Term
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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 |
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Term
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Definition
| The ability of a person needing services to obtain those services. |
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Term
| Acquired Immune Deficiency Syndrome (AIDS) |
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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. |
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Term
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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. |
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Term
| Activities of Daily Living |
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Definition
| Individual self-performance skills needed in everyday life such as ambulation/locomotion, eating, toileting, grooming/personal hygiene, and bathing. |
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Term
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Definition
| An allied health professional trained to develop and provide leisure time activities for facility residents (patients). |
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Term
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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. |
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Term
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Definition
| Short-term, intense medical care for an episode of illness or injury often requiring hospitalization. |
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Term
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Definition
| Episodic conditions that require short-term but intensive medical interventions. |
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Term
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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). |
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Term
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Definition
| See NURSING HOME ADMINISTRATOR/NURSING FACILITY ADMINISTRATOR |
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Term
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Definition
| A contract that spells out the services the nursing home will provide and the cost of those services. |
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Term
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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. |
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Term
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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). |
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Term
| Adverse Drug Reaction (ADR) |
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Definition
| Any unintended response to a drug which is injurious or harmful to health and which occurs at normal doses. |
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Term
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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. |
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Term
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Definition
| Prejudicial treatment of the elderly based on stereotypes and misconceptions. |
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Term
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Definition
| Accommodating the changing needs of older adults while living in familiar surroundings. |
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Term
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Definition
| Verbal, vocal, and motor activities that are repetitive and outside of socially acceptable norms. |
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Term
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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. |
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Term
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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. |
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Term
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Definition
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Term
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Definition
| Able to walk with or without difficulty or help. |
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Term
| Ambulatory Care (Ambulatory Services) |
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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. |
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Term
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Definition
| An annual assessment of a resident's (patient's) physical, mental, emotional, cognitive, and functional status. |
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Term
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Definition
| Psychoactive medications given to reduce anxiety (e.g., Ativan, Valium, Xanax) |
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Term
|
Definition
| Removing or destroying microorganisms. |
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Term
|
Definition
| Impaired ability to communicate. |
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Term
|
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. |
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Term
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Definition
| Absence of harmful microorgansms called pathogens. It refers to the practice of clean procedures, such as hand-washing. |
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Term
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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. |
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Term
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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. |
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Term
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Definition
| A health care professional who is specially trained and licensed to provide direct clinical services to individuals with hearing or balance disorders. |
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Term
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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. |
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Term
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Definition
| A cluster of notions that include self-determination, freedom, independence, and liberty of choice or actions. |
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Term
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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. |
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Term
|
Definition
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Term
|
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. |
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Term
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Definition
| The human tendency to pay attention to, affiliate with and respond positively to nature. |
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Term
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Definition
| A facility that offers room and board and sometimes supervision of daily activities. It does NOT offer health care. |
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Term
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Definition
| A physician who specializes in the treatment of heart diseases. |
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Term
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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). |
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Term
|
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. |
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Term
|
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. |
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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. |
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Term
|
Definition
| The process by which federal and state governments determine if a health care facility meets Medicare and/or Medicaid standards. |
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Term
| Certified Nursing Assistant (CNA) |
|
Definition
| A nurse aide who has completed at least the minimum training required by regulations. |
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Term
|
Definition
| The nurse in charge or supervising a particular part of a facility for a given time shift. |
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Term
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Definition
| A psychoactive drug used by a facility for discipline or convenience and not for medical treatment. |
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Term
|
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. |
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Term
|
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. |
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Term
| Clinical Information System |
|
Definition
| Information technology that is designed to be used by various clinicians to support the delivery of patient care. |
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Term
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Definition
| A care-planning tool that outlines in a time sequence important aspects of care necessary for meeting specific outcomes. |
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Term
| Clinical Practice Guidelines |
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Definition
| Evidence-based standardized protocols indicated for the treatment of specific health conditions. |
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Term
| Code of Federal Regulations (CFR) |
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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. |
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Term
|
Definition
| The simultaneous presence of two or more health problems. |
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Term
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Definition
| Pharmacist who is contracted by the nursing home to do drug regimen reviews and provide other services. |
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Term
|
Definition
