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Nursing Home Administration Glossary
Terms, prefixes, suffixes, common diagnoses, abbreviations. This is ALL of these others rolled into one.
938
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Professional
04/01/2011

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Term
Abuse
Definition
(1) Willful intent to cause harm. Abuse may be resident to resident or staff to resident harm.(2) Fraud committed against a public program such as Medicare or Medicaid
Term
Accelerated Method of Depreciation
Definition
A depreciation method that allows for larger amounts of depreciation in early years and smaller amounts in later years. The double declining-balance method is an example. (This enables the owner to receive tax and/or reimbursement benefits more quickly than using the straight line method ).
Term
Access
Definition
The ability of a person needing services to obtain those services.
Term
Accident
Definition
Any unexpected or unintentional incident, which may result in injury or illness to a resident. This does not include adverse outcomes from treatment or care.
Term
Accounting
Definition
The process of identifying, recording, and communicating information about the financial position and results of operations of a business entity, using principles designed to facilitiate informed decision-making by the entity's managers as well as by external groups.
Term
Accounting Equation
Definition
    Assets = Liabilities + Owners' Equity (capital).    This equation states that the assets of a firm are equal to the claims of the creditors plus the claims of the owners. The balance sheet is a detailed statement of this equation.
Term
Accounts Payable
Definition
Amounts owed to suppliers for goods and services.
Term
Accounts Receivable
Definition
Amounts owed to the facility for services or for the sale of goods.
Term
Accreditation
Definition
Accreditation of a nursing facility by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Term
Accrual Basis of Accounting
Definition
A system of accounting in which revenues are recorded in the period earned, and expenses are recorded in the period incurred even if cash is received or paid in a later or earlier time period. (Contrast with CASH BASIS of accounting)
Term
Accumulated Depreciation
Definition
The total depreciation from the start of the life of a plant asset to any point in time. On the balance sheet, there is a deduction for accumulated depreciation taken from the gross evaluation of depreciable plant and equipment to yield a net evaluation.
Term
Acquired Immune Deficiency Syndrome (AIDS)
Definition
AIDS develops when a person infected with the human immunodeficiency virus (HIV) undergoes a breakdown and becomes susceptible to serious illness and death from other viruses, parasistes, fungi, and bacteria.
Term
Acid-Test Ratio (or Quick Ratio)
Definition
Cash and other current assets that can be converted to cash right away (such as marketable securities and current receivables) divided by current liabilities. A measure of the ability of a firm to pay its current liabilities in the very short term (see also CURRENT RATIO).
Term
Activities
Definition
Refer to any endeavor, other than routine activities of daily living, in which a resident participates that is intended to enhance his/her sense of well-being and to promote or enhance physical, cognitive, and emotional health. These include, but are not limited to, activities that promote self-esteem, pleasure, comfort, education, creativity, success, and independence.
Term
Activities of Daily Living
Definition
Individual self-performance skills needed in everyday life such as ambulation/locomotion, eating, toileting, grooming/personal hygiene, and bathing.
Term
Activity Therapist (AT)
Definition
An allied health professional trained to develop and provide leisure time activities for facility residents (patients).
Term
Acuity
Definition
The level of severity of a patient's condition. For example, patients who require intensive services are referred to as those having a higher level of acuity in relation to those who require less care.
Term
Acute Care
Definition
Short-term, intense medical care for an episode of illness or injury often requiring hospitalization.
Term
Acute Conditions
Definition
Episodic conditions that require short-term but intensive medical interventions.
Term
Adjusting Entries
Definition
Entries made at the end of an accounting period to record certain transactions or other accounting events that have not been recorded or have been improperly recorded during the accounting period. Examples include entries for depreciation expense and unused portions of prepaid expenses.
Term
Administer
Definition
The direct application of a vaccine or prescribed drug or device, whether by injection, ingestion or any other means, to the body of a resident (patient).
Term
Administrative Information System
Definition
Information technology that is designed to assist in carrying out financial and administrative support activities such as payroll, patient accounting, billing, accounts receivable, materials management, budgeting, cost control and office automation.
Term
Administrative Law
Definition
Rules and regulations formulated by departments or agencies of the executive branch of government to carry out the intent of statutory law.
Term
Administrator
Definition
See NURSING HOME ADMINISTRATOR/NURSING FACILITY ADMINISTRATOR
Term
Administrator In Training (AIT)
Definition
An internship with a certified preceptor required for an LTCA (NHA) license in some states; a person undertaking on-the-job training, or an internship, approved by a given state in preparation for licensing as a NHA.
Term
Admission Agreement
Definition
A contract that spells out the services the nursing home will provide and the cost of those services.
Term
Adult Day Care
Definition
A daytime program of nursing, rehabilitation therapies, supervision and socialization that enables elderly people to remain in the community and live with family. Services are generally provided on weekdays from 7 am to 6 pm to individuals who return home in the evening.
Term
Advance Directive
Definition
Written instructions from residents (patients) about the management and provision of care if they become incapacitated (e.g., living wills, do not resuscitate orders, durable power of attorney for healthcare).
Term
Adverse Drug Reaction (ADR)
Definition
Any unintended response to a drug which is injurious or harmful to health and which occurs at normal doses.
Term
Adverse Impact
Definition
Under the Civil Rights Act of 1964 and its amendments, adverse impact occurs whenever the selection rate for any protected group is less than 80% of the rate for the group with the highest rate. The focus is on the hiring standard used by the employer as a method of screening applicants. "The burden of proof is on the employer to show that a hiring standard is job related."
Term
Affirmative Action
Definition
Review of a facility's hiring practices (recruiting, advertising, and data on the applicants) by the federal government to ensure conformity to the 1964 Civil Rights Act and its amendments. Legal violations can be processed if it is determined that the facility has discriminated based on age, sex, marital status, race, religion, handicap or national origin.
Term
Aged
Definition
People who by definition in their culture have reached an advanced age during which they may become less productive. In the U.S. they are offen referred to as senior citizens, especially after reaching age 65.
Term
Ageism
Definition
Prejudicial treatment of the elderly based on stereotypes and misconceptions.
Term
Agent
Definition
Someone authorized to act on behalf of another (a principal); for example, a corporation generally authorizes the administrator to represent it or act on its behalf.
Term
Aging-in-place
Definition
Accommodating the changing needs of older adults while living in familiar surroundings.
Term
Aging of Accounts Receivable
Definition
Summarizing unpaid balances in terms of age groups, such as: currently due, 1-30 days past due, 31-60 days past due each of the remaining 30-day periods through 151-180 days past due, and finally past due more than 180 days. This classification may be broken down by type of debtor. Aging receivables is a step in the collections effort, in reporting on the balance sheet a deduction from accounts receivable for estimated bad debt, and in making write-off decisions.
Term
Aging Schedule
Definition
Also called an "aging report," it shows the length of time that various amounts within each patient's account have been outstanding (not paid).
Term
Agitation
Definition
Verbal, vocal, and motor activities that are repetitive and outside of socially acceptable norms.
Term
Allopathic Medicine
Definition
Medical approach--as practiced by physicians trained as doctors of medicine (MDs)--that views medical treatment as active intervention to produce a counteracting reaction in an attempt to neutralize the effects of disease.
Term
Allowable Charge
Definition
The maximum fee that a third party will use in reimbursing or paying a provider for a service rendered.
Term
Allowable Costs
Definition
Costs that are reimburseable under a third-party payment formula.
Term
Alzheimer's Disease
Definition
A progressive degenerative disease of the brain, producing memory loss, confusion, irritability, and severe funtional decline. The disease becomes progressively worse and eventually results in death.
Term
Ambulation
Definition
Moving about.
Term
Ambulatory
Definition
Able to walk with or without difficulty or help.
Term
Ambulatory Care (Ambulatory Services)
Definition
Services that require the patients to come and receive needed services at a community-based location. In a broader context, ambulatory care can be any outpatient services such as a visit to the physician's office or clinic or outpatient surgery.
Term
Americans with Disabilities Act
Definition
Forced businesses and organizations to make significant changes in physical accessibility to their buildings and in the employment and customer service policies.
Term
Amortization of Debt
Definition
The periodic reduction of a debt by regular payments applied to both principal and interest over a scheduled period.
Term
Ancillary Charges
Definition
Extra charges for supplies and services, e.g., drugs and lab tests, that are not included in the per diem rate.
Term
Annual Assessment
Definition
An annual assessment of a resident's (patient's) physical, mental, emotional, cognitive, and functional status.
Term
Antianxiety Medication
Definition
Psychoactive medications given to reduce anxiety (e.g., Ativan, Valium, Xanax)
Term
Anti-Kickback Law
Definition
The Medicare and Medicaid Anti-Kickback Law penalizes anyone who knowingly and willfully solicits, receives, offers, or pays a remunerationin cash or in kind to induce, or in return for: A. Referring and individual to a person for the furnishing, or arranging of the furnishing, of an item or service to be paid for by the Medicare or Medicaid program; or B. Arranging or recommending the purchase, lease, or order of goods or services to be paid for under Medicare or Medicaid. Violators are subject to criminal penalties or exclusion from participation in the Medicare and Medicaid programs, or both (see also SAFE HARBORS).
Term
Antisepsis
Definition
Removing or destroying microorganisms.
Term
Aphasia
Definition
Impaired ability to communicate.
Term
Apraxia
Definition
A speech disorder in which the tongue, lips, and vocal chords are unable to work together. As a result, the person is unable to say what he or she wants to say.
Term
Arbitration
Definition
Utilization of a third party to resolve disputes. As used here, this concept is related to facilities that have unions. The third party hears the arguments on both sides and then makes a decision which is binding on both the union and the facility.
Term
Area of refuge
Definition
A zone of safety within a building that is protected from the effects of fire and smoke that provides direct access to an exit.
Term
As-built plans
Definition
The blueprints or plans depicting the way the building was actually completed and approved.
Term
Asepsis
Definition
Absence of harmful microorgansms called pathogens. It refers to the practice of clean procedures, such as hand-washing.
Term
Aspiration
Definition
The inhaling of foreign objects, such as food or beverages if swallowed incorrectly into the lungs; results in introduction of bacteria from the mouth and stomach into the lungs which can lead to pulmonary bacterial infection known as aspiration pneumonia.
Term
Assessment
Definition
The process by which health care professionals attempt to reliably characterize the patient's physical health, functional abilities, cognitive functioning, psychological state, social well-being, and past and current use of formal services.
Term
Assets
Definition
Resources owned by a business that are measured in monetary terms. On a balance sheet, assets are generally classified into current and noncurrent portions. Current Assets are cash, accounts receivable, supply inventories, and prepaid expenses. Noncurrent assets include Property, Plant & Equipment (PP&E)(also referred to as fixed assets, capital assets, or plant assets) which are assets having an estimated life in excess of one year and not intended for sale in the ordinary course of operations.
Term
Assisted Living Facility (ALF)
Definition
Term applied to broad array of residential options for frail senior who need assistance with one or more activities of daily living, such as dressing or bathing, but do not require continuous skilled nursing care. ALF's generally emphasize a homelike environment offering a maximum amount of independence, privacy, and choice.
Term
Audiologist
Definition
A health care professional who is specially trained and licensed to provide direct clinicl services to individuals with hearing or balance disorders.
Term
Audit
Definition
Examination of accounting systems, controls, and records to ascertain their conformity to legal and professional standards and their adequacy in protecting against loss of assets by fraud and waste.
Term
Autism
Definition
A complex developmental disability that typically appears during the first three years of life and is the result of a brain disorder. It affects the person's social interaction and communication.
Term
Autonomy
Definition
A cluster of notions that include self-determination, freedom, independence, and liberty of choice or actions.
Term
Average Daily Census
Definition
The average number of patients per day over a specified period of time such as a week, a month, or a year.
Term
Avoidable Accident
Definition
An accident that occurred because the facility failed to identify a hazard, evaluate the hazard, implement interventions, and monitor the effectiveness.
Term
Baby Boomers
Definition
People born between 1946 and 1964. This age group constitutes approximately 70 million Americans who will start retiring around 2010. By 2030, when all the Baby Boomers will have retired, experts predict that they will severely strain the nation's health care system.
Term
Bad Debt
Definition
An account receivable determined to be uncollectible.
Term
Balance Sheet (or Statement of Financial Position)
Definition
A report summarizing a firm's assets, liabilities, and owners' equity at a specific date.
Term
Bank Statement
Definition
Statement sent by a bank to a bank account holder showing beginning and ending balances, and all transactions in the account for a month.
Term
Bank Statement Reconciliation
Definition
Process of explaining and correcting any discrepancies between a bank statement balance and the depositor's record of the cash balance.
Term
Bargaining Unit
Definition
Determination by the National Labor Relations Board of which workers will be grouped together for the purposes of forming or taking steps towards forming a union.
Term
Bed-hold
Definition
When a patient is temporarily out of the facility (at a hospital or with family), but the bed is being held and must be paid for.
Term
Bedsore
Definition
See PRESSURE SORE/ULCER
Term
Behavioral Intervention
Definition
Non-drug interventions used to change the resident's (patient's) behavior or environment to lessen or accommodate the resident's (patient's) behavioral symptoms.
Term
Benefit Period
Definition
Period of consecutive days during which covered services furnished to a patient, up to certain specified maximum amounts, may be paid for by an insurance plan. Each insurance carrier has its own definition of benefit period.
Term
Benefits (Fringe Benefits)
Definition
Compensation other than wages paid to workers, such as paid vacation/leave, paid health insurance, and retirement plans.
Term
Best practices
Definition
Evidence-based practices
Term
Bidding
Definition
The process of requesting from vendors a response (bid or offer) to provide goods or services according to written specifications. The bidding may be closed (directed to select bidders) or open (to all bidders). The bids may be negotiated (as to price, payment terms, etc.) before a contract is finalized.
Term
Biophilia
Definition
The human tendency to pay attention to, affiliate with and respond positively to nature.
Term
Bloodborne Pathogens
Definition
Pathogenic micro-organisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency Virus (HIV).
Term
Board of Directors
Definition
Also "board of trustees" or "governing body." It has the ultimate legal responsibility for a facility's operations.
Term
Boarding Home
Definition
A facility that offers room and board and sometimes supervision of daily activities. It does NOT offer health care.
Term
Bonds
Definition
Interest-bearing notes, usually in $1,000 or $5,000 amounts, in which the issuer (borrower) promises to repay the bondholder (lender) the principal and interest of a loan according to a schedule.
Term
Bookkeeping
Definition
The clerical process of recording the financial transactions of an organization.
Term
Break-Even Point
Definition
The point at which total revenues for a firm or a program are equal to the total expenses incurred. This may be illustrated on a graph where revenues (and expenses) are plotted on the vertical axis while resident-days are plotted on the horizontal axis. Look for the point where the line representing total cost (fixed plus variable) intersects with the line representing total revenue. The number of resident-days indicated by the point on the horizontal axis directly below this intersection is the number of resident days needed for the firm or program to break even, i.e., neither incur any loss nor make any profit.
Term
Budget
Definition
A tool for exercising financial control. It sets expectations that become financial objectives that the administrator is responsible for achieving. "Budgeting" is the process of financial planning.
Term
Cardiologist
Definition
A physician who specializes in the treatment of heart diseases.
Term
Care Plan
Definition
A plan designed to meet all of a resident's (patient's) identified physical, mental, emotional, cognitive, and functional needs. The care plan is generally the result of assessment and collaboration by an interdisciplinary team of provider staff (also known as the Plan of Care).
