XT. End-of-Life Interview

XT. End-of-Life Interview Module of SHARE 2013

item label type description
XT104 Question IWER:note sex of decedent (ask if unsure)
XT001 Question [{Name of the deceased}] has participated in the SHARE study before [his/her] death. [His/Her] contribution was very valuable. We would find it extremely helpful to havesome information about the final year of [{Name of the deceased}]'s life. All the information collected is strictly confidential, and will be held anonymously.
XT006 Question IWER:Code proxy respondent's sex.
XT002 Question Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased?
XT003 Question IWER:Specify other relative
XT004 Question IWER:Specify other non-relative
XT005 Question During the last twelve months of [his/her] life, how often did you have contact with [{Name of the deceased}], either personally, by phone, mail, email, or any other electronicmeans?
XT007 Question Can you tell me your year of birth?
XT101 Question Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]?
XT102 Question In which month and year was [{Name of the deceased}] born?MONTH:YEAR:
XT103 Question In which month and year were [{Name of the deceased}] born?MONTH: ______YEAR:
XT008 Question We would lik e to k now more about the circumstances of [{Name of the deceased}] 's death. In what month and year did [he/she] pass away?MONTH:YEAR:
XT009 Question In what month and YEAR did [he/she] pass away?MONTH: ______YEAR:
XT010 Question How old was [{Name of the deceased}] when [he/she] passed away?
XT109 Question Was [{Name of the deceased}] married at the time of [his/her] death?
XT039 Question How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children.
XT011 Question What was the main cause of [his/her] death?
XT012 Question IWER:Specify other cause of death
XT013 Question How long had [{Name of the deceased}] been ill before [he/she] died?
XT014 Question Did [he/she] die ...
XT045 Question IWER:Specify other place of death
XT015 Question In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home?
XT016 Question During the last year of [his/her] life, for how long altogether did [{Name of the deceased}] stay at hospitals, hospices or nursing homes?
XT017 Question We would now lik e to ask you some questions about any expenses which [{Name of the deceased}] incurred as a result of the medical care [he/she] received in the last 12months before [he/she] died. For each of the types of care I will now read out, please indicate whether the deceased received the care and, if so, give your best estimate ofthe costs incurred from that care. Please include only costs not paid or reimbursed by the health insurance or the employer.
XT018 Question Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)?
XT019 Question About how much did [his/her] [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospice stays/medication/aidsand appliances/home care or home help due to disability] cost (in the last 12 months of [his/her] life)?
XT105 Question We would lik e to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months?
XT106 Question During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty rememberingwhat year it was? (Please name only difficulties that lasted at least three months?)
XT107 Question During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?)
XT020 Question Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months.
XT022 Question Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities?
XT023 Question Who, including yourself, has helped mainly with these activities? Please name at most three persons.
XT024 Question Overall, during the last twelve months of [his/her] life, for how long did the deceased receive help?
XT025 Question And about how many hours of help were necessary during a typical day?
XT026a Question The next questions are about the assets and life insurance policies the deceased may have owned and what happened to those assets after [{Name of the deceased}] died.I appreciate that this may upset or distress you, but we would find it very helpful to have some information about the financial issues surrounding death. Before I continue,though, I'd lik e to assure you again that everything you have already told me and anything else you tell me will be k ept completely confidential.
XT026b Question Some people mak e a will to determine who receives what parts of the estate.Did [{Name of the deceased}] have a will?
XT027 Question Who were the beneficiaries of the estate, including yourself?
XT028 Question IWER:Specify other relative
XT029 Question IWER:Specify other non-relative
XT030 Question Did the deceased own [his/her] home or apartment - either in total or a share of it?
XT031 Question After any outstanding mortgages, what was the value of the home or apartment or the share of it owned by the deceased?
XT051 Question IWER:Specify other relative
XT052 Question IWER:Specify other non-relative
XT053 Question IWER:First names of children who inherited home
XT033 Question Did the deceased own any life insurance policies?
XT034 Question In total, about what was the value of all life insurance policies owned by the deceased?
XT035 Question Who were the beneficiaries of the life insurance polices, including yourself.
XT054 Question IWER:Specify other relative
XT055 Question IWER:Specify other non-relative
XT056 Question IWER:First names of children who were beneficiaries
XT036 Question I will now read out a few types of assets people may have. For each item, please tell me whether the deceased owned them at the time of [his/her] death and, if so, pleasegive your best estimate of their value after any outstanding debts.
XT037 Question Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]?
XT038 Question About what was the value of the [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities] ownedby [{Name of the deceased}] at the time of [his/her] death?
XT040b Question Would you say that some children received more than others to mak e up for previous gifts?
XT040c Question Would you say that some children received more than others to give them financial support?
XT040d Question Would you say that some children received more than others because they helped or cared for the deceased towards the end of [his/her] life?
XT040e Question Would you say that some children received more than others because of other reasons?
XT040f Question What other reasons do you mean?
XT041 Question Finally, we would lik e to k now about the deceased's funeral. Was the funeral accompanied by a religious ceremony?
XT108 Question We have ask ed you many questions about numerous aspects of [{Name of the deceased}]'s health and finances, and we want to thank you very much for your assistancewith them. Is there anything else you would lik e to add about the life circumstances of [{Name of the deceased}] in [his/her] last year of life?
XT042 Question This is the end of the interview. Thank you once again for all the information you have given us. It will prove extremely useful in helping us to understand how people fare atthe end of their lives
XT043 Question IWER:Please state mode of interview
XT044 Question IWER:Your interviewer id.
XT032 Question Who inherited the deceased's home or apartment, including yourself?
Start of XT. End-of-Life Interview
 
XT104

IWER:note sex of decedent (ask if unsure)

IWER:NOTE SEX OF DECEDENT (ASK IF UNSURE)
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XT001

[{Name of the deceased}] has participated in the SHARE study before [his/her] death. [His/Her] contribution was very valuable. We would find it extremely helpful to havesome information about the final year of [{Name of the deceased}]'s life. All the information collected is strictly confidential, and will be held anonymously.

