C2. Functional limitations and helpers

Module C2. Functional limitations and helpers of survey KLoSAw5

item label type description
C201 Question Now I would like to know how much you [R's name] need someone to help you with very simple daily activities. Please give your response based on your activities over the past one week. If you are now receiving help with doing such activities due to an illness or injury but expect these are to be cured in less than three months, then answer that you don't need help. Let's start.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?
C202 Question Do you have difficulties in washing your face and hair and brushing your teeth? Do you need someone to help you with that?
C203 Question Do you have difficulties with bathing or showering (You may not scrub your back alone.)? Do you need someone to help you with that?
C204 Question Do you have difficulties with eating (You may use forks or other tools.)? Do you need someone to help you with that?
C205 Question 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?
C206 Question 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?
C207 Question 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?
C208 Question 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?
C209 Question Do you need someone to help you with doing housework, such as cleaning or tidying up the house, making bed and washing dishes?
C210 Question Do you need someone to help you with preparing meals? Preparing meals means preparing ingredients, cooking, and setting the table.
C211 Question 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?
C212 Question Do you need someone to help you with going out a short distance without using transportation? x
C213 Question Do you need someone to help you with going out using transportation, such as buses, subways, taxies, and cars?
C214 Question Do you need someone to help you with shopping, that is, deciding what to buy, paying money and getting change?
C215 Question Do you need someone to help you with managing money, such as managing small sums of pocket money, savings accounts and other assets?
C216 Question Do you need someone to help you with making or taking phone calls?
C217 Question Do you need someone to help you with taking medications, that is, taking the right portion of medication right on time?
C218 Question 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.
C219 Question How many days did [name selected in C218] help you during the past one month? (unit: a day)
C220 Question How many hours per day does [name selected in C218] usually help you? (unit: an hour) [IWER: less than an hour=1]
C221 Question Is [name selected in C218] paid to help you?
C222 Question How much did you pay [name selected in C218] in the past one month? (unit: 10,000 Korean won)
C223 Question 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 How much did you paid? C223b How much did your children, parents and other relatives pay? C223c How much did private health insurances pay? Total
C224 Question 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.
C225 Question [IWER: C2. FUNCTIONAL LIMITATIONS AND HELPERS ended. Please press 'save' botton.] How often did R receive assistance in answering section C2-FUNCTIONAL LIMITATIONS AND HELPERS?
C226 Question What is the proxy's relationship to R? If unknown, please ask the proxy. What is your relationship to R?
C223a Question Out-of-pocket payments
C223b Question Payments by relatives including children and parents
C223c Question Payments reimbursed by private health insurances
Start of C2. Functional limitations and helpers
 
C201

Now I would like to know how much you [R's name] need someone to help you with very simple daily activities. Please give your response based on your activities over the past one week. If you are now receiving help with doing such activities due to an illness or injury but expect these are to be cured in less than three months, then answer that you don't need help. Let's start.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?

NOW I WOULD LIKE TO KNOW HOW MUCH YOU [R'S NAME] NEED SOMEONE TO HELP YOU WITH VERY SIMPLE DAILY ACTIVITIES. PLEASE GIVE YOUR RESPONSE BASED ON YOUR ACTIVITIES OVER THE PAST ONE WEEK. IF YOU ARE NOW RECEIVING HELP WITH DOING SUCH ACTIVITIES DUE TO AN ILLNESS OR INJURY BUT EXPECT THESE ARE TO BE CURED IN LESS THAN THREE MONTHS, THEN ANSWER THAT YOU DON'T NEED HELP. LET'S START.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?
expand
 
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?
expand
 
C209

Do you need someone to help you with doing housework, such as cleaning or tidying up the house, making bed and washing dishes?

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

Do you need someone to help you with preparing meals? Preparing meals means preparing ingredients, cooking, and setting the table.

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

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? x

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?
expand
 
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?

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?