Term
Career Ladder
Definition
Paths or promotion routes established by the organization along which employees can seek to progress, such as financial assistance and release time to CNAs who seek to become a licensed nurse, or a licensed practical nurse who seeks to become a registered nurse.
Term
Career Paths
Definition
Defined avenues for upward mobility available to employees within an organization (similar to career ladder)
Term
Case Mix
Definition
A system that uses resident (patient) attributes (e.g., functional status in ADLs or coginitive abilities) to classify residents (patients) for purposes such as reimbursement. OR A measure of the intensity of care and services used by a group of residents in a nursing facility. "Case" refers to the overall data collected and used regarding an individual person under study. "Used" describes the combination of variables (observations) used for flassifying an observation accordint to distinctive characteristics on the basis of a dependent variable, such as time or costs.
Term
Case Mix Index
Definition
Each RUG group is assigned a weight, or numeric score, which reflects the relative resources predicted to provide care to a resident. The higher the case mix index (weight), the greater the resource requirements are for the resident. Payment for each resident is made monthly to the facility based on the case mix index for the facility.
Term
Case-Mix-Based Payment Systems
Definition
Payment systems used by Medicare and many state Medicaid programs under which the per diem rates for each nursing facility are determined in part by some measure of the acuity, and thus the likely resource consumption, of each covered resident in the facility. Assessments are conducted to classify covered residents into defined groups based primarily on functional disability scores, but certain diagnoses, service needs and behavioral problems may also be considered. The per diem rate is different for each group, with higher rates paid for residents needing and receiving more services.
Term
Cash Basis of Accounting
Definition
A system of accounting in which revenues are recorded when cash is received, and expenses are recorded when cash is paid (contrast with accrual basis of accounting).
Term
Cash Flow
Definition
Cash inflows from collections of revenues and other sources minus cash outflows for payments of expenses and liabilities. A cash budget of cash-flow forecast projects these amounts, whereas a cash flow report shows actual experience.
Term
Census
Definition
Number of patients in a facility on a given day.
Term
Centers for Medicare & Medicaid Services (CMS)
Definition
Federal agency responsible for administering the Federal Medicare and Medicaid programs. CMS headquarters is located in Baltimore, Maryland. Formerly the Health Care Financing Administration (or HCFA). Also administers Child Health Insurance Programs.
Term
Certificate of Need (CON)
Definition
Aimed at restraining health care facility costs and allowing coordinated planning of new services and construction.  Laws authorizing such programs are one mechanism by which state governments seek to reduce overall health and medical costs. Require certain health care providers to obtain state approval before offering certain new or expanded services.
Term
Certification
Definition
The process by which federal and state governments determine if a health care facility meets Medicare and/or Medicaid standards.
Term
Certified Nursing Assistant (CNA)
Definition
A nurse aide who has completed at least the minimum training required by regulations.
Term
Charge Nurse
Definition
The nurse in charge or supervising a particular part of a facility for a given time shift.
Term
Charity Care
Definition
Care provided to a patient who does not have the capacity to pay.
Term
Chart of Accounts
Definition
A list of names and numbers of all the accounts used in a business. There typically are accounts for various subcategories of each of the following: assets, liabilities, owner's equity, revenues, and expenses.
Term
Chemical Restraint
Definition
A psychoactive drug used by a facility for discipline or convenience and not for medical treatment.
Term
Chronic
Definition
Continuing over a long period of time or recurring frequently. Chronic conditions often begin inconspicuously and symptoms are less pronounced than in acute conditions.
Term
Chronic Care
Definition
Care for residents (patients) who enter a nursing facility typically because they have chronic illnesses that require more assistance than they have available in their own home. The residents (patients) tend to remain in the facility for several months to years.
Term
Civil Law
Definition
Body of laws governing private legal affairs, such as private rights and duties, contracts, and commercial relations.
Term
Civil Liability
Definition
The three primary sources in health care malpractice lawsuits are: (1) failure to obtain consent before intervening in the life of the resident; (2) breach or violation of a contract or promise; and (3) the rendering of substandard, poor-quality care.
Term
Civil Money Penalties
Definition
A per day or per instance fine resulting from deficiencies in quality of care or resident safety following a CMS Survey.
Term
Claim
Definition
A bill submitted to the fiscal intermediary claiming payment for services provided.
Term
Clinical Approach to Hiring Decision
Definition
A hiring technique in which the employer makes the decision after reviewing all the information in hand about the match of the applicant and the job (see also STATISTICAL APPROACH)
Term
Clinical Information System
Definition
Information technology that is designed to be used by various clinicians to support the delivery of patient care.
Term
Clinical Pathway
Definition
A care-planning tool that outlines in a time sequence important aspects of care necessary for meeting specific outcomes.
Term
Clinical Practice Guidelines
Definition
Evidence-based standardized protocols indicated for the treatment of specific health conditions.
Term
Coaching
Definition
Either help given by a superior to a subordinate, or personal assistance from a person who is not the employee's supervisor, but may be a manager of another division or from outside the company.
Term
Code of Federal Regulations (CFR)
Definition
The federal Congress passes laws for which implementing rules are written and enforced…these are the The Federal Requirements and Guidelines to Surveyors; guidelines issued by the federal government interpreting how a given law is to be administered.
Term
Collection period
Definition
Number of days' worth of revenue that is accounts receivable.
Term
Collective Bargaining
Definition
Bargaining by groups of workers recognized and constituted through supervised election procedures under the National Labor Relations Board.
Term
Community Advisory Board
Definition
Composed of key community leaders, the community advisory board functions as the "eyes and ears" for the facility. Through their influences, the advisory board members can also assist the administrator to form meaningful partnerships with community agencies.
Term
Community-Based Care
Definition
See, similar idea, Adult Day Care
Term
Comorbidity
Definition
The simultaneous presence of two or more health problems.
Term
Compensation Management
Definition
Determining and administering wage, incentive, and benefit programs for a facility.
Term
Compensation Theory
Definition
Ideas or approaches to the functions of wages and benefits in motivating employees to meet the requirements of the employer (see e.g., EQUITY THEORY).
Term
Consultant Pharmacist
Definition
Pharmacist who is contracted by the nursing home to do drug regimen reviews and provide other services.
Term
Continence
Definition
The ability to self-regulate bladder and bowel elimination.
Term
Continuing Care Retirement Community (CCRC)
Definition
Also called a life-care community, it is an organization that integrates and coordinates the independent living and other institution-based components of the LTC continuum. Different levels of services are generally housed in separate buildings, all located on one campus.
Term
Continuum of long-term care
Definition
The full range of long-term care services that increase in the level of acuity and complexity from one end to the other -- from informal and community-based services at one end of the continuum to the institutional system at the other end.
Term
Contractual Discount
Definition
The difference between the rate the facility normally charges for services to its self-pay residents, and the lower rate that the facility has agreed to receive as reimbursement from Medicare, Medicaid, or other third-party payers. For external reporting purposes, revenues are recorded as the amount to be actually collected. However, for internal reporting purposes, management may record such contractual discounts as deductions from operating revenues on the income statement and accounts receivable on the balance sheet so that the amount of discounts given to each payer class is known.
Term
Controlled Subtance
Definition
A drug, substance or immediate precursor included in Schedules I to V of the Controlled Substance Act (e.g., morphine, acetaminophen with codeine, oxycodone). Except as provided under the law, their possession and use are illegal.
Term
Controller (or Comptroller)
Definition
The chief accountant of a firm.
Term
Controlling
Definition
(as a managerial behavior) Determination by administration of how well jobs have been done and what progress is being made to achieve the organization goals, then taking necessary corrective actions to achieve these goals. It is the process of monitoring, evaluating and correcting.
Term
Corporate Integrity Agreement
Definition
Agreement negotiated by the Office of the Inspector General (OIG) with a health care provider as part of the settlement of a federal health care program investigation arising under the False Claims Act. To avoid worse penalties, a company may agree to such compliance activities as: hire a compliance officer or appoint a compliance committee, develop writeen standards and policies, implement an employee training program, and/or retain an independent review organiztion to review claims submitted to fderal health care programs.
Term
Cost Center
Definition
An organizational unit charged with responsibility for controlling its own costs, and so its costs (for salaries, supplies, etc.) are separately accumulated in the accounts. A cost center may or may not be a revenue center, i.e., a unit providing direct services to patients for which they are charged.
Term
Cost of Living Allowance (COLA)
Definition
Upward adjustments in wages during times of inflation to assist workers to maintain their purchasing power.
Term
Cost Shifting
Definition
Practice by health care providers of charging private-pay patients more than the actual costs of their care, in order to compensate for shortfalls in payments for patients covered by Medicaid and other government programs which may pay less than actual costs.
Term
Cross-contamination
Definition
Transfer of disease causing organisms through contact with a dirty surface, unwashed hands, or insects.
Term
Cultural Competency
Definition
The ability of service agencies to understand the world view of clients of different cultures, and adapt practices to ensure their effectiveness.
Term
Cultural Diversity
Definition
The mosaic of individuals and groups with varying backgrounds, experiences, styles, perceptions, values and beliefs.
Term
Culture
Definition
A society's typical ways of behaving; its customs, mores and beliefs
Term
Culture Change (Cultural Change)
Definition
A course of action to move from one way of doing things to another. In long-term care, culture change is widely referred to as a process of transforming from an institutional to a homelike model. It is the integration of the three elements of person-centered care -- clinical care, socio-residential elements and human factors -- along with the enrichment of the environments in which people live and the empowerment of both clients and associates.
Term
Current Ratio
Definition
Current assets divided by current liabilities. A measure of a firm's ability to pay current debts. A current ratio much below 1.00 (or 1:1) may indicate problems in meeting current liabilities as they become due. (see also ACID-TEST RATIO).
Term
Custodial Care
Definition
Nonmedical care that includes routine assistance with the ADLs but does not include active nursing or rehabilitative treatments. Such care is provided to maintain function because the person's overall condition is not likely to improve.
Term
Data Assessment and Verification (DAVE)
Definition
A program administered by CMS designed to ensure accuracy of MDS data accomplished through data analysis, off-site review, on-site review, and provider education.
Term
Days in Resident Accounts Receivable
Definition
The number of days during which expenses could be paid using the cash on hand. It is: Cash + Marketable Securities (Total operating expenses minus depreciation)/365
Term
Days of Care
Definition
Also called "Patient Days." Cumulative census over a specified period of time.
Term
Debilitated
Definition
Weak and infirm, unable to care for many personal needs
Term
Debt Service Coverage Ratio
Definition
Projected annual cash flow (i.e., excess of cash receipts over cash expenses), divided by required annual debt payments. Measure used by potential lenders of the credit-worthiness of an entity.
Term
Debt-to-Assets Ratio
Definition
A measure of the relative obligations of a facility. Generally, the lower the debt ratio, the more financially sound the facility is believed to be. The ratio is calculated by: (Current Liabilities + Noncurrent Liabilities) / Total Assets
Term
Deemed Status
Definition
Medicare rule that a hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations is deemed to have met the Medicare certification criteria.
Term
Deficiency
Definition
A nursing facility's failure to meet any of the standards as determined by a survey.
Term
Degenerative
Definition
Disorders in which tissue or an organ deterioriates and vitality is diminished.
Term
Dehydration
Definition
A loss of the body's normal water content which can affect both physical and mental functions. Individuals with brain, kidney, or gastrointestinal disease may find it difficult to maintain a normal amount of water in the body with the aid of medications.
Term
Dementia
Definition
A generic term that describes progressive and irreversible mental dysfunction that results in complex cognitive decline. These cognitive changes are commonly accompanied by disturbances of mood, behavior and personality.
Term
Dentition
Definition
The makeup of a set of teeth including their kind, number, arrangement and usability.
Term
Depreciation
Definition
The systematic allocation of the cost of a fixed asset to expense over its useful life.
Term
Depression
Definition
An abnormal state of mind in which a person usually becomes inactive and disinterested in his environment and lacks motivation.
Term
Dermatologist
Definition
A specialist physician who treats infections, growths, injuries, and other disorders related to the skin.
Term
Dietary history
Definition
A review of a resident's usual food intake patterns, including any food preferences, chewing and swallowing problems, or difficulties with self-feeding that might affect overall food intake.
Term
Dietitian
Definition
Sometime referred to as nutritionist, a dietitian provides nutritional information and diet-related services to residents/patients.
Term
Director of Nursing (DON)
Definition
A registered nurse responsible for supervising the activities, functions, and training of nursing personnel.
Term
Differentiation
Definition
A competitive strategy in which a facility creates distinctive features that allow customers to distinguish the facility's offer from that of its competitors.
Term
Director of Nursing Services (DNS)
Definition
See DIRECTOR OF NURSING (DON).
Term
Discharge Planning
Definition
A process that includes decisions about when a patient may need to be discharged from the facility and what may be needed to make a smooth transition from one level of care to another or from the facility to living independently.
Term
Discrimination
Definition
The use of any selection procedure which has an adverse impact on the hiring, promotion or other employment or membership opportunities of members of any race, age, religion, marital status, sex, or national origin.
Term
Dispense
Definition
To deliver a prescribed drug to an ultimate user, including the compounding, packaging, and labeling necessary to prepare the prescribed drug.
Term
Dividend
Definition
A distribution of earnings to shareholders of a corporation.
Term
Do-Not-Resuscitate (DNR) Order
Definition
An advance directive in which a person specifies that he or she does not wish to have heartbeat or breathing restored in the event of a cardiac or respiratory arrest.
Term
Double-entry Accounting
Definition
The system of recording transactions that requires each transaction to be recorded at least twice: as an addition or subtraction to one account (and that is called a debit) , and as an addition or subtraction to at least one other account (and that is called a credit). This system provides a logical way to record much information. At the end of a period, after all adjusting entries are made, the sum of the debits should equal the sum of the credits. When a trial balance indicates that these two totals are equal, the "books balance" and financial statements can be prepared. Failure to find this equality is an indicator that one or more recording errors were made.
Term
Double-entry Rules
Definition
Increases in asset accounts and expense accounts are recorded as debits; decreases are credits. Increases in liability, revenue, and owners' equity accounts are credits, decreases are credits.
Term
Drug
Definition
Any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease or other conditions in persons. Any substance other than a device or food intended to affect the structure or any function of the body of persons. In the survey guidelines, drug is used in most cases to mean medication.
Term
Drug Irregularity
Definition
A drug that is given without a medical reason, in an excessive or inadequate dose or duration of therapy, where side effects indicate that a dose modification or drug discontinuation is indicated, or inadequate monitoring for effect of manufacturer's recomendations for laboratory monitoring. This therapy results in potential negative outcomes or is not achieving the stated objectives of the prescriber. The consulting pharmacist should address this potential drug therapy problem at the time of their drug regimen review.
Term
Drug Regimen Review (DRR)
Definition
The review of drugs being used by a resident (patient) to determine effect and potential for harmful effects.
Term
Drug Utilization Review (DUR)
Definition
The study of drug use patterns in a facility.
Term
Dual Certificaiton
Definition
A facility that is dually certified as both a skilled nursing facility and a nursing facility. Such facilities can admit Medicare and Medicaid residents in any part of the facility.
Term
Durable Power of Attorney
Definition
Appointment of an agent who is empowered to act on behalf of the person creating the power in the case of future incompetence. (Ordinary POA ends when the person creating the power becomes incompetent).
