Glossary of Eldercare Terminology

This interactive tool covers medical terms, medical conditions, health care services and programs, gerontology terms and Medicare and Medicaid terms. While some medical conditions or treatments may be mentioned here, this guide does not endorse any treatments and it is not a comprehensive text. You should consult your medical, financial or legal advisor if you have any questions about these terms.

- A -


Activities of Daily Living (ADLs): Activities that include help in walking, getting in
and out of bed, bathing, dressing, eating, toileting and self-administration of
medications. Widely used as a basis for assessing functional status.

Acute Care: Medical care designed to treat or cure disease or injury, usually within
a limited time period. Acute care usually refers to physician and/or hospital services
of less than three months' duration.

Administration on Aging (AOA): An agency of the US Department of Health and
Human Services that is the focal point for older persons and their concerns at the
federal level.

Administrator: A person licensed to run a nursing home; one who has received
training in fiscal, legal, social and medical aspects of running an institution.

Adult Day Care: The recreational and rehabilitation services provided for persons
who require daytime supervision. An alternative between care in the home and care
in an institution.

Allied Health Professionals: Persons with special training in fields related to
medicine, such as medical social work and physical or occupational therapy. Allied
health professionals work with physicians or other health professionals.

Alzheimer's Disease: A progressive, irreversible form of dementia. It is the most
common form of dementia, affecting 5% of those over 65 and 20% of those over 80.
The cause of the disease is unknown at this time. Symptoms begin with loss of
memory and rational thinking and usually progress to total disability over a number
of years. Its effects are mainly on the mind, not the physical body.

Ambulatory: Able to walk about.

Ambulatory With Assistance: Able to get about with the aid of a cane, crutch,
brace, wheelchair or walker.

Analgesics: A class of drugs used to reduce pain. Aspirin, Tylenol, Darvon, Codeine,
Demerol and Dilaudid are analgesics.

Ancillary Services: Those services needed by a nursing home resident, but not
provided by a nursing home, such as podiatry, dentistry, etc., and which may not be
included in the basic rate of the facility.

Antacids: For heartburn or upset stomach. Maalox and Mylanta are antacids.

Anti-Anxiety Medications: A group of tranquilizing drugs which have a calming or
soothing, quieting or pacifying effect without depressing. Valium and Librium are
anti-anxiety medications.

Anti-Depressant Medications:
A group of drugs that work to regulate mood.
Elavil, Desyrel, Prozac and Tofranil are some anti-depressants.

Anti-Hypertensive Medications: Drugs that lower blood pressure. Serpasil is an
anti-hypertensive.

Anti-Inflammatory Medications: Drugs used to treat inflammation like that
occurring with arthritis. Aspirin, Butazolidin, Indocin and Motrin/Ibuprofen are anti-
inflammatory drugs.

Anti-Psychotic Medications: Another group of tranquilizing drugs which are more
powerful than anti-anxiety drugs and work to reduce psychotic behaviors. Thorazine,
Haldol, Mellaril and Navene are anti-psychotic drugs.

Appeals Council: A group under the Social Security Administration (SSA) that
meets in Washington, DC, and receives requests to review the decision of the
hearing officer (i.e., the second step in the appeals process of the SSA). The Appeals
Council is the third and final "in-house" appellant source. The Appeals Council
determines whether or not it shall review the case in question.

Approved Amount: The amount Medicare determines to be reasonable for a service
that is covered under Part B. It may be less than the actual amount charged. For
many services, including doctor services, the approved amount is taken from a fee
schedule that assigns a dollar value to all Medicare-covered services that are paid
under that fee schedule.

Area Agency on Aging (AAA): Local government agencies that grant or contract
with public and private organizations to provide services for older persons within
their area.

Arteriosclerosis: Fatty deposits inside artery walls causing a decrease in size and
flexibility of artery; the following terms are used in conjunction with this basic
condition:
    Ateriosclerosis Brain Disease: As the above, affects the brain.
    Arteriosclerosis Heart Disease: As the above, affects the heart.
    Atherosclerosis: Another word for arteriosclerosis.

Assignment:
A method of billing Medicare for services. The provider agrees to bill
Medicare directly for services and agrees to accept Medicare's allowed charge as
payment in full. Medicare pays the provider directly. The provider can then bill the
beneficiary for deductibles and coinsurance.

