POMP : Archive

US Administration on Aging

PERFORMANCE OUTCOMES MEASURES PROJECT

Archive

Performance Measurement Surveys

Home-Based Services

Other

POMP Archive

National Survey

Conferences

Participants

Links

Project Overview

This archive provides a summary of the work of the past six years, including earlier versions of the performance measure questionnaires and their technical assistance materials. Here is a list of the performance measures developed.

Caregiver

POMP V (Year 2004)

Caregiver Assessment (Telephone) Survey (Version: June 3, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Caregiver Assessment (Mail) Survey (Version: June 9, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Service Definitions Card (Version: June 14, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Data Collection Overview (Version: June 9, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Implementation Instructions (Version: June 10, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sampling Procedures Report (Version: June 9, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sample List with Results (Version: June 10, 2004)
In Microsoft Excel or Adobe Acrobat (PDF)
Codebook for Caregiver (Version: September 20, 2004)
In Microsoft Word or Adobe Acrobat (PDF)

POMP IV (Year 2003)

Caregiver Satisfaction (Telephone) Survey (Version: April 15, 2003)
Caregiver Satisfaction (Mail) Survey (Version: April 21, 2003)
Data Collection Overview (Version: April 16, 2003)
Implementation Instructions (Version: April 15, 2003)
Service Definitions Card (Version: April 15, 2003)
Sampling Procedures Report (Version: April 22, 2003)
Sample List with Results (Version: April 15, 2003)
Coder Checklist for Caregiver Section (Version: April 25, 2003)
Caregiver Codebook (Version: April 25, 2003)

POMP III (Year 2002)

Caregiver Satisfaction Survey 2002 (Version: April 30, 2002)
Data Collection Summary (Version: May 2, 2002)
Implementation Instructions (Version: July 2, 2001)
Record of Contact (Version: May 2, 2002)

POMP II (Year 2001)

Caregiver Satisfaction Survey 2001 (Version: August 20, 2001)
Caregiver Data Collection Flyer (Version: July 2, 2001)
Caregiver Data Collection Script (Version: July 2, 2001)
Caregiver Logbook Example (Version: July 5, 2001)

POMP I (Year 2000)

Caregiver Satisfaction Survey 2000 (Version: September 14, 2000)
Caregiver Data Collection Flyer (Version: September 18, 2000)
Caregiver Data Collection Script (Version: September 18, 2000)
Caregiver Logbook Example (Version: July 10, 2000)

Case Management

POMP IV (Year 2003)

Case Management Survey: Client Module (Version: March 23, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Case Management Survey: Proxy Module (Version: March 23, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Case Management Survey: Program Administrator Module (Version: March 8, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Data Collection Overview (Version: March 25, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sampling Procedures Report (Version: March 23, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sample List with Results (Version: March 5, 2004)
In Microsoft Excel or Adobe Acrobat (PDF)
Codebook for Client/Proxy Module (Version: March 23, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Codebook for Program Administrator Module (Version: March 8, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Case Management Database (Version: April 5, 2004)

Demographics

POMP V (Year 2004)

Demographics Survey (Version: May 18, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Demographics Codebook (Version: May 18, 2004)
In Microsoft Word or Adobe Acrobat (PDF)

POMP IV (Year 2003)

Demographics Survey (Version: February 28, 2003)
Demographics Codebook (Version: March 20, 2003)
Demographics Coder Checklist (Version: March 12, 2003)

POMP II-III (Years 2001-2002)

Demographics Survey (Version: February 25, 2002)
In Microsoft Word or Adobe Acrobat (PDF)
Demographic Intake Form (Version: February 1, 2001)

Emotional Well-Being

POMP V (Year 2004)

Emotional Well-being Survey (Version: March 10, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Emotional Well-being Codebook (Version: March 10, 2004)
In Microsoft Word or Adobe Acrobat (PDF)

POMP IV (Year 2003)

Emotional Well-being Survey (Version: February 26, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Emotional Well-being Codebook (Version: March 20, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Emotional Well-being Coder Checklist (Version: March 17, 2003)
In Microsoft Word or Adobe Acrobat (PDF)

POMP I-III (Years 2000-2002)

Emotional Well-being Survey (Version: March 15, 2002)
In Microsoft Word or Adobe Acrobat (PDF)
Emotional Well-being Survey 2001 (Version: January 30, 2001)
Emotional Well-being Survey 2000 (Version: March 1, 2000)

Home Care Satisfaction

The HCSM was developed by Scott Miyake Geron at Boston University. There are several subscales of the HCSM, each focusing on satisfaction of a particular service. The Home Care Satisfaction Measure (HCSM) is copyrighted material, and is not to be reproduced or otherwise duplicated without the written permission of the copyright owner, Trustees of Boston University. Such permission for non-profit organizations and academic research purposes shall normally be given.