[{NAME OF THE DECEASED}] HAS PARTICIPATED IN THE SHARE STUDY BEFORE [HIS/HER] DEATH. [HIS/HER] CONTRIBUTION WAS VERY VALUABLE. WE WOULD FIND IT EXTREMELY HELPFUL TO HAVESOME INFORMATION ABOUT THE FINAL YEAR OF [{NAME OF THE DECEASED}]'S LIFE. ALL THE INFORMATION COLLECTED IS STRICTLY CONFIDENTIAL, AND WILL BE HELD ANONYMOUSLY.
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XT006

IWER:Code proxy respondent's sex.

IWER:CODE PROXY RESPONDENT'S SEX.
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XT002

Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased?

BEFORE WE START ASK ING QUESTIONS ABOUT THE LAST YEAR OF LIFE OF [{NAME OF THE DECEASED}], WOULD YOU PLEASE TELL ME WHAT WAS YOUR RELATIONSHIP TO THE DECEASED?
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If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? = 7 »
 
   
 
XT003

IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE
   
If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? = 8 »
 
   
 
XT004

IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE
   
XT005

During the last twelve months of [his/her] life, how often did you have contact with [{Name of the deceased}], either personally, by phone, mail, email, or any other electronicmeans?

DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, HOW OFTEN DID YOU HAVE CONTACT WITH [{NAME OF THE DECEASED}], EITHER PERSONALLY, BY PHONE, MAIL, EMAIL, OR ANY OTHER ELECTRONICMEANS?
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If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? <> 1 Husband or wife or partner 2 Son or Daughter 3 Son- or Daughter-in-law 4 Son or Daughter of husband, wife or partner 5 Grandchild 6 Sibling 7 Other relative (specify) 8 Other non-relative (specify)  »
 
   
 
XT007

Can you tell me your year of birth?

CAN YOU TELL ME YOUR YEAR OF BIRTH?
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XT101

Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]?

LET US NOW TALK ABOUT THE DECEASED. JUST TO MAK E SURE THAT WE HAVE THE CORRECT INFORMATION ABOUT [{NAME OF THE DECEASED}], CAN I JUST CONFIRM THAT [HE/SHE] WAS BORN IN[{MONTH AND YEAR BIRTH OF DECEASED}]?
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If Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]? = 5 »
 
   
 
XT102

In which month and year was [{Name of the deceased}] born?MONTH:YEAR:

IN WHICH MONTH AND YEAR WAS [{NAME OF THE DECEASED}] BORN?MONTH:YEAR:
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XT103

In which month and year were [{Name of the deceased}] born?MONTH: ^XT102_DecMonthBirthYEAR:

IN WHICH MONTH AND YEAR WERE [{NAME OF THE DECEASED}] BORN?MONTH: ______YEAR:
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XT008

We would lik e to k now more about the circumstances of [{Name of the deceased}] 's death. In what month and year did [he/she] pass away?MONTH:YEAR:

WE WOULD LIK E TO K NOW MORE ABOUT THE CIRCUMSTANCES OF [{NAME OF THE DECEASED}] 'S DEATH. IN WHAT MONTH AND YEAR DID [HE/SHE] PASS AWAY?MONTH:YEAR:
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XT009

In what month and YEAR did [he/she] pass away?MONTH: ^XT008_MonthDiedYEAR:

IN WHAT MONTH AND YEAR DID [HE/SHE] PASS AWAY?MONTH: ______YEAR:
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XT010

How old was [{Name of the deceased}] when [he/she] passed away?

HOW OLD WAS [{NAME OF THE DECEASED}] WHEN [HE/SHE] PASSED AWAY?
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XT109

Was [{Name of the deceased}] married at the time of [his/her] death?

WAS [{NAME OF THE DECEASED}] MARRIED AT THE TIME OF [HIS/HER] DEATH?
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XT039

How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children.

HOW MANY CHILDREN DID [{NAME OF THE DECEASED}] HAVE THAT WERE STILL ALIVE AT THE TIME OF [HIS/HER] DEATH? PLEASE INCLUDE FOSTER AND ADOPTED CHILDREN.
 
XT011

What was the main cause of [his/her] death?

WHAT WAS THE MAIN CAUSE OF [HIS/HER] DEATH?
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If What was the main cause of [his/her] death? = 97 »
 
   
 
XT012

IWER:Specify other cause of death

IWER:SPECIFY OTHER CAUSE OF DEATH
   
If What was the main cause of [his/her] death? = 8 »
 
   
 
XT013

How long had [{Name of the deceased}] been ill before [he/she] died?

HOW LONG HAD [{NAME OF THE DECEASED}] BEEN ILL BEFORE [HE/SHE] DIED?
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XT014

Did [he/she] die ...

DID [HE/SHE] DIE ...
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If Did [he/she] die ... = 97 »
 
     
   
XT045

IWER:Specify other place of death

IWER:SPECIFY OTHER PLACE OF DEATH
     
 
XT015

In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home?

IN THE LAST YEAR BEFORE [HE/SHE] DIED, ON HOW MANY DIFFERENT OCCASIONS DID [{NAME OF THE DECEASED}] STAY IN A HOSPITAL, HOSPICE OR NURSING HOME?
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If In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home? > 1 Not at all 2 1 to 2 times 3 3 to 5 times 4 More than 5 times  »
 
     
   
XT016

During the last year of [his/her] life, for how long altogether did [{Name of the deceased}] stay at hospitals, hospices or nursing homes?

