Page 180 - QAP Manual 2020

NCI™ ADULT IN-PERSON SURVEY (IPS) 2020-21

BI-41 Has this person ever lived in an institutional setting for longer than a year (for example a
Developmental Center, nursing home or large ICF)? Check ALL THAT APPLY. This question is
asking whether the person has ever lived for at least 12 consecutive months in an institutional
setting.

□ 1. No
□ 2. State hospital or state developmental center for people with I/DD
□ 3. ICF, private
□ 4. Nursing home
□ 5. Other (such as children’s residential settings, psychiatric facility):
_______________________________________________________________
□ 99. Don’t know

BI-42 What amount of paid support does this person receive at home? (Include any paid support,
regardless of funding source.) Check ONE.

□ 1. 24-hour on-site support or supervision (people living with or being available in their home
during all hours that they are home)
□ 2. Daily on-site support (for a limited number of hours per day, not round-the-clock)

□ 3. Scheduled, less frequent than daily support
□ 4. As-needed visitation and phone contact
□ 5. None of the above
□ 99. Don’t know

Page 20 of 76