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 Now I would like to know how much you [R's name] need someone to help you with very simple daily activities. Please give your response based on your activities over the past one week. If you are now receiving help with doing such activities due to an illness or injury but expect these are to be cured in less than three months, then answer that you don't need help. Let's start.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 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you have difficulties with eating (You may use forks or other tools.)? Do you need someone to help you with that? != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with doing housework, such as cleaning or tidying up the house, making bed and washing dishes? != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with preparing meals? Preparing meals means preparing ingredients, cooking, and setting the table. != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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? != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with going out a short distance without using transportation? x != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with going out using transportation, such as buses, subways, taxies, and cars? != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with shopping, that is, deciding what to buy, paying money and getting change? != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect  »
 
   
 
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)

HOW MANY DAYS DID [NAME SELECTED IN C218] HELP YOU DURING THE PAST ONE MONTH? (UNIT: A DAY)
     
   
C220

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

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

HOW MUCH DID YOU PAY [NAME SELECTED IN C218] IN THE PAST ONE MONTH? (UNIT: 10,000 KOREAN WON)
     
   
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).
ITEMS AMOUNT
C223a How much did you paid? C223b How much did your children, parents and other relatives pay? C223c How much did private health insurances pay? Total
= 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).
ITEMS AMOUNT
C223a How much did you paid? C223b How much did your children, parents and other relatives pay? C223c How much did private health insurances pay? Total

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 HOW MUCH DID YOU PAID? C223B HOW MUCH DID YOUR CHILDREN, PARENTS AND OTHER RELATIVES PAY? C223C HOW MUCH DID PRIVATE HEALTH INSURANCES PAY? 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: C2. FUNCTIONAL LIMITATIONS AND HELPERS ended. Please press 'save' botton.] How often did R receive assistance in answering section C2-FUNCTIONAL LIMITATIONS AND HELPERS?

[IWER: C2. FUNCTIONAL LIMITATIONS AND HELPERS ENDED. PLEASE PRESS 'SAVE' BOTTON.] HOW OFTEN DID R RECEIVE ASSISTANCE IN ANSWERING SECTION C2-FUNCTIONAL LIMITATIONS AND HELPERS?
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If [IWER: C2. FUNCTIONAL LIMITATIONS AND HELPERS ended. Please press 'save' botton.] 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
Start of C2. Functional limitations and helpers

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C201
Now I would like to know how much you [R's name] need someone to help you with very simple daily activities. Please give your response based on your activities over the past one week. If you are now receiving help with doing such activities due to an illness or injury but expect these are to be cured in less than three months, then answer that you don't need help. Let's start.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?

NOW I WOULD LIKE TO KNOW HOW MUCH YOU [R'S NAME] NEED SOMEONE TO HELP YOU WITH VERY SIMPLE DAILY ACTIVITIES. PLEASE GIVE YOUR RESPONSE BASED ON YOUR ACTIVITIES OVER THE PAST ONE WEEK. IF YOU ARE NOW RECEIVING HELP WITH DOING SUCH ACTIVITIES DUE TO AN ILLNESS OR INJURY BUT EXPECT THESE ARE TO BE CURED IN LESS THAN THREE MONTHS, THEN ANSWER THAT YOU DON'T NEED HELP. LET'S START.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 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


========================================================================
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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


========================================================================
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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


========================================================================
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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


========================================================================
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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?

DO YOU NEED SOMEONE TO HELP YOU WITH DOING HOUSEWORK, SUCH AS CLEANING OR TIDYING UP THE HOUSE, MAKING BED AND WASHING DISHES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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.

DO YOU NEED SOMEONE TO HELP YOU WITH PREPARING MEALS? PREPARING MEALS MEANS PREPARING INGREDIENTS, COOKING, AND SETTING THE TABLE.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?

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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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C212
Do you need someone to help you with going out a short distance without using transportation? x

DO YOU NEED SOMEONE TO HELP YOU WITH GOING OUT A SHORT DISTANCE WITHOUT USING TRANSPORTATION? X
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?

DO YOU NEED SOMEONE TO HELP YOU WITH MANAGING MONEY, SUCH AS MANAGING SMALL SUMS OF POCKET MONEY, SAVINGS ACCOUNTS AND OTHER ASSETS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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C216
Do you need someone to help you with making or taking phone calls?