DURING THE LAST YEAR OF [HIS/HER] LIFE, FOR HOW LONG ALTOGETHER DID [{NAME OF THE DECEASED}] STAY AT HOSPITALS, HOSPICES OR NURSING HOMES?
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XT107

During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?)

DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY RECOGNIZINGFAMILY MEMBERS OR GOOD FRIENDS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?)
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As CNT goes from 1 to 8  »
 
   
 
If ((CNT < 3) or (CNT > 5)) or (XT105 <> 1) »
 
     
   
XT018

Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)?

HAS [{NAME OF THE DECEASED}] HAD ANY [CARE FROM A GENERAL PRACTITIONER/CARE FROM SPECIALIST PHYSICIANS/HOSPITAL STAYS/CARE IN A NURSING HOME/HOSPICESTAYS/MEDICATION/AIDS AND APPLIANCES/HOME CARE OR HOME HELP DUE TO DISABILITY] (IN THE LAST 12 MONTHS OF [HIS/HER] LIFE)?
expand
     
   
If Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)? = 1 Yes 5 No  »
 
       
     
XT019

About how much did [his/her] [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospice stays/medication/aidsand appliances/home care or home help due to disability] cost (in the last 12 months of [his/her] life)?

ABOUT HOW MUCH DID [HIS/HER] [CARE FROM A GENERAL PRACTITIONER/CARE FROM SPECIALIST PHYSICIANS/HOSPITAL STAYS/CARE IN A NURSING HOME/HOSPICE STAYS/MEDICATION/AIDSAND APPLIANCES/HOME CARE OR HOME HELP DUE TO DISABILITY] COST (IN THE LAST 12 MONTHS OF [HIS/HER] LIFE)?
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XT105

We would lik e to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months?

WE WOULD LIK E TO K NOW MORE ABOUT THE DIFFICULTIES PEOPLE HAVE IN THEIR LAST YEAR OF LIFE BECAUSE OF A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY PROBLEMS. DURING THE LAST YEAR OF[HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY REMEMBERING WHERE [HE/SHE] WAS? PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?
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XT106

During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty rememberingwhat year it was? (Please name only difficulties that lasted at least three months?)

DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY REMEMBERINGWHAT YEAR IT WAS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?)
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XT107

During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?)

DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY RECOGNIZINGFAMILY MEMBERS OR GOOD FRIENDS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?)
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XT020

Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months.

BECAUSE OF A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY PROBLEM, DID [{NAME OF THE DECEASED}] HAVE DIFFICULTY DOING ANY OF THE FOLLOWING ACTIVITIES DURING THE LAST TWELVE MONTHSOF [HIS/HER] LIFE? PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS.
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If (Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months. > 0) and NOT (96 includes XT020) »
 
   
 
XT022

Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities?

THINK ING ABOUT THE ACTIVITIES THAT THE DECEASED HAD PROBLEMS WITH DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, HAS ANYONE HELPED REGULARLY WITH THESE ACTIVITIES?
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If Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities? = 1 Yes 5 No  »
 
     
   
XT023

Who, including yourself, has helped mainly with these activities? Please name at most three persons.

WHO, INCLUDING YOURSELF, HAS HELPED MAINLY WITH THESE ACTIVITIES? PLEASE NAME AT MOST THREE PERSONS.
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XT024

Overall, during the last twelve months of [his/her] life, for how long did the deceased receive help?

OVERALL, DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, FOR HOW LONG DID THE DECEASED RECEIVE HELP?
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XT025

And about how many hours of help were necessary during a typical day?

AND ABOUT HOW MANY HOURS OF HELP WERE NECESSARY DURING A TYPICAL DAY?
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XT026A

The next questions are about the assets and life insurance policies the deceased may have owned and what happened to those assets after [{Name of the deceased}] died.I appreciate that this may upset or distress you, but we would find it very helpful to have some information about the financial issues surrounding death. Before I continue,though, I'd lik e to assure you again that everything you have already told me and anything else you tell me will be k ept completely confidential.

THE NEXT QUESTIONS ARE ABOUT THE ASSETS AND LIFE INSURANCE POLICIES THE DECEASED MAY HAVE OWNED AND WHAT HAPPENED TO THOSE ASSETS AFTER [{NAME OF THE DECEASED}] DIED.I APPRECIATE THAT THIS MAY UPSET OR DISTRESS YOU, BUT WE WOULD FIND IT VERY HELPFUL TO HAVE SOME INFORMATION ABOUT THE FINANCIAL ISSUES SURROUNDING DEATH. BEFORE I CONTINUE,THOUGH, I'D LIK E TO ASSURE YOU AGAIN THAT EVERYTHING YOU HAVE ALREADY TOLD ME AND ANYTHING ELSE YOU TELL ME WILL BE K EPT COMPLETELY CONFIDENTIAL.
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XT026B

Some people mak e a will to determine who receives what parts of the estate.Did [{Name of the deceased}] have a will?

SOME PEOPLE MAK E A WILL TO DETERMINE WHO RECEIVES WHAT PARTS OF THE ESTATE.DID [{NAME OF THE DECEASED}] HAVE A WILL?
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XT027

Who were the beneficiaries of the estate, including yourself?

WHO WERE THE BENEFICIARIES OF THE ESTATE, INCLUDING YOURSELF?
expand
 
If 6 includes XT027 »
 
   
 
XT028

IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE
   
If 7 includes XT027 »
 
   
 
XT029

IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE
   
XT030

Did the deceased own [his/her] home or apartment - either in total or a share of it?

DID THE DECEASED OWN [HIS/HER] HOME OR APARTMENT - EITHER IN TOTAL OR A SHARE OF IT?
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If Did the deceased own [his/her] home or apartment - either in total or a share of it? = 1 Yes 5 No  »
 
   
 
XT031

After any outstanding mortgages, what was the value of the home or apartment or the share of it owned by the deceased?

