Many of the definitions below were referenced from LongTermCareLiving.com, a guide to planning, preparing, and paying for long term care — a site produced and managed by the American Health Care Association (AHCA).

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A

Activities of Daily Living (ADL)
The physical functions necessary for independent living, including bathing, dressing, eating, toileting, walking or wheeling, and transferring into and out of bed.

Acute
A sudden and severe condition.

Activity coordinator
A trained nursing home staff member who is responsible for leisure activities in the facility. Activity coordinators develop programs for patients based on individual abilities and interests. Activity programs must be designed to help patients maintain their highest level of functioning.

Administration on Aging
An agency of the U.S. Department of Health and Human Services. AOA is an advocate agency for older persons and their concerns at the federal level. AOA works closely with its nationwide network of State and Area Agencies on Aging (AAA).

Administrative Costs
A general term that refers to Medicare and Medicaid administrative costs, as well as CMS administrative costs. Medicare administrative costs are comprised of the Medicare related outlays and non-CMS administrative outlays. Medicaid administrative costs refer to the Federal share of the States' expenditures for administration of the Medicaid program. CMS administrative costs are the costs of operating CMS (e.g., salaries and expenses, facilities, equipment, rent and utilities, etc.). These costs are reflected in the Program Management account.

Administrator
The staff member responsible for the overall management of the nursing home. Every Tennessee nursing home must have a full-time administrator who is licensed by the state.

Adult Day Care Center
A community based program offering structured activities and meals. Some health services may be offered for an additional fee. Transportation may be provided. Most programs operate during the week and can be attended full or part-time.

Adult Day Care
A program that provides protective care for adults who stay at home at night but who need supervision and assistance during the day, generally because the family caretaker must go to work. A number of Tennessee nursing homes have adult day care programs and many are offered in conjunction with the Alzheimer's Association.

Age-Associated Memory Impairment
Mild memory loss that increases with age. Mild memory loss is normal and should not be confused with forms of dementia, which are progressive and affect every day living.

Alzheimer's Disease
A progressive and irreversible organic disease, typically occurring in the elderly and characterized by degeneration of the brain cells, leading to dementia, of which Alzheimer's is the single most common cause. Progresses from forgetfulness to severe memory loss and disorientation, lack of concentration, loss of ability to calculate numbers and finally to increased severity of all symptoms and significant personality changes.

Ambulate
To walk.

Aphasia
The loss of ability to express oneself and/or understand language.

Apraxia
Inability to carry out a complex or skilled movement due to deficiencies in cognition.

Area Agencies on Aging (AAA)
State and local programs that help older people plan and care for their life-long needs. These needs include adult day care, skilled nursing care/therapy, transportation, personal care, respite care, and meals.

Assessment 
Determination of a resident's care needs, based on a formal, structured evaluation of the resident's physical and psychological condition and ability to perform activities of daily living.

Assisted Living
Senior housing that provides individual apartments, which may or may not have a kitchenette. Facilities offer 24 hour on site staff, congregate dining, and activity programs. Assisted living facilities provide certain medical services, which typically can be self-administered, for those who do not need the more intensive nursing services provided in a nursing home. Limited nursing services may be provided for an additional fee.

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B

Bed Sores
See Pressure Ulcers

Bedfast
To be bed ridden.

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C

Case Mix
Is the distribution of patients into categories reflecting differences in severity of illness or resource consumption.

Case Mix Index
The average DRG relative weight for all Medicare admissions. The numeric score or weight given to certain RUG.

Center for Medicare and Medicaid (CMS)
Formerly the U.S. Health Care Financing Administration, CMS is an element of the Department of Health and Human Services, which finances and administers the Medicare and Medicaid programs. Among other responsibilities, CMS establishes standards for the operation of nursing facilities that receive funds under the Medicare or Medicaid programs.

Certified Nursing Assistant (CNA)
The CNA provides personal care to residents or patients, such as bathing, dressing, changing linens, transporting and other essential activities. CNAs are trained and certified to work under the supervision of an RN or LPN.

Chronic
A lasting, lingering or prolonged illness.

Chronic Disease
A disease which is permanent, or leaves residual disability, or is caused by nonreversible pathological alteration.

Civil Monetary Penalties (CMPs)
When a licensed nursing home has been cited with a deficiency by the state, the nursing home may have to pay a per-day fine until the deficiency has been corrected. The amount of the fine depends on the severity of the infraction.

Cognitive Impairment
A diminished mental capacity, such as difficulty with short-term memory.

