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OCR for page 389
Glossary
Accredited Facility: a hospital accredited by the Joint
Commission on the Accreditation of Hospitals (JCAH) or
the American Osteopathic Association (AOA), or a SNF,
ICE, or HHA accredited by the JCAH.
Activities of Daily Living (ADL): basic self-care
activities, including eating, bathing, dressing,
transferring from bed to chair, bowel and bladder
control, and independent ambulation, which are widely
used as a basis for assessing individual functional
status.
Acute Care: medical care designed to treat or cure
disease or injury, usually within a limited time
period. Acute care usually refers to physician and/or
hospital services whose duration is less than 3 months.
Adult Day-Care: social and health services provided for
physically or mentally impaired individuals in a
nonresidential, day-care setting.
Aged: persons aged 65 and over.
Age-Specific Rate: the rate of occurrence of an event
(for example, death, marriage, birth, illness) for a
specified age group in a population.
Aging of the Population: the increasing proportion in the
total population of older (age 65 and over) relative to
younger (less than age 65) persons. It is generally
389
OCR for page 390
390 / GLOSSARY
measured in percentage distribution by age group, but
also measured in median age, the age at which 50 percent
of the population is older and 50 percent is younger.
A-Key Deficiencies: violations of certain Conditions of
Participation that were identified as being of primary
importance by the HCFA in 1981. Violations of these
conditions were, at that time, considered more serious
than the remaining, or B-level, deficiencies.
Allowable Costs: costs of operating a facility, which are
reimbursable by the state under the state Medicaid
program.
Alzheimer's Disease: the most common form of dementia, an
organic brain disease leading to progressive loss of
brain function and eventual death. The cause is unknown
and there is no effective standard medical treatment.
Annual Survey: the process of inspecting a health care
facility for compliance with state licensing regulations
and/or Federal Conditions and Standards of
Participation.
Assessment Technology: testing instruments or procedures
to measure and evaluate. In long-term care, instruments
or procedures used to measure the physical, mental, and
social functioning of individuals.
Assistive Device: a tool, prosthesis, or adaptive
equipment that helps an individual compensate for
certain functional impairments, such as a hearing aid
for hearing loss, glasses for vision loss, a cane to aid
walking, or a universal cuff for difficulty in eating.
Average Per Diem State Rates: the average amount spent by
a state for each Medicaid long-term-care resident each
day.
Bed-Fast, Bed-Bound: a condition in which one is confined
to bed and not able to walk, sit, or move about
independently.
Bed-to-Population Ratio: the number of beds certified fo
a specific health care service to every 1,000 persons in
the group intended to use the service. For example, the
number of SNF beds per 1,000 persons aged 65 and over.
OCR for page 391
GLOSSARY / 391
Board and Care Homes: nonmedical facilities that provide
room and board and some degree of protective supervision
on a 24-hour basis. Examples include adult foster
homes, group homes, larger residential care facilities,
and retirement homes.
Case Mix: the combination of diagnoses, medical care, and
social care needs present in the population of a health
care facility.
Case-Mix Payments: a reimbursement system based on the
principle that payment for services should take into
account the illness level of the resident. Each
resident is assessed at some standard time interval and
receives services appropriate to those determined
needs. The case mix model develops an average
patient profile for each facility. The state then pays
that average rate for all Medicaid residents in that
facility. The case mix system moole! establishes a
rate for each patient which is determined at each
assessment.
Categorically Needy: under Medicaid, categorically needy
cases are aged, blind, or disabled individuals or
families and children who are otherwise eligible for
Medicaid and who meet financial eligibility requirements
for Aid to Families with Dependent Children (AFDC),
Supplemental Security Income (SSI), or an optional state
supplement.
Ceiling, Cap: highest allowable cost payable by the state
under the state Medicaid program.
Certificate of Need (CON): a certification made by the
state under P.L. No. 92-641 that determines that a
certain health service is needed and authorizes a
specific operator, at the operator's request, to provide
that service.
Certification for Medicaid: the survey's determination
regarding a Medicaid provider's compliance with health
and safety requirements.
Certification for Medicare: a recommendation made by the
state survey agency to the federal agency regarding the
compliance of providers with the Conditions of
Participation and Conditions of Coverage.