Assisted Living: A special combination of housing, personal services and health
care designed to respond to the individual needs of those who require help with
Activities of Daily Living. Care is provided in a professionally managed group living
environment and usually includes private occupancy units, three meals a day, 24-
hour staff availability to meet the individual's scheduled and unscheduled needs and
some medical care.

Assisted Living Facility: At this time, regulations governing Assisted Living
Facilities are confusing and in flux, with little consistency throughout the country.
Some states have regulations for Assisted Living Facilities and a number of states are
considering revisions in their existing regulations related to these types of facilities
and assisted living-type environments and care. The breadth of state regulations
varies from comprehensive regulations on staffing, physical design, required services
and resident characteristics to minimal requirements. Some Board and Care Home
statutes cover Assisted Living Facilities.

Authorized Representative or Representative Payee: Any person that the Social
Security (SS) beneficiary or Supplemental Security Income (SSI) recipient requests
to be given the right to represent him/her in any business with the Social Security
Administration (SSA). Many people choose an attorney for this role. The right to
have an authorized representative exists for all claimants of SS and SSI benefits and
is secured by obtaining and completing the "Appointment of Representative" form
(SSA-1966;12/68) which defines the limit for fees to be charged by the authorized
representative, the penalties for charging an unauthorized fee and conflict of
interest. The form also formally identifies the authorized representative for the SSA.


- B -


Bed Pan: A pan used to allow elimination of urine and feces while remaining in bed.

Benefit Maximum: The limit a health insurance policy will pay for a certain loss or
covered service. The benefit can be expressed either as 1) a length of time (e.g., 60
days), or 2) a dollar amount (e.g., $350 for a specific illness or procedure), or 3) a
percentage of the Medicare approved amount. The benefits may be paid to the
policyholder or to a third party. This may refer to a specific illness, time frame or the
life of the policy.

Benefit Period: A way of measuring the claimant's use of services under Medicare's
Hospital Insurance. The claimant's first Benefit Period starts the first time he enters a
hospital after his hospital insurance begins. When the claimant has been out of a
hospital (or other facility primarily providing skilled nursing or rehabilitation services)
for 60 days in a row, a new benefit period starts the next time he enters the hospital.
There is no limit to the number of benefit periods he can have.

Blood Pressure (BP): Measurement of the pressure of the blood in the arteries.
High blood pressure is called hypertension.

Bowel and Bladder Training: A program of retraining of bowel and bladder
functions to minimize or eliminate the inability to control these functions.

- C -


Call Bell: A button or bell that is connected to a light at the nurses' station in a
health care facility. Used by residents to summon nurses or aides.

Cancer: A malignant growth of tissue.

Carcinoma: A malignant tumor that may affect almost any organ or part of the body
and spread through the blood stream.

Carriers: Private insurance organizations under contract with the federal
government that handle claims from doctors and other suppliers of services covered
by the medical insurance part of Medicare (Part B).

Categorically Needy Medicaid Program: Those individuals who are eligible for all
medical services under state Medical Assistance Programs (Medicaid) on the basis of
financial need.

Catheter: A tube passed through the urethra and into the bladder to drain urine.
Other names used are Foley, Foley Catheter and In-Dwelling Catheter.

Certificate of Need (CON): A certificate issued by a government body to a health
acre provider who is proposing to construct, modify or expand a facility, or to offer
new or different types of health care services. CON is intended to prevent duplication
of services and over-bedding. The certificate signifies that the change has been
approved.

Certification: The granting of a certificate to a facility that is found in an annual
inspection to be in compliance with a set of federal standards on staffing, cleanliness
and maintenance of records, etc. Nursing homes must be certified in order to be
reimbursed for care provided to Medicare and Medicaid recipients.

Chair Bound: Unable to get out of a chair without the help of another person.

Charge Nurse: A Licensed Practical Nurse (LPN) or Registered Nurse (RN) who is
responsible for supervising the aides of a given unit, dispensing medication and
providing patient care.

Chemical Restraint: Drugs that contain a substance that has a depressant effect on
the central nervous system.

Chuks: Trade name for a disposable pad that is soft on one side and waterproof on
the other. Used under incontinent persons or under draining areas of the body.