Homemaker Service (HCSM-HM13) Subscale Questionnaire
Home Health Aide Service (HCSM-HHA13) Subscale Questionnaire
Case Management Service (HCSM-CM13) Subscale Questionnaire
Home Delivered Meal Service (HCSM-MS11) Subscale Questionnaire
Grocery Service (HCSM-GS10) Subscale Questionnaire
Data Collection Summary (Version: November 20, 2002)
Client Information Sheet (Version: February 21, 2002)
Sampling Procedures Report (Version: July 15, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Sample List with Results (Version: July 15, 2003)
In Microsoft Excel or Adobe Acrobat (PDF)

Information and Assistance

POMP IV (Year 2003)

Information and Assistance Survey (Version: March 13, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Data Collection Overview (Version: March 13, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Implementation Instructions (Version: March 13, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Sampling Procedures Report (Version: March 13, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Logbook (a.k.a. Sample List) (Version: March 13, 2003)
In Microsoft Excel or Adobe Acrobat (PDF)
Interview Coder Checklist for I&A Section (Version: March 13, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Interview Coder Checklist for Demographics Section (Version: March 12, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Information and Assistance Codebook (Version: April 15, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Demographics Codebook (Version: March 20, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
I&A Database in Access 2002 (Version: May 7, 2003; Size: 5.5MB)

POMP III (Year 2002)

Information and Assistance Satisfaction Survey 2002 (Version: April 4, 2002)
Demographics Survey for 2002 (Version: February 25, 2002)
Data Collection Summary (Version: April 4, 2002)
Operator Instructions (Version: April 4, 2002)
Implementation Instructions (Version: April 4, 2002)
Daily Caller Logbook (Version: April 4, 2002)
Record of Contact (Version: April 4, 2002)

POMP II (Year 2001)

Information and Assistance Satisfaction Survey 2001 (Version: September 28, 2001)
I&A Data Collection Flyer (Version: September 24, 2001)
I&A Data Collection Script (Version: September 24, 2001)
I&A Operator Instructions (Version: September 24, 2001)
I&A Daily Caller Logbook Example (Version: September 24, 2001)
I&A Sample List Example (Version: September 24, 2001)

POMP I (Year 2000)

Information and Assistance Satisfaction Survey 2000 (Version: July 10, 2000)
I&A Demographics Intake Form (Version: August 1, 2000)
I&A Data Collection Flyer (Version: July 14, 2000)
I&A Data Collection Script (Version: July 14, 2000)
I&A Operator Instructions (Version: July 14, 2000)
I&A Daily Caller Logbook Example (Version: July 14, 2000)
I&A Sample List Example (Version: July 14, 2000)

Nutrition

POMP V (Year 2004)

Congregate Meals Survey: Core Module, Phone (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Congregate Meals Survey: Core Module, Self (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Congregate Meals Survey: Extended Module, Phone (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Congregate Meals Survey: Extended Module, Self (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Congregate Meals Survey: Satisfaction Module, Phone (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Congregate Meals Survey: Satisfaction Module, Self (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Data Collection Overview (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sampling Procedures Report (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sample List with Results (Version: April 15, 2004)
In Microsoft Excel or Adobe Acrobat (PDF)
Codebook for Congregate Meals (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Codebook for Congregate Meals: Satisfaction Module (Version: June 17, 2004)
In Microsoft Word or Adobe Acrobat (PDF)

Home Delivered Meals Survey: Core Module, Phone (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Home Delivered Meals Survey: Core Module, Self (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Home Delivered Meals Survey: Extended Module, Phone (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Home Delivered Meals Survey: Extended Module, Self (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Home Delivered Meals Survey: Satisfaction Module, Phone (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Home Delivered Meals Survey: Satisfaction Module, Self (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Data Collection Overview (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sampling Procedures Report (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sample List with Results (Version: April 15, 2004)
In Microsoft Excel or Adobe Acrobat (PDF)
Codebook for Home Delivered Meals (Version: April 19, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Codebook for Home Delivered Meals: Satisfaction Module (Version: April 15, 2004)
In Microsoft Word or Adobe Acrobat (PDF)