Term
Dysarthria
Definition
Slurred or unintelligible speech due to muscle weakness or other problem.
Term
Dysphagia
Definition
Difficulty in swallowing due to a dysfunction in any phase of the swallowing process.
Term
EBITDAR
Definition
Earnings before interest, taxes, depreciation, amortization, and rent. This shows cash flow available to pay interest, rent and taxes after paying operational costs. It is a measure used by potential lenders of the credit-worthiness of an entity.
Term
Eden Alternative
Definition
A cultural change that entails viewing the surroundings in facilities as habitats for human beings rather than as facilities for the frail and elderly, as well as applying the lessons of nature in creating vibrant and vigorous settings.
Term
Effective Pest Control Program
Definition
Measures used to eradicate and contain common household pests (e.g., roaches, ants, mosquitoes, flies, mice and rats).
Term
Elimination Period
Definition
In a long-term care insurance plan, the initial waiting period during which LTC services are used but not covered by insurance.
Term
Emphysema
Definition
A chronic condition characterized by damaged air sacs in the lungs. The resulting reduction of surface area available for gas exchange makes brething difficult and makes the heart work harder to circulate blood through the lungs. All these changes make less oxygen available to the body.
Term
Employee Assistance Program (EAP)
Definition
24-hour, 7-day-a-week confidential telephone service providing assistance to employees on matters such as child and elder care, substance abuse, financial counseling, etc.
Term
Employee Handbook
Definition
A compilation of the facility policies that directly relate to work conditions. It is often treated as a binding contract by the courts.
Term
Empowerment
Definition
The concept of encouraging and authorizing workers to take the initiative to improve operations, reduce costs, and improve quality of services.
Term
Energy metabolism
Definition
The process in the body of breaking down calories consumed into usable energy to allow the body to perform normal body functions.
Term
Enforcement Grid
Definition
A table developed by the Center for Medicare and Medicaid Services that defines severity and scope of federal deficiencies and indicates whether plans of correction and remedies are necessary. (See the SHSRA webite glossary for more detailed info).
Term
Enteral Feeding
Definition
Delivery of liquid food through a tube directly into the stomach.
Term
Environment
Definition
Refers to any area outside or inside the facility that is frequented by residents, staff, and guests and areas within the facility including the residents' rooms, bathrooms, hallways, dining and activity areas and therapy areas.
Term
Epidemic
Definition
Excessive prevalence of a negative health condition.
Term
Epilepsy
Definition
A brain disorder in which signals sent by nerve cells become disturbed, causing strange sensations, emotions, convulsions, muscle spasms, or loss of consciousness.
Term
Equal Employment Opportunities Commission (EEOC)
Definition
The organization was created by the Civil Rights Act of 1964 to carry out the provisions of that act. Also administers ADA, ADEA, Equal Pay Act, Pregnancy Discrimination, GINA, and other acts.
Term
Equity
Definition
The excess of a firm's assets over its liabilities equals the owner's equity (in a for-profit corporation).
Term
Equity Theory
Definition
Concept that employees seek an exchange in which their wages and benefits are equal to their work effort, especially when compared to wages and benefits being paid to similarly situated co-workers.
Term
Error of Central Tendency
Definition
Error by supervisors using rating scales in employee evaluations when consistently giving only moderate scores to employees on performance appraisals, regardless of whether the employee is a poor or an outstanding performer.
Term
Esophagostomy Tube
Definition
A small tube that enteres a surgical incision on the side of the neck and is generally removed after each feeding. The tube allows food to enter the esophagus and then flow down into the stomach.
Term
Ethics Committee
Definition
A multidisciplinary forum that is generally called upon to make decisions in the patient's best interest, particularly when legal avenues are not clear-cut.
Term
Evidence-Based Care
Definition
Delivery of services using best practices that have been established through clinical research.
Term
Exempt Employees
Definition
Salaried workers who are exempt from overtime provisions of the Fair Labor Standards Act.
Term
Expectancy Theory
Definition
Belief that the level of motivation to perform (make an effort at work) is a mathematical function of the expectations individuals have about future outcomes multiplied by the value the employee places on these outcomes.
Term
Extended Survey
Definition
A federal survey conducted within 14 days of a finding of sustandard care during a standard federal survey (see also STANDARD SURVEY).
Term
Extrapyramidal Symptoms (EPS)
Definition
Abnormal movements of the mouth or tongue, pill rolling, tremors, rigid movements, mask-like face, constant movement of legs or body, tics, blinking, pacing, eyes rolled up, drooling.
Term
False Claims Act
Definition
Federal law that provide for civil or criminal penalties for individuals and entities for submitting a false claim, or causing a false claim to be submitted, to a federal health care program. False or fraudulent claims include claims for items not provided or not provided as claimed, claims for services that are not medically necessary, and claims when there has been a failure of care. Many states have a parallel law that applies to the state Medicaid and other state health care programs.
Term
Federal Mediation and Conciliation Service (FMCS)
Definition
A federal agency making government facilities available for conciliation, mediation and voluntary arbitration of labor disputes.
Term
First In, First Out (FIFO)
Definition
1. Inventory usage ideal of using the oldest supplies first (as long as the use-by or expiration date has not been reached). To facilitate this, new supplies are shelved based on the use-by or expiration date, so that the oldest products are stored in front of, or otherwise made more accessible than, more recently acquired products. 2. Inventory costing method for balance sheet purposes that assumes that the first goods purchased (first-in) are the first goods used (first-out), so the ending inventory should be valued at the cost of the most recent goods purchased. The Last In, Last Out method assumes the opposite , and values ending inventory at the cost of the earliest goods purchased.
Term
Fixed Costs
Definition
Costs that do not vary with the number of patients. These costs are not controllable.
Term
Flexible Budget
Definition
An adjusted budget in which the budgeted costs are raised or lowered to reflect the actual census.
Term
Flex Time
Definition
A program allowing employees to choose the hours they work, so long as they put in the expected number of hours per time period.
Term
Flexible Spending Account
Definition
An optional benefit in which employees can set aside a designated amount of funds for guture medical services. As medical services are incurred, the charge is made against the account. The funds are usually a pre-tax withdrawal from the employees check. This optional benefit must be a careful calculation and is usually for persons that have consistent or relatively high medical expenses. There is an administrative fee from the processing agent and funds not used can't be carried over to the next year.
Term
Fraud
Definition
Deliberate deceit by providers or consumers in obtaining payment for services that were not actually delivered or received, or in claiming program eligibility. To be distinquished from abuse, which refers to improper or excessive use of program benefits, resources, or services by either providers or consumers. Abuse is not necessarily intentional or illegal.
Term
Functional Disabilities
Definition
Limitations on one's ability to function independently.
Term
Funded Depreciation
Definition
The setting aside of a portion of retained earnings (equal to a depreciation expense) in a separate account designated to be used only for the purchase of replacement capital assets.
Term
Gait
Definition
How a person walks.
Term
Gastrostomy Tube (G-tube)
Definition
A mechanism for delivering nutrition through a tube that passes through a surgical opening in the abdomen and into the stomach.
Term
General Ledger
Definition
Financial record, consisting of a collection of accounts, that summarizes all the entries in each of the journals for an accounting period, for the purpose of keeping a continuous record of account balances and arriving at a trial balance.
Term
Generally Accepted Accounting Principles (GAAP)
Definition
The policies, standards, and rules followed by accountants in the preparation of financial statements and in recording and summarizing transactions.
Term
Geriatric Medicine
Definition
Also called geriatrics. The medical knowledge of physical disability in older persons--including diagnosis, treatment, and prevention of disorders. Geriatric medicine recognizes aging as a normal process, not a disease state.
Term
Geriatrician
Definition
A physician with special training in geriatric medicine. In earlier years, this training was self-taught through the special attention physicians gave their older patients. Now, one- and three-year training programs, which follow the regular medical curriculum, are established in a number of teaching medical centers.
Term
Gerontology
Definition
The study of aging from the broadest perspective. Gerontologists examine not only the clinical and biological aspects of aging but also psychosocial, and historical conditions.
Term
Global Rating
Definition
A summary score based on the components of a performance appraisal.
Term
Goal Setting
Definition
Setting of objectives to be achieved by an employee before the next performance appraisal.
Term
Good Faith
Definition
A legal term that refers to actions that are generally consistent with how a reasonable person would act under similar circumstances.
Term
Governance
Definition
The act of governing. It refers to trusteeship and stewardship of an organization's resources and capabilities to benefit is stakeholders.
Term
Green House
Definition
A small freestanding facility designed to house 7 to 10 residents who live together in a homelike setting. Generally, a number of Green Houses are arranged around a central skilled nursing facility that provides support services.
Term
Grievance Procedure
Definition
The established method, and outlined in the employee handbook, by which an employee can have any decision of a supervisor reviewed by higher level management with the organization.
Term
Guardian
Definition
Legal representative, appointed by a court, to make decisions for a person not competent to make their own decisions. Generally, resident (patient) guardians have all of the legal rights normally granted to competent residents (patients).
Term
Halo Effect
Definition
Error made by supervisors using rating scales in an employee evaluation where they value one particular type of job behavior and permit the presence or absence of that one trait to color several or most other trait ratings.
Term
Harm
Definition
Negative effect that has occurred to a resident (patient), infringement of a resident's (patient's) rights, or compromising of a resident's (patient's) ability to meet their highest practicable level of physical, mental or psychosocial well being.
Term
Health Hazard Chemical
Definition
One for which there is significan evidence, based on at least one study conducted in accordance with established scientfic principles, that an acute or chronic health effect may occur in exposed employees.
Term
Health Insurance
Definition
A fringe benefit available to many nursing facility employees. Typically the employee is covered free or shares in the cost, and can obtain family coverage for an additional periodic payment.
Term
Health Insurance Portability and Accountability Act (HIPAA)
Definition
Established principles of patient privacy and confidentiality regarding use and misuse of their personal medical information and records, as well as standards for communication, storage and transmission of information.
Term
Health Maintenance Organization (HMO)
Definition
An organization that has management responsibility for providing comprehensive health care services on a prepayment basis to voluntarily enrolled persons within a designated population.
Term
Hierarchy
Definition
A Research Utilization Group methodology of assessment classification where an assessment is placed in the first classification category (there are over 40 reimbursement categories) and where a match is found by evaluating resident conditions and services. They are normally ordered from highest to lowest, for example extensive services, rehabilitation, special care, clinically complex, impaired cognition, behavioral problems, and reduced physical functions. These categories vary from time to time.
Term
Historical Cost (or Acquisition Cost)
Definition
Cost of acquiring a depreciable asset, which includes not only the purchase price but also the cost of taxes, shipping, assembly and installation.
Term
Holistic Model
Definition
A philosophy that empasizes that health care delivery should focus not merely on a person's physical and mental needs, but should also emphasize well-being in every aspect of what makes a person whole and complete.
Term
Home- and Community-Based Services (HCBS) Waiver
Definition
Enacted under Section 1915(c) of the Social Security Act, the program allows states to offer LTC services that are not otherwise available through the Medicaid program. The latter had authorized payments for institutional care only.
Term
Home Health Care
Definition
Delivery of services such as nursing care and rehabilitation therapies to patients in their own homes because such patients do not need to be in an institution and yet are generally unable to leave their homes safely to get the care they need.
Term
Home Telehealth Systems
Definition
Use of telecommunication technology for the distance monitoring of patients and delivery of health care with or without the use of video technology.
Term
Hospice Care
Definition
Supportive care provided to terminally ill patients and their families in the final six months (Medicare definition) of a patient's life. This care is managed and coordinated by a certified Medicare hospice provider. It is a program for caring for the dying, in order to enhcance whatever life remains rather than battling illness or warding off death.
Term
Human Immunodeficiency Virus (HIV)
Definition
A virus that gradually destroys the body's natural immune system designed to fight infections and disease.
Term
Human Resource Management
Definition
The organizational function of planning for human resource needs, recruitment, selection, compensation, development, evaluation, and handling of grievances and labor relations.
Term
Hypertension
Definition
High blood pressure.
Term
Hypnotic Medication
Definition
A psychoactive medication given to sedate or calm (e.g., Sonata, Restoril, Ambien).
Term
Iatrogenic
Definition
Complications caused by the process of medical care.
Term
ICF/MR
Definition
A federal certification for an Intermediate Care Facility for the Mentally Retarded.
Term
Immediate Jeopardy (IJ)
Definition
A situation in which a provider's noncompliance with one or more regulations has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident (patient). (42 CFR Part 489.3.)
Term
In Migration--Out Migration
Definition
Movement of laborers into or out of the geographic area within which a facility is recruiting for specific positions.
Term
Incidence
Definition
A type of CHSRA QI that provides a description of what has taken place with a resident (patient) over the course of the last two MDS or OASIS assessments.
Term
Incident
Definition
Any unexpected negative occurrence involving a patient, family, or employee, or visitor.
Term
Income
Definition
An increase in owner's equity resulting from services rendered or goods provided.
Term
Income Statement (or Statement of Revenue and Expenses)
Definition
A report which lists in summary form revenues and expenses for a certain time period, such as a month or a year. A profit results from an excess of revenues over expenses for the period, and a loss occurs when expenses exceed revenues. So the income statement also shows profit or loss, and is therefore also called the profit-and-loss (or P-and-L) statement.
Term
Incontinence
Definition
Lacking voluntary control over the bladder or bowel. In most people incontinence can be treated and controlled, if not cured. Specific changes in body function, often resulting from disease or the use of medications, are the cause of incontinence.
Term
Independent Contractors
Definition
Category of persons providing services who are not considered by the IRS as employees. Therefore, employers generally do not have to withhold federal income tax or FICA taxes on payments to independent contractors. The IRS offers 20 guidelines for determining whether an individual falls into this category. The general rule is that independent contractors "follow independent trade, business or profession in which they offer their services to the general public," and those who pay for their services "have the right to control or direct only the result of the work and not the means and methods of accomplishing the result." However, employers who pay an independent contractor $600 or more during a year must issue and file a Form 1099-MISC.
Term
Individual Bargaining
Definition
Individuals with skills especially needed by a facility may be able to negotiate a higher wage than other employees in similar positions.
Term
Individual Program Plan
Definition
A written statement of the services to be provided, as developed by an interdisciplinary team, and based on a comprehensive functional assessment of an individual's active treatment needs.
Term
Indwelling Catheter
Definition
A catheter that remains in the bladder to drain urine into a bag.
Term
Infantalization
Definition
Treating older adults as children.
Term
Infection Control
Definition
A comprehensive program to prevent the transmission of infections protecting the residents, the staff, and visitors from contracting infections while in the facility.
Term
Infectious Waste
Definition
Hazardous waste that can pose health risks from communicable infectious agents.
Term
Informed Consent
Definition
The person giving consent receives information necessary to make a health care decision, including information about the benefits, reasonable risks, alternatives, the right to refuse, and consequences of any treatment or service.
Term
Injury
Definition
Physical, financial, or emotional harm.
Term
Initial Survey
Definition
An on-site federal survey to determine whether a provider meets the requirements to begin participating in the Medicare and/or Medicaid programs.
Term
In-Service Training
Definition
Seminars, online programs, DVDs, workshops, etc., offered during the work career of the employee. An "in-service" is an educational session.