Coinsurance: The amount, usually 20% of Medicare allowed charges, that are not
reimbursed by the Medicare program.

Coma: A state of unconsciousness from which one can not be aroused.

Commode: A portable toilet used in a patient's room.

Congregate Housing: Apartment houses or group accommodations that provide
health care and other support services to functionally impaired older persons who do
not need routine nursing care.

Conservatorship: A "conservator" may be appointed to manage the individual's
property and business affairs only if a court determines that the person is unable to
manage his property for reasons such as mental illness, mental deficiency, physical
illness or disability, advanced age, chronic use of drugs, chronic intoxication,
confinement, detention by a foreign power or disappearance; and (if) the person has
property that will be wasted or dissipated unless proper management is provided, or
that funds are needed for the support, care and welfare of the person or those
entitled to be supported by him and that protection is necessary and desirable to
obtain or provide funds.

Continent: Able to control the passage of urine and feces. The opposite is
incontinent or unable to control the passage of urine or feces.

Continuum of Care: A comprehensive system of Long-Term Care services and
support systems in the community, as well as in institutions. The continuum
includes: 1) community support services such as senior centers; 2) in-home care,
such as home delivered meals, homemaker services, home health services, shopping
assistance, personal care, chore services and friendly visiting; 3) community-based
services such as adult day care; 4) non-institutional housing arrangements such as
congregate housing, shared housing and Board and Care Homes; 5) nursing homes
and sub-acute and acute facilities if necessary.

Contractures: Shortening of muscles producing distortions or deformities or
abnormal limitations of movement of the joints.

CPR: Cardio-Pulmonary Resuscitation.

Custodial Care: Care that attempts to maintain a person at an existing level and
that does not involve any skilled rehabilitation or nursing services. See also Personal
Care.

- D -


Decubitis Ulcer:
A sore or ulcer caused by the lack of blood circulating to some
area of the body. This condition often results from sitting or lying in one position too
long. Other names are bedsores and pressure sores.

Deductible: A yearly amount required by Medicare or other insurance carriers that
is the responsibility of the patient or other parties.

Dehydration: Lack of adequate fluid in the body. A crucial factor in the health of
older people.

Denial of Payment: An enforcement sanction that can be used by a state agency or
the federal government when a facility has serious deficiencies.

Dermatologist: A physician specializing in the diagnosis and treatment of disease,
defects and injuries of the skin.

Diabetes: A condition caused by the failure of the pancreas to secrete insulin. An
older person may have poor circulation, poor eyesight or other debilitating
complications from this disease.

Diabetic Medications: Replacement medications used to control Diabetes. Insulin,
Orinase and Diabinase are Diabetic medications.

Dietician: One qualified by training an education in planning menus and regular and
special diets, and in establishing dietary procedures.

Director of Nursing: A Registered Nurse (RN) who oversees the nursing
department, including nursing supervisors, Licensed Practical Nurses, nurses aides
and orderlies. The Director of Nursing writes job descriptions, hires and fires
members of the nursing staff and writes and executes procedures and policies for
nursing practice.

Disorientation: Loss of one's bearings; loss of sense of familiarity with one's
surroundings; or loss of one's bearings with respect to time, place and person.

Diuretics: A class of drugs given to help the body rid itself of excess fluid; often
used on older persons with heart disease.

Diagnostic Related Group (DRG): Groups into which all types of illnesses are
classified in order to determine payment to hospitals by Medicare.

Do Not Resuscitate Order (DNR): A code or order usually appearing in a patient's
medical record indicating that in the event the heart and/or breathing stops, no
intervention be undertaken by staff. Death occurs undisturbed. This does not mean
that the individual does not receive care. Continuing care is provided as it would to
any individual (medications for pain, antibiotics, etc.) except as stated above.

Drainage Bag: A plastic bag used to collect urine from a catheter.

Draw Sheet: A small sheet covering a rubber or plastic sheet on a bed or
wheelchair; used under an incontinent person.

Durable Medical Equipment (DME): As defined by Medicare, DME is equipment
that 1) can withstand repeated use, 2) is primarily and customarily used to serve a
medical purpose, 3) is generally not useful to a person in the absence of an illness or
injury, and 4) is appropriate for use in the home. Examples include oxygen and
wheelchairs.