AFTER ANY OUTSTANDING MORTGAGES, WHAT WAS THE VALUE OF THE HOME OR APARTMENT OR THE SHARE OF IT OWNED BY THE DECEASED?
expand
   
 
XT032

Who inherited the deceased's home or apartment, including yourself?

WHO INHERITED THE DECEASED'S HOME OR APARTMENT, INCLUDING YOURSELF?
IWER:CODE RELATIONSHIP TO DECEASED.
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If 6 includes XT032 »
 
     
   
XT051

IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE
     
 
If 7 includes XT032 »
 
     
   
XT052

IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE
     
 
If 3 includes XT032 »
 
     
   
XT053

IWER:First names of children who inherited home

IWER:FIRST NAMES OF CHILDREN WHO INHERITED HOME
     
XT033

Did the deceased own any life insurance policies?

DID THE DECEASED OWN ANY LIFE INSURANCE POLICIES?
expand
 
If Did the deceased own any life insurance policies? = 1 Yes 5 No  »
 
   
 
XT034

In total, about what was the value of all life insurance policies owned by the deceased?

IN TOTAL, ABOUT WHAT WAS THE VALUE OF ALL LIFE INSURANCE POLICIES OWNED BY THE DECEASED?
expand
   
 
XT035

Who were the beneficiaries of the life insurance polices, including yourself.

WHO WERE THE BENEFICIARIES OF THE LIFE INSURANCE POLICES, INCLUDING YOURSELF.
expand
   
 
If 6 includes XT035 »
 
     
   
XT054

IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE
     
 
If 7 includes XT035 »
 
     
   
XT055

IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE
     
 
If 3 includes XT035 »
 
     
   
XT056

IWER:First names of children who were beneficiaries

IWER:FIRST NAMES OF CHILDREN WHO WERE BENEFICIARIES
     
XT036

I will now read out a few types of assets people may have. For each item, please tell me whether the deceased owned them at the time of [his/her] death and, if so, pleasegive your best estimate of their value after any outstanding debts.

I WILL NOW READ OUT A FEW TYPES OF ASSETS PEOPLE MAY HAVE. FOR EACH ITEM, PLEASE TELL ME WHETHER THE DECEASED OWNED THEM AT THE TIME OF [HIS/HER] DEATH AND, IF SO, PLEASEGIVE YOUR BEST ESTIMATE OF THEIR VALUE AFTER ANY OUTSTANDING DEBTS.
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As CNT goes from 1 to 5  »
 
   
 
XT037

Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]?

DID [HE/SHE] OWN ANY [BUSINESSES, INCLUDING LAND OR PREMISES/OTHER REAL ESTATE/CARS/FINANCIAL ASSETS, E.G. CASH, BONDS OR STOCK S/JEWELRY OR ANTIQUITIES]?
expand
   
 
If Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]? = 1 Yes 5 No  »
 
     
   
XT038

About what was the value of the [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities] ownedby [{Name of the deceased}] at the time of [his/her] death?

ABOUT WHAT WAS THE VALUE OF THE [BUSINESSES, INCLUDING LAND OR PREMISES/OTHER REAL ESTATE/CARS/FINANCIAL ASSETS, E.G. CASH, BONDS OR STOCK S/JEWELRY OR ANTIQUITIES] OWNEDBY [{NAME OF THE DECEASED}] AT THE TIME OF [HIS/HER] DEATH?
expand
     
If (How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children. > 1) and NOT (9 includes XT027) »
 
   
 
XT040A
   
 
If XT040A = 1 »
 
     
   
XT040B

Would you say that some children received more than others to mak e up for previous gifts?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS TO MAK E UP FOR PREVIOUS GIFTS?
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XT040C

Would you say that some children received more than others to give them financial support?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS TO GIVE THEM FINANCIAL SUPPORT?
expand
     
   
XT040D

Would you say that some children received more than others because they helped or cared for the deceased towards the end of [his/her] life?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS BECAUSE THEY HELPED OR CARED FOR THE DECEASED TOWARDS THE END OF [HIS/HER] LIFE?
expand
     
   
XT040E

Would you say that some children received more than others because of other reasons?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS BECAUSE OF OTHER REASONS?
expand
     
   
If Would you say that some children received more than others because of other reasons? = 1 Yes 5 No  »
 
       
     
XT040F

What other reasons do you mean?

WHAT OTHER REASONS DO YOU MEAN?
       
XT041

Finally, we would lik e to k now about the deceased's funeral. Was the funeral accompanied by a religious ceremony?

FINALLY, WE WOULD LIK E TO K NOW ABOUT THE DECEASED'S FUNERAL. WAS THE FUNERAL ACCOMPANIED BY A RELIGIOUS CEREMONY?
expand
 
XT108

We have ask ed you many questions about numerous aspects of [{Name of the deceased}]'s health and finances, and we want to thank you very much for your assistancewith them. Is there anything else you would lik e to add about the life circumstances of [{Name of the deceased}] in [his/her] last year of life?

WE HAVE ASK ED YOU MANY QUESTIONS ABOUT NUMEROUS ASPECTS OF [{NAME OF THE DECEASED}]'S HEALTH AND FINANCES, AND WE WANT TO THANK YOU VERY MUCH FOR YOUR ASSISTANCEWITH THEM. IS THERE ANYTHING ELSE YOU WOULD LIK E TO ADD ABOUT THE LIFE CIRCUMSTANCES OF [{NAME OF THE DECEASED}] IN [HIS/HER] LAST YEAR OF LIFE?
 