POMP IV (Year 2003)

Congregate Meals Survey 2003 (Version: April 18, 2003)
Nutrition Survey Data Collection Procedures (Version: April 3, 2003)
Sampling Procedures Report for Congregate Meals (Version: April 3, 2003)
Sample List with Results for Congregate Meals Survey (Version: April 3, 2003)
Congregate Meals Coder Checklist (Version: April 23, 2003)
Congregate Meals Codebook (Version: April 23, 2003)

Home Delivered Meals Survey 2003 (Version: April 18, 2003)
Nutrition Survey Data Collection Procedures (Version: April 3, 2003)
Sampling Procedures Report for Home Delivered Meals (Version: April 3, 2003)
Sample List with Results for Home Delivered Meals Survey (Version: April 3, 2003)
Home Delivered Meals Coder Checklist (Version: April 23, 2003)
Home Delivered Meals Codebook (Version: April 23, 2003)

Food Security Module 2003 (Version: May 6, 2003)
Food Security Module Codebook (Version: May 6, 2003)
Demographics Survey for 2003 (Version: February 28, 2003)
Demographics Codebook (Version: March 20, 2003)
Demographics Coder Checklist (Version: March 12, 2003)

POMP III (Year 2002)

Nutritional Risk Survey for Home Delivered Meals 2002 (Version: March 21, 2002)
Nutritional Risk Survey for Congregate Meals 2002 (Version: March 21, 2002)
Nutritional Risk Survey Overview (Version: March 21, 2002)
Nutritional Risk Survey Cover Sheet (Version: March 21, 2002)

POMP II (Year 2001)

Nutritional Outcome Survey 2001 (Version: January 30, 2001)
Nutritional Outcome Survey Data Collection Summary Flyer (Version: January 30, 2001)
Nutritional Outcome Survey Enrollment Instructions (Version: January 29, 2001)
Nutritional Outcome Survey Follow-up Instructions (Version: January 29, 2001)
Social Functioning Survey - Enrollment Version (Version: January 29, 2001)
Social Functioning Survey - Follow-up Version (Version: January 30, 2001)

POMP I (Year 2000)

Nutritional Risk Survey 2000 (Version: March 16, 2000)
NR Paper-Logbook (Optional)
Nutritional Risk Data Collection Summary Flyer (Version: March 15, 2000)
Nutritional Risk Enrollment Instructions (Version: March 22, 2000)
NR Client Data Form (Optional)
Nutritional Risk Data Collection Script (Version: March 15, 2000)
Nutritional Risk Data Collection Script with Emotional Well-being and Social Functioning Instructions (Version: March 15, 2000)
Social Functioning Survey for the Nutritional Risk Clients (Version: March 16, 2000)
Emotional Well-being Survey (Version: March 1, 2000)

Physical Functioning

POMP V (Year 2004)

Physical Functioning and Health Survey (Version: March 10, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Physical Functioning Codebook (Version: March 10, 2004)
In Microsoft Word or Adobe Acrobat (PDF)

POMP IV (Year 2003)

Physical Functioning and Health Survey (Version: February 26, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Physical Functioning Codebook (Version: March 20, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Physical Functioning Coder Checklist (Version: March 17, 2003)
In Microsoft Word or Adobe Acrobat (PDF)

POMP II-III (Years 2001-2002)

Physical Functioning and Health Survey 2002 (Version: February 5, 2002)
Physical Functioning Survey 2001 (Version: January 29, 2001)

Providers Survey

POMP VI (Year 2005)

Master Version: Providers of Home and Community-Based Services Survey for 2005 (Under Development)
Providers of Home and Community-Based Services Survey Codebook for 2005 (Under Development)

State of Arizona Version: Providers of Home and Community-Based Services Survey for 2005 (Version: October 11, 2005)

Senior Center Participant Survey

POMP V (Year 2004)

Senior Center Participant Survey: Core Questions (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Senior Center Participant Survey: Optional Questions (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Senior Center Descriptors Survey (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Instructions (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sample Design for Participant Survey (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Sampling Procedures Report (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Participant Sample List with Results (Version: June 30, 2004)
In Microsoft Excel or Adobe Acrobat (PDF)
Senior Center Sample List with Results (Version: June 30, 2004)
In Microsoft Excel or Adobe Acrobat (PDF)
Codebook for Senior Center Participant Survey: Core Questions (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Codebook for Senior Center Participant Survey: Optional Questions (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Codebook for Senior Center Descriptor Survey (Version: June 30, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Senior Center Database (August 29, 2004)