Durable Power of Attorney: A Power of Attorney not affected by subsequent
disability of the individual.

- E -

Edema: Collection of fluids in tissues that result in swelling.

Emphysema: A condition in which the lungs become distended or ruptured.

Explanation of Medicare Benefits (EOMB) Form: The statement that Medicare
sends the beneficiary to show what action has been taken by the carrier in
processing the Medicare claim. If payment is issued to the Medicare beneficiary, a
check will be attached. Most Medigap policies pay claims based on an EOMB

- F -


Family Care Rest Home: Provides permanent facilities, resident beds and personal
care services (safety, comfort, nutritional needs, well-being) for three or less
residents who are normally able to manage activities of daily living in a family
setting.

Financially Needy: Those individuals who are eligible for all medical services under
a state Medical Assistance Plan (Medicaid) on the basis of financial need.

Fire Resistance Rating: The time, in minutes or hours, that materials have
withstood a fire exposure as established in accordance with test procedures of
Standard Methods of Fire Test Building Construction and Material.
Fiscal Agent: A contractor that processes or pays vendor claims on behalf of the
Medicaid agency.

Fiscal Intermediaries: Private insurance organizations under contract with the
federal government to handle Medicare claims from hospitals, skilled nursing
facilities and home health agencies (Part A).

- G -

Gastrointestinal Disease: Disease of the stomach, colon, bowels, or rectum; i.e.,
peptic ulcer (ulcer of the stomach), colitis and diverticulitis (inflammatory disease of
the large bowels).

Gastrointestinal Medications: Medications to relieve stomach problems. Tagamet
and Donnatal are Gastrointestinal Medications.

Geri-Chair: A wheelchair that can not be self-propelled. It must be pushed by
someone else, has a high back, foot ledge and removable dining tray.

Glaucoma: Disease of the eye. Results in atrophy of the optic nerve and blindness.
An early sign of glaucoma is a complaint that lights appear to have a halo around
them.

Grab Bar: Bars or railings placed around tubs, showers and toilets to be used to
steady oneself.

- H -

Hand Rails: Railings placed on walls of halls to steady oneself. Used to improve
safety.

Health Care Financing Administration (HCFA): An executive department of the
Department of Health and Human Services that has ultimate authority over Medicare
and Medicaid.

Health Insurance Information Counseling Assistance Program (HIICAP):
Program for Medicare beneficiaries where peer counselors respond to questions and
requests for help in navigating the private and public insurance systems.

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). HMOs are
sponsored by large employers, labor unions, medical schools, hospitals, medical
clinics and insurance companies. Development of HMOs was spurred by the federal
government in the 1970s as a means to correct the structural, inflationary problems
with the conventional fee-for-service health care payment systems.

Hearing: (in reference to the Social Security Administration) The second step in the
appeals process whereby an administrative law judge of the SSA hears the initial or
recommended decision made by the SSA along with any new evidence and issues a
decision.

Heart Attack: Common term used to describe sudden internal damage to the heart
often as a result of arteriosclerotic heart disease.

Heart Medications: Medicines that control the heart beat. Digoxin, Lanoxin and
Digitalis are commonly used examples.

Heimlich Maneuver: A type of first aid administered to individuals who are choking.

Hip Pinning: A surgical procedure used to repair a broken hip. Refers to the placing
of a steel plate or pin to hold splinters together.

Home Health Agency (HHA): A public or private agency certified by Medicare that
specializes in providing skilled nurses, homemakers, home health aides and
therapeutic services, such as physical therapy in an individual's home.

Home Health Care: Health services provided in the homes of the elderly, disabled
sick or convalescent. The types of services provided include nursing care, social
services, home health aide and homemaking services, and various rehabilitation
therapies (e.g., speech, physical and occupational therapy).

Homemaker or Home Health Aid: A person who is paid to help in the home with
personal care, light housekeeping, meal preparation and shopping. Some states and
agencies make a distinction between homemaking (or housekeeping) services and
personal care services.

Hospice: Care that addresses the physical, spiritual, emotional, psychological,
social, financial and legal needs of the dying patient and his/her family. A concept
that refers to enhancing the dying person's quality of life. Hospice care can be given
in the home, a special hospice facility or a combination of both.