Charge Nurse: a person who is (1) licensed by the state
in which practicing as a registered nurse or practical
OCR for page 392
392 / GLOSSARY
(vocational) nurse who (a) is a graduate of a
state-approved school of practical (vocational) nursing,
or (b) has 2 years of appropriate experience following
licensure by waiver as a practical (vocational) nurse,
and has achieved a satisfactory grade on a proficiency
examination approved by the state's Secretary of Health,
or on a state licensure examination which the Secretary
finds at least equivalent to the proficiency examination
(such determinations of proficiency do not apply with
respect to persons initially licensed by a state or
seeking initial qualifications as a practical
(vocational) nurse after December 31, 1977~; and (2) is
experienced in nursing service administration and
supervision in areas such as rehabilitative or geriatric
nursing, or acquires such preparation through formal
staff development programs.
Charges: the dollar rates that a provider of the services
places on the services provided. The provider's cost
and charges are not necessarily identical, because the
charge may also contain a handling and/or profit rate.
Chronic Condition: a physical or mental illness or
disorder characterized by a long duration (usually more
than 3 months) or frequent recurrence.
Class-Based or Flat-Rate Reimbursement Systems: rates set
statewide or for groups of facilities in a particular
state, based on the cost history of the entire group.
The state may determine groups by geographic regions,
size, ownership status, or any other characteristics it
chooses.
Cohort: a population group that shares a common property,
characteristic, or event, such as a year of birth or
year of marriage. The most common cohort is the "birth
cohort," a group of individuals born within a defined
time period, usually a calendar year or a 5-year
interval.
Complaint Visit: a brief visit made by the state survey
agency to a health care facility in response to a
complaint made about the facility to the agency.
Conditions of Participation: the regulatory criteria, as
outlined in 42 CFR 405.1122 and the following, by which
a state survey agency determines whether a skilled
nursing facility is eligible to participate in the
OCR for page 393
GLOSSARY / 393
Medicare or Medicaid program. Conditions are composed
of a number of items (standards), which may be composed
of several additional items (elements). Standards and
elements are intended to explicate Conditions.
Cost: actual expenses incurred for inputs. For example,
the cost of nursing home care includes direct costs such
as staff salary, facility, equipment, supplies, and
indirect costs such as mortgage, general and
administrative fees, and cost of capital.
Cost-to-Charge Ratio: a constant used by researchers and
policymakers to calculate the charges or cost of a given
input when only partial or incomplete charge or cost
figures are readily available.
Decertification or Termination: the process of suspending
or revoking a health care facility's certification to
participate in the Medicare and/or Medicaid programs.
Decubitus Ulcer, Decubiti: a break in the surface of the
skin that appears in areas under pressure in reclining
or sitting because of a circulatory defect in the area
under pressure. Also called bed sores, pressure sores.
Deficiencies: the designation a surveyor makes on
finding a facility out of compliance with Conditions and
Standards of Participation.
Dementia: the loss of intellectual mental function, due
to many different acute and chronic diseases, including
Alzheimer's disease, which may affect the white matter
and blood supply of the cerebrum.
Diabetes Mellitus: a familial constitutional disorder of
carbohydrate metabolism that is characterized by
inadequate secretion or utilization of insulin, by
excessive amounts of sugar in the blood and urine, and
by thirst, hunger, and loss of weight.
Diagnosis-Related Groups (DRGs): a classification system
that groups patients according to diagnosis, type of
treatment, age, and other relevant criteria. In October
1983, Medicare instituted a prospective reimbursement
system based on 467 DRGs. Under this system, hospitals
are paid a set fee for treating patients in a single DRG
category, regardless of the actual cost of care for the
individual.
Dietetic Service Supervisor: a person who (1) is a
qualified dietician; or (2) is a graduate of a dietetic
OCR for page 394
394 / GLOSSARY
technician or dietetic assistant training program
(corresponding or classroom), approved by the American
Dietetic Association; or (3) is a graduate of a
state-approved course that provided 90 or more hours of
classroom instruction in food service supervision and
has experience as a supervisor in a health care
institution with consultation from a dietician; or (4)
has training and experience in food service supervision
and management in a military service.