DO YOU NEED SOMEONE TO HELP YOU WITH MAKING OR TAKING PHONE CALLS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


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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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 No, I don't need any help
3 Yes, I need help to some extent
5 Yes, I need help in every respect


If Now I would like to know how much you [R's name] need someone to help you with very simple daily activities. Please give your response based on your activities over the past one week. If you are now receiving help with doing such activities due to an illness or injury but expect these are to be cured in less than three months, then answer that you don't need help. Let's start.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? (C201) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you have difficulties in washing your face and hair and brushing your teeth? Do you need someone to help you with that? (C202) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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? (C203) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you have difficulties with eating (You may use forks or other tools.)? Do you need someone to help you with that? (C204) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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? (C205) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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? (C206) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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? (C207) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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? (C208) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with doing housework, such as cleaning or tidying up the house, making bed and washing dishes? (C209) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with preparing meals? Preparing meals means preparing ingredients, cooking, and setting the table. (C210) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect 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? (C211) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with going out a short distance without using transportation? x (C212) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with going out using transportation, such as buses, subways, taxies, and cars? (C213) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect and Do you need someone to help you with shopping, that is, deciding what to buy, paying money and getting change? (C214) != 1 No, I don't need any help 3 Yes, I need help to some extent 5 Yes, I need help in every respect  »

As CNT goes from 1 to 5 THEN »

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| | 
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.
- - - - - - - - - - - - - - - - - - - - - - - - -
2 Spouse
3 Mother
4 Father
5 Mother-in-law
6 Father-in-law
47 Brother-in-law/sister-in-law
48 Son-in-law/sister-in-law
49 Grandchild
50 Other relatives


| | 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. (C218) = 56 »

| | | ========================================================================
| | | 
EXITFOR
EXITFOR

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| | 
C219
How many days did [name selected in C218] help you during the past one month? (unit: a day)

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

| | ========================================================================
| | 
C220
How many hours per day does [name selected in C218] usually help you? (unit: an hour) [IWER: less than an hour=1]

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

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| | 
C221
Is [name selected in C218] paid to help you?

IS [NAME SELECTED IN C218] PAID TO HELP YOU?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | If Is [name selected in C218] paid to help you? (C221) = 5 »

| | | ========================================================================
| | | 
EXITFOR
EXITFOR

| | ========================================================================
| | 
C222
How much did you pay [name selected in C218] in the past one month? (unit: 10,000 Korean won)

HOW MUCH DID YOU PAY [NAME SELECTED IN C218] IN THE PAST ONE MONTH? (UNIT: 10,000 KOREAN WON)

| | 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).
ITEMS AMOUNT
C223a How much did you paid? C223b How much did your children, parents and other relatives pay? C223c How much did private health insurances pay? Total
(C223) = C222 »


| | | ========================================================================
| | | 
EXITFOR
EXITFOR

If CNT != 1 »

| ========================================================================
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).
ITEMS AMOUNT
C223a How much did you paid? C223b How much did your children, parents and other relatives pay? C223c How much did private health insurances pay? Total


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 HOW MUCH DID YOU PAID? C223B HOW MUCH DID YOUR CHILDREN, PARENTS AND OTHER RELATIVES PAY? C223C HOW MUCH DID PRIVATE HEALTH INSURANCES PAY? TOTAL


========================================================================
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.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Spouse
2 Parents
3 Son
4 Daughter
5 Son-in-law/daughter-in-law
6 Sibling
7 Grandchildren
8 Others
9 Voluntary worker
10 Publicly provided helper
11 Personally hired helper
12 No helper


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C225
[IWER: C2. FUNCTIONAL LIMITATIONS AND HELPERS ended. Please press 'save' botton.] How often did R receive assistance in answering section C2-FUNCTIONAL LIMITATIONS AND HELPERS?

[IWER: C2. FUNCTIONAL LIMITATIONS AND HELPERS ENDED. PLEASE PRESS 'SAVE' BOTTON.] HOW OFTEN DID R RECEIVE ASSISTANCE IN ANSWERING SECTION C2-FUNCTIONAL LIMITATIONS AND HELPERS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Never
2 A few times
3 Most or all of the time
4 The section was done by a proxy respondent


If [IWER: C2. FUNCTIONAL LIMITATIONS AND HELPERS ended. Please press 'save' botton.] How often did R receive assistance in answering section C2-FUNCTIONAL LIMITATIONS AND HELPERS? (C225) = 4 »

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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?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Spouse
2 Mother
3 Father
4 Mother-in-law
5 Father-in-law
6 Brother/sister
7 Brother-in-law/sister-in-law
8 Son/daughter
9 Son-in-law/daughter-in-law
10 Grandchild
11 Other relatives
12 Helper or other non-relatives


End of C2. Functional limitations and helpers