Hypertension: High blood pressure or elevated pressure in the arteries.

- I -

IMR: Intermediate Care Facility for the Mentally Retarded.

Incapacitated Adult: A legally incapacitated person is someone impaired by
sickness, accident, injury, mental illness, mental disability, chronic use of drugs,
chronic intoxication or any other causes, to the extent that the person does not have
sufficient understanding or ability to make or communicate responsible decisions
concerning his/her day-to-day care.

Informed Consent: A legal term that refers to a person's consent to a proposed
medical intervention after receiving relevant information. The information that is
legally required includes: diagnosis, nature and purpose of the proposed
intervention, risks and consequences of the proposed treatment, probability that the
treatment will be successful, feasible treatment alternatives and prognosis if the
treatment is not given.

Injection: The administration of medication or nutrient directly into the body via a
special needle. These may be given into the muscle (IM), into the subcutaneous
tissue (Sub-Q) or directly into the venous system (IV).

Institutionalization: Admission of an individual to an institution, such as a nursing
home, where he or she will reside for an extended period of time or indefinitely.

Insulin: A medication used to treat Diabetes.

I and O: Intake (of food and liquids) and output (of urine and feces).

- L -


Laxatives: For constipation. Milk of Magnesia and Ex-Lax are laxatives.

Legal Services Developer: The legal professional designated by the State Unit on
Aging to provide legal advice and representation to older individuals. The State Unit
may either provide the service directly or contract for its services including
counseling and representation on civil matters by a licensed attorney or where
permitted, a trained paralegal.

Licensed Practical Nurse (LPN): One who has completed one or two years in a
school of nursing or vocational training school. LPNs are in charge of nursing in the
absence of a Registered Nurse (RN). LPNs often give medications and perform
treatments. They are licensed by the state in which they work.

Life Care Arrangement or Life Care Contract: Contract between a resident and a
nursing home in which the resident assigns to the home all of his/her personal assets
in return for a guaranteed lifetime of care.

Living Will: A document stating that describes a person's wishes with respect to the
use of heroic life support measures to maintain one's life.

Long-Term Care: The medical and social care given to individuals who have severe,
chronic impairments. Long-Term Care can consist of care in the home, by family
members assisting through voluntary or employed help (e.g., as provided by
established home health agencies), or care in institutions. Various types of Long-
Term Care facilities exist throughout the country and they frequently differ in their
available staff, reimbursements and services.

- M -


Managed Care: Used as a description for an entire array of programs. Generally,
managed care implies that there is some form of influence in the delivery of health
care by persons other than the caregiver and patient. It includes several concepts as
part of its program: quality assurance, aggressive care management, peer review
and data gathering and dissemination to providers. The gatekeeper – one person,
usually a primary care physician – opens the door to the various disciplines and
specialty providers, providing the necessary coordinated care. This type of care
emphasizes that the use of services is controlled to manage costs.

Meal-On-Wheels: A program that delivers meals to people who are homebound.

Medicaid: An assistance program through which the federal government and the
individual states share in payment for the medical care of certain categories of needy
and low-income people. In order to be reimbursed for providing care to a Medicaid
recipient, a nursing home must be certified by Medicaid as meeting certain
standards.

Medical Director: A physician who is to formulate and direct policy for medical care
in the nursing home.

Medicare: A federal health insurance program for people 65 and over and some
under 65 who are disabled. Medicare has two parts. Part A is also called Hospital
Insurance, and Part B is called Medical Insurance. Under certain conditions, Medicare
pays for limited short-term care in a Skilled Nursing Facility. Medicare requires that a
nursing home be certified as meeting certain standards of cleanliness, staffing,
record keeping, etc. in order to be reimbursed for care provided to Medicare
beneficiaries.

Medicare Summary Notice (MSN): A notice that is sent to a Medicare beneficiary
after a claim is processed explaining what the provider billed for, how much was
approved, how much Medicare paid and what the beneficiary is responsible for. This
has been replaced by the Explanation of Medicare Benefits (EOMB), which
summarizes all services over a specified period, generally monthly.

Medigap Insurance: These policies are sold by private insurance companies. They
are specifically designed to help pay health care expenses either not covered or not
fully covered by Medicare.