Term
Instrumental (Independent) Activities of Daily Living (IADLs)
Definition
Activities that include meal preparation, housework (e.g., cooking), managing finances (e.g., keeping a checkbook) or medications, telephone use, shopping, and transporation (e.g., how one moves up and down stairs, how one moves in and out of cars).
Term
Intangible Asset
Definition
An item or right that has no physical substance and provides an economic benefit. The reputation of a nursing facility as the best caregiver in the community is a valuable intangible asset, for example.
Term
Integrated Pest Management (IPM)
Definition
A program of Serv Safe that outlines procedures for controlling access of pests to the building.
Term
Interdependence
Definition
A state of living together (symbiosis) in a mutually beneficial relationship.
Term
Interdisciplinary Team
Definition
A facility team which allows involvement of mulitple medical disciplines in providing patient care; can consist of all or some of the following professionals: physician, nurse, social worker/case manager, dietitian, therapists, pharmacists, etc.
Term
Internist
Definition
A physician who specializes in treating diseases related to the internal organs of the body.
Term
Interoperable
Definition
Electronic medical information that is available simultaneously to various health care providers.
Term
Inventory
Definition
The goods and materials on hand which are to be used in producing services or held for resale.
Term
Invoice
Definition
Document prepared by a seller for a buyer that describes goods sold or services rendered and the terms for payment.
Term
Jejunostomy tube (J-tube)
Definition
A surgically placed tube that enters the small intestine for the delivery of specialized nutritional formulas.
Term
Job
Definition
A collection of tasks assigne to an employee.
Term
Job Analysis
Definition
The process of defining a position in terms of tasks or behaviors required, specifying the qualification of the employee to be assigned those duties.
Term
Job Bidding
Definition
The practice of posting available jobs on bulletin boards and encouraging employees to apply or bid for openings.
Term
Job Description
Definition
A statement of the tasks to be done based on the job analysis, usually including a list of duties and responsibilities of the position in order of importance.
Term
Job Evaluation
Definition
The process of assessing and rating all jobs in an organization as a basis for the wage and salary system.
Term
Job Family
Definition
A group of two or more jobs that have similar duties, for example, the duties of the registered nurse and licensed nurse practitioners.
Term
Job Posting
Definition
Same as job bidding; a form of internal recruitment in which the job opening is literally posted on the bulletin boards, inviting employees to bid.
Term
Job Specification
Definition
A statement of the skills, education, and experience required to perform the work. This is derived from the job description.
Term
Job Title
Definition
Naming of the job to distinguish that job from all other jobs, often indicating level, e.g., Supervisor II.
Term
Job Worth
Definition
Establishing the value of a job by comparing it to all other jobs to e accomplished by an organization.
Term
Journal
Definition
Book of original entry, the first place in which transactions are formally recorded. Entries are in chronological order. A separate journal is generally maintained for the following categories of transactions: cash receipts, cash payments, billings, accounts payable, and payroll. A General Journal is used for entries that to not properly belong in any of the other journal s, and for adjusting entries. Adjusting entries include entries entries for depreciation, prepaid expenses, and inventory usage.
Term
Kerr-Mills Act
Definition
Congressional legislation that made federal funds available to states for health care for the needy.
Term
Key Job Comparison
Definition
A method of establishing wage rates for jobs, based on comparing all jobs in the organization to a touchstone job in the facility, such as nursing.
Term
Kickback
Definition
A portion of a fee, salary, or other payment that is given to a third party for having assisted--or refrained from preventing--the payment in the first place. Most types of kickbacks are unethical or illegal.
Term
Labor Market
Definition
The geographic area from which applicants for positions are to be recruited.
Term
Layoff
Definition
Temporary dismissal of workers from their jobs due to lack of work, not "for cause."
Term
Leadership
Definition
The art of engaging colleagues, collaboratively toward a shared vision. As defined by Yukl, leadership is "the process of influencing others to understand and agree about what needs to be done and how to do it, and the process of facilitating individuals and collective efforts to accomplish shared objectives." Alternatively defined, it is influencing people to act for certain goals that represent the values and motivations -- wants, needs, aspirations, and expectations -- of both leaders and followers.
Term
Learned Helplessness
Definition
A psychological state in which patients believe that they can no longer do anything for themselves and must depend on others.
Term
Lease
Definition
A contract requiring the lessee (user) to make periodic payments (rentals) for a specified period of time to the lessor (owner) for the use of an asset. Operating leases are generally for a short term or limited number of years. A capital lease is a long-term lease agreement extending generally for the entire life of equipment or property leased. Operating lease expenses are listed on the income statement. Capital leases should be reported as assets and as long-term liabilities on the balance sheet. The asset (capital lease) is amortized for depreciated based on its useful life.
Term
Leniency Error
Definition
Consistently giving high ratings to all employees when evaluating employees in an attempt to avoid conflict.
Term
Liabilities
Definition
Debts owed by a firm to a persons or firms other than its owners. On a balance sheet, liabilities are classified as current if they are due within one year from the balance sheet date, and long-term (or non-current) if they are due more than one year from the balance sheet date.
Term
License
Definition
A duly-issued certificate that permits a person to practice or a nursing home to operate in a given state.
Term
Licensed Practical Nurse (LPN)
Definition
A person licensed as a practical nurse by state statute. An LPN performs simple acts in the care of convalescent, subacute or chronically ill patients; or provides care to acutely ill patients under the specific direction of a registered nurse, physician, podiatrist or dentist. Similar to an LVN (Licensed Vocational Nurse) in some states.
Term
Licensure
Definition
The granting of a license to a provider that has been determined to meet a state's requirements for operation.
Term
Life Insurance
Definition
Some facilities offer free or shared fees for life insurance (a specific payment amount upon the death of the insured), usually term type life insurance, as a benefit. Term insurance features low premiums or high-dollar coverage, but has no cash, loan or other value.
Term
Life Safety Code
Definition
Rules and standards developed by the National Fire Protection Association to specify numerous fire safety and other elements of building construction, fixtures, and furnishings that nursing facilities must comply with.
Term
Line Manager
Definition
Person responsible for performing most of the personnel functions, who is delegated authority by the administrator to make decisions on his/her behalf and authority to commit facility resources.
Term
Line of Credit
Definition
Form of financing in which a financial institution commits itself to make a loan to a company up to a specified maximum amount. The company may choose to use its line of credit, subject to the terms of credit, when and if the need arises.
Term
List of Excluded Individuals/ Entities
Definition
Online database maintained by the OIG (at www.hhs.gov/oig) providing information regarding over 15,000 individuals and entities that are excluded from participation in Medicare, Medicaid and other federal health care programs. Certified facilities should check (and periodically recheck) this list and must refrain from contracting with or otherwise doing business with anyone on it in the course of providing items or services for which payment may be made under a federal health care program. Providers are advised to check also the General Services Administration (GSA) monthly "List of Parties Excluded From Federal Procurement and Nonprocurement Programs" at http://epls.arnet.gov.
Term
Living Will
Definition
An advance directive specifying a person's wishes regarding medical treatment in the event this person becomes incompetent.
Term
Loan-to-Value Percentage
Definition
The maximum loan amount based on a percentage of the borrowing facility's appraised value.
Term
Long-Term Asset
Definition
An asset with future economic benefits that are expected for a number of years. Long-term assets are reported on the balance sheet as noncurrent assets and include buildings and equipment. A new central building for a life care community may have a long-term expected asset value for perhaps 40 or more years to come.
Term
Long Term Care (LTC)
Definition
A general term used to describe care in nursing homes. This term is also used to describe a broader continuum of care for chronic and disabled persons that include nursing homes, assisted living facilities, board and care facilities, and community care such as home health agencies. It is a variety of individualized and well-coordinated total care services that promote the maximum possible independence for people with functional limitations and that are provided over an extended period of time, using appropriate current technology and available evidence-based practices, in accordance with a holistic approach while maximizing both the quality of clinical care and the individual's quality of life.
Term
Long Term Care Facility
Definition
An institution, commonly referred to as a nursing home, that is duly licensed to provide long-term care services.
Term
Maintenance Rehabilitation
Definition
Rehabilitation that is aimed at preserving the present level of function and preventing secondary complications.
Term
Malpractice
Definition
Negligence or carelessness in the delivery of services according to accepted standards of care so that harm is caused to the recipient of care.
Term
Managed Care
Definition
An approach to delivering a comprehensive array of health care services to a defined group of enrolled members through efficient management of service utilization and payment to providers.
Term
Managed Care Organization (MCO)
Definition
Entity that integrates the financing and delivery of health care to covered individuals by means of arrangements with a limited number of selected providers. It provides financial incentives for membership, quality assurance programs, and formal utilization management programs (i.e., processes to evaluate the necessity, appropriateness, and efficacy of health care services). (see also Medicaid MCO).
Term
Management
Definition
Organization and coordination of the activities of a department or group of people in accordance with objectives, policies and procedures. It is what managers do to maintain an organization and to move it forward. Management is about getting things accomplished on a daily basis...as opposed to leadership, it's "things" versus "people." You lead people and manage things.
Term
Management Information System (MIS)
Definition
A system for managing information to assist the organization in evaluating, planning, and implementation of daily work to improve processes and resident care.
Term
Management By Objectives (MBO)
Definition
A system of managementthat is based on a joint agreement between supervisors and associates on what specific measurable objectives would be accomplished over a given period of time, at the end of which the supervisors evaluate individual associates on the basis of the accomplishment of these objectives.
Term
Manpower Inventory
Definition
A projection of the present and future availability of qualified personnel in a number sufficient to meet facility needs.
Term
Mediation
Definition
Another concept that is related to facilities that are unionized. In this case, the third party seeks to reach a settlement between the union and the facility on an issue.
Term
Medicaid
Definition
A state program that provides medical services to clients of the state public assistance program and, at the state's option, other needy indviduals, as well as supplements hospital and nursing facility (NF) services that are mandated under Medicaid. States may decide on the amount, duration, and scope of additional services. Generally, the only types of institutions participating solely in Medicaid are Nursing Facilities (NFs) and Intermediate Care Facilities for the Mentally Retarded (ICF/MR). Also called Title 19 of the Social Security Act, it is a jointly funded federal-state health insurance program for the indigent.
Term
Medicaid Managed Care Organization (MCO)
Definition
Entity that has entered into a risk contract with a state Medicaid agency to provide a specified package of benefits to Medicaid enrollees in exchange for a monthly capitation payment on behalf of each enrollee. These plans may include or carve out acute care services. Some MCOs coordinate Medicare and Medicaid services for dually eligible beneficiaries. Such arrangements may include a capitated amount for both Medicare and Medicaid services or only Medicaid with an additional fee paid to the MCO to coordinate Medicare services that are not part of the plan.
Term
Medical Model
Definition
Delivery of health care that places its primary emphasis on the treatment of disease, relief of symptoms, and intensive use of medical technology, with little emphasis on the promotion of optimum health in a holistic context.
Term
Medical Nutrition Therapy
Definition
A diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate, decrease or increase specific nutrients in the diet. (May also be called Therapeutic Diet).
Term
Medicare
Definition
A federal insurance program providing a wide range of benefits for specific periods of time through providers and suppliers participating in the program. Providers, in Medicare, are patient care institutions such as hospitals, hospices, nursing homes, and home health agencies. Benefits are payable for most people over age 65, Social Security beneficiaries under 65 entitle to disability beneifts, and individuals needing renal dialysis or renal transplantation. Payment for services is made by the federal government through designated fiscal intermediaries (FIs) and carriers to the providers and suppliers. Title 18 of the Social Security Act to cover health care services for the elderly, certain disabled people, and those who have end-stage renal disease.
Term
Medicare Data Communication Network
Definition
(MDCN). A secure connection that is used to transmit MDS data to each state's repository. A user ID and password is issued for each person who requires access to the CMS MDS intranet.
Term
Medication Error
Definition
Medications not given as intended by the prescriber, as required by the drug manufacturer, or according to acceptable professional standards.
Term
Mental Retardation
Definition
Below-average intellectual functioning that is long term and incurable.
Term
Mentor
Definition
An individual who agrees to advise a person over a set period of time.
Term
Minimum Data Set (MDS)
Definition
A federally mandated resident assessment instrument used to assess resident physical, mental, emotional, cognitive, and functional limitations and strengths. The MDS must be administered to all residents in Medicare- or Medicaid-certified facilities at the time of admission, annually, quartely, and when a significant change in a resident's condition occurs.
Term
Minimum Data Set (MDS)
Definition
The MDS is a resident assessment tool, utilizing computerized resident information to assess and monitor resident care. Reports are electronically transmitted to CMS, as well, to classify a resident into a resource utilization group (RUG) which sets the reimbursement level for the patient's care. It is a core set of screening, clinical, and functional status elements, including common definitions and coding categories that form the foundation for the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare and/or Medicaid. It is, simply put, a set of standardized screening elements that must be assessed for each patient admitted to a SNF.
Term
MDS Completion Date
Definition
The date at which the RN assessment coordinator attests that all portions of the MDS have been completed.
Term
Misappropriation
Definition
The deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's (patient's) belongings or money without their consent.
Term
Mortgage
Definition
A written promise giving a creditor an interest in the debtor's property as security (collateral) for a debt.
Term
Multidisciplinary (or interdisciplinary)
Definition
A team approach to problem solving or delivery of care in which all key disciplines, such as nursing, food service, therapy, social work, and activities, participate and make joint decisions.
Term
Multisensory Stimulation (MSS)
Definition
Also known as "multisensory behavior therapy (MSBT)," it involves stimulation of all the primary senses through a combined effect of textured objects, soft music, colored lighting, aromas, and favorite foods. Snoezelen is the Dutch term for this.
Term
Nasoduodenal Tube
Definition
A mechanism for delivering nutrition through a tube that passes through the patient's nose and goes down into the duodenum, the first part of the small intestine.
Term
Nasogastric tube (NG-tube)
Definition
A method of delivering nutrition through a tube that passes through the nasal openings, down to the esophagus, and into the stomach.
Term
National Institute of Occupational Safety and Health (NIOSH)
Definition
Federal agency formed under the Occupational Safety and Health Act (OSHA) to establish and monitor workplace safety standards.
Term
National Labor Relations Board
Definition
An organized panel set up to administer the process under the National Labor Relations Act, under which unions become certified as the bargaining agents for groups of workers.
Term
National licensing exam
Definition
The examinatin handled by NAB (National Association of Boards of Examiners of Long-Term-Care Administrators, Inc….a private organization) that an applicant must take to be a licensed NHA or ALA (two different exams).
Term
Neglect
Definition
Failure to provide goods and services to prevent resident (patient) harm, mental anguish, or mental illness.
Term
Negligence
Definition
Failure to exercise the degree of care that a reasonable person would exercise in similar circumstances.
Term
Nephrologist
Definition
A physician who specializes in kidney diseases, kidney transplantation, and dialysis therapy. Nephrology is classified as an internal medicine subspecialty.
Term
Nepotism
Definition
Favoring one's family members in hiring practices.
Term
Net present value
Definition
In corporate finance, the present value (i.e., the value of cash to be received in the future expressed in current dollars) of an investment in excess of the initial amount invested. When a proposed project, such as building a new wing has a positive net present value, it should perhaps proceed; when a proposed wing shows a negative net present value, it should perhaps be delayed or abandoned.
Term
Nosocomial Infection
Definition
An infection that is acquired by a person within the facility.
Term
Nosocomial Infection in the LTC Facility
Definition
An infection that develops after admission to the LTCF. Infections that are incubating at the time of admission, or develop within 48 to 72 hours of admission, usually are community-acquired or hospital associated if the person was transferred from the hospital.