XT042

This is the end of the interview. Thank you once again for all the information you have given us. It will prove extremely useful in helping us to understand how people fare atthe end of their lives

THIS IS THE END OF THE INTERVIEW. THANK YOU ONCE AGAIN FOR ALL THE INFORMATION YOU HAVE GIVEN US. IT WILL PROVE EXTREMELY USEFUL IN HELPING US TO UNDERSTAND HOW PEOPLE FARE ATTHE END OF THEIR LIVES
expand
 
XT043

IWER:Please state mode of interview

IWER:PLEASE STATE MODE OF INTERVIEW
expand
 
XT044

IWER:Your interviewer id.

IWER:YOUR INTERVIEWER ID.
 
End of XT. End-of-Life Interview
Start of XT. End-of-Life Interview

========================================================================
XT104
IWER:note sex of decedent (ask if unsure)

IWER:NOTE SEX OF DECEDENT (ASK IF UNSURE)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Male
2 Female


========================================================================
XT001
[{Name of the deceased}] has participated in the SHARE study before [his/her] death. [His/Her] contribution was very valuable. We would find it extremely helpful to havesome information about the final year of [{Name of the deceased}]'s life. All the information collected is strictly confidential, and will be held anonymously.

[{NAME OF THE DECEASED}] HAS PARTICIPATED IN THE SHARE STUDY BEFORE [HIS/HER] DEATH. [HIS/HER] CONTRIBUTION WAS VERY VALUABLE. WE WOULD FIND IT EXTREMELY HELPFUL TO HAVESOME INFORMATION ABOUT THE FINAL YEAR OF [{NAME OF THE DECEASED}]'S LIFE. ALL THE INFORMATION COLLECTED IS STRICTLY CONFIDENTIAL, AND WILL BE HELD ANONYMOUSLY.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Continue


========================================================================
XT006
IWER:Code proxy respondent's sex.

IWER:CODE PROXY RESPONDENT'S SEX.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Male
2 Female


========================================================================
XT002
Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased?

BEFORE WE START ASK ING QUESTIONS ABOUT THE LAST YEAR OF LIFE OF [{NAME OF THE DECEASED}], WOULD YOU PLEASE TELL ME WHAT WAS YOUR RELATIONSHIP TO THE DECEASED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Husband or wife or partner
2 Son or Daughter
3 Son- or Daughter-in-law
4 Son or Daughter of husband, wife or partner
5 Grandchild
6 Sibling
7 Other relative (specify)
8 Other non-relative (specify)


If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? (XT002) = 7 »

|  ========================================================================
XT003
IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE

If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? (XT002) = 8 »

|  ========================================================================
XT004
IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE

========================================================================
XT005
During the last twelve months of [his/her] life, how often did you have contact with [{Name of the deceased}], either personally, by phone, mail, email, or any other electronicmeans?

DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, HOW OFTEN DID YOU HAVE CONTACT WITH [{NAME OF THE DECEASED}], EITHER PERSONALLY, BY PHONE, MAIL, EMAIL, OR ANY OTHER ELECTRONICMEANS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Daily
2 Several times a week
3 About once a week
4 About every two weeks
5 About once a month
6 Less than once a month
7 Never


If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? (XT002) <> 1 Husband or wife or partner 2 Son or Daughter 3 Son- or Daughter-in-law 4 Son or Daughter of husband, wife or partner 5 Grandchild 6 Sibling 7 Other relative (specify) 8 Other non-relative (specify)  »

|  ========================================================================
XT007
Can you tell me your year of birth?

CAN YOU TELL ME YOUR YEAR OF BIRTH?
- - - - - - - - - - - - - - - - - - - - - - - - -
1900..1992


========================================================================
XT101
Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]?

LET US NOW TALK ABOUT THE DECEASED. JUST TO MAK E SURE THAT WE HAVE THE CORRECT INFORMATION ABOUT [{NAME OF THE DECEASED}], CAN I JUST CONFIRM THAT [HE/SHE] WAS BORN IN[{MONTH AND YEAR BIRTH OF DECEASED}]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


If Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]? (XT101) = 5 »

|  ========================================================================
XT102
In which month and year was [{Name of the deceased}] born?@bMONTH@b:YEAR:

IN WHICH MONTH AND YEAR WAS [{NAME OF THE DECEASED}] BORN?@BMONTH@B:YEAR:
- - - - - - - - - - - - - - - - - - - - - - - - -
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December


|  ========================================================================
XT103
In which month and year were [{Name of the deceased}] born?MONTH: ^XT102_DecMonthBirth@bYEAR@b:

IN WHICH MONTH AND YEAR WERE [{NAME OF THE DECEASED}] BORN?MONTH: ______@BYEAR@B:
- - - - - - - - - - - - - - - - - - - - - - - - -
1900..2008


========================================================================
XT008
We would lik e to k now more about the circumstances of [{Name of the deceased}] 's death. In what @bmonth@b and year did [he/she] pass away?@bMONTH@b:YEAR:

WE WOULD LIK E TO K NOW MORE ABOUT THE CIRCUMSTANCES OF [{NAME OF THE DECEASED}] 'S DEATH. IN WHAT @BMONTH@B AND YEAR DID [HE/SHE] PASS AWAY?@BMONTH@B:YEAR:
- - - - - - - - - - - - - - - - - - - - - - - - -
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December


========================================================================
XT009
In what month and @bYEAR@b did [he/she] pass away?MONTH: ^XT008_MonthDied@bYEAR@b:

IN WHAT MONTH AND @BYEAR@B DID [HE/SHE] PASS AWAY?MONTH: ______@BYEAR@B:
- - - - - - - - - - - - - - - - - - - - - - - - -
1 2006
2 2007
3 2008
4 2009
5 2010
6 2011
7 2012
8 2013


========================================================================
XT010
How old was [{Name of the deceased}] when [he/she] passed away?

HOW OLD WAS [{NAME OF THE DECEASED}] WHEN [HE/SHE] PASSED AWAY?
- - - - - - - - - - - - - - - - - - - - - - - - -
20..120


========================================================================
XT109
Was [{Name of the deceased}] married at the time of [his/her] death?

