SOMEONE TO HELP YOU WITH THAT?
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C208

Now I will ask questions about a bit more difficult activities. Please give your response based on your activities over the past one week. If you are temporarily receiving help with doing such activities for a certain reason but expect the situation to last less than three months, then answer that you don't need help. Do you have difficulties with personal grooming (including brushing hair, clipping nails/ toenails, putting on make-up (female) and shaving (male))? Do you need someone to help you with that?

NOW I WILL ASK QUESTIONS ABOUT A BIT MORE DIFFICULT ACTIVITIES. PLEASE GIVE YOUR RESPONSE BASED ON YOUR ACTIVITIES OVER THE PAST ONE WEEK. IF YOU ARE TEMPORARILY RECEIVING HELP WITH DOING SUCH ACTIVITIES FOR A CERTAIN REASON BUT EXPECT THE SITUATION TO LAST LESS THAN THREE MONTHS, THEN ANSWER THAT YOU DON'T NEED HELP. DO YOU HAVE DIFFICULTIES WITH PERSONAL GROOMING (INCLUDING BRUSHING HAIR, CLIPPING NAILS/ TOENAILS, PUTTING ON MAKE-UP (FEMALE) AND SHAVING (MALE))? DO YOU NEED SOMEONE TO HELP YOU WITH THAT?
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C209

Do you need someone to help you with doing housework, such as cleaning or tidying up the house, making bed and washing dishes? [IWER: If R cannot mop the floor, but can scrub, or R cannot fold heavy bedding, but is able to do light ones, then mark 3.]

DO YOU NEED SOMEONE TO HELP YOU WITH DOING HOUSEWORK, SUCH AS CLEANING OR TIDYING UP THE HOUSE, MAKING BED AND WASHING DISHES?
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C210

Do you need someone to help you with preparing meals? Preparing meals means preparing ingredients, cooking, and setting the table. [IWER: If another person prepares ingredients or if R can cook rice, but is unable to prepare side dishes, then mark 3.]

DO YOU NEED SOMEONE TO HELP YOU WITH PREPARING MEALS? PREPARING MEALS MEANS PREPARING INGREDIENTS, COOKING, AND SETTING THE TABLE.
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C211

Do you need someone to help you with doing laundry, that is, doing laundry using a washing machine or by hand and hanging out the wash to dry? [IWER: If R is unable to launder large items but can do small items, such as underwear and socks, or if R can do laundry but is unable to hang out the wash, then mark 3.]

DO YOU NEED SOMEONE TO HELP YOU WITH DOING LAUNDRY, THAT IS, DOING LAUNDRY USING A WASHING MACHINE OR BY HAND AND HANGING OUT THE WASH TO DRY?
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C212

Do you need someone to help you with going out a short distance without using transportation? [IWER: Enter 1 if R uses assistance devices, such as a cane. Enter 3 if R needs to ride a wheelchair.]

DO YOU NEED SOMEONE TO HELP YOU WITH GOING OUT A SHORT DISTANCE WITHOUT USING TRANSPORTATION? X
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C213

Do you need someone to help you with going out using transportation, such as buses, subways, taxies, and cars?

DO YOU NEED SOMEONE TO HELP YOU WITH GOING OUT USING TRANSPORTATION, SUCH AS BUSES, SUBWAYS, TAXIES, AND CARS?
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C214

Do you need someone to help you with shopping, that is, deciding what to buy, paying money and getting change?

DO YOU NEED SOMEONE TO HELP YOU WITH SHOPPING, THAT IS, DECIDING WHAT TO BUY, PAYING MONEY AND GETTING CHANGE?
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C215

Do you need someone to help you with managing money, such as managing small sums of pocket money, savings accounts and other assets? [IWER: Enter 3 if large sums of money is managed by someone else.]

DO YOU NEED SOMEONE TO HELP YOU WITH MANAGING MONEY, SUCH AS MANAGING SMALL SUMS OF POCKET MONEY, SAVINGS ACCOUNTS AND OTHER ASSETS?
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C216

Do you need someone to help you with making or taking phone calls? [IWER: Enter 3 if R can only dial the numbers she/he knows.]

DO YOU NEED SOMEONE TO HELP YOU WITH MAKING OR TAKING PHONE CALLS?
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C217

Do you need someone to help you with taking medications, that is, taking the right portion of medication right on time?