Term
Note
Definition
A written promise to pay a specific sum with or without interest at a fixed future date.
Term
Nurse Aide Competency
Definition
Federal and/or state training and capability requirements needed for employment of nurse aides in nursing homes.
Term
Nurse Aide Registry
Definition
A listing of nurse aides who have met Federal and/or State training and competency requirements needed for employment in nursing homes.
Term
Nurse Aide, Nursing Assistant (NA)
Definition
An unlicensed caregiver, under professional nurse supervision, who provides nursing and professional care.
Term
Nurse Practiioner
Definition
A registered nurse who meets additional state requirements to meet this designation. In some states, nurse practitioners may act as physician extenders to conduct certain activities such as ordering tests and medications.
Term
Nursing Facility (NF)
Definition
A nursing home that meets the requirements for Medicaid certification as defined in 1919(a) of the Federal Social Security Act.
Term
Nursing Facility (NF)
Definition
A facility licensed to provide assistance with activities of daily living such as bathing, dressing, eating (often referred to as custodial care) in addition to providing general nursing and medical care. A nursing facility must be certified to receive Medicaid reimbursement.
Term
Nursing Home Administrator - NHA (Nursing Facility Administrator - NFA, AKA LTCA or Long-Term Care Administrator)
Definition
The person charged to operate a nursing homeand licensed by the state. "As the nursing home evolved, the title of the person was changed from operator to nursing home administrator. Since then the term nursing home has changed to nursing facility. A few states changed nursing HOME administrator to nursing FACILITY administrator. However, the term nursing facility has not become popular. Predominantly they are called nursing HOMES, so the title nursing homes administrator (NHA) is likely to remain in vogue." (Townsend, et al, page 7).
Term
Nursing Home Compare
Definition
A public website, www.medicare.gov, which includes facility information and previous survey results from the Online Survey Certification and Reporting data (OSCAR)and other facility performance measures from the Minimum Data Set (MDS) for consumer review.
Term
Nursing Home Quality Improvement Initiative
Definition
A program of the CMS and U.S. Department of Health and Human Services that compiles information about nursing home residents on eight situations/conditions called quality measures (QMs) and makes the information available to consumers.
Term
Occupancy Rate
Definition
The ratio of actual number of resident days to the total possible resident days, usually expressed as a percentage. Alternatively, the ratio of occupied beds to available licensed beds. For example, if a facility has 100 beds and 80 are occupied for a day, the occupancy rate is 80/100 or 80%. This may be reported as the average of the daily occupancy rates for a period , such as 30 days or a year. A particular resident's bed may be considered an occupied bed in calculating this rate even though that resident is in the hospital or temporarily discharged for some other reason, if the facility is receiving a "bed-hold" or "bed-reserve" rate and/or is reserving the bed for that resident.
Term
Occupational Therapist (OT)
Definition
A person licensed, certified, or registered under state statutes to perform as an occupational therapist. Generally these individuals are certified by the American Occupational Therapy Association (AOTA).
Term
Occupational Therapy
Definition
Specializes in the adaptive use of the upper extremities for performing various tasks…evaluating and treating funcitonal impairments in the ADLs. Ocuupational therapists (OTs)also play a vital role in evaluating the independent living environment when the patient is scheduled for discharge to home.
Term
Office of Inspector General (OIG)
Definition
Office in the US Department of Health and Human Services charged with identifying and eliminating fraud, abuse and waste in the Medicare, Medicaid, and othe DHHS programs. The OIG carries out this mission through a nationwide program of audits, inspections, and investigations, and through issuance of Special Fraud Alerts.
Term
Ombudsman
Definition
Paid or voluntary staff that investigate nursing home complaints from residents and their families and act as resident advocates addressing concerns of nursing home residents. Many Ombudsman programs are associated with state department or boards of aging. An ombusdman is a trained professional who works independtly with area nursing home residents and their families to resolve concerns they may have about their lives in a facility.
Term
Omnibus Budget Reconciliation Act of 1987 (OBRA)
Definition
Changes to the Federal Social Security Act that significantly changed how nursing homes and home health agencies are regulated for Medicare and Medicaid certification. A law that enacted reforms in nursing facility care and provided the statutory authority for the MDS.
Term
Oncology
Definition
A medical specialty dealing with cancers and tumors.
Term
One-to-one Programming
Definition
Refers to programming provided to residents who will not, or cannot, effectively plan their own activity pursuits, or residents needing specialized or extended programs to enhance overall daily routine and activity pursuit needs.
Term
Online Survey/ Certification and Reporting (OSCAR)
Definition
CMS database that includes Medicare and Medicaid certified facility demographic information, results of on-site surveys, and aggregate nursing home resident characteristics for comparision with state and national peer information.
Term
Online Survey/ Certification and Reporting (OSCAR)
Definition
A database of facility characteristics and previous inspection results related to nursing facility performance. The OSCAR 3 report summarizes a facility's regulatory compliance history . The OSCAR 4 reports the facility's recent survey results and provides an opportunity for benchmarking by comparing those results to other facilities, statewide and nationwide.
Term
On-The-Job-Training
Definition
Assignment of employee to one staff member who assists the employee to acquire the capabilities required in a position in the facility.
Term
Operating Margin
Definition
Total profit (or loss) as a percent of total revenue.
Term
Ophthalmologist
Definition
A physician who specializes in the treatment of diseases and injuries of the eye.
Term
Opportunity Cost
Definition
The value of the benefits sacrificed when money or other asset is used one way rather than in an alternative way. It is the net benefits that might have been obtained had the money been spent on the next best use. For example, if $1,000 is spent for activity program supplies, the opportunity cost of NOT having the benefits of $1,000 worth of food or landscaping services, or of not earning the interest had the money simply been left in the bank.
Term
Optician
Definition
An optical technician who generally hold an associate's degree in opticianry. An optician dispenses and fits eyeglasses.
Term
Optometrist
Definition
A licensed professional who holds a doctor of optometry (OD) degree and is trained to diagnose and treat vision problems and other eye disorders. They most commonly prescribe eyeglasses and contact lenses.
Term
Organizing
Definition
(a managerial behavior) The grouping of activities and people who will carry them out, assigning roles and delegating authority.
Term
Orthopedist
Definition
A physician who specializes in correcting deformities of the skeletal system and may surigally repair bones and joints.
Term
Osteopathic Medicine
Definition
Medical approach -- practiced by doctors of osteopathic medicine (DOs) -- that emphasizes the musculoskeletal system of the body such as correction of joints and tissues.
Term
Outcome
Definition
The status of care provided to a resident (patient).
Term
Ownership
Definition
Term coined to suggest giving employees a proprietary sense of participation in the facility and its goals through treating employees as members of a team.
Term
Palliation
Definition
Medical care that is focused on relieving unpleasant symptoms such as pain, discomfort, and nausea.
Term
Palliative Care
Definition
Management and support provided for the reduction or abatement of pain, for other physical symptoms and psychosocial and spiritual needs of individuals with terminal illness and includes physician services, skilled nursing care, medical services, social services, services of volunteers and bereavement services, but does not mean treatment provided to cure a medical condition or disease to artificially prolong life. It is the alleviating of suffering where "cure" of underlying disease is no longer possible.
Term
Parentral Nutrition
Definition
Delivering a special liquid nutritional formulation directly into the blood stream, when the gastrointestinal tract is not functioning properly.
Term
Parkinson's Disease
Definition
A progressive disorder of the central nervous system. Clinically, the disease is characterized by a decrease in spontaneous movements, gait difficulty, postural instability, rigidity and tremor. Parkinson's diseas is caused by the degeneration of certain neurons in the brain.
Term
Passivity
Definition
A decline in human emotions, withdrawal from interactions with others and surroundings, and a decrease in motor activity.
Term
Pathogen
Definition
Disease-causing organism.
Term
Pathological Waste
Definition
Human waste that may contain human tissue, blood, or body fluids.
Term
Payback Period
Definition
A simple device for comparing investment proposals. It is the time in years for the net cash inflow from a capital investment to be equal to its cost, that is for the item to "pay for itself." It is criticized for failure to consider the time value of money, expected net cash flows after the payback period, and some key benefits from use of an item. If the estimated net cash receipts are the same amount each year, the payback period is calculated by dividing the total investment by the expected annual savings or increase in net cash inflow. Depreciation does not affect cash flow, so it is ignored. EXAMPLE: A machine is purchased for $30,000 to replace a worker earning $20,000 per year. Payback period = Total Investment Annual savings or increased net cash flow = $30,000 $20,000 = 1.5 years
Term
Percentile Rank
Definition
For the CHSRA QIs,a means of ranking providers based on how they compare with each other on each separate QI. The higher a provider's percentile ranking, the more apt the provider is to have a care concern.
Term
Performance Evaluation
Definition
Usually an annual evaluation of employees in which the performance of the employee is formalized into written appraisals or rating scales by the administrator and given to the employee prior to a face-to-face meeting to review the evaluation and allow the employee to respond to the comments or rating. This evaluation is based on clear measures and goals set the previous year. Setting work goals for the next evaluation period is also part of this evaluation process.
Term
Performance Feedback
Definition
Same as performance evaluation; comments by the employee on the employee on the evluation by the administrator.
Term
Performance-Centered Objectives
Definition
Stating training goals in terms of behaviors that can be learned and observed by supervisors or others, e.g., ability to demonstrate proper procedures for turning a residnet suffering from pressure ulcers.
Term
Person Appropriate Activities
Definition
Refers to the idea that each resident has a personal identity and history that involves more than just his/her medical illnesses or functional impairments. (Miller, cited in The Long Term Care Survey, 2008, page 86).
Term
Person-Centered / Person-Directed Care
Definition
A philosophy of care in which the focus of the community is on meeting the expressed desires of the residents.
Term
Personnel Manager
Definition
A staff function. Assists line managers in record keeping, recruitment, selection, training and retaining employees as well as compensation management and performance evaluation. This person is most responsible for the human resources function.
Term
Physiatrist
Definition
A physician who has specialized in physical medicine and rehabilitation.
Term
Physical Hazard Chemical
Definition
One for which there is scientifically valid evidentce that it is combustible liquid, a compressed gas, explosive, flammable, or organic peroxide, an oxidizer, pyrophoric, unstable (reactive) or water-reactive.
Term
Physical Restraint
Definition
Devices that prevent or restrict resident (patient) movement. A device or manual method that works to treat a medical symptom(s) but is attached to or adjacent to the individual's body so that freedom of movement or normal access to one's body is restricted.
Term
Physical Therapist (PT)
Definition
A person licensed, certified, or registered by state statute to perform as a physical therapist. Generally, these individuals are certified by the American Physical Therapy Association (APTA).
Term
Physical Therapy
Definition
Focuses on evaluating and treating musculoskeletal disorder… geared toward improving ambulation, joing mobility, and balance; strength training; fitting and using artificial limbs; training to use canes and walkers. (Singh, 2008, page 296).
Term
Physician Assistant (PA)
Definition
A person licensed or certified by state statute to perform as a physician assistant. It is a trained professional who can perform physical examinations, diagnose and treat illnesses, order and interpret laboratory tests, and make rounds at LTC facilities under the direction of a physician.
Term
Pioneer Network
Definition
A national organization that began as a grassroots movement of caregivers, consumer advocates, and other who were concerned abou thte quality of life in nursing homes. The organiztion advocates cultural change in nursing facilities through educating, sharing of ideas, and forming coalitions with stakeholders such as regulators, ombudsmen, consumers, and care professionals.
Term
Plan of Correction (POC)
Definition
A provider;s plan for how and when it will correct federal deficiencies and/or state violations.
Term
Plan of Correction (POC)
Definition
A written plan developed by the facility, outlining steps the facility has taken or will take to correct deficiencies found during licensure or other surveys.
Term
Planning
Definition
(as a managerial behavior) Deciding what is to be done, setting short- and long-term objectives, then identifying the means for achieving them. Requires forecasting the economic, social, and political environment anticipated for the organization and the resources that will be available to it.
Term
Pledging of Accounts Receivable
Definition
Use of receivables as security or collateral for a loan. When this is done "with recourse," the borower remains responsible for collecting the receivables but promises to use the proceeds for repaying the debt. In contrast, factoring of receivables is the sale of receivables as a means of short-term financing. When this is done "without recourse," the seller transfers not only the receivables but also the risk of default.
Term
Podiatrist
Definition
A physician who treats patients with diseases or deformities of the feet.
Term
Position
Definition
The responsibilities and duties performed by one individual. There are as many positions as there are employees.
Term
Post-Acute Care
Definition
Care for residents (patients) who are admitted to a facility following an acute care hospitalization. Care may involve high-intensity rehabilitation or clinically complex care. Most post-acute stays are for less than 30 days. Some post-acute stays lead to long term admissions for chronic care.
Term
Posting
Definition
A step the accounting process when journal entries are transferred (posted) to accounts in the general ledger in order to summarize information such as cash on hand.
Term
Post-Survey Revisit
Definition
An on-site provider visit intended to verify correction of deficiencies and/or violaitons cited during a survey.
Term
Preadmission Screening/ Annual Resident Review (PASARR)
Definition
Federally required screening of all nursing home residents, prior to admission, to determine if the individual residents are mentally ill or mentally retarded.
Term
Preceptor
Definition
A LTC administrator who meets prescribed qualifications and has been certified to mentor interns in an AIT program.
Term
Preliminary Interview
Definition
A short questionnaire and interview used by some facilities to help screen out unsuitable applicants for a position.
Term
Prepaid Expense
Definition
Expenses paid in advance for several months, e.g., building rental payments, journal subscriptions, insurance premiums. These expenses are allocated to the months by adjusting entries.
Term
Pressure Sore/Ulcer
Definition
An inflamed lesion of the skin or internal mucous tissue caused by pressure or friction. Pressure sores are classified (Stages 1 - 4) for increasing severity.
Term
Prevailing Wage Rate
Definition
The wages paid by the predominant number of facilities in a community. Most businesses indicate they pay the prevailing wage rate or a competitive rate.
Term
Prevalence
Definition
A type of QI or QM that provides a description of a resident or patient at a point.
Term
Preventive Labor Relations
Definition
Maximizing the communicaiton and facility accpetance by non-unionized employees in hope that they will feel no need to form a union to achieve their work goals.
Term
Preventive Maintenance
Definition
A prgram to assure that equipment and components operate in optimal conditions. This includes inspections of all systems and equipment on a scheduled basis and planned performance of certain tasks aimed at prevening unexpected equipment failures.
Term
Primary Care
Definition
Basic, routine, continuous, and coordinated medical care rendered by a primary care physician or a mid-level provider such as a physician's assistant or nurse practitioner.
Term
Prior Assessment
Definition
The assessment that occurs in the most recent four months (46-165 days) preceding the target assessment (See Assessment and Target Assessment).
Term
Program of Activities
Definition
Includes a combination of large and small group, one-to-one, and self-directed activities; and a system that supports the development, implementation, and evaluation of the activities provided to the residents in the facilities.
Term
Progressive Discipline
Definition
Use of a specified number of verbal, then more stern written warnings for each offense of the same rule before suspending or firing an employee.
Term
Prospective Payment System (PPS)
Definition
A payment system developed for Medicare for skilled nursing facilities that pays facilities an all-inclusive rate for all Medicare Part A beneficiary services. Payment is determined by a case mix classification system (RUGs).