| The ability to self-regulate bladder and bowel elimination. |
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Term
| Continuing Care Retirement Community (CCRC) |
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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. |
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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. |
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Term
|
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. |
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Term
|
Definition
| Transfer of disease causing organisms through contact with a dirty surface, unwashed hands, or insects. |
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Term
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Definition
| A society's typical ways of behaving; its customs, mores and beliefs |
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Term
|
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. |
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Term
| Data Assessment and Verification (DAVE) |
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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. |
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Term
|
Definition
| Weak and infirm, unable to care for many personal needs |
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Term
|
Definition
| Disorders in which tissue or an organ deterioriates and vitality is diminished. |
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Term
|
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. |
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Term
|
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. |
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Term
|
Definition
| The makeup of a set of teeth including their kind, number, arrangement and usability. |
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Term
|
Definition
| An abnormal state of mind in which a person usually becomes inactive and disinterested in his environment and lacks motivation. |
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Term
|
Definition
| A specialist physician who treats infections, growths, injuries, and other disorders related to the skin. |
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Term
|
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. |
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Term
|
Definition
| Sometime referred to as nutritionist, a dietitian provides nutritional information and diet-related services to residents/patients. |
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Term
| Director of Nursing (DON) |
|
Definition
| A registered nurse responsible for supervising the activities, functions, and training of nursing personnel. |
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Term
| Director of Nursing Services (DNS) |
|
Definition
| See DIRECTOR OF NURSING (DON). |
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Term
|
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. |
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Term
|
Definition
| To deliver a prescribed drug to an ultimate user, including the compounding, packaging, and labeling necessary to prepare the prescribed drug. |
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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. |
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Term
|
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. |
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Term
|
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. |
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Term
| Drug Regimen Review (DRR) |
|
Definition
| The review of drugs being used by a resident (patient) to determine effect and potential for harmful effects. |
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Term
| Drug Utilization Review (DUR) |
|
Definition
| The study of drug use patterns in a facility. |
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Term
|
Definition
| Slurred or unintelligible speech due to muscle weakness or other problem. |
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Term
|
Definition
| Difficulty in swallowing due to a dysfunction in any phase of the swallowing process. |
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Term
|
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. |
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Term
|
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. |
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Term
|
Definition
| The process in the body of breaking down calories consumed into usable energy to allow the body to perform normal body functions. |
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Term
|
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). |
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Term
|
Definition
| Delivery of liquid food through a tube directly into the stomach. |
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Term
|
Definition
| Excessive prevalence of a negative health condition. |
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Term
|
Definition
| A brain disorder in which signals sent by nerve cells become disturbed, causing strange sensations, emotions, convulsions, muscle spasms, or loss of consciousness. |
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Term
|
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. |
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Term
|
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. |
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Term
|
Definition
| Delivery of services using best practices that have been established through clinical research. |
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Term
|
Definition
| Salaried workers who are exempt from overtime provisions of the Fair Labor Standards Act. |
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Term
|
Definition
| A federal survey conducted within 14 days of a finding of sustandard care during a standard federal survey (see also STANDARD SURVEY). |
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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. |
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Term
|
Definition
|
|
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. |
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Term
|
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. |
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Term
|
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. |
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Term
|
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. |
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Term
|
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. |
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Term
|
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). |
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Term
|
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. |
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Term
|
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. |
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Term
|
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. |
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Term
|
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. |
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Term
|
Definition
| Use of telecommunication technology for the distance monitoring of patients and delivery of health care with or without the use of video technology. |
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Term
|
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. |
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Term
| Human Immunodeficiency Virus (HIV) |
|
Definition
| A virus that gradually destroys the body's natural immune system designed to fight infections and disease. |
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Term
|
Definition
|
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Term
|
Definition
| A psychoactive medication given to sedate or calm (e.g., Sonata, Restoril, Ambien). |
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Term
|
Definition
| Complications caused by the process of medical care. |
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Term
|
Definition
| A federal certification for an Intermediate Care Facility for the Mentally Retarded. |
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Term
|
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. |
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Term
|
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. |
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Term
|
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. |
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Term
|
Definition
| A catheter that remains in the bladder to drain urine into a bag. |
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Term
|
Definition
| Treating older adults as children. |
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Term
|
Definition
| A comprehensive program to prevent the transmission of infections protecting the residents, the staff, and visitors from contracting infections while in the facility. |
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Term
|
Definition
| Hazardous waste that can pose health risks from communicable infectious agents. |
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Term
|
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. |
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Term
|
Definition
| An on-site federal survey to determine whether a provider meets the requirements to begin participating in the Medicare and/or Medicaid programs. |
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Term
|
Definition
| Physical, financial, or emotional harm. |
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|
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). |
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Term
|
Definition
| A state of living together (symbiosis) in a mutually beneficial relationship. |
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Term
|
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. |
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Term
|
Definition
| A physician who specializes in treating diseases related to the internal organs of the body. |
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Term
|
Definition
| Electronic medical information that is available simultaneously to various health care providers. |