DO YOU NEED SOMEONE TO HELP YOU WITH TAKING MEDICATIONS, THAT IS, TAKING THE RIGHT PORTION OF MEDICATION RIGHT ON TIME?
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If Do you have difficulties with dressing, including taking clothes out of a closet and buttoning or zipping up? Do you need someone to help you with that? != 1 and Do you have difficulties in washing your face and hair and brushing your teeth? Do you need someone to help you with that? != 1 and Do you have difficulties with bathing or showering (You may not scrub your back alone.)? Do you need someone to help you with that? != 1 and Do you have difficulties with eating (You may use forks or other tools.)? Do you need someone to help you with that? != 1 and Do you have difficulties in getting out of bed and walking out of the room (You may use equipment or devices to get up.)? Do you need someone to help you with that? != 1 and Do you have difficulties in using the toilet (including taking off clothes and cleaning oneself after defecating or urinating. You may use a portable toilet.). Do you need someone to help you with that? != 1 and Do you have difficulties in controlling urination and defecation (You may use a catheter (conduit) or a pouch by yourself.)? Do you need someone to help you with that? != 1 and Now I will ask questions about a bit more difficult activities. Please give your response based on your activities over the past one week. If you are temporarily receiving help with doing such activities for a certain reason but expect the situation to last less than three months, then answer that you don't need help. Do you have difficulties with personal grooming (including brushing hair, clipping nails/ toenails, putting on make-up (female) and shaving (male))? Do you need someone to help you with that? != 1 and Do you need someone to help you with doing housework, such as cleaning or tidying up the house, making bed and washing dishes? [IWER: If R cannot mop the floor, but can scrub, or R cannot fold heavy bedding, but is able to do light ones, then mark 3.] != 1 and Do you need someone to help you with preparing meals? Preparing meals means preparing ingredients, cooking, and setting the table. [IWER: If another person prepares ingredients or if R can cook rice, but is unable to prepare side dishes, then mark 3.] != 1 and Do you need someone to help you with doing laundry, that is, doing laundry using a washing machine or by hand and hanging out the wash to dry? [IWER: If R is unable to launder large items but can do small items, such as underwear and socks, or if R can do laundry but is unable to hang out the wash, then mark 3.] != 1 and Do you need someone to help you with going out a short distance without using transportation? [IWER: Enter 1 if R uses assistance devices, such as a cane. Enter 3 if R needs to ride a wheelchair.] != 1 and Do you need someone to help you with going out using transportation, such as buses, subways, taxies, and cars? != 1 and Do you need someone to help you with shopping, that is, deciding what to buy, paying money and getting change? != 1 »
 
   
 
As CNT goes from 1 to 5 THEN
 
     
   
C218

If you need help with activities of daily living, name the five people who help you the most in order. Who is the person that comes [1st/2nd/..] in helping you? Please state the person's name or relationship with you.

IF YOU NEED HELP WITH ACTIVITIES OF DAILY LIVING, NAME THE FIVE PEOPLE WHO HELP YOU THE MOST IN ORDER. WHO IS THE PERSON THAT COMES [1ST/2ND/..] IN HELPING YOU? PLEASE STATE THE PERSON'S NAME OR RELATIONSHIP WITH YOU.
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If If you need help with activities of daily living, name the five people who help you the most in order. Who is the person that comes [1st/2nd/..] in helping you? Please state the person's name or relationship with you. = 56 »
 
       
     
EXITFOR
       
   
C219

How many days did [name selected in C218] help you during the past one month? (unit: a day) days

HOW MANY DAYS DID [NAME SELECTED IN C218] HELP YOU DURING THE PAST ONE MONTH? (UNIT: A DAY)

____________ DAYS
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C220

How many hours per day does [name selected in C218] usually help you? (unit: an hour) [IWER: less than an hour=1] hours

HOW MANY HOURS PER DAY DOES [NAME SELECTED IN C218] USUALLY HELP YOU? (UNIT: AN HOUR) [IWER: LESS THAN AN HOUR=1]

_______ HOURS
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C221

Is [name selected in C218] paid to help you?