Term
Prospective Rate-Setting
Definition
Practice by Medicare and most state Medicaid programs of using predetermined rates to reimburse nursing facilities without adjusting payment to cover actual costs. The states use a wide variety of methodologies to develop these rates. If the provider can keep costs below the formula determined rate, a profit can be made. If the provider's costs exceed the rate, a loss is incurred.
Term
Provider Initiative Project (PIP)
Definition
A quality indicator information system for long term care developed by the Center for Health Systems Research and Analysis (CHSRA) at the University of Wisconsin-Madison that utilizes MDS assessment data.
Term
Psychoactive Medication
Definition
Medications used to change, modify, or alter an individual's behavior or mood. This general term includes antianxiety, antidepressant, antipsychotic, and hypnotic medications.
Term
Psychotropic Medications
Definition
Psychoactive medications used to change, modify, or alter an individual's behavior or mood. This general term includes antianxiety, antidepressant, antipsychotic, and hypnotic medications.
Term
PUID
Definition
The personal user ID (PUID) is an individual logon that is unique to each staff member who uses the ePIP system. New IDs can be requested at any time by contacting the ePIP help desk.
Term
Purchase Order
Definition
Document from a prospective purchaser requesting a seller to provide certain quantities of described goods or services at a given price, with payment to be made later.
Term
QI Domain
Definition
For the CHSRA QIs,the broad areas of care that represent the common conditions and important aspects of care and life to nursing home residents. Each domain is represented by one or more QIs.
Term
Quality Assurance
Definition
A provider program to monitor and study the quality of the services it delivers, and to make recommendations for improvement. A designated quality assurance committee usually coordinates this activity.
Term
Quality Indicators (QIs)
Definition
CHSRA's indicators of provider level and resident (patient) level status derived from MDS (OASIS) information. The QIs are pointers or signposts of resident (patient) and/or provider care problems. QIs are used by surveyors to help structure the survey process and can be used by the provider to help monitor and improve their own performance.
Term
Quality Initiative Survey (QIS)
Definition
CMS intends to move surveys in the facilty to a process of doing surveys on laptops using wireless technology. This will enable the surveyors to communicate with each other via laptop throughout the survey process itself.
Term
Quality Measures (QMs)
Definition
Publicly reported information made available by CMS to help consumers assess the quality of nursing home care. There are two categories of quality measures: (1) conditions relevant primarily to long-term residents (patients) (chronic care), including decline in late loss ADLs, pressure sores, residents with pain, physical restraints, and prevalence of infections; and (2) short-stay (temporary) residents (patients) (post-acute care), specifically prevalence of delirium, residents with pain, and improvements in walking. Many of the QMs are based on, and virtually identical to, QIs.
Term
Quality of Care
Definition
General area of the federal nursing home requirements that addressess specific issues.
Term
Quality of Life
Definition
General area of the federal nursing home regulations that addresses residnet (patient) life issues such as dignity, participation in activities, social services, accommodation of needs, and the facility's environment such as lighting, sound, temperature and homelike environment.
Term
Quarterly Assessments
Definition
MDS assessments required each quarter for all residents (patients) in Medicare and/or Medicaid facilities.
Term
Range of Motion (ROM)
Definition
The extent or magnitude of a resident's (patient's) joint movement.
Term
Rate Range
Definition
The pay variation permitted within a class or grade of jobs.
Term
Rating Scale
Definition
Listing a number of characteristics, traits and/or requirements of an employee's position on a line or scale which is checked off by the rater as the degree to which the employee does or does not possess a specified characteristic or trait, or fulfill a stated requirement.
Term
Ratio Hiring
Definition
Requirement by a government agency that an employer increase the proportion of women or minority persons in the employer's workforce.
Term
Reality Orientation
Definition
A form of therapy for confused or disoriented individuals that consists of reiteration of the person's idnetity, orientation to time and place, and reinforcement of consistency in daily routine. Repeated attempts are made to draw the person into conversation, using simple questions, pictures, or whatever may spark their interest.
Term
Reasonable Accommodation
Definition
Actions such as alteration of facilities and the work environment as well as job restructuring to focus on the essential functions, and altering or eliminating nonessential aspects of a job in order to accommodate a disabled employee.
Term
Recreational Therapist (RT)
Definition
A person certified, by a recognized certifying organization, to perform as a recreational therapist.
Term
Referrals
Definition
Recommendations by others of a person for a position at a facility.
Term
Registered Dietitian
Definition
The health professional designated to oversee food and nutrition services in acute and long-term care settings by both the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations; the professional has received a degree in nutrition science, completed a 1,000-hour dietetic internship, and passed a comprehensive national registration examination - a minimum of 15 continuing education hours must be obtained and approved by the Commission on Dietetic Registration for the registered dietitian credentials to be maintained.
Term
Registered Dietitian (RD)
Definition
A person registered as a dietitian by state statute or the American Dietetics Association.
Term
Registered Nurse (RN)
Definition
A person registered as a nurse by state statute.
Term
Registered Pharmacist (RPh)
Definition
A person registered as a pharmacist by state statute.
Term
Regulations
Definition
Federal requirements promulgated to "flesh out" the statutory requirements in the Social Security Act (see also Rules and Statutory Requirement).
Term
Reserve
Definition
Funds set aside to meet some future obligation.
Term
Resident Assessment Instrument (RAI)
Definition
A tool to help facilities identify residents' needs and strengths and develop an appropriate care plan. The federal RAI system includes: the MDS, RAPS, and utilization guidelines. It is the designation for the complete resident assessment process mandated by CMS, including the comprehensive MDS, RAPS, and care planning decisions.
Term
Resident Assessment Protocols (RAPs)
Definition
Eighteen problem-oriented guides for care planning with "trigger" conditions to signal the need for additional assessment and review (e.g., activities RAP, mood state RAP, pressure ulcer RAP, etc.). Checking certain boxes or combination of boxes upon filling out the MDS form trigger the requirement for that resident's care plan to address condition(s) identified as in need of special attention.
Term
Resident Centered Care
Definition
Practices that encourage residents to be involved in making decisions about their care and daily activities; examples of resident-centered dietary functions include cook-to-order eating schedules, resident-involved menu planning, and buffet style or family dining meal service.
Term
Resource Utilization Group (RUG)
Definition
Group based on MDS information; utilized to determine reimbursement rates.
Term
Resource Utilization Groups (RUGS)
Definition
A collection of nursing facility resident classification systems used in a variety of case mix indexed reimbursement systems. Using assessment tools like the MDS 2.0, these systems group residents by expected level of resource utilization, usually based upon staff time measurements per resident per day. Relative resource utilization is reflected in a case mix index (CMI) value assigned to each RUG cell.
Term
Respite Care
Definition
Any temporary long-term care service (adult day care, home health, or temporary institutionalization) that focuses on giving family caregivers time off while the patient's care is taken over by the respite care provider.
Term
Restricted Funds
Definition
Funds established to account for assets with uses limited by the requirements of donors or grantees. For example, a fund may be restricted to plant replacement. If the donor has specified that the principal must be maintained perpetually, and only the investment income it generates may be expended, the principal is accounted for as an endowment fund.
Term
Retained Earnings
Definition
(or earned surplus, undistributed profits): The income left to a company after taxes and dividends have been paid and that are a major source of funds for the company's expansion.
Term
Return on Equity (ROE)
Definition
A means of assessing a company's profitability. It is calculated by dividing the firm's annual net income by total shareholder's equity.
Term
Revenues
Definition
Income earned from carrying out the activities of a firm. Revenues of health care institutions are typically reported in terms of these three components: a. Patient service revenues may be divided into the "room, board, and general nursing services" covered by rates billed to all patients; and ancillary services, such as physical therapy or pharmacy, which are billed to only some patients. Patient service revenues accounts may also be segregated by level of care (skilled, intermediate) or by payer status (self-pay, Medicare, Medicaid, commercial insurance). b. Other operating revenuesare revenues earned incidental to the main purpose of rendering patient care, such as revenues from teh employee cafeteria, beauty shop, and other concessions. c. Non-operating revenues may include separate line items for interest and other investment income, unrestricted gift income or gains (or losses) on sales of property.
Term
RUG Creep
Definition
A form of upcoding under the Medicare prospective Payment System for SNFs which occurs when the SNF falsely or fraudulently completes the MDS, and this results in incorrect assignment of a resident to a higher-paying RUG category.
Term
Safe Harbors
Definition
Federal regulations that define practices that, if fully followed, will not be considered violations of the federal anti-kickback. There are regulations, for example, that describe conditions under which discounts may be received from equipment suppliers, and conditions under which payments may be made to operators of referral services.
Term
Scope
Definition
The extent or magnitude of deficient facility practice on resident (patient) outcome. There are three levels of scope as described in the Federal Enforcement Grid (see also ENFORCEMENT GRID)
Term
Search Firm
Definition
Employment agency which usually focuses its efforts on middle and upper level positions, often conducting national searches, charging the employer for the services.
Term
Self-Insurance
Definition
An alternative to purchased insurance. An entity assumes its own expenses relative to a specific risk of loss by periodically setting aside an actuarially determined amount of money, which may be held by a trustee.
Term
Sentinel Health Events
Definition
Significant conditions or events that exist for only a single case or a few cases. For the CHSRA QI, they may represent a significant problem that needs to be investigated (e.g., fecal impaction, dehydration, pressure ulcers--low risk).
Term
Septicemia
Definition
Also called "blood poisoning," it is a rapidly progressing and life threatening infection due to the presence of bacteria in the blood.
Term
Servant Leadership
Definition
Leadership in which the focus is on serving others.
Term
Severity
Definition
The effect of seriousness of deficient facility practice on residnet (patient) outcome. There are four levels of severity as described in the Federal Enforcement Grid (see also ENFORCEMENT GRID).
Term
Sharps
Definition
A term used to describe medical devices such as needles, lancets and syringes, which put individuals at risk for "needle sticks," or the transmission of blood and bodily fluids from the device to an individual.
Term
Shelf-Stable Food
Definition
Preserved (often canned or boxed) food which is able to be stored at room temperature for long periods and made ready for service in an emergency situation without the use of electricity.
Term
Short-Term Stay
Definition
Admission and discharge of a nursing home resident (patient) that occurs in less than 14 days.
Term
Side Effect
Definition
Undesirable effect of a medication that causes minimal discomfort in some people.
Term
Significant Change
Definition
A major decline or improvement in a resident's status that will not normally resolve itself without further intervention by staff or by implementing standard disease-related clinical interventions, that has an impact on more than one are of a resident's health status and requires interdisciplinary review or revision of the care plan, or both.
Term
Significant Change in Condition
Definition
A substantial modification in a resident's (patient's) physical, mental, emotional, cognitive, or functional status that requires a new assessment using the MDS instrument, and also generally requires notification of the resident's (patient's) attending physician, family, or guardian.
Term
Significant Medication Error
Definition
Medication error that cause a resident (patient) discomfort and/or jeopardizes his/her health and safety.
Term
Significant Weight Loss
Definition
The threshold used to determine when intervention and documentation is required to prevent under-nutrition from excessive weight loss; in the long term care setting, significant weight loss is 5% in 30 days, 7.5% in 90 days and 10% in 180 days.
Term
Skilled Nursing Facility (SNF)
Definition
A nursing home that meets the requirements for Medicaid certification as defined in 1819(a) of the Federal Social Security Act. Also the term used by most states to define the type of nursing home that is licensed to provide the highest level of care.
Term
Skilled Nursing Facility (SNF)
Definition
A facility licensed to provide nursing and medical care requiring a certain level of training and experitse. To qualify as a Medicare provider and receive Medicare reimbursement, a facility must be certified as a SNF.
Term
Social Security Act
Definition
Federal statutory law that includes the requirements for participation in the Medicare and Medicaid programs.
Term
Special Fraud Alerts
Definition
Statements issued by the Office of Inspector General (OIG) to the general health care community addressing national trends of health care fraud and providing guidance relative to violations of the anti-kickback statute and other federal laws.
Term
Speech Language Pathology
Definition
Encompasses evaluation and treatment of speech, language, and cognitive disorders…treats several kinds of disorders such as aphasia, dysarthria, and dysphagia.
Term
Speech Pathologist (SP)
Definition
A person licensed, certified, or registered by state statute to perform as a speech pathologist.
Term
Speech Therapist (ST)
Definition
A person licensed, certified, or registered by state statute to perform as a speech therapist.
Term
Staffing
Definition
Involves such activities as recruiting, orienting, training, rating, disciplining and terminating employees.
Term
Standard of Care
Definition
The duty to have and to use the degree of knowledge and skill that is usually possessed and used by competent, prudent similar health care providers in like or similar circumstances.
Term
Standard Precautions
Definition
(SPs) General infection control precautions to be used when delivering hands-on care to any patient, or when handling soiled articles of linen and clothing. It requires the use of gloves, gowns, and masks as necessary to avoid contact with body fluids.
Term
Standard Survey
Definition
An on-site federal survey of nursing homes conducted every 9-15 months to determine compliance with federal regulations for Medicare and/or Medicaid.
Term
Stark Act
Definition
Common name for a set of laws, including the Ethics in Patient Referrals Act of 1989, that prohibits the practice of "self-referral" by physicians, that is, referrals of Medicare and Medicaid patients to a provider of services paid for by government programs, when the physician has a direct or indirect ownership or investment interest in that provider. "Safe harbors" is the name given to permissable referral practices, as outlined in laws. Some states have a law limiting "self-referral" regardless of payer source.
Term
State Operations Manual (SOM)
Definition
The title given to the current set of requirements and guidelines to surveyors. Current edition with changes in red can be downloaded from the CMS web site, www.cms.gov
Term
Statement of Cash Flows
Definition
Financial statement that displays how the cash balance has changed during a fiscal period. Cash increases and decreases are reported in three categories of activities: operating, investing, and financing. This information can be useful in assessing the entity's ability to generate positive future net cash flows, meet its financial obligations, and pay dividends.
Term
Statement of Changes in Owners' Equity (or Fund Balance)
Definition
A financial statement that reflects the beginning owner's equity, the profit or loss of the current period, and the ending owner's equity as of the Balance Sheet date. Not-for-profits use "fund balance" instead of "owner's equity."
Term
Statement of Deficiency (SOD)
Definition
A written summary of noncompliance with regulations found during a federal provider survey or complaint investigation (see also VIOLATION). Statements of deficiency are written on a CMS 2567 form.
Term
Statistical Approach to Hiring
Definition
Identifying the most valid predictors of job success, then using weights in a formula to choose among applicants for a position (see also CLINICAL APPROACH).
Term
Stoma
Definition
An artificially created opening in the body.
Term
Straight-line Method of Depreciation
Definition
A depreciation method that allocates equal amounts of depreciation expense to each full period of the asset's life: Annual Depreciation Expense = (Historical cost) / (Years of estimated useful life)
Term
Stroke
Definition
A sudden interruption in the blood supply of the brain. Most strokes are caused by an abrupt blockage of arteries leading to the brain (ischemic stroke). Other strokes are caused by bleeding into brain tissue when a blood vessel bursts (hemorrhagic stroke).
Term
Subacute
Definition
Type of nursing home care that is generally considered above skilled nursing but below acute hospital care.