Dietician: a person who (1) is eligible for registration
by the American Dietetic Association under its
requirements in effect on January 17, 1974; or (2) has a
baccalaureate degree with major studies in food and
nutrition, dietetics, or food service management, has 1
year of supervisory experience in the dietetic service
of a health care institution, and participates annually
in continuing dietetic education.
Director of Nursing Services: a registered nurse who is
licensed by the state in which practicing, and has 1
year of additional education or experience in such areas
as rehabilitative or geriatric nursing, and participates
annually in continuing nursing education.
Disability: the inability to perform an activity in the
manner or in the range considered normal because of
physical or mental impairment.
Discharge: a formal release from a hospital or a skilled
nursing facility (SNF). Discharges include persons who
died during their stay, or were transferred to another
facility.
Distinct Part Facility: a nursing home which is certified
by the state agency to provide both skilled and
intermediate care in separate designated areas of the
facility.
Drug Administration: an act in which a single dose of a
prescribed drug is given to a patient by an authorized
person In accordance with all laws and regulations
governing such acts. The complete act of administration
entails removing an individual dose from a previously
dispensed, properly labeled container (including a unit
dose container), verifying it with the physician's
orders, giving the individual dose to the proper
patient, and promptly recording the time and dose given.
OCR for page 395
GLOSSARY / 395
Drugs and Biologicals: substances included (or approved
for inclusion) in the United States Pharmacopoeia, the
National Formulary, or the United States Homeopathic
Pharmacopoeia, or in New Drugs or Accepted Dental
Remedies (except for any drugs and biologicals
unfavorably evaluated therein), or as approved by the
pharmacy and drug therapeutics committee (or equivalent
committee) of the medical staff of the hospital
furnishing such drugs and biologicals for use in such
hospital.
Dually Certified Facility: a nursing home which is
certified by the state agency to provide both skilled
and intermediate care in all areas of the facility.
Elements: regulatory certification requirements which
explicate standards and conditions of participation.
See Conditions of Participation and Standards of
Participation.
Expenditure: under Medicaid, an amount paid out by a
state agency for the covered medical expenses of
eligible participants.
Extended Care Services: items and services furnished to
an inpatient of a skilled nursing facility including (1)
nursing care provided by or under the supervision of a
registered professional nurse; (2) bed and board in
connection with the furnishing of such nursing care; (3)
physical, occupational, or speech therapy furnished by
the skilled nursing facility or by others under
arrangements with them made by the facility; (4) medical
social services; (5) such drugs, biologicals, supplies,
appliances, and equipment furnished for use in the
skilled nursing facility, as are ordinarily furnished by
such facility for the care and treatment of inpatients;
(6) medical services provided by an intern or
resident-in-training of a hospital with which the
facility has in effect a transfer agreement, under a
teaching program of such hospital, and other diagnostic
or therapeutic services provided by a hospital with
which the facility has such an agreement in effect; and
(7) such other services necessary to the health of the
patients as are generally provided by skilled nursing
facilities; excluding, however, any item or service if
OCR for page 396
396 / GLOSSARY
it would not be included if furnished to an inpatient of
a hospital.
Extencled Survey: a comprehensive survey requiring
surveyor to review all conditions, standards, and
elements, and to interview a large number of residents.
Facility-Specific Reimbursement Rates: rates set for
each facility based on that facility's cost history.
Follow-up Visit: a brief return visit made by the state
survey agency to a health care facility within 90 days
of an annual survey in order to determine a facility's
progress on correcting violations found by the survey
agency during the annual survey.
Functional Dependence: the inability to attend to one's
own needs, including the basic activities of daily
living. Dependence may result from the changes that
accompany natural aging, or from a disease or related
pathological condition.
Functional Impairment: inability to perform basic
self-care functions such as eating, dressing, and
bathing, or instrumental activities of daily living,
including home management activities such as cooking,
shopping, or cleaning, because of a physical, mental, or
emotional condition.
Handicap: a disadvantage resulting from a physical or
mental impairment or disability that limits or prevents
the fulfillment of a role that is normal (for that
individual) in a given environment.
Heavy-Care Residents: residents of skilled or
intermediate care facilities who require a great deal of
attention for medical care, nursing care, and/or
assistance with activities of daily living. Bed-fast or
severely demented residents are examples of heavy-care
residents.