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|
Term
| Jejunostomy tube (J-tube) |
|
Definition
| A surgically placed tube that enters the small intestine for the delivery of specialized nutritional formulas. |
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Term
|
Definition
| A psychological state in which patients believe that they can no longer do anything for themselves and must depend on others. |
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Term
|
Definition
| A duly-issued certificate that permits a person to practice or a nursing home to operate in a given state. |
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|
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. |
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Term
|
Definition
| The granting of a license to a provider that has been determined to meet a state's requirements for operation. |
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Term
|
Definition
| An advance directive specifying a person's wishes regarding medical treatment in the event this person becomes incompetent. |
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|
Term
|
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. |
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|
Term
|
Definition
| An institution, commonly referred to as a nursing home, that is duly licensed to provide long-term care services. |
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|
Term
| Maintenance Rehabilitation |
|
Definition
| Rehabilitation that is aimed at preserving the present level of function and preventing secondary complications. |
|
|
Term
|
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
|
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. |
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Term
|
Definition
| The date at which the RN assessment coordinator attests that all portions of the MDS have been completed. |
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|
Term
|
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. |
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|
Term
|
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. |
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|
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
|
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. |
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|
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
|
Definition
| Medications not given as intended by the prescriber, as required by the drug manufacturer, or according to acceptable professional standards. |
|
|
Term
|
Definition
| Below-average intellectual functioning that is long term and incurable. |
|
|
Term
|
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
|
Definition
| The deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's (patient's) belongings or money without their consent. |
|
|
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. |
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|
Term
|
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. |
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Term
| Nasogastric tube (NG-tube) |
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Definition
| A method of delivering nutrition through a tube that passes through the nasal openings, down to the esophagus, and into the stomach. |
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Term
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Definition
| Failure to provide goods and services to prevent resident (patient) harm, mental anguish, or mental illness. |
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Term
|
Definition
| Failure to exercise the degree of care that a reasonable person would exercise in similar circumstances. |
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Term
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Definition
| A physician who specializes in kidney diseases, kidney transplantation, and dialysis therapy. Nephrology is classified as an internal medicine subspecialty. |
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Term
| Nosocomial Infection in the LTC Facility |
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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. |
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Term
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Definition
| Federal and/or state training and capability requirements needed for employment of nurse aides in nursing homes. |
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Term
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Definition
| A listing of nurse aides who have met Federal and/or State training and competency requirements needed for employment in nursing homes. |
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Term
| Nurse Aide, Nursing Assistant (NA) |
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Definition
| An unlicensed caregiver, under professional nurse supervision, who provides nursing and professional care. |
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Term
|
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. |
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Term
|
Definition
| A nursing home that meets the requirements for Medicaid certification as defined in 1919(a) of the Federal Social Security Act. |
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Term
| Nursing Home Administrator - NHA (Nursing Facility Administrator - NFA, AKA LTCA or Long-Term Care Administrator) |
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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). |
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Term
| Nursing Home Quality Improvement Initiative |
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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. |
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Term
| Occupational Therapist (OT) |
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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). |
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Term
|
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. |
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Term
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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. |
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Term
| Omnibus Budget Reconciliation Act of 1987 (OBRA) |
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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. |
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Term
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Definition
| A medical specialty dealing with cancers and tumors. |
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Term
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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. |
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Term
| Online Survey/ Certification and Reporting (OSCAR) |
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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. |
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Term
|
Definition
| A physician who specializes in the treatment of diseases and injuries of the eye. |
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Term
|
Definition
| An optical technician who generally hold an associate's degree in opticianry. An optician dispenses and fits eyeglasses. |
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Term
|
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. |
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Term
|
Definition
| A physician who specializes in correcting deformities of the skeletal system and may surigally repair bones and joints. |
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Term
|
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. |
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Term
|
Definition
| The status of care provided to a resident (patient). |
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Term
|
Definition
| Medical care that is focused on relieving unpleasant symptoms such as pain, discomfort, and nausea. |
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Term
|
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. |
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Term
|
Definition
| Delivering a special liquid nutritional formulation directly into the blood stream, when the gastrointestinal tract is not functioning properly. |
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Term
|
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. |
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Term
|
Definition
| A decline in human emotions, withdrawal from interactions with others and surroundings, and a decrease in motor activity. |
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Term
|
Definition
| Disease-causing organism. |
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Term
|
Definition
| Human waste that may contain human tissue, blood, or body fluids. |
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Term
|
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. |
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Term
| Person Appropriate Activities |
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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). |
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Term
|
Definition
| A physician who has specialized in physical medicine and rehabilitation. |
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Term
|
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. |
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Term
|
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). |
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Term
|
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). |
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Term
|
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. |
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Term
|
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. |
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Term
|
Definition
| A provider;s plan for how and when it will correct federal deficiencies and/or state violations. |
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Term
|
Definition
| A physician who treats patients with diseases or deformities of the feet. |
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Term
|
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. |