Term
Subacute Care
Definition
As defined by the American Health Care Association, this is: "a comprehensive inpatient prgram designed for the individual who: (1) has had an acute event as a result of an illness, injury or exacerbation of a disease process: (2) has a determined course of treatment; and (3) does not require intensive diagnostice and/or invasive procedures." Subacute medical and rehabilitative care programs in nursing facilities may include specialty programs for : Post operative recovery, extensive wound care, ventilator support, brain injury care, hospice care, and respiratory or pulmonary management.
Term
Substandard Care
Definition
Substandard quality of care is any deficiency in 42 CFR 483.13 -- Resident Behavior and Faciility Pracice, 42 CFR 483.15 -- Quality of Life or 42 CFR 483.25 -- Quality of Care that constitutes immediate jeopardy to resident (patient) health or safety; or a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm that is not immediate jeopardy, with no actual harm. On the Federal Enforcement Grid, substandard care equates to boxes F, H, I, J, K and L, and also results in imposition of penalties (see also ENFORCEMENT GRID). Four elements are required for a civil lawsuit: (1) duty owed, (2) breach or violation of that duty, (3) damage or injury, and (4) causation.
Term
Substandard Quality of Care
Definition
One or more requirements were not met, resulting in immediate jeopardy to resident health or safety, and a scope or pattern of widespread actual harm, or a widespread potential for more than minimal harm.
Term
Substantial Compliance
Definition
Minor deficiencies or violations, but a facility generally meets the intent of federal or state regulations. On the Federal Enforcement Grid, Substantical Compliance is equated to boxes A-C (see also ENFORCEMENT GRID).
Term
Supplies
Definition
Items consumed in the normal course of business operations, e.g., bandages and soap. Projected supply expenses are included in the operating budget, not the capital budget.
Term
Survey
Definition
An inspection to verify compliance with state and federal standards.
Term
Swapping
Definition
Practice of a supplier giving a nursing facility excessive discounts on Medicare Part A items and services in return for the ability to service and bill nursing facility residents with part B coverage. This may be considered an illegal inducement.
Term
Target Assessment
Definition
The most recent full or quarterly assessment that is available for the time in which the QM score is calculated (see ASSESSMENT and PRIOR ASSESSMENT).
Term
Task
Definition
A coordinated and aggregated series of work elements used to produce an output (e.g., making beds).
Term
Task Analysis
Definition
Review of job descriptions and activities essential for performing each job (step two of establishing training needs).
Term
Temperature Danger Zone
Definition
The temperature range of 40F (5C) and 140F (60C) in which food bacteria thrive and multiply rapidly.
Term
Terminal Care
Definition
Care provided to a dying resident (patient) that may or may no include hospice care (see also HOSPICE CARE).
Term
Texture Modification
Definition
Changing the consistency of food offered to a resident to help accommodate difficulties in chewing or swallowing; textures can include chopped food (the size of green peas), ground food (the size of apple seeds), and pureed food (the consistency of smooth mashed potatoes).
Term
Therapeutic Diet
Definition
A diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate, decrease or increase specific nutrients in the diet. (May also be called Medical Nutrition Diet).
Term
Third Party Payer
Definition
Commercial insurer or other private or pulbic entity (such as Medicare and Medicaid) which pays for all or part of the charges for a resident.
Term
Threshold
Definition
A set point for each CHSRA QI at which the likelihood of a problem is sufficient to warrant further investigation. There may also be a concern below the threshold especially if the percentile rank is close to the threshold. Generally, the threshold point is set at the 90th percentile (see also PERCENTILE RANK).
Term
Transfer
Definition
(1) Movement of a patient from one surface to another, such as from a bed to a chair, or from a wheelchair to a car seat. (2) Movement of a patient from one facility to another.
Term
Transformation
Definition
The act or process of major or complete change.
Term
Transformational Leadership
Definition
A participatory, holistic, organizationally driven leadership model where the focus is on educating, supporting and caring for one another.
Term
Transitional Care Unit (TCU)
Definition
A skilled nursing unit located within a hospital.
Term
Transmission-based Precautions
Definition
Infection control precautions to follow when caring for patients who have communicable disease. These precautions are used in addition to standard precautions.
Term
Unavoidable Accident
Definition
An accident occurring despite the facility's efforst to identify a hazard, evaluate the hazard, implenet interventions, and monitor the effectiveness.
Term
Uniform Guidelines on Employee Selection Procedures
Definition
A publication of four federal agencies in 1987 setting standards by which federal agencies determine the acceptability of validation procedures used for written tests and other selection devices.
Term
Universal Precautions
Definition
Measures taken to prevent transmission of infection from contact with blood or other body fluids or materials having blood or other body fluids on them, as recommended by the U.S. Public Health Services Centers for Disease Control and adopted by the US Occupational Safety and Health Administration (OSHA) as 29 CFR 1910.1030.
Term
Unnecessary Drug
Definition
Any of the following: drug that is given without a medical reason; drug given in excessive does; drug given for an excessive amount of time; drug without adequate monitoring; drug given with side effects and/or adverse drug reactions indicate the drug should be reduced or discontinued.
Term
Upcoding
Definition
The selection, when a claim is submitted to a third-party payer, of a billing code that is not the most appropriate descriptor of a service or condition and that may result in an overpayment to the provider. One type of upcoding is RUG creep.
Term
Useful Life (or Service Life)
Definition
The period of time a fixed asset (such as a building, piece of equipment, or vehicle) can be used by its owner in the production or sale of other assets or services. In order to allocate depreciationover time, total service life must be estimated when a fixed asset is purchased.
Term
Utilization Review
Definition
Intended to ensure that the Medicare system did not pay for care beyond that which was determined to be necessary. In recent years, has seen increased involvement of other payers and the compressing of allowable lengths of stay.
Term
Validation Therapy
Definition
A type of therapy in which a person's belief that he or she is actually living in the past is accepted and validated by staff members working with the patient.
Term
Variable Cost
Definition
A cost that varies with the change in the number of patients.
Term
Variance
Definition
The granting of an alternate requirement in place of a federal or state regulation.
Term
Variance Analysis
Definition
A control technique that evaluates significant differences between budgeted and actual revenues and expenses.
Term
Ventilator
Definition
A small machine that takes over the breathing function by automatically moving air into and out of the patient's lungs.
Term
Violation
Definition
A written summary of noncompliance with regulations found during a state provider survey or complaint investigation (see also STATEMENT OF DEFICIENCY). The written document is generally called a Notice of Violation.
Term
Vital Signs
Definition
Generally, body temperature, pulse rate, blood pressure, and respiratory rate are referred to as vital signs. Any abnormalities in these measures triggers further clinical evaluation.
Term
Vision
Definition
A mental image or dream of what an organization is trying to create and become.
Term
W-2
Definition
Form that the IRS requires an employer to give each employee by January 31 that shows the employee's earnings and income tax and FICA tax deductions for the past year.
Term
W-4
Definition
Form that the IRS requires an employer to allow each employee to submit on which the employee indicates marital status and number of withholding allowances claimed. This information must be used by the employer in determining amount of income tax to withhold.
Term
Wage Class
Definition
Establishment of pay grades and rates by employers to both achieve equity and offer some flexibility to supervisors in setting an employee's wage.
Term
Wage Mix
Definition
Determination of wage rates by considering the labor market, prevailing wage rates, cost of living, ability to pay, collective bargaining agreements, individual bargaining agreements, and value of the job.
Term
Wage Policy
Definition
Decisions by management on the rate of pay for the facility staff, the amount of discretion supervisors may use in setting individual salaries, the spread between pay rates for long-time and new employees, and the periods between pay raises together.
Term
Waiver
Definition
The granting of an exemption from a federal or state regulation (see also VARIANCE).
Term
Working Capital
Definition
The excess of current assets over curreent liabilities. Working capital management is the effort to increase this desirable excess by increasing current assets in various ways and decreasing current liabilities in various ways.
Term
Write-off
Definition
Removing an uncollectible account from the accounts receivable. Bad debts expense is increased and the asset, account receivable, is decreased when the account receivable is written off.
Term
Analgesic
Definition
reduces pain (does not cure illness). Two types are (a) opiates as codeine, morphine, and Davon and (b) nonopiates as aspirin, Tylenol and Advil
Term
Antacid
Definition
neutralizes the acid in the stomach
Term
Antianemic
Definition
used in treatment of anemia
Term
Antibiotic
Definition
destroys microorganisms in the body
Term
Anticoagulant
Definition
depresses (slows) the clotting of blood
Term
Anticonvulsant
Definition
used to prevent or control convulsions
Term
Antidepressant
Definition
given to relieve depression
Term
Antidote
Definition
used to counteract poisons
Term
Antihistamine
Definition
used in certain allergy cases and to dry out nasal tissues to reduce postnasal drip
Term
Antiseptic
Definition
slows down growth of bacteria, but does not kill all of the bacteria
Term
Antispasmodic
Definition
relieves smooth muscle spasm
Term
Antipsychotic
Definition
drug given for mental disorders
Term
Antiseptic
Definition
destroys or inhibits the growth of microorganisms in the environment
Term
Antitoxin
Definition
neutralizes bacterial toxins in infections
Term
Antitussive
Definition
given to control coughing
Term
Astringent
Definition
used to constrict skin and mucous membranes by withdrawing water
Term
Carminative
Definition
an agent that reduces flatulence (gas) in the stomach or intestinal tract
Term
Cathartic
Definition
laxative, purgative, inducing bowel movements
Term
Caustic
Definition
destroys tissue by local application
Term
Chemotherapeutics
Definition
chemicals used to treat illness
Term
Coagulant
Definition
stimulates clotting of the blood
Term
Decongestant
Definition
constricts blood vessels in the nose and relieves nasal congestion
Term
Diaphoretic
Definition
used to induce perspiration
Term
Disinfectant
Definition
destroys pathogenic organisms
Term
Diuretic
Definition
stimulates elimination of urine, often used with medications prescribed to reduce hypertension
Term
Emetic
Definition
induces vomiting
Term
Emollient
Definition
used to soften and soothe tissue
Term
Expectorant
Definition
used to induce coughing, an agent that increases bronchial secretion and facilitates its expulsion (coughing)
Term
Generic Substitution
Definition
a different brand or an unbranded drug product substituted by the pharmacist for a trade-name drug product prescribed. The drugs are exactly the same chemically and in the same dosage form, but distributed by different drug companies.
Term
Hypertensive
Definition
helps raise blood pressure
Term
Hypnotic
Definition
assists patients/residents to fall asleep
Term
Laxative
Definition
used to relieve constipation
Term
Miotic
Definition
constricts the pupil of the eye
Term
Mydiratic
Definition
dilates the pupil of the eye
Term
Palliative
Definition
relieves pain without curing
Term
Parenteral
Definition
drug or solution given by subcutaneous or intravenous injection
Term
Placebo
Definition
inactive medication having no physical healing effect. Usually given to satisfy the resident. Also used in drug studies to determine the effectiveness of another drug. May be given orally, by injection, as a suppository, or topically
Term
Sedative
Definition
relieves anxiety and emotional tensions
Term
Suppository
Definition
semisolid substance for introduction int the rectum, vagina or urethra where it is dissolved and absorbed.
Term
Suspension
Definition
medication served in a liquid form
Term
Tonic, or stimulant
Definition
used to stimulate body activity
Term
Topical medication
Definition
medication applied to an area of the skin, as ointments and lotions
Term
Vasoconstrictor
Definition
causes blood vessels to narrow or constrict
Term
Vasodilator
Definition
expands or dilates blood vessels
Term
Vitamins
Definition
used in replacement therapy
Term
aa
Definition
of each
Term
Abd
Definition
abdomen
Term
ac
Definition
before meals
Term
AD
Definition
advance directive
Term
ADL
Definition
activities of daily living
Term
Ad lib
Definition
as much as desired, at pleasure
Term
A/G
Definition
albumin/globulin ratio
Term
AIDS
Definition
acquired immunity deficiency syndrome
Term
A.M.A.
Definition
against medical advice
Term
AMD
Definition
age-related mascular degeneration
Term
amp
Definition
ampule
Term
amt
Definition
amount
Term
aq
Definition
water
Term
aq dist
Definition
distilled water
Term
ASH.D.
Definition
arteriosclerotic heart disease
Term
BE
Definition
barium enema
Term
bId
Definition
twice a day
Term
BMR
Definition
basal metabolic rate
Term
BP or B/P
Definition
blood pressure
Term
BRP
Definition
bathroom privileges
Term
c
Definition
with
Term
Ca
Definition
carcinoma
Term
CAD
Definition
coronary artery disease
Term
caps
Definition
capsules
Term
cath
Definition
catheter
Term
CBC
Definition
complete blood count
Term
c c
Definition
cubic centimeter
Term
cf
Definition
compare
Term
CHF
Definition
congestive heart failure
Term
CMP
Definition
comprehensive metabolic panel
Term
CNS
Definition
central nervous system
Term
COLD
Definition
chronic obstructive lung disease, same as COPD
Term
comp
Definition
compound
Term
COPD
Definition
chronic obstructive pulmonary disease
Term
CVA
Definition
cerebral vascular accident
Term
d/c
Definition
discontinued
Term
decub
Definition
lying down
Term
Diab
Definition
diabetic
Term
Diag or Dx
Definition
diagnosis
Term
Diff
Definition
differential blood count
Term
Dil
Definition
dilute
Term
Disc
Definition
discontinue
Term
Disch or D/C
Definition
discharge
Term
DM
Definition
diabetes mellitus
Term
DNR
Definition
do not resuscitate
Term
dx
Definition
diagnosis
Term
EEG
Definition
electroencephalogram
Term
EKG or ECG
Definition
electrocardiogram
Term
EMS
Definition
emergency medical service
Term
ESRD
Definition
end stage renal disease
Term
exam
Definition
examination
Term
fl or fld
Definition
fluid
Term
FUO
Definition
fever of unknown origin
Term
Fx
Definition
fracture
Term
GII
Definition
gastrointestinal
Term
gm
Definition
gram
Term
gr
Definition
grain
Term
gtt or gtts
Definition
drop(s)
Term
H or hr
Definition
hour
Term
HBP
Definition
high blood pressure
Term
HBV
Definition
Hepatitis B virus that infects the liver; highly contagious
Term
HIV
Definition
human immunodeficiency virus
Term
hs
Definition
at bedtime
Term
hypo
Definition
hypodermically
Term
IDDM
Definition
insulin dependent diabetes mellitus
Term
IM
Definition
intramuscular
Term
inf
Definition
infusion
Term
I & O
Definition
intake and output
Term
IV
Definition
intravenous
Term
KUB
Definition
kidney-ureter-bladder
Term
l
Definition
liter
Term
lab
Definition
laboratory
Term
Lat
Definition
lateral
Term
lb
Definition
pound
Term
liq
Definition
liquid
Term
mg
Definition
milligram
Term
min
Definition
minute
Term
ml
Definition
milliliter
Term
mm
Definition
millimeter
Term
MN
Definition
midnight
Term
MRSA
Definition
methicillin-resistant Staphylococcus aureus
Term
N
Definition
noon
Term
NIDDM
Definition
noninsulin dependent diabets mellitus
Term
no
Definition
number
Term
noct.