- N -

Nasal Gastric Tube (NG Tube): A tube passed through the nose to the stomach
for the purpose of liquid feeding (gastric feeding).

- O -


Occupational Therapist (OT): A person trained to conduct therapy to maintain,
restore or teach skills to improve manual dexterity and hand-eye coordination.

Older Americans Act: Law enacted in 1965 (PL 89-73) that gives elderly citizens
more opportunity to participate in and receive the benefits of modern society. For
example, adequate housing, income, employment, nutrition and health care.

Ombudsman: A "citizen's representative" in a nursing home who protects a person's
rights through advocacy, providing information and encouraging institutions to
respect citizens' rights.

Operation Restore Trust (ORT): A special initiative of the Department of Health
and Human Services against fraud, waste and abuse in Medicare and Medicaid. The
project targets areas of high spending growth such as Skilled Nursing Facilities,
Home Health Agencies and Durable Medical Equipment suppliers.

Ophthalmologist: A physician specializing in the diagnosis and treatment of
diseases, defects and injuries of the eye.

Organic Brain Syndrome (OBS): May be acute or chronic; reversible or
irreversible – resulting in impaired mental function.

Osteoporosis: A disorder that causes a gradual decrease in the strength of bone
tissues. Bones "thin out," becoming less dense or more porous, and thus lose
strength. The loss of strength can result in an increased incidence of broken bones.

- P -


Parkinson's Disease: Shaking palsy caused by a neurological disorder.

Paraplegia: Usually involves paralysis of the legs and often other muscles up to the
middle of the chest resulting from damage to the spine.

Participating Provider: An institution, facility, agency, health professional or other
person certified or licensed by the appropriate agency of the state having
jurisdiction, and holding a current signed participation agreement with the Medicaid
agency.

Patient Care Plan: A plan formulated by a Registered Nurse in conjunction with a
physician for the on-going care and rehabilitation for a nursing home resident to
their optimum potential.

Patient Co-Payment: The amount of allowed charges that is the responsibility fo
the Medicaid recipient to pay.

Peer Review Organization (PRO): A physician group or other professional medical
organization that assume responsibility for the review of the quality and
appropriateness of services covered by Medicare and Medicaid. PROs determine
whether services are medically necessary, provided in accordance with professional
standards, and in the case of institutional services, rendered in an appropriate
setting. PROs must review a Skilled Nursing Facility's (SNF) care when a hospitalized
patient is discharged to the SNF and is readmitted to the hospital within 30 days, or
a Medicare beneficiary complains to a PRO about a SNF's quality of care.

Personal Care: Care that involves help with eating, dressing, walking and other
personal needs but very little or no nursing supervision. The terms "custodial care,"
"domiciliary care" and "residential care" are often used interchangeably with personal
care, although personal care strictly defined may imply a somewhat higher level of
service.

Personal Needs Allowance (PNA): Money under the Medicaid program that is
protected (set aside) for a nursing home resident's personal use.

Physical Therapist (PT): A person trained to retain or restore functioning in the
musculature of the arms, legs, hands, feet, back and neck through movement,
exercises or treatments.

Physician Assistant (PA): A person who performs a number of tasks that were
traditionally performed by the physician (i.e., taking medical histories or making
routine examinations). Training for Physician Assistants usually includes a specialized
2-year program. Physician Assistants always work under the supervision of a
physician.

Podiatrist:
A physician specializing in the diagnosis and treatment of disease,
defects and injuries of the foot.

Post-Surgical Recovery: Recovery from major surgery.

Power of Attorney: The simplest and least expensive legal device for authorizing a
person to manage the affairs of another. In essence, it is a written agreement,
usually with a close relative, an attorney, business associate of financial advisor,
authorizing that person to sign documents and conduct transactions on the
individual's behalf. The individual can delegate as much or as little power as desired
and end the arrangement at any time.

Presbycusis: Impaired hearing due to old age.

Privacy Curtain: A curtain that can be pulled around a patient's bed affording
privacy from other people in the room.

PRN: An abbreviation used to indicate that a medication is given or treatment
performed only as the need arises.

Proprietary Facility: A facility that is operated for the purpose of making a profit.

Psychopathy: Any mental disease, especially one characterized by defective
character or personality.

Psychotropic Medications: Drugs used in the treatment and control of mental
illness.