Continuing Care Retirement Community (CCRC)
A housing community that provides different levels of care based on what each resident needs over time. This is sometimes called "life care" and can range from independent living in an apartment to assisted living to full-time care in a nursing home. Residents move from one setting to another based on their needs but continue to live as part of the community. Care in CCRCs is usually expensive. Generally, CCRCs require a large payment before you move in and charge monthly fees.

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D

Deficiency (NURSING HOME)
A finding that a nursing home failed to meet one or more federal or state requirements.

Dementia
Progressive mental disorder that affects memory, judgement and cognitive powers. One type of dementia is Alzheimer's disease.

Department of Health and Human Services
An executive department of the federal government that is responsible for the oversight of the Medicare and Medicaid programs.

Developmental Disability (DD)
Refers to a serious and chronic disability, originating before age 18, which is attributable to a mental or physical impairment or combination of mental and physical impairments. Those affected have limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity of independent living, economic self-sufficiency. Those who have a developmental disability often require long-term treatment and care-planning.

Direct Care Costs
Costs associated with nursing, therapies, medical supplies, oxygen, pharmacy, consultants or medical director.

Discharge Planner
A social worker or nurse who assists patients and their families with health care arrangements following a hospital stay.

Director of Nursing
A nurse who supervises other nurses and certified nurse technicians. In Tennessee facilities, the director of nursing (DON) must be a registered nurse unless the facility has special permission to use a licensed practical nurse.

Durable Medical Equipment (DME)
Durable medical equipment, as defined by Medicare, is equipment which can 1) withstand repeated use, 2) is primarily and customarily used to serve a medical purpose, 3) generally not useful to a person in the absence of an illness or injury, and 4) is appropriate for use in the home (e.g. wheelchairs, hospital beds, walkers).

Durable Power of Attorney for Health Care (DPAHC)
A legal document in which a competent person gives another person (called an attorney-in-fact) the power to make health care decisions for him or her if unable to make those decisions. A DPA can include guidelines for the attorney-in-fact to follow in making decisions on behalf of the incompetent person.

Dual Eligibles
Someone who is qualified for both Medicaid and Medicare.

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E

F

G

Geriatrics
The branch of medicine that focuses on providing health care for the elderly and the treatment of diseases associated with the aging process.

Grouper
A software program which links MDS data to RUG categories.

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H

Health Care Power of Attorney
The appointment of a health care agent to make decisions when the principal becomes unable to make or communicate decisions.

Health Maintenance Organization (HMO)
An organization that, for a prepaid fee, provides a comprehensive range of health maintenance and treatment services (including hospitalization, preventive care, diagnosis, and nursing).

Home-and community-based services (HCBS)
Services that are provided to people in their homes by various types of providers. HCBS may include services such as case management, minor home modifications, home delivered meals and personal emergency response systems.

Home Health Agency (HHA)
An agency that provides medical services in a home setting. Services may be provided by a nurse, occupational, speech or physical therapist, social worker, or home health aide.

Home Health Aide
A person who provides personal care such as bathing, dressing and grooming. May include light housekeeping services.

Hospice
Hospice/palliative care is provided to enhance the life of the dying person. Often provided in the home by health professionals, today there are many nursing facilities and acute care settings that also offer hospice services. Hospice care, typically offered in the last six months of life, emphasizes comfort measures and counseling to provide social, spiritual and physical support to the dying patient and his or her family.

Hospice Care
The provision of short-term inpatient services for pain control and management of symptoms related to terminal illness.

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I

Indirect Care Costs
Dietary services raw food, laundry, housekeeping, social services, or activities.

Informal Dispute Resolution (IDR)
When a state inspector cites a licensed nursing facility as being deficient in some area and the facility believes the citation is inaccurate or unwarranted, the facility may ask the state for a hearing called an IDR. At the hearing, it is up to the facility to prove to state officials that it is in compliance with state regulations.

Intermediate Care Facility/Mentally Retarded (ICF/MR)
A licensed facility with the primary purpose of providing health or rehabilitative services for people with mental retardation or people with developmental disabilities.

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J

Joint Commissionon Accreditation of Healthcare Organizations
An organization that accredits healthcare organizations. In the future, the JCAHO may play a role in certifying these organizations' compliance with the HIPAA A/S requirements.