Definition
at night
Term
NPO
Definition
nothing by mouth
Term
NV
Definition
nausea and vomiting
Term
od
Definition
right eye
Term
OOB
Definition
out of bed
Term
os
Definition
left eye
Term
OT
Definition
occupational therapy
Term
ou
Definition
each eye
Term
oz
Definition
ounce
Term
p
Definition
pulse
Term
pc
Definition
after meal
Term
PEARL
Definition
pupils equal and reactive to light
Term
PEG
Definition
percutaneous endoscopic gastrostomy
Term
po
Definition
by mouth
Term
prn
Definition
as needed
Term
prog
Definition
prognosis
Term
PROM
Definition
passive range of motion
Term
pt
Definition
pint
Term
PT
Definition
physical therapy
Term
PX
Definition
physical exam
Term
qd
Definition
every day
Term
qh
Definition
every hour
Term
qhs
Definition
each bedtime
Term
qid
Definition
four times a day
Term
qn
Definition
every night
Term
qod
Definition
every other day
Term
qs
Definition
sufficient quantity
Term
ROM
Definition
range of motion
Term
Rx
Definition
prescription
Term
s
Definition
without
Term
SOB
Definition
shortness of breath
Term
sol
Definition
solution
Term
sos
Definition
one dos, if necessary
Term
spec
Definition
specimen
Term
SS
Definition
soap solution
Term
ss
Definition
half
Term
stat
Definition
immediately
Term
surg
Definition
surgery
Term
T
Definition
temperature
Term
tab
Definition
tablet
Term
TB
Definition
tuberculosis
Term
tId
Definition
three times a day
Term
tinct or tr
Definition
tincture
Term
TO
Definition
telephone order
Term
TPR
Definition
temperature, pulse and respiration
Term
u
Definition
unit
Term
ung
Definition
ointment
Term
URI
Definition
upper respiratory infection
Term
UTI
Definition
urinary tract infection
Term
VO
Definition
verbal order
Term
vol
Definition
volume
Term
vs
Definition
vital signs
Term
WBC
Definition
white blood cells
Term
W/C
Definition
wheel chair
Term
wt
Definition
weight
Term
a-, an-
Definition
without
Term
ab-
Definition
from, off, away
Term
ad-
Definition
toward, to, at
Term
an-
Definition
without
Term
adeno-
Definition
gland
Term
ambi-
Definition
both
Term
ana-
Definition
up, toward
Term
angio-
Definition
relating to a vessel
Term
ante-
Definition
in front of, before
Term
anti-
Definition
against
Term
arthro-
Definition
pertaining to the joints
Term
auto-
Definition
self, same
Term
bact
Definition
relating to bacteria
Term
bi-
Definition
two
Term
bio-
Definition
relation to life
Term
brady-
Definition
slow
Term
broncho-
Definition
relating to the trachea or windpipe
Term
carcino-
Definition
pertaining to cancer
Term
cardi or cardio-
Definition
pertaining to the heart
Term
cata-
Definition
downward, against
Term
celio-
Definition
pertaining to the abdomen
Term
cephalo-
Definition
head
Term
cervico-
Definition
neck OR cervix
Term
chiro-
Definition
pertaining to the hand
Term
chole-
Definition
pertaining to bile
Term
circum-
Definition
around
Term
com-, con-
Definition
with, together
Term
contra-
Definition
against, opposite
Term
counter-
Definition
against, opposite
Term
cranio-
Definition
pertaining to the head
Term
cysto-
Definition
pertaining to the bladder
Term
cyto-
Definition
relation to a cell
Term
de-
Definition
down, away from
Term
dent- or denti-
Definition
teeth
Term
derm-, derma- or dermi-
Definition
pertaining to the skin
Term
dextro-
Definition
toward or on the right side
Term
di-
Definition
double, twice
Term
dia-
Definition
through, apart
Term
dys-
Definition
painful, difficult
Term
ecto-
Definition
out, away from
Term
em-, en-
Definition
in front of, before
Term
encephalo-
Definition
condition of the brain or head
Term
endo-
Definition
within, inner
Term
entero-
Definition
relating to the intestines
Term
epi-
Definition
above, upon, over
Term
eu-
Definition
good
Term
fibro-
Definition
pertaining to fiber
Term
gastro-
Definition
stomach
Term
gero-
Definition
old age
Term
glyco-
Definition
relationship to sweetness (sugar)
Term
gyneco-, gyno-
Definition
pertaining to a female
Term
hemato-, hema- or hemo-
Definition
pertaining to the blood
Term
hemi-
Definition
half
Term
hepato-
Definition
liver
Term
histo-
Definition
relationship to tissue
Term
hydro-
Definition
pertaining to water
Term
hyper-
Definition
excessive
Term
hypno(a)-
Definition
relating to sleep
Term
hypo-
Definition
deficiency, lack of
Term
hystero-
Definition
relating to the uterus
Term
ileo-
Definition
relating to the ileum (remote end of the small intestine)
Term
infra-
Definition
below, beneath
Term
inter-
Definition
between
Term
intro-
Definition
in, into
Term
kerato-
Definition
relating to the cornea, or horny tissue
Term
labio-
Definition
relating to the lip
Term
macro-
Definition
large, long
Term
mast-
Definition
relating to the breast
Term
mega-
Definition
large, oversize
Term
meta-
Definition
after, beyond, transformation
Term
micro-
Definition
small
Term
mono-
Definition
one or single
Term
multi-
Definition
many
Term
myel-
Definition
pertaining to the spinal cord
Term
myo-
Definition
relating to muscle
Term
naso-
Definition
pertaining to the nose and nasal passages
Term
necro-
Definition
relating to death
Term
neuro-
Definition
relating to the nerves
Term
nephro-
Definition
pertaining to the kidney
Term
odont-
Definition
relating to the teeth
Term
omo-
Definition
pertaining to the shoulder
Term
opthalmo-
Definition
relating to the eye
Term
opto-
Definition
relating to vision
Term
ortho-
Definition
straight
Term
osteo-
Definition
pertaining to the bones
Term
oto-
Definition
pertaining to the ear
Term
oxy-
Definition
sharp, acute
Term
pachy-
Definition
thick
Term
pan-
Definition
all
Term
para-
Definition
two like parts
Term
patho-
Definition
disease
Term
per-
Definition
through
Term
peri-
Definition
around
Term
phlebo-
Definition
relating to a vein
Term
pneumo-
Definition
lung
Term
poly-
Definition
many, much
Term
procto-
Definition
relating to the anus
Term
pseudo-
Definition
false
Term
psycho-
Definition
pertaining to the mind
Term
pulmo-
Definition
lung
Term
pyo-
Definition
signifying pus
Term
quadra-
Definition
involving four
Term
rachi-
Definition
spine
Term
rhino-
Definition
nose
Term
semi-
Definition
partial, not full
Term
sub-
Definition
under
Term
syn-
Definition
loss
Term
tachy-
Definition
rapid
Term
thermo-
Definition
heat
Term
thoracic-
Definition
pertaings to the chest or thorax
Term
tri-
Definition
three
Term
uni-
Definition
one
Term
uro-
Definition
relating to the urine
Term
vaso-
Definition
vessel
Term
-ac
Definition
pertaining to
Term
-algia
Definition
pain
Term
-cele
Definition
hernia
Term
-centesis
Definition
surgical puncture
Term
-clasis
Definition
breaking
Term
-clysis
Definition
washing, irrigation
Term
-cyte
Definition
cell
Term
-ectasia
Definition
dilation, stretching
Term
-emesis
Definition
vomiting
Term
-ectomy
Definition
excision (cutting out)
Term
-emia
Definition
denoting a condition of the blood
Term
-emis
Definition
vomiting
Term
-genesis
Definition
condition of producing
Term
-ism
Definition
abnormal condition from excess of something
Term
-itis
Definition
inflammation
Term
-lith
Definition
stone
Term
-lysis
Definition
breakdown
Term
-malasia
Definition
softening
Term
-mania
Definition
madness or passion for
Term
-megaly
Definition
enlargement
Term
-odynia
Definition
painful condition
Term
-ology
Definition
study of
Term
-oma
Definition
tumor
Term
-opsy
Definition
vision
Term
-orexia
Definition
appetitie, desire
Term
-orrhaphy
Definition
suture
Term
-orrhea
Definition
flow, discharge
Term
-osis
Definition
abnormal or diseased condition
Term
-ostomy
Definition
to make a new opening
Term
-otomy
Definition
incision, to cut into
Term
-paresis
Definition
partial or incomplete paralysis
Term
-path
Definition
morbid or diseased
Term
-pathy
Definition
disease
Term
-penia
Definition
deficiency
Term
-pepsia
Definition
digestion
Term
-pexy
Definition
fixation, to put into place
Term
-philia
Definition
a liking or affinity for
Term
-phobia
Definition
fear
Term
-plasty
Definition
surgical repair
Term
-plegia
Definition
paralysis
Term
-pnea
Definition
breath
Term
-rhythmia
Definition
rhythmical
Term
-rrhage
Definition
abnormal or excessive discharge or flow
Term
-rrhea
Definition
discharge
Term
-sclerosis
Definition
hardening
Term
-spasm
Definition
sudden violent contraction of muscles
Term
-stasis
Definition
arrest, control
Term
-taxis
Definition
order, arrangement
Term
-tripsy
Definition
crushing
Term
-trophy
Definition
development, nourishment
Term
-uria
Definition
urine
Term
AIDS
Definition
Acquired immune deficiency syndrome that results in a person having little or not immunity to disease.
Term
Alcoholism
Definition
A chronic, progressive, potentially fatal disease characterized by physical dependency and/or pathological organ changes due to ingestion of alcohol.
Term
Alzheimer's disease
Definition
A chronic, progressive, degenerative cognitive disorder. It accounts for over 60% of all dementias, commonly occurring in people over 65. The disease is staged according to the behaviors exhibited by the victim. There are three stages, with Stage I considered the early stage and Stage III the late stage.
Term
AMD
Definition
Age-related macular degeneration is a disorder of the eye characterized by inability to see anything that requires straight ahead vision, often resulting in blindness.
Term
Angina pectoris
Definition
Severe pain about the heart, usually radiating to the left shoulder and down the arm.
Term
Anorexia
Definition
Loss of appetite (seems under-stated).
Term
Aphasia
Definition
Absence or impairment of the ability to communicate through oral and/or written language; it often occurs after brain damage in accidents and from strokes.
Term
Apnea
Definition
Temporary cessation of breathing, a serious symptom sometimes occurring in the aged during profound sleep.
Term
Arteriosclerosis
Definition
Thickening, hardening and loss of elasticity of the walls of the arteries; it is the most frequent metabolic disorder of the aged.
Term
Arthritis
Definition
Inflammation of a joint, usually accompanied by pain, and frequently by changes in bone and joint structure.
Term
Atrophy
Definition
A decrease in size of an organ or tissue can result from a number of factors including malnutrition and inactivity.
Term
BDA
Definition
Benign disequilibrium of aging, a very common disorder in which the balance centers of the inner ear fail to function properly causing imbalance while walking.
Term
Botulism
Definition
Food poisoning caused by toxin of bacillus that may infect preserved foods, sausage and canned meats.
Term
Carcinoma
Definition
A new growth or malignant tumor that tends to give rise to metastasis; it is synonomous with the term cancer.
Term
Cataract
Definition
The darkening of the lense of the eye or its capsule or both; very common in the aged; the most common cause of blindness of adults. The only effective treatment is surgery.
Term
Cerebrobascular accident (CVA)
Definition
A cerebrovascular condition resulting from a hemorrhage, a stroke - may result in paralysis.
Term
Congestive heart failure (CHF)
Definition
A condition characterized by weakness, breathlessness, abdominal discomfort, and edema in the lower portions of the body due to reduced outflow of blood from the heart.
Term
Coronary heart disease
Definition
Myocardial damage due to insufficient blood supply, caused by pathological changes in the coronary arteries.
Term
Cystitis
Definition
Inflammation of the bladder, usually following urinary tract infection.
Term
Dementia
Definition
Impairment of mental powers due to organic causes.
Term
Depression
Definition
An emotional condition, an affective disorder characterized by feelings of hopelessness, sadness, inadequacy. It is the most frequent mental problem in nursing facilities. Residents may withdraw, isolate themselves, lack motivation, and/or show agitation.
Term
Diabetes
Definition
A general term for disease characterized by many symptoms, one of which is excessive urination. There are many types but usually refers to diabetes mellitus (sugar diabetes) in which there is a deficiency of insulin.
Term
End-stage renal disease
Definition
A permanent failure of the kidneys to perform essential functions that results in a need for dialysis.
Term
Epilepsy
Definition
A recurring paroxysmal disorder of the brain characterized by sudden, brief convulsive seizures, altered consciousness, motor activity, or sensory phenomena.
Term
Fecal Impaction
Definition
Constipation caused by a firm mass of feces in the colon or rectum. The size or firmness prevents its passage. Common in nursing home residents.
Term
Glaucoma
Definition
Disease of the eye characterized by increase in pressure within the eye; may result in blindness. It can be controlled bu generally has no cure.
Term
Heart attack
Definition
Descriptive term for a clinical condition caused by occlusion of a coronary artery(s), characterized by heavy pressure or squeezing pain in the chest that may spread to the shoulder and arm. There may also be sweating, nausea, vomiting, and shortness of breath.
Term
Hemiparesis
Definition
Partial or incomplete paralysis of one side of the body.
Term
Hemiplegia
Definition
Paralysis of one side of the body.
Term
Hypertension
Definition
A condition in which a person has higher blood pressure than normal.
Term
Hemophilia
Definition
Hereditary blood disease in which there is greatly prolonged coagulation time for blood; abnormal bleeding occurs.
Term
Herpes
Definition
A general term used for a variety of infections of nerve endings caused by a number of different herpes viruses.
Term
Methicillin-resistant Staphylococcus Aureus (MRSA)
Definition
Infection that is resistant to anti-infective agents. Patients with MRSA should be isolated in a manner consistent with the state of infection.
Term
Multiple sclerosis
Definition
A chronic, slowly progressive disease of the nervous system, with many symptoms, that is degenerative.
Term
Nephritis
Definition
Inflammation of the kidney.
Term
Obesity
Definition
Abnormal amount of fat on the body, usually 20 to 30 percent over the average weight for a person's age, sex, and height.
Term
Osteoporosis
Definition
Disease of the bone characterized by a reduction in bone density associated with loss of calcium.
Term
Paraplegia
Definition
Paralysis of lower portion of the body and of both legs.
Term
Parkinson's Disease
Definition
A chronic nervous disease characterized by a fine slowly-spreading tremor, muscular weakness and rigidity, and peculiar gait; common in the aged.
Term
Pulmonary conditions
Definition
Disorders of the lungs and bronchial tubes, as pneumonia, lung cancer and bronchitis.
Term
Quadriplegia
Definition
Paralysis of all four limbs and usually the trunk of the body.
Term
Senile dementia
Definition
Deteriorative mental state due to organic brain damage occurring in the aged, characterized by loss of memory.
Term
Shingles
Definition
Acute inflammation of peripheral nerves in the trunk of the body, and sometimes elsewhere, by a herpes virus.
Term
Standing Orders
Definition
Physician orders that nurses can activate in specific situations without first having to notify the physician. These orders are specific to the individual attending physician, and the scope of the orders may vary greatly from one doctor to the next.
Term
Stroke
Definition
Sudden loss of consciousness followed by paralysis caused by hemorrhage into the brain, formation of a blood clot, or rupture of an artery in the brain; a cerebrovascular accident (CVA).
Term
Syndrome
Definition
A group of signs and symptoms that collectively characterize or indicate a particular disease or abnormal condition, as Down's Syndrome.
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