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Term
|
Definition
| An on-site provider visit intended to verify correction of deficiencies and/or violaitons cited during a survey. |
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Term
| Preadmission Screening/ Annual Resident Review (PASARR) |
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Definition
| Federally required screening of all nursing home residents, prior to admission, to determine if the individual residents are mentally ill or mentally retarded. |
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Term
|
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. |
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Term
|
Definition
| A type of QI or QM that provides a description of a resident or patient at a point. |
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Term
|
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. |
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Term
|
Definition
| The assessment that occurs in the most recent four months (46-165 days) preceding the target assessment (See Assessment and Target Assessment). |
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Term
|
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. |
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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. |
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Term
|
Definition
| Medications used to change, modify, or alter an individual's behavior or mood. This general term includes antianxiety, antidepressant, antipsychotic, and hypnotic medications. |
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Term
|
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. |
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Term
|
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. |
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Term
|
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. |
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Term
|
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. |
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Term
|
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. |
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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. |
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Term
|
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. |
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Term
|
Definition
| General area of the federal nursing home requirements that addressess specific issues. |
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Term
|
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. |
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Term
|
Definition
| MDS assessments required each quarter for all residents (patients) in Medicare and/or Medicaid facilities. |
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Term
|
Definition
| The extent or magnitude of a resident's (patient's) joint movement. |
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Term
|
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. |
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Term
| Recreational Therapist (RT) |
|
Definition
| A person certified, by a recognized certifying organization, to perform as a recreational therapist. |
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Term
|
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. |
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Term
| Registered Dietitian (RD) |
|
Definition
| A person registered as a dietitian by state statute or the American Dietetics Association. |
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Term
|
Definition
| A person registered as a nurse by state statute. |
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|
Term
| Registered Pharmacist (RPh) |
|
Definition
| A person registered as a pharmacist by state statute. |
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Term
|
Definition
| Federal requirements promulgated to "flesh out" the statutory requirements in the Social Security Act (see also Rules and Statutory Requirement). |
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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. |
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|
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. |
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Term
|
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. |
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|
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. |
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Term
|
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. |
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Term
|
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) |
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Term
|
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). |
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Term
|
Definition
| Also called "blood poisoning," it is a rapidly progressing and lfe threatening infection due to the presence of bacteria in the blood. |
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|
Term
|
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). |
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Term
|
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. |
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Term
|
Definition
| Admission and discharge of a nursing home resident (patient) that occurs in less than 14 days. |
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Term
|
Definition
| Undesirable effect of a medication that causes minimal discomfort in some people. |
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Term
|
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. |
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|
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. |
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Term
| Significant Medication Error |
|
Definition
| Medication error that cause a resident (patient) discomfort and/or jeopardizes his/her health and safety. |
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Term
|
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. |
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|
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. |
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Term
|
Definition
| Federal statutory law that includes the requirements for participation in the Medicare and Medicaid programs. |
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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. |
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Term
|
Definition
| A person licensed, certified, or registered by state statute to perform as a speech pathologist. |
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Term
|
Definition
| A person licensed, certified, or registered by state statute to perform as a speech therapist. |
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|
Term
|
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. |
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Term
|
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. |
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|
Term
|
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. |
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|
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 |
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|
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. |
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Term
|
Definition
| An artificially created opening in the body. |
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Term
|
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). |
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Term
|
Definition
| Type of nursing home care that is generally considered above skilled nursing but below acute hospital care. |
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Term
|
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. |
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Term
|
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). |
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Term
|
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). |
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Term
|
Definition
| The temperature range of 40F (5C) and 140F (60C) in which food bacteria thrive and multiply rapidly. |
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Term
|
Definition
| Care provided to a dying resident (patient) that may or may no include hospice care (see also HOSPICE CARE). |
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Term
|
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). |
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|
Term
|
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). |
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|
Term
|
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). |
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Term
|
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. |
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|
Term
| Transitional Care Unit (TCU) |
|
Definition
| A skilled nursing unit located within a hospital. |
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|
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. |
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|
Term
|
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. |
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|
Term
|
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. |
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|
Term
|
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. |
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|
Term
|
Definition
| The granting of an alternate requirement in place of a federal or state regulation. |
|
|
Term
|
Definition
| A small machine that takes over the breathing function by automatically moving air into and out of the patient's lungs. |
|
|
Term
|
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
|
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. |
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|
Term
|
Definition
| The granting of an exemption from a federal or state regulation (see also VARIANCE). |
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|
Term
|
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.) |
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