Home Care: medical, social, and supportive services
provided in the home, usually intended to maintain
independent functioning and avoid institutionalization.
Home Health Agency (HHA): a public or private
organization providing skilled nursing services, other
therapeutic services and other assisting services in the
patient's home, and which meets certain conditions to
ensure the health and safety of the individuals who
receive the services.
OCR for page 397
GLOSSARY / 397
Hospital-Based Facility: a designated area of a hospital
certified by the state to provide skilled and/or
intermediate care.
Impairment: a physical or mental abnormality that can be
readily identified or diagnosed.
Independent Professional Review: see Inspection of Care.
Input Measurement: examination of resources, activities,
or tools used to provide a service in order to determine
the quality of service provided.
Inspection of Care: a regular program of medical review
(including medical evaluation) by one or more medical
review teams (composed of physicians or registered
nurses and other appropriate health and social service
personnel) to determine (1) the care being provided in
nursing facilities; (2) the adequacy of the services
available in particular nursing facilities (or
institutions) to meet the current health needs and
promote the maximum physical well-being of patients
receiving care in the home (or institution); (3) the
necessity and desirability of the continued placement of
patients in the nursing home (or institution); and (4)
the feasibility of meeting the patient's health care
needs through alternative institutional or
noninstitutional services.
Instrumental Activities of Daily Living (IADL): home
management and independent living activities such as
cooking, cleaning, using a telephone, shopping, doing
laundry, providing transportation, and managing money.
Intermediate Care Facility (ICE): an institution
furnishing health-related care and services to
individuals who do not require the degree of care
provided by hospitals or skilled nursing facilities as
defined under Title XIX (Medicaid) of the Social
Security Act.
Intermediate Sanctions: penalties short of termination of
a facility's Medicaid or Medicare contract, which are
imposed by states against health care facilities found
out of compliance with state or federal regulations.
Key Indicators: measures of quality of care and quality
of life which focus on care given to residents, the
results (outcome) of such care, and the manner (process)
OCR for page 398
398 / GLOSSARY
in which the care is given, for example, use of certain
drugs, and incidence of infections and decubiti.
Level of Care: the amount of medical care and assistance
with activities of daily living needed by individuals in
a group. Traditionally, level of care refers to the SNF
and ICE groups.
Licensed Nursing Personnel: registered nurses or
practical (vocational) nurses licensed by the state in
which they practice.
Life Care/Continuing Care Communities: communities that
provide a range of services for elderly residents,
including homes or apartments for independent living,
home care services, infirmary, and sometimes nursing
home services. Payment of an initial membership or
entrance fee and a monthly fee guarantees the individual
most types of health and social services for the rest of
his/her life.
Life Expectancy: a measure of the average remaining years
of life at specified ages for different subgroups (for
example, by sex and race) of a population.
Life Safety Code (LSC), Fire Safety Code: regulatory
criteria used by the state health agency or fire
marshal! to determine whether a physical plant is
structurally safe and adequately prepared against fire.
Long Stayers: nursing home residents who are no longer
able to live outside of institutions and who generally
reside in nursing homes for many months or years, often
until they die.
Long-Term Care: a variety of ongoing health and social
services provided for individuals who need assistance on
a continuing basis because of physical or mental
disability. Services can be provided in an institution,
the home, or the community, and include informal
services provided by family or friends as well as formal
services provided by professionals or agencies.
Long-Term-Care Facility: any skilled nursing facility,
intermediate care facility, nursing home, adult care
home, or similar institution regulated by a state.
Medicaid: a federal/state program, authorized by Title
XIX of the Social Security Act, to provide medical care
for low-income individuals. Federal regulations specify
mandated services, but states can determine optional
OCR for page 399
GLOSSARY / 399
services and eligibility standards. The federal
government's share of costs ranges from 50 to 78 percent
and is based on per capita income in the state.
Medicaid Retrospective Reimbursement Systems: state
reimbursement systems in which a facility's costs are
reimbursed after the expenditure. Each state may have
different allowable costs and ceilings, and may vary
costs by factors such as region or size of facility.
Medically Needy: under Medicaid, medically needy cases
are aged, blind, or disabled individuals or families and
children who are otherwise eligible for Medicaid, and
whose income resources are above the limits for
eligibility as categorically needy (AFDC or SSI) but
because of their medical problem are considered within
limits set under the Medicaid state plan.