IS [NAME SELECTED IN C218] PAID TO HELP YOU?
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If Is [name selected in C218] paid to help you? = 5 »
 
       
     
EXITFOR
       
   
C222

How much did you pay [name selected in C218] in the past one month? (unit: 10,000 Korean won) MW

HOW MUCH DID YOU PAY [NAME SELECTED IN C218] IN THE PAST ONE MONTH? (UNIT: 10,000 KOREAN WON)
______ MW
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If You have said that you paid [C222] MW (10,000 Korean won) to your helpers in the past one month. How much did you pay out-of-pocket? Also, how much did your relatives or private health insurances pay on behalf of you? Please include in the private health insurance category any payments that you made and were reimbursed by private health insurances. (unit: 10,000 Korean won) Categories are 1 out-of-pocket payments (C223a), 2 payments by relatives including children and parents (C223b), 3 payments reimbursed by private health insurances (C223c). [IWER: The sum of all items must be equal to [C222] MW.] = C222 »
 
       
     
EXITFOR
       
If CNT != 1 »
 
   
 
Question Combination

   
 
C223A

Out-of-pocket payments

OUT-OF-POCKET PAYMENTS

   
 
C223B

Payments by relatives including children and parents

PAYMENTS BY RELATIVES INCLUDING CHILDREN AND PARENTS

   
 
C223C

Payments reimbursed by private health insurances

PAYMENTS REIMBURSED BY PRIVATE HEALTH INSURANCES
   
 
C223

You have said that you paid [C222] MW (10,000 Korean won) to your helpers in the past one month. How much did you pay out-of-pocket? Also, how much did your relatives or private health insurances pay on behalf of you? Please include in the private health insurance category any payments that you made and were reimbursed by private health insurances. (unit: 10,000 Korean won) Categories are 1 out-of-pocket payments (C223a), 2 payments by relatives including children and parents (C223b), 3 payments reimbursed by private health insurances (C223c). [IWER: The sum of all items must be equal to [C222] MW.]

YOU HAVE SAID THAT YOU PAID [C222] MW (10,000 KOREAN WON) TO YOUR HELPERS IN THE PAST ONE MONTH. HOW MUCH DID YOU PAY OUT-OF-POCKET? ALSO, HOW MUCH DID YOUR RELATIVES OR PRIVATE HEALTH INSURANCES PAY ON BEHALF OF YOU? PLEASE INCLUDE IN THE PRIVATE HEALTH INSURANCE CATEGORY ANY PAYMENTS THAT YOU MADE AND WERE REIMBURSED BY PRIVATE HEALTH INSURANCES. (UNIT: 10,000 KOREAN WON) CATEGORIES ARE 1 OUT-OF-POCKET PAYMENTS (C223A), 2 PAYMENTS BY RELATIVES INCLUDING CHILDREN AND PARENTS (C223B), 3 PAYMENTS REIMBURSED BY PRIVATE HEALTH INSURANCES (C223C).



ITEMS AMOUNT

C223A OUT-OF-POCKET PAYMENTS

C223B PAYMENTS BY RELATIVES INCLUDING CHILDREN AND PARENTS

C223C PAYMENTS REIMBURSED BY PRIVATE HEALTH INSURANCE

TOTAL


   
 

End Combination
   
C224

Who is likely to help you if you need help with activities of daily living, such as eating, dressing, or using the bathroom, over a long period of time in the future? Please select all that apply.

WHO IS LIKELY TO HELP YOU IF YOU NEED HELP WITH ACTIVITIES OF DAILY LIVING, SUCH AS EATING, DRESSING, OR USING THE BATHROOM, OVER A LONG PERIOD OF TIME IN THE FUTURE? PLEASE SELECT ALL THAT APPLY.
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C225

[IWER: How often did R receive assistance in answering section C2-FUNCTIONAL LIMITATIONS AND HELPERS?]

[IWER: HOW OFTEN DID R RECEIVE ASSISTANCE IN ANSWERING SECTION C2-FUNCTIONAL LIMITATIONS AND HELPERS?]
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If [IWER: How often did R receive assistance in answering section C2-FUNCTIONAL LIMITATIONS AND HELPERS?] = 4 »
 
   
 
C226

What is the proxy's relationship to R? If unknown, please ask the proxy. What is your relationship to R?

WHAT IS THE PROXY'S RELATIONSHIP TO R? IF UNKNOWN, PLEASE ASK THE PROXY. WHAT IS YOUR RELATIONSHIP TO R?
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End of C2. Functional limitations and helpers