Domain 1 - Care, Services and Supports

Abuse

(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

Access

The ability of a person needing services to obtain those services.

Acquired Immune Deficiency Syndrome (AIDS)

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, parasites, fungi, and bacteria.

Activities

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.

Activities of Daily Living

Individual self-performance skills needed in everyday life such as ambulation/locomotion, eating, toileting, grooming/personal hygiene, and bathing.

Activity Therapist (AT)

An allied health professional trained to develop and provide leisure time activities for facility residents (patients).

Acuity

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.

Acute Care

Short-term, intense medical care for an episode of illness or injury often requiring hospitalization.

Acute Conditions

Episodic conditions that require short-term but intensive medical interventions.

Administer

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).

Administrator

See NURSING HOME ADMINISTRATOR/NURSING FACILITY ADMINISTRATOR

Admission Agreement

A contract that spells out the services the nursing home will provide and the cost of those services.

Adult Day Care

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.

Advance Directive

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).

Adverse Drug Reaction (ADR)

Any unintended response to a drug which is injurious or harmful to health and which occurs at normal doses.

Aged

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 often referred to as senior citizens, especially after reaching age 65.

Ageism

Prejudicial treatment of the elderly based on stereotypes and misconceptions.

Aging-in-place

Accommodating the changing needs of older adults while living in familiar surroundings.

Agitation

Verbal, vocal, and motor activities that are repetitive and outside of socially acceptable norms.

Allopathic Medicine

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.

Alzheimer's Disease

A progressive degenerative disease of the brain, producing memory loss, confusion, irritability, and severe functional decline. The disease becomes progressively worse and eventually results in death.

Ambulation

Moving about.

Ambulatory

Able to walk with or without difficulty or help.

Ambulatory Care (Ambulatory Services)

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.

Annual Assessment

An annual assessment of a resident's (patient's) physical, mental, emotional, cognitive, and functional status.

Antianxiety Medication

Psychoactive medications given to reduce anxiety (e.g., Ativan, Valium, Xanax)

Antisepsis

Removing or destroying microorganisms.

Aphasia

Impaired ability to communicate.

Apraxia

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.

Asepsis

Absence of harmful micro-organsms called pathogens. It refers to the practice of clean procedures, such as hand-washing.

Aspiration

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.

Assessment

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.

Audiologist

A health care professional who is specially trained and licensed to provide direct clinical services to individuals with hearing or balance disorders.

Autism

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.

Autonomy

A cluster of notions that include self-determination, freedom, independence, and liberty of choice or actions.

Bed-hold

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.

Bedsore

See PRESSURE SORE/ULCER

Behavioral Intervention

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.

Biophilia

The human tendency to pay attention to, affiliate with and respond positively to nature.

Boarding Home

A facility that offers room and board and sometimes supervision of daily activities. It does NOT offer health care.

Cardiologist

A physician who specializes in the treatment of heart diseases.

Care Plan

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).

Case Mix

A system that uses resident (patient) attributes (e.g., functional status in ADLs or cognitive 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 classifying an observation according to distinctive characteristics on the basis of a dependent variable, such as time or costs.

Case Mix Index

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.

Centers for Medicare & Medicaid Services (CMS)

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.

Certification

The process by which federal and state governments determine if a health care facility meets Medicare and/or Medicaid standards.

Certified Nursing Assistant (CNA)

A nurse aide who has completed at least the minimum training required by regulations.

Charge Nurse

The nurse in charge or supervising a particular part of a facility for a given time shift.

Chemical Restraint

A psychoactive drug used by a facility for discipline or convenience and not for medical treatment.

Chronic

Continuing over a long period of time or recurring frequently. Chronic conditions often begin inconspicuously and symptoms are less pronounced than in acute conditions.

Chronic Care

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.

Clinical Information System

Information technology that is designed to be used by various clinicians to support the delivery of patient care.

Clinical Pathway

A care-planning tool that outlines in a time sequence important aspects of care necessary for meeting specific outcomes.

Clinical Practice Guidelines

Evidence-based standardized protocols indicated for the treatment of specific health conditions.

Code of Federal Regulations (CFR)

The federal Congress passes laws for which implementing rules are written and enforced...these are The Federal Requirements and Guidelines to Surveyors; guidelines issued by the federal government interpreting how a given law is to be administered.

Comorbidity

The simultaneous presence of two or more health problems.

Consultant Pharmacist

Pharmacist who is contracted by the nursing home to do drug regimen reviews and provide other services.

Continence

The ability to self-regulate bladder and bowel elimination.

Continuing Care Retirement Community (CCRC)

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.

Continuum of long-term care

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.

Controlled Substance

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.

Cross-contamination

Transfer of disease causing organisms through contact with a dirty surface, unwashed hands, or insects.

Culture

A society's typical ways of behaving; its customs, mores and beliefs

Custodial Care

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.

Data Assessment and Verification (DAVE)

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.

Debilitated

Weak and infirm, unable to care for many personal needs

Degenerative

Disorders in which tissue or an organ deteriorates and vitality is diminished.

Dehydration

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.

Dementia

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.

Dentition

The makeup of a set of teeth including their kind, number, arrangement and usability.

Depression

An abnormal state of mind in which a person usually becomes inactive and disinterested in his environment and lacks motivation.

Dermatologist

A specialist physician who treats infections, growths, injuries, and other disorders related to the skin.

Dietary history

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.

Dietitian

Sometime referred to as nutritionist, a dietitian provides nutritional information and diet-related services to residents/patients.

Director of Nursing (DON)

A registered nurse responsible for supervising the activities, functions, and training of nursing personnel.

Director of Nursing Services (DNS)

See DIRECTOR OF NURSING (DON).

Discharge Planning

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.

Dispense

To deliver a prescribed drug to an ultimate user, including the compounding, packaging, and labeling necessary to prepare the prescribed drug.

Do-Not-Resuscitate (DNR) Order

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.

Drug

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.

Drug Irregularity

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 recommendations 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.

Drug Regimen Review (DRR)

The review of drugs being used by a resident (patient) to determine effect and potential for harmful effects.

Drug Utilization Review (DUR)

The study of drug use patterns in a facility.

Dysarthria

Slurred or unintelligible speech due to muscle weakness or other problem.

Dysphagia

Difficulty in swallowing due to a dysfunction in any phase of the swallowing process.

Eden Alternative

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.

Emphysema

A chronic condition characterized by damaged air sacs in the lungs. The resulting reduction of surface area available for gas exchange makes breathing difficult and makes the heart work harder to circulate blood through the lungs. All these changes make less oxygen available to the body.

Energy metabolism

The process in the body of breaking down calories consumed into usable energy to allow the body to perform normal body functions.

Enforcement Grid

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 website glossary for more detailed info).

Enteral Feeding

Delivery of liquid food through a tube directly into the stomach.

Epidemic

Excessive prevalence of a negative health condition.

Epilepsy

A brain disorder in which signals sent by nerve cells become disturbed, causing strange sensations, emotions, convulsions, muscle spasms, or loss of consciousness.

Esophagostomy Tube

A small tube that enters 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.

Ethics Committee

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.

Evidence-Based Care

Delivery of services using best practices that have been established through clinical research.

Exempt Employees

Salaried workers who are exempt from overtime provisions of the Fair Labor Standards Act.

Extended Survey

A federal survey conducted within 14 days of a finding of substandard care during a standard federal survey (see also STANDARD SURVEY).

Extrapyramidal Symptoms (EPS)

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.

Gait

How a person walks.

Gastrostomy Tube (G-tube)

A mechanism for delivering nutrition through a tube that passes through a surgical opening in the abdomen and into the stomach.