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K

L

Levels of care (Level I and Level II)
The intensity of care provided to nursing home patients depends on their medical needs. Most patients need a less intensive level of care that the Medicaid program calls Level I (formerly called intermediate care), while others need a more intensive level called Level II or skilled nursing care. The cost of Level II care is higher than that of Level I, both to private pay patients and to the Medicaid program. The Medicare program does not cover Level I care and covers skilled care only in certain circumstances and in certified facilities.

Long Term Care (LTC)
The broad spectrum of medical and support services provided to persons who have lost some or all capacity to function on their own due to a chronic illness or condition, and who are expected to need such services over a prolonged period of time. Long term care can consist of care in the home by family members who are assisted with voluntary or employed help, adult day health care, or care in assisted living or skilled nursing facilities.

Long-Term Care Facilities
A range of institutions that provide health care to people who are unable to manage independently in the community. Facilities may provide short-term rehabilitative services as well as chronic care management.

Long Term Care Insurance
A policy designed to help alleviate some of the costs associated with long term care. Benefits are often paid in the form of a fixed dollar amount (per day or per visit) for covered expenses and may exclude or limit certain conditions from coverage.

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M

Market Basket
The cost of the mix of goods and services (including personnel costs but excluding non-operating costs) comprising routine, ancillary, and special care unit inpatient hospital services.

MDS (Minimum Data Set)
Is the core set of screening and assessment elements of the Resident Assessment Instrument (RAI). This resident assessment instrument provides a comprehensive, accurate, standardized, reproducible assessment of each long term care facility resident's functional capabilities and helps staff to identify health problems. This assessment is performed on every resident in a Medicare and/or Medicaid-certified long term care facility including private pay.

MDS 2.0
Minimum Data Set, version two. The most current resident assessment instrument.

Medicaid
The federally supported, state operated public assistance program that pays for health care services to people with a low income, including elderly or disabled persons who qualify. Medicaid pays for long term nursing facility care, some limited home health services, and may pay for some assisted living services, depending on the state.

Medicaid-Certified Bed
A nursing facility bed in a building or part of a building which has been determined to meet federal standards for serving Medicaid recipients.

Medicare
The federal program providing primarily skilled medical care and medical insurance for people aged 65 and older, some disabled persons and those with end-stage renal disease.

Medicare Part A
Hospital insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care, and some home health care. Most people get Medicare Part A automatically when they turn 65.

Medicare Part B
Medical insurance that helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover (like some home health care). Part B helps pay for these covered services and supplies when they are medically necessary. A monthly premium must be paid to receive Part B.

Medicare-Certified Bed
A nursing facility bed in a building or part of a building, which has been determined to meet federal standards for serving Medicare patients requiring skilled nursing care.

Medicare Supplemental Insurance
This is private insurance (often called Medigap) that pays Medicare's deductibles and co-insurances, and may cover services not covered by Medicare. Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare.

Medigap Insurance
A term commonly used to describe Medicare supplemental insurance policies available from various companies. Medigap is private insurance that may be purchased by Medicare-eligible individuals to help pay the deductibles and co-payments required under Medicare. Medigap policies generally do not pay for services not covered by Medicare.

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N

Nursing Facility (NF)
Nursing facilities are licensed to provide custodial care, rehabilitative care, such as physical, occupational or speech therapy or specialized care for Alzheimer's patients. Additionally, nursing facilities offer residents planned social, recreational and spiritual activities.

Nursing Home
A facility licensed with an organized professional staff and inpatient beds and that provides continuous nursing and other health-related, psychosocial, and personal services to patients who are not in an acute phase of illness, but who primarily require continued care on an inpatient basis.

Nurse, Licensed Practical (LPN)
A graduate of a state-approved practical nursing education program, who has passed a state examination and been licensed to provide nursing and personal care under the supervision of a registered nurse or physician. An LPN administers medications and treatments and acts as a charge nurse in nursing facilities.

Nurse, Registered (RN)
Nurses who have graduated from a formal program of nursing education (two-year associate degree, three-year hospital diploma, or four-year baccalaureate) and passed a state-administered exam. RNs have completed more formal training than licensed practical nurses and have a wide scope of responsibility including all aspects of nursing care.

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O

Occupational Therapist
Occupational therapists evaluate, treat, and consult with individuals whose abilities to cope with the tasks of everyday living are threatened or impaired by physical illness or injury, psychosocial disability, or developmental deficits. Occupational therapists work in hospitals, rehabilitation agencies, long-term-care facilities, and other health-care organizations.

