|Alliance for Better Long Term Care|
|Nursing Home Checklist & Words to Know|
Words to Know
ADL’s -Activities of Daily Living
Activities you usually do during a normal day such as getting in and out of bed, bathing, dressing, eating, and using the bathroom. The ability to do these activities often determines the level of care needed.
Employee of nursing home who helps coordinate admission of new residents into their nursing home.
CMS -Centers for Medicare & Medicaid Services
A federal agency that oversees the regulation of nursing facilities that are paid with medical assistance (Medicaid) or Medicare funds.
A determination that a nursing facility meets the federal care standards for operating a home with medical assistance or Medicare funds.
CNA -Certified Nursing Assistant
CNA’s are trained and certified to help nurses by providing non-medical assistance to patients, such as help with bathing, dressing, and using the bathroom.
The percent of the Medicare approved amount that you have to pay after you pay the deductible for Part A and/or Part B. In the Original Medicare Plan, the coinsurance payment is a percentage of the approved amount for the service.
Nonskilled, personal care, such as help with activities of daily living like bathing, dressing, eating, getting in and out of bed or a chair, moving around, and using the bathroom. It may also include care that people do themselves, like using eye drops. Medicare does not pay for custodial care.
A failure to meet a state licensure rule for care. Violations are categorized by seriousness. Those that cause the greatest risk of harm must be corrected the soonest. Failure to correct them incurs the highest level of fines.
The social worker at the hospital or rehabilitation facility who helps find the right nursing home for a patient and coordinates the transfer of that patient into a nursing home.
ESRD -End-Stage Renal Disease
Kidney failure that is severe enough to need lifetime dialysis or a kidney transplant.
A consumer group composed of the nursing home residents’ relatives and friends. These councils meet regularly to improve the quality of life in their facility.
A joint federal and state program that helps with medical costs for eligible Rhode Islanders based on income and assets. Most nursing home costs are covered if you qualify for both Medicare and Medicaid.
The Federal health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with end-stage renal disease. Medicare approved amount for health care expenses, and you pay your share (co-pay). The original Medicare plan has two parts: Part A (hospital insurance) and Part B (medical insurance).
Medicare Managed Care Plan
These are health care choices in some areas of the country. In most plans, you can only go to doctors, specialists, or hospitals on the plan’s list. Plans must cover all Medicare Part A and Part B health care. Some plans cover extras, like prescription drugs. Your costs may be lower than in the Original Medicare Plan.
Medicare Private Fee-for-Service Plan
A private insurance plan that accepts people with Medicare. You may go to any Medicare approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare program, decides how much it will pay and what you pay for the services you get. You may pay more for Medicare covered benefits. You may have extra benefits the Original Medicare Plan does not cover.
Office of Facilities Regulation
Division of the Rhode Island Department of Health that inspects and regulates nursing homes.
Original Medicare Plan
A pay-per-visit health plan that lets you go to any doctor, hospital or other health care provider who accepts Medicare. You must pay the deductible. Medicare pays its share of the Medicare approved amount, and you pay your share (coinsurance). The Original Medicare Plan has two parts: Part A (hospital insurance) and Part B (medical insurance).
QIO’s -Quality Improvement Organizations
Groups of practicing doctors and other health care experts. They are paid by the Federal government to check and improve the care given to Medicare patients. They must review our complaints about the quality of care given by: inpatient hospitals, hospital outpatient departments, hospital emergency rooms, skilled nursing facilities, home health agencies, Medicare Private Fee-for Service plans, and ambulatory surgical centers.
A group of residents in a nursing home who meet regularly to improve the quality of life in their facility.
Physical restraints are any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body. Chemical restraints are any drug used for discipline or convenience and not required to treat medical symptoms.
Skilled Nursing Care
A level of care that must be given or supervised by Registered Nurses. All of your needs are taken care of with this type of service. Examples of skilled nursing care are: getting intravenous injections, tube feeding, oxygen to help you breathe, and changing sterile dressings on a wound. Any service that could be safely done by an average non-medical person (or one’s self) without the supervision of a Registered Nurse is not considered skilled care.
SNF -Skilled Nursing Facility
A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.
State Health Insurance Assistance Program
A State program that gets money from the Federal Government to give free health insurance counseling and assistance to people with Medicare.
State Medical Assistance Office
A State agency that is in charge of the State’s Medicaid program and can provide information about programs to help pay medical bills for people with low incomes. Also provides help with prescription drug coverage.
The periodic inspection of a nursing home by staff of the Rhode Island Department of Health, Division of Facilities Regulation.