WAS [{NAME OF THE DECEASED}] MARRIED AT THE TIME OF [HIS/HER] DEATH?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


========================================================================
XT039
How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children.

HOW MANY CHILDREN DID [{NAME OF THE DECEASED}] HAVE THAT WERE STILL ALIVE AT THE TIME OF [HIS/HER] DEATH? PLEASE INCLUDE FOSTER AND ADOPTED CHILDREN.

========================================================================
XT011
What was the main cause of [his/her] death?

WHAT WAS THE MAIN CAUSE OF [HIS/HER] DEATH?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Cancer
2 A heart attack
3 A stroke
4 Other cardiovascular related illness such as heart failure, arrhythmia
5 Respiratory disease
6 Disease of the digestive system such as gastrointestinal ulcer, inflammatory bowel disease
7 Severe infectious disease such as pneumonia, septicemia or flu
8 Accident
97 Other (Please specify)


If What was the main cause of [his/her] death? (XT011) = 97 »

|  ========================================================================
XT012
IWER:Specify other cause of death

IWER:SPECIFY OTHER CAUSE OF DEATH

If What was the main cause of [his/her] death? (XT011) = 8 »

|  ========================================================================
XT013
How long had [{Name of the deceased}] been ill before [he/she] died?

HOW LONG HAD [{NAME OF THE DECEASED}] BEEN ILL BEFORE [HE/SHE] DIED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Less than one month
2 One month or more but less than 6 months
3 6 months or more but less than a year
4 One year or more


|  ========================================================================
XT014
Did [he/she] die ...

DID [HE/SHE] DIE ...
- - - - - - - - - - - - - - - - - - - - - - - - -
1 at______
2 at another person
3 in a hospital
4 in a nursing home
5 in a residential home or sheltered housing
6 in a hospice
97 at some other place (Please specify)


If Did [he/she] die ... (XT014) = 97 »

| |  ========================================================================
| | 
XT045
IWER:Specify other place of death

IWER:SPECIFY OTHER PLACE OF DEATH

|  ========================================================================
XT015
In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home?

IN THE LAST YEAR BEFORE [HE/SHE] DIED, ON HOW MANY DIFFERENT OCCASIONS DID [{NAME OF THE DECEASED}] STAY IN A HOSPITAL, HOSPICE OR NURSING HOME?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Not at all
2 1 to 2 times
3 3 to 5 times
4 More than 5 times


If In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home? (XT015) > 1 Not at all 2 1 to 2 times 3 3 to 5 times 4 More than 5 times  »

| |  ========================================================================
| | 
XT016
During the last year of [his/her] life, for how long altogether did [{Name of the deceased}] stay at hospitals, hospices or nursing homes?

DURING THE LAST YEAR OF [HIS/HER] LIFE, FOR HOW LONG ALTOGETHER DID [{NAME OF THE DECEASED}] STAY AT HOSPITALS, HOSPICES OR NURSING HOMES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Less than one week
2 One week or more but less than one month
3 One month or more but less than 3 months
4 3 months or more but less than 6 months
5 6 months or more but less than a year
6 A full year


========================================================================
XT107
During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?)

DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY RECOGNIZINGFAMILY MEMBERS OR GOOD FRIENDS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


As CNT goes from 1 to 8  » »

If (CNT < 3) or (CNT > 5)) or (We would lik e to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months? (XT105) <> 1 Yes 5 No ) »

| |  ========================================================================
| | 
XT018
Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)?

HAS [{NAME OF THE DECEASED}] HAD ANY [CARE FROM A GENERAL PRACTITIONER/CARE FROM SPECIALIST PHYSICIANS/HOSPITAL STAYS/CARE IN A NURSING HOME/HOSPICESTAYS/MEDICATION/AIDS AND APPLIANCES/HOME CARE OR HOME HELP DUE TO DISABILITY] (IN THE LAST 12 MONTHS OF [HIS/HER] LIFE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| |  If Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)? (XT018) = 1 Yes 5 No  »

| | |  ========================================================================
| | | 
XT019
About how much did [his/her] [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospice stays/medication/aidsand appliances/home care or home help due to disability] cost (in the last 12 months of [his/her] life)?

ABOUT HOW MUCH DID [HIS/HER] [CARE FROM A GENERAL PRACTITIONER/CARE FROM SPECIALIST PHYSICIANS/HOSPITAL STAYS/CARE IN A NURSING HOME/HOSPICE STAYS/MEDICATION/AIDSAND APPLIANCES/HOME CARE OR HOME HELP DUE TO DISABILITY] COST (IN THE LAST 12 MONTHS OF [HIS/HER] LIFE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
0..980000


========================================================================
XT105
We would lik e to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months?

WE WOULD LIK E TO K NOW MORE ABOUT THE DIFFICULTIES PEOPLE HAVE IN THEIR LAST YEAR OF LIFE BECAUSE OF A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY PROBLEMS. DURING THE LAST YEAR OF[HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY REMEMBERING WHERE [HE/SHE] WAS? PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


========================================================================
XT106
During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty rememberingwhat year it was? (Please name only difficulties that lasted at least three months?)

DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY REMEMBERINGWHAT YEAR IT WAS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


========================================================================
XT107
During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?)

DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY RECOGNIZINGFAMILY MEMBERS OR GOOD FRIENDS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


========================================================================
XT020
Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months.

BECAUSE OF A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY PROBLEM, DID [{NAME OF THE DECEASED}] HAVE DIFFICULTY DOING ANY OF THE FOLLOWING ACTIVITIES DURING THE LAST TWELVE MONTHSOF [HIS/HER] LIFE? PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Dressing, including putting on shoes and socks
2 Walking across a room
3 Bathing or showering
4 Eating, such as cutting up your food
5 Getting in or out of bed
6 Using the toilet, including getting up or down
96 None of these


If (Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months. (XT020) > 0) and NOT (96 IN XT020) »

|  ========================================================================
XT022
Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities?