Ombudsman
The Ombudsman Program is a public/government/community-supported program that advocates for the rights of all residents in 24-hour long-term care facilities. Volunteers visit local facilities weekly, monitor conditions of care and try to resolve problems involving meals, finances, medication, therapy, placements and communication with the staff.

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P

Private Pay Patients
Patients who pay for their own care or whose care is paid for by their family or another private third party, such as an insurance company. The term is used to distinguish patients from those whose care is paid for by governmental programs (Medicaid, Medicare, and Veterans Administration).

Physical Therapy
Services provided by specially trained and licensed physical therapists in order to relieve pain, restore maximum function, and prevent disability or injury.

Pre-Admission Screening
An assessment of a person's functional, social, medical, and nursing needs, to determine if the person should be admitted to nursing facility or other community-based care services available to eligible Medicaid recipients. Screenings are conducted by trained preadmission screening teams.

Pressure Ulcers
A breakdown of the skin, to which older, bed-ridden persons are especially susceptible. Also referred to as pressure sores or decubitis ulcers. For bed-ridden persons, prevention includes turning every two hours.

Private pay patients
Patients who pay for their own care or whose care is paid for by their family or another private third party, such as an insurance company. The term is used to distinguish patients from those whose care is paid for by governmental programs (Medicaid, Medicare and Veterans Administration).

Prospective Payment System (PPS)
The federal Medicare program bases its per day payment rates to skilled nursing facilities (SNFs) on this payment system, that was mandated by the Balanced Budget Act of 1997. The rates are adjusted according to the patients' conditions and needs and geographic variation in wages. The purpose of the system is to account for the costs of essential services to patients. (SEE also Resource Utilization Groups)

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Q

R

RED
Rate Effective Date.

Resident
A person living in a long-term care facility. Since nursing facilities are licensed health care facilities, residents are often also referred to as patients.

Resident Assistant (RA)
RAs generally work in assisted living residences and provide direct personal care services to residents, but they are not certified CNAs. Depending on the state, this position is also available in some nursing facilities.

Resident Care Plan
A written plan of care for nursing facility residents, developed by an interdisciplinary team which specifies measurable objectives and timetables for services to be provided to meet a resident's medical, nursing, mental and psychosocial needs.

Residential Care Facility
Group living arrangements that are designed to meet the needs of people who cannot live independently, but do not require nursing facility services. These homes offer a wider range of services than independent living options. Most provide help with some of the activities of daily living. In some cases, private long-term care insurance and medical assistance programs will help pay for this type of service.

Resource Utilization Groups (RUGs)
These 44 categories make up the patient classification system used by the Medicare program to adjust its payment rates to skilled nursing facilities. (SEE also Prospective Payment System)

RUG III
Resource Utilization Group, version three. Categories in which residents are placed in order to determine the care related costs.

Respite Care
Scheduled short-term nursing facility care provided on a temporary basis to an individual who needs this level of care but who is normally cared for in the community. The goal of scheduled short-term care is to provide relief for the caregivers while providing nursing facility care for the individual. Short-term stay beds used for respite care must be distinct from general nursing facility beds.

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S

Senior Housing
Independent living units, generally apartments. Any supportive services, if needed, are through contract arrangement between tenant and service provider.

Skilled Nursing Care
Nursing and rehabilitative care that can be performed only by, or under the supervision of, licensed and skilled medical personnel.

Skilled Nursing Facility (SNF)
Provides 24-hour nursing care for chronically-ill or short-term rehabilitative residents of all ages.

Speech Therapy
This type of service helps individuals overcome communication conditions such as aphasia, swallowing difficulties and voice disorders. Medicare may cover some of the costs of speech therapy after client meets certain requirements.

Sub-Acute Care
A level of care designed for the individual who has had an acute event as a result of an illness, and is in need of skilled nursing or rehabilitation but does not need the intensive diagnostic or invasive procedures of a hospital.

Sub-Acute Care Facilities
Specialized units often in a distinct part of a nursing facility. Provide intensive rehabilitation, complex wound care, and post-surgical recovery for persons of all ages who no longer need the level of care found in a hospital.

Survey
A detailed, unannounced inspection of each licensed nursing home conducted at least once a year by the Indiana State Department of Health.

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T

U

V

Ventilator
A ventilator, also known as a respirator, is a machine that pushes air into the lungs through a tube placed in the trachea (breathing tube). Ventilators are used when a person cannot breathe on his or her own or cannot breathe effectively enough to provide adequate oxygen to the cells of the body or rid the body of carbon dioxide.

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W

X

Y

Z

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