Medicare: a federally funded health insurance program
authorized by Title XVIII of the Social Security Act to
pay for medical care for elderly and disabled
beneficiaries. Medicare reimburses part of the costs
for acute care and some types of long-term care.
Beneficiaries pay an annual deductible and co-payments
for most covered services. The program is divided into
two sections: Part A, which covers hospital and
inpatient physicians' services, and an optional Part B.
which covers outpatient physician and some other
outpatient services.
Medicare Cost-Based Reimbursement: a uniform federal
payment system that is based on a facility's costs for
providing that service.
Medicare Medicaid Automated Certification System (MMACS):
a data base system operated by the Health Care Financing
Administration to collect data from state survey
agencies on certification activities.
Nurse-Bed Ratio: the number of full-time equivalent
nursing personnel to the number of beds. The ratio can
be presented at the facility, local
national level.
state, regional, or
Nurse's Aide, Nursing Aide, Nursing Assistant: people
who, under the supervision of a licensed nurse, provide
medical care and assistance with activities of daily
living to residents, and who are not themselves licensed
to independently provide care.
OCR for page 400
400 / GLOSSARY
Nursing Home: a residential long-term-care facility that
provides 24-hour care, skilled nursing care, and
personal care on an inpatient basis. The definition of
a nursing home varies by state.
Nursing Services: services provided under the direction
or supervision of one or more registered nurses or
licensed practical or vocational nurses.
Ombudsman: a state representative or a representative of
a public agency or a private nonprofit organization
(which is not responsible for licensing or certifying
long-term care services) who (1) investigates and
resolves complaints made by or on behalf of older
individuals who are residents of long-term-care
facilities relating to administrative action that may
adversely affect the health, safety, welfare, and rights
of such residents; (2) monitors the development and
implementation of federal, state, and local laws,
regulations, and policies with respect to long-term-care
facilities in that state; (3) provides information as
appropriate to public agencies regarding the problems of
older individuals residing in long-term-care facilities;
(4) provides for training volunteers and promotes the
development of citizen organizations to participate in
the ombudsman program; and (5) carries out such other
activities as the State Health Commissioner deems
appropriate.
Outcome Measurement: examination of the results of a
service in order to determine the quality of the service
provided.
Out-of-Pocket Expenditures: amounts not covered by any
third-party payer that must be paid directly by the
consumers, out of their own pockets.
Patient Assessment Computerized (PAC) System: a standard
resident assessment system developed and used by a
private nursing home chain, the National Health
Corporation, located in Murfreesboro, Tennessee.
Patient Care and Services (PaCS): a new survey protocol
developed by the Health Care Financing Administration.
Patient Care Profile: a standard resident assessment
system developed by Mr. William Thoms, a nursing home
administrator in New Hampshire. It is now being used by
OCR for page 401
GLOSSARY / 401
the Hillhaven Corporation, a national nursing home
chain.
Payment: the dollar amount that is transferred on behalf
of the recipient from one or more agents to the provider
of the service.
Physicians' Services: professional services performed by
physicians, including surgery, consultation, and home
office and institutional calls.
Plan of Correction: the form by which a facility
documents its procedures and time frame for correcting
violations of certification regulations cited by the
state survey agency.
Process Measurement: the examination of methods of
providing a service in order to evaluate the quality of
the service provided.
Professional Standards Review Organization (PSRO): a
physician or other professional medical organization
(consisting of physicians and other health professionals
with independent admitting hospital privileges) that
enter into an agreement with the U.S. Department of
Health and Human Services to assume the responsibility
for the review of the quality and appropriateness of
services covered by Medicare, Medicaid, and the Maternal
and Child Health program. PSROs determine whether
services are medically necessary, provided in accordance
with professional standards, and, in the case of
institutional services, rendered in the appropriate
setting.
Prospective Reimbursement Systems: systems in which the
day rate or line item rate is set beforehand, based on a
formula that takes into account historical
expenditures. Typically these systems are adjusted
annually and use an inflation or similar factor as the
basis for future adjustment.
Rehabilitation: social or medical care designed to
restore patients to their former capacity or to a
condition of health or independent activity.