- R -


Reality Therapist: A person trained to help reorient the disoriented patient to time,
place and person.

Reasonable Charges: The allowable charges that Medicare will cover on a
percentage basis. They are published annually for an effective date of July 1 and are
based on the actual charges made by physicians and suppliers in the claimant's area
during the previous calendar year.

Reconsideration: A review by the Social Security Administration (SSA) of the Social
Security or Supplemental Security Income applicant's or recipient's file and the
formal determination by the SSA which is being appealed. Reconsideration
constitutes the first step in the SSA's appeals process.

Recreational Activities Director or Recreational Therapist: The person
responsible in a nursing home for developing, scheduling and conducting a
multifaceted program geared to meet the social and diversional needs of all
residents.

Registered Nurse (RN): A graduate nurse who has completed a minimum of two
years of education at an accredited school of nursing. RNs are licensed by the state
in which they work.

Rehabilitation Therapy: Therapy aimed at restoring or maintaining the greatest
possible function and independence. Rehabilitation therapy is especially useful to
persons who have suffered from stroke, an injury or disease by helping them recover
the maximum use of the affected area(s) of the body.

Representative Payee: An individual who is chosen by the Social Security
Administration (SSA) and who agrees to receive a Social Security or SSI recipient's
check and to handle the funds in the best interest of the recipient. The process of
selecting a Representative Payee was initiated by the SSA because not everybody
who receives either a Social Security or an SSI check can handle his/her own funds.
Also see Authorized Representative.

Reserve Days: The lifetime reserve of 60 Benefit Days of coverage in excess of the
standard 90 days coverage that Medicare offers as a right to each Medicare
beneficiary. That is, after a Medicare claimant has been in the hospital for 90 days
(an allowable time for which Medicare will pay a percentage of reasonable costs), the
claimant can use the 60 Reserve Days at that time if he/she has to remain in the
hospital that long by doctor's orders. However, if the claimant does not wish to use
the Reserve Days at that time, he/she must tell the hospital in writing ahead of time.
Otherwise, the extra days will betaken from his/her Reserve Days automatically.

Resident Rights: Those rights prescribed by federal law for residents or nursing
homes participating in Medicare and Medicaid.

Residents Council: An organization of nursing home residents. Its goal is to
improve the quality of life, care and communication within an institution by providing
some measure of control or self-determination by the residents.

Respite: The in-home care of a chronically ill beneficiary intended to give the
caregiver a rest. Can also be provided by a hospice or a nursing facility.

Retirement: The act of leaving paid employment. The retiree, upon reaching a pre-
determined age, is usually provided some regular payment such as a pension and/or
Social Security payment.

Restraint: A device used to prevent a person from falling out of a chair (e.g., a belt
around the waist tied to a wheelchair or a jacket with straps tied to a wheelchair). A
jacket restraint could be used to prevent a person from crawling over the side rails of
a bed. Wrist restraints are used under unusual circumstances. Restraints should be
used as protection for the resident only when other means are not reasonable.

Room Occupancy Fee: The basic room rental fee for residents of a nursing home.

- S -

Sedatives: Drugs that provide calm and quiet to those in a state of nervous
excitement. Noctec, Nembutal, Seconal, Chloral Hydrate and Phenobarbital are
commonly used examples.

Self Care: The ability to bathe, dress, toilet and feed oneself.

Self Help: The concept that individuals can manage many of their own health
problems when given sufficient instruction and appropriate medications.

Senility: Popularized laymen's term used by doctors and the public alike to
categorize the mental deterioration that may occur with aging.

Senior Center: A community facility for the elderly. Senior centers provide a variety
of activities for their members including any combination of recreational, educational,
cultural or social events. Also, some centers offer nutritious meals and limited health
care services.

Skilled Care: Institutional care that is less intensive than hospital care in its nursing
and medical service, but which includes procedures whose administration requires
the training and skills of an RN. Both Medicare and Medicaid reimburse for care at
the skilled level if it is provided in a facility which has been certified as meeting the
Skilled Nursing Facility (SNF) standards.

Skilled Nursing Facility (SNF): A facility that has been certified by Medicare
and/or Medicaid to provide skilled care.