THINK ING ABOUT THE ACTIVITIES THAT THE DECEASED HAD PROBLEMS WITH DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, HAS ANYONE HELPED REGULARLY WITH THESE ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


If Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities? (XT022) = 1 Yes 5 No  »

| |  ========================================================================
| | 
XT023
Who, including yourself, has helped mainly with these activities? Please name at most three persons.

WHO, INCLUDING YOURSELF, HAS HELPED MAINLY WITH THESE ACTIVITIES? PLEASE NAME AT MOST THREE PERSONS.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy respondent)
2 Husband or wife or partner of the deceased
3 Mother or father of the deceased
4 Son of the deceased
5 Son-in-law of the deceased
6 Daughter of the deceased
7 Daughter-in-law of the deceased
8 Grandson of the deceased
9 Granddaughter of the deceased
10 Sister of the deceased
11 Brother of the deceased
12 Other relative
13 Unpaid volunteer
14 Professional helper (e.g. nurse)
15 Friend or neighbor of the deceased
16 Other person


| |  ========================================================================
| | 
XT024
Overall, during the last twelve months of [his/her] life, for how long did the deceased receive help?

OVERALL, DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, FOR HOW LONG DID THE DECEASED RECEIVE HELP?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Less than one month
2 One month or more but less than 3 months
3 3 months or more but less than 6 months
4 6 months or more but less than a year
5 A full year


| |  ========================================================================
| | 
XT025
And about how many hours of help were necessary during a typical day?

AND ABOUT HOW MANY HOURS OF HELP WERE NECESSARY DURING A TYPICAL DAY?
- - - - - - - - - - - - - - - - - - - - - - - - -
0..24


========================================================================
XT026A
The next questions are about the assets and life insurance policies the deceased may have owned and what happened to those assets after [{Name of the deceased}] died.I appreciate that this may upset or distress you, but we would find it very helpful to have some information about the financial issues surrounding death. Before I continue,though, I'd lik e to assure you again that everything you have already told me and anything else you tell me will be k ept completely confidential.

THE NEXT QUESTIONS ARE ABOUT THE ASSETS AND LIFE INSURANCE POLICIES THE DECEASED MAY HAVE OWNED AND WHAT HAPPENED TO THOSE ASSETS AFTER [{NAME OF THE DECEASED}] DIED.I APPRECIATE THAT THIS MAY UPSET OR DISTRESS YOU, BUT WE WOULD FIND IT VERY HELPFUL TO HAVE SOME INFORMATION ABOUT THE FINANCIAL ISSUES SURROUNDING DEATH. BEFORE I CONTINUE,THOUGH, I'D LIK E TO ASSURE YOU AGAIN THAT EVERYTHING YOU HAVE ALREADY TOLD ME AND ANYTHING ELSE YOU TELL ME WILL BE K EPT COMPLETELY CONFIDENTIAL.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Continue


========================================================================
XT026B
Some people mak e a will to determine who receives what parts of the estate.Did [{Name of the deceased}] have a will?

SOME PEOPLE MAK E A WILL TO DETERMINE WHO RECEIVES WHAT PARTS OF THE ESTATE.DID [{NAME OF THE DECEASED}] HAVE A WILL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


========================================================================
XT027
Who were the beneficiaries of the estate, including yourself?

WHO WERE THE BENEFICIARIES OF THE ESTATE, INCLUDING YOURSELF?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy)
2 Husband or wife or partner of the deceased
3 Children of the deceased
4 Grandchildren of the deceased
5 Siblings of the deceased
6 Other relatives (specify) of the deceased
7 Other non-relatives (specify)
8 Church, foundation or charitable organization
9 Deceased did not leave anything at all (SPONTANEOUS)


If 6 IN XT027 »

|  ========================================================================
XT028
IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE

If 7 IN XT027 »

|  ========================================================================
XT029
IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE

========================================================================
XT030
Did the deceased own [his/her] home or apartment - either in total or a share of it?

DID THE DECEASED OWN [HIS/HER] HOME OR APARTMENT - EITHER IN TOTAL OR A SHARE OF IT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


If Did the deceased own [his/her] home or apartment - either in total or a share of it? (XT030) = 1 Yes 5 No  »

|  ========================================================================
XT031
After any outstanding mortgages, what was the value of the home or apartment or the share of it owned by the deceased?

AFTER ANY OUTSTANDING MORTGAGES, WHAT WAS THE VALUE OF THE HOME OR APARTMENT OR THE SHARE OF IT OWNED BY THE DECEASED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy respondent)
2 Husband or wife or partner
3 Sons or daughters (ASK FOR FIRST NAMES)
4 Grandchildren
5 Siblings
6 Other relatives (specify)
7 Other non-relatives (specify)


|  ========================================================================
XT032
Who inherited the deceased's home or apartment, including yourself?

WHO INHERITED THE DECEASED'S HOME OR APARTMENT, INCLUDING YOURSELF?
IWER:CODE RELATIONSHIP TO DECEASED.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy respondent)
2 Husband or wife or partner
3 Sons or daughters (ASK FOR FIRST NAMES)
4 Grandchildren
5 Siblings
6 Other relatives (specify)
7 Other non-relatives (specify)

If 6 IN XT032 »

| |  ========================================================================
| | 
XT051
IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE

If 7 IN XT032 »

| |  ========================================================================
| | 
XT052
IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE

If 3 IN XT032 »

| |  ========================================================================
| | 
XT053
IWER:First names of children who inherited home

IWER:FIRST NAMES OF CHILDREN WHO INHERITED HOME

========================================================================
XT033
Did the deceased own any life insurance policies?