Resource Utilization Groups (RUGS): a standard method of
grouping nursing home residents in accordance with the
services they require (and, therefore, with the staff
and other resources needed to supply those services).
OCR for page 402
402 / GLOSSARY
Retrospective Reimbursement Systems: systems in which the
amount of reimbursement is based on the cost of the
services already provided. These amounts are usually
controlled or limited by a cap, a ceiling, or percent of
actual costs incurred.
Risk Factors: characteristics, behaviors, substances, or
environmental and other factors that are statistically
associated with an increased likelihood of developing a
given condition.
Short Stayers: nursing home residents who generally come
from hospitals ant! wit be discharged home or will die in
a very short time.
Skilled Nursing Facility (SNF): defined by the federal
government as an institution that has a transfer
agreement with one or more participating hospitals, and
that is primarily engaged in providing to inpatients
skilled nursing care and rehabilitative services, and
that meets specific regulatory certification
requirements.
Social Worker: a person who is licensed, if applicable,
by the state in which practicing, is a graduate of a
school of social work accredited or approved by the
Council on Social Work Education, and has 1 year of
social work experience in a health care setting.
Spend-Down: under the Medicaid program, a method by which
an individual establishes Medicaid eligibility by
reducing gross income through incurring medical expenses
until net income (after medical expenses) meets Medicaid
financial requirements. A resident spends down when
she/he is no longer sufficiently covered by a
third-party payor (usually Medicare) and has exhausted
all personal assets. The resident then becomes eligible
for Medicaid coverage.
Standard Survey: a semiannual inspection based on review
of a facility's performance with regard to key
indicators and interviews with a stratified sample of
residents.
Standards of Participation: the regulatory criteria, as
outlined in 42 CFR 442.300 and the following, by which a
state survey agency determines whether an intermediate
care facility is eligible to participate in the Medicaid
OCR for page 403
GLOSSARY / 403
program. Standards are composed of elements. See also
Conditions of Participation.
State Plan: a comprehensive written commitment by a
Medicaid agency to administer or supervise the
administration of a Medicaid program in accordance with
federal requirements.
State Survey Agency: the state health agency or other
appropriate state or local agency that performs survey
and review functions for Medicare and Medicaid.
Substate Ombudsman: a representative of the state
ombudsman who performs ombudsman responsibilities in a
given area of the state. See also Ombudsman.
Supplemental Security Income (SSI): a program of income
support for low-income aged, blind, and disabled
persons, established by Title XVI of the Social Security
Act.
Supplementary Medical Insurance (SMI): a voluntary
insurance program (also known as Medicare Part B) that
provides insurance benefits for physician and other
medical services in accordance with the provisions of
Title XVIII of the Social Security Act, for aged and
disabled individuals who elect to enroll under such
program. The program is financed by premium payments by
enrollees, and contributions from funds appropriated by
the federal government.
Swing-Beds: beds located in a hospital that are
certified by the state for use by patients in need of
acute or skilled care.
Title III of the Older Americans Act: federal legislation
that provides funding to states for development and
coordination of services for the elderly. The
Administration on Aging allocates Title III funds to
states primarily on the basis of the proportion of each
state's population aged 60 and over.
24-Hour Nursing Services: services for which nursing
personnel are on duty 24 hours a day. The term "nursing
personnel" includes registered nurses and licensed
practical or vocational nurses.
Urinary Incontinence: inability to control urinary
f unction.
Utilization Review: a review, on a sample or other basis,
of admissions to the institution, the duration of stays
OCR for page 404
404 / GLOSSARY
therein, and the professional services (including drugs
and biologicals) furnished, to determine the medical
necessity of the services and the most efficient use of
available health facilities and services. It is made by
either a staff committee of the institution composed of
two or more physicians with or without participation of
other professional personnel, or by a group outside the
institution that is similarly composed and that is
established by the local medical society and some or all
of the hospitals and skilled nursing facilities in the
locality, or (if there has not been established such a
group serving such institution) that is established in
such other manner as may be approved by the state's
Secretary of Health.
Waivers: exemption from meeting a particular regulatory
requirement. Waivers for certification requirements may
be given by states to facilities. Waivers for program
requirements may be given by the federal government to
states.
Representative terms from entire chapter:
nursing home