Social Security: A national insurance program that provides income to workers
when they retire or are disabled and to dependent survivors when a worker dies.
Retirement payments are based on worker's earning during employment

Social Security Administration (SSA): The federal governmental agency that
administers programs throughout the US by means of geographically defined
regional offices which in turn are broken down into geographically defined district
offices.

Social Services: Services designed to help individuals with problems that concern
housing, transportation, meals, recreation and family support and relations. These
services are provided by professional Social Workers.

Social Worker: A person trained to identify social and emotional needs of nursing
home residents and provide services necessary to meet them. Full-time social
workers are not required in nursing homes, although facilities must provide social
services. This person often has responsibility for admissions and discharges.

Special Diet: A diet that adds or subtracts certain nutrients in specified amounts or
makes other modifications (e.g., pureed) because of medical condition (e.g., diabetic
diet).

Spend Down: Under the Medicaid program, a method by which an individual
establishes Medicaid eligibility by reducing gross income through incurring medical
expenses until net income (after medical expenses) meets Medicaid financial
requirements. A resident spends down when he/she is no longer sufficiently covered
by a third-party payor (usually Medicare) and has exhausted all personal assets. The
resident then becomes eligible for Medicaid coverage.

Spousal Impoverishment: The community property and assets of a community
spouse of a nursing facility resident may be divided according to standards set by the
Health Care Financing Administration and state law as a means of protecting the
assets of the non-institutionalized spouse.

Stroke: Occurs when blood supply to a part of the brain tissue is cut off, and, as a
result, the nerve cells in that part of the brain can not function. Effects may be
severe or slight, temporary or permanent depending on how widespread the damage
is.

Subacute Care: Care provided to patients who are sufficiently stabilized to no
longer require Acute Care services, but are too complex for treatment in a
conventional nursing center. Subacute programs typically treat patients who are
medically complex and require extensive physiological monitoring, intravenous
therapy or pre- or post-operative care. Care may focus on a specific medical
specialty, such as physical rehabilitation, cardiac rehabilitation, wound care,
infectious disease care, neurological rehabilitation, orthopedic care, pre- and post-
transplant care and pulmonary care, including ventilator care.

Supplemental Security Income (SSI): A federal program that pays monthly
checks to people in need who are 65 or older and to people in need at any age who
are blind or disabled. The purpose of the program is to provide sufficient resources
so they can have a basic monthly income. Eligibility is based on income and assets.

Suppliers: Persons or organizations other than doctors and health care facilities that
furnish equipment or services covered by Medical Insurance (Part B) of Medicare
(e.g., ambulance firms, independent laboratories and organizations that rent or sell
medical equipment).

Surveyor: Agent of the state licensure office who inspects (surveys) nursing homes
for the purpose of licensure and certification.

- T -

Third-Party Payment: Payment for care that is made by someone other than the
patient or his/her family (e.g., Medicare or private insurance companies).

TPR: Abbreviation for the measurement of Temperature, Pulse and Respiration.

Tranquilizers: A group of drugs that bring tranquility by calming, soothing, quieting
or pacifying. Thorazine, Valium and Librium are commonly used examples.

Transfer of Assets: Transfer of a potential Medicaid recipient's money or
possessions to a third party, which may be interpreted under state and federal
Medicaid law as an attempt to qualify the person for Medicaid when he/she would not
otherwise be eligible. Medicaid regulations govern time frames and conditions which
individuals may transfer assets to others without jeopardizing Medicaid eligibility.

Turn Q 2H: Turn every two hours. A nursing home resident who is unable to move
himself/herself for a physical or mental reason must be turned frequently to a
different position to prevent skin breakdown and other physical problems.

- U -


Urinary Tract Infection (UTI): An infection in the urinary tract, most common in
patients with catheters.

Utilization Review: A cost control device that requires any participating hospital or
nursing home to evaluate the appropriateness of Medicare and Medicaid patients'
admission to and continued stay in the institution. Such a review is conducted by a
utilization review committee composed of physicians and other health professionals
who must review 1) the medical necessity of the admission and 2) the medical
necessity of continued institutionalization.

- V -


VA: Veterans Administration

Vital Signs: Temperature, Pulse, Respiration and Blood Pressure.

- W -

Walker: A lightweight frame held in front of a person to give stability in walking. It
offers more stability than a cane.

 

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