DID THE DECEASED OWN ANY LIFE INSURANCE POLICIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


If Did the deceased own any life insurance policies? (XT033) = 1 Yes 5 No  »

|  ========================================================================
XT034
In total, about what was the value of all life insurance policies owned by the deceased?

IN TOTAL, ABOUT WHAT WAS THE VALUE OF ALL LIFE INSURANCE POLICIES OWNED BY THE DECEASED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1000..50000000


|  ========================================================================
XT035
Who were the beneficiaries of the life insurance polices, including yourself.

WHO WERE THE BENEFICIARIES OF THE LIFE INSURANCE POLICES, INCLUDING YOURSELF.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy respondent)
2 Husband or wife or partner
3 Sons or daughters (ASK FOR FIRST NAMES)
4 Grandchildren
5 Siblings
6 Other relatives (specify)
7 Other non-relatives (specify)


If 6 IN XT035 »

| |  ========================================================================
| | 
XT054
IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE

If 7 IN XT035 »

| |  ========================================================================
| | 
XT055
IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE

If 3 IN XT035 »

| |  ========================================================================
| | 
XT056
IWER:First names of children who were beneficiaries

IWER:FIRST NAMES OF CHILDREN WHO WERE BENEFICIARIES

========================================================================
XT036
I will now read out a few types of assets people may have. For each item, please tell me whether the deceased owned them at the time of [his/her] death and, if so, pleasegive your best estimate of their value after any outstanding debts.

I WILL NOW READ OUT A FEW TYPES OF ASSETS PEOPLE MAY HAVE. FOR EACH ITEM, PLEASE TELL ME WHETHER THE DECEASED OWNED THEM AT THE TIME OF [HIS/HER] DEATH AND, IF SO, PLEASEGIVE YOUR BEST ESTIMATE OF THEIR VALUE AFTER ANY OUTSTANDING DEBTS.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Continue


As CNT goes from 1 to 5  » »

|  ========================================================================
XT037
Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]?

DID [HE/SHE] OWN ANY [BUSINESSES, INCLUDING LAND OR PREMISES/OTHER REAL ESTATE/CARS/FINANCIAL ASSETS, E.G. CASH, BONDS OR STOCK S/JEWELRY OR ANTIQUITIES]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


If Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]? (XT037) = 1 Yes 5 No  »

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XT038
About what was the value of the [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities] ownedby [{Name of the deceased}] at the time of [his/her] death?

ABOUT WHAT WAS THE VALUE OF THE [BUSINESSES, INCLUDING LAND OR PREMISES/OTHER REAL ESTATE/CARS/FINANCIAL ASSETS, E.G. CASH, BONDS OR STOCK S/JEWELRY OR ANTIQUITIES] OWNEDBY [{NAME OF THE DECEASED}] AT THE TIME OF [HIS/HER] DEATH?
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1 Some children received more than others
2 The estate was divided about equally among all children
3 The estate was distributed exactly among the children
4 The children have not received anything


If (How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children. (XT039) > 1) and NOT (9 IN XT027) »

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XT040A
XT040A

If XT040A = 1 »

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XT040B
Would you say that some children received more than others to mak e up for previous gifts?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS TO MAK E UP FOR PREVIOUS GIFTS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


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XT040C
Would you say that some children received more than others to give them financial support?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS TO GIVE THEM FINANCIAL SUPPORT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


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XT040D
Would you say that some children received more than others because they helped or cared for the deceased towards the end of [his/her] life?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS BECAUSE THEY HELPED OR CARED FOR THE DECEASED TOWARDS THE END OF [HIS/HER] LIFE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


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XT040E
Would you say that some children received more than others because of other reasons?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS BECAUSE OF OTHER REASONS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| |  If Would you say that some children received more than others because of other reasons? (XT040E) = 1 Yes 5 No  »

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XT040F
What other reasons do you mean?

WHAT OTHER REASONS DO YOU MEAN?

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XT041
Finally, we would lik e to k now about the deceased's funeral. Was the funeral accompanied by a religious ceremony?

FINALLY, WE WOULD LIK E TO K NOW ABOUT THE DECEASED'S FUNERAL. WAS THE FUNERAL ACCOMPANIED BY A RELIGIOUS CEREMONY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


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XT108
We have ask ed you many questions about numerous aspects of [{Name of the deceased}]'s health and finances, and we want to thank you very much for your assistancewith them. Is there anything else you would lik e to add about the life circumstances of [{Name of the deceased}] in [his/her] last year of life?

WE HAVE ASK ED YOU MANY QUESTIONS ABOUT NUMEROUS ASPECTS OF [{NAME OF THE DECEASED}]'S HEALTH AND FINANCES, AND WE WANT TO THANK YOU VERY MUCH FOR YOUR ASSISTANCEWITH THEM. IS THERE ANYTHING ELSE YOU WOULD LIK E TO ADD ABOUT THE LIFE CIRCUMSTANCES OF [{NAME OF THE DECEASED}] IN [HIS/HER] LAST YEAR OF LIFE?

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XT042
This is the end of the interview. Thank you once again for all the information you have given us. It will prove extremely useful in helping us to understand how people fare atthe end of their lives

THIS IS THE END OF THE INTERVIEW. THANK YOU ONCE AGAIN FOR ALL THE INFORMATION YOU HAVE GIVEN US. IT WILL PROVE EXTREMELY USEFUL IN HELPING US TO UNDERSTAND HOW PEOPLE FARE ATTHE END OF THEIR LIVES
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Continue


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XT043
IWER:Please state mode of interview

IWER:PLEASE STATE MODE OF INTERVIEW
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Face-to-face
2 Telephone


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XT044
IWER:Your interviewer id.

IWER:YOUR INTERVIEWER ID.

End of XT. End-of-Life Interview