Service Recipients Survey

POMP VI (Year 2005)

Home and Community Service Recipients Survey (Version: June 15, 2005)
In Rich Text Format (RTF) or Adobe Acrobat (PDF)
Sampling Instructions (Version: July 5, 2005)
In Rich Text Format (RTF) or Adobe Acrobat (PDF)
Example of Client List Sorted by Case Mix Code (Version: June 27, 2005)
In Microsoft Excel or Adobe Acrobat (PDF)
Sampling Procedures Report (Version: July 7, 2005)
In Rich Text Format (RTF) or Adobe Acrobat (PDF)
Sample List - Interviewer Worksheet (Version: July 7, 2005)
In Microsoft Excel or Adobe Acrobat (PDF)
Results Reporting Form (Version: July 7, 2005)
In Microsoft Excel or Adobe Acrobat (PDF)
Codebook for Service Recipient (Version: June 22, 2005)
In Microsoft Word or Adobe Acrobat (PDF)
Database Installation Instructions (Version: June 23, 2005)
Service Recipients Data Entry and Reporting System (Version: June 28, 2005)

Social Functioning

POMP V (Year 2004)

Social Functioning Survey (Version: March 10, 2004)
In Microsoft Word or Adobe Acrobat (PDF)
Social Functioning Codebook (Version: March 10, 2004)
In Microsoft Word or Adobe Acrobat (PDF)

POMP IV (Year 2003)

Social Functioning Survey (Version: February 26, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Social Functioning Codebook (Version: March 20, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Social Functioning Coder Checklist (Version: March 17, 2003)
In Microsoft Word or Adobe Acrobat (PDF)

POMP I-III (Years 2000-2002)

Social Functioning Survey: Short Form (Version: January 29, 2001)
In Microsoft Word or Adobe Acrobat (PDF)
Social Functioning Survey: Long Form (Version: January 29, 2001)
In Microsoft Word or Adobe Acrobat (PDF)
Social Functioning Survey 2001 (Version: January 31, 2001)
Social Functioning Survey 2000 (Version: March 1, 2000)

Transportation

POMP IV (Year 2003)

Transportation Consumer Assessment (Telephone) Survey (Version: March 12, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Transportation Consumer Assessment (Mail) Survey (Version: March 24, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Data Collection Overview (Version: March 12, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Implementation Instructions (Version: March 12, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Sampling Procedures Report (Version: March 12, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Sample List with Results (Version: March 12, 2003)
In Microsoft Excel or Adobe Acrobat (PDF)
Interviewer Checklist for Transportation Section (Version: March 12, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Coder Checklist for Transportation Section (Version: March 12, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Interviewer/Coder Checklist for Demographics Section (Version: March 12, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Demographics Codebook (Version: March 20, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Transportation Codebook (Updated: April 2, 2003)
In Microsoft Word or Adobe Acrobat (PDF)
Transportation Database in Access 2002 (Version: April 21, 2003; Size: 5.5MB)

POMP III (Year 2002)

Transportation Satisfaction (Telephone) Survey (Version: April 24, 2002)
In Microsoft Word or Adobe Acrobat (PDF)
Transportation Satisfaction (Mail) Survey (Version: April 24, 2002)
In Microsoft Word or Adobe Acrobat (PDF)
Data Collection Summary (Version: April 18, 2002)
Implementation Instructions (Version: April 10, 2002)

POMP II (Year 2001)

Transportation Satisfaction (Phone) Survey (Version: May 7, 2001)
Transportation Satisfaction (Mail) Survey (Version: June 1, 2001)

POMP I (Year 2000)

Transportation Satisfaction Survey (Version: June 1, 2000)
Transportation Data Collection Flyer (Version: June 1, 2000)
Transportation Data Collection Script (Version: June 1, 2000)
Transportation Caller Logbook Example (Version: June 1, 2000)

Supporting Materials

Project Flyer (Version: Jan. 28, 2000)
Data Collection Overview (Version: Jan. 28, 2000)
Generating a Master Client List (Version: Jan. 28, 2000)
General Sampling Plan (Version: April 5, 2000)
Summary of 4 Step Sampling Process (Version: June 1, 2000)
Sample Size Calculator Instructions (Version: March 16, 2004)
Sample Size Calculator (Version: March 16, 2004)