Glossary

The gathering of information to rate or evaluate your health and needs.

One way to make nursing homes safe is to install a water sprinkler system in case of fire. These systems are called “automatic sprinkler systems.”

Currently, newly constructed and recently remodeled nursing homes must have automatic sprinkler systems to put out fires. Federal Rules require that by late 2013, ALL nursing homes will have an automatic sprinkler system installed throughout the nursing home.

Since March 2005, Federal rules also require that nursing homes install battery-operated smoke alarms in all resident rooms and public areas.

CMS is the federal agency that runs the Medicare and Medicaid programs, and initiatives to make sure that people with Medicare and/or Medicaid are able to get high quality health care.

State government agencies inspect health care providers, including home health agencies, hospitals, nursing homes, dialysis facilities and other providers. These providers are certified if they pass inspection. Being certified is not the same as being accredited. Medicare or Medicaid only covers care by certified providers or in a certified facility or program. Inspections can also be referred to as surveys.

A complaint is a problem reported by residents, their families, and nursing home staff. A facility-reported incident is a problem reported by the nursing home staff. Some complaints can lead to enforcement actions because the nursing home isn’t complying with regulations.

A Continuing Care Retirement Community is a housing community that offers 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.

Dementia refers to a group of symptoms that are caused by changes in brain function. Signs of dementia include changes in memory, personality, and behavior. Dementia makes it hard for a person to carry out normal daily activities.

Fire Safety Deficiency is a finding that a nursing home failed to meet one or more Federal fire safety requirements.

A Health Deficiency is a finding that a nursing home failed to meet one or more Federal health requirements during an annual health inspection or a complaint inspection. Inspectors identify health deficiencies by observing the nursing home's performance, its practices, or the conditions in the facility.

Long Term Care is a “variety” of services that help people with health or personal needs and activities of daily living over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Most long-term care services help with activities of daily living, such as eating, bathing, dressing or moving about. Medicare doesn't pay for such care unless it's part of certain short-term stays following hospitalization.

Get more information about different kinds of long term care

Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Medicare is 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 (permanent kidney failure with dialysis or a transplant, sometimes called ESRD).

Multi-nursing home chains have two or more homes under one ownership or operations.

Some nursing homes can have a combination of Medicare, Medicaid, and/or private pay beds. Certified beds represent the number of Medicare and/or Medicaid beds. Please check with the nursing home to find out what types of beds are available.

Nursing home is a term that includes both skilled nursing facilities and nursing facilities. Skilled nursing facilities (SNF) are those that participate in both Medicare and Medicaid. Nursing facilities (NF) are those that participate in Medicaid only.

Nursing homes primarily engage in providing residents skilled nursing care and related services for residents who require medical or nursing care and rehabilitation services for the rehabilitation of injured, disabled, or sick persons.

This nursing home participates in the Medicaid program and can care for people with Medicaid. If a nursing home doesn’t participate in the Medicaid program or no longer participates in the Medicaid program, and the resident runs out of other funds/coverage, the resident will have to move to another nursing home if he/she wants to have their nursing home stay paid by Medicaid.

This nursing home participates in the Medicare program and can care for people with Medicare who meet certain requirements for skilled care. Generally Medicare covers short stays.

The Quality Indicator Survey (QIS) process and the traditional standard inspection are the two types of inspections approved by CMS to determine compliance with Medicare/Medicaid requirements. The QIS uses a structured review of the medical records and direct observations of the care of larger samples of residents to derive rates for a comprehensive set of Quality of Care Indicators (QCIs). Inspectors then investigate care areas that have been triggered for review by the QCIs. The QIS process is being pilot tested in several states.

The nursing home quality measures come from resident assessment data that nursing homes routinely collect on all residents at specified intervals during their stay. These data are converted into quality measures that give you another source of information about how well nursing homes are caring for their residents' physical and clinical needs. The quality measures have 4 intended purposes:

1. To give you information about the care at nursing homes to help you choose a nursing home for yourself or others
2. To give you information about the care at nursing homes where you or family members already live
3. To get you to talk to nursing home staff about the quality of care
4. To give data to the nursing home to help them with their quality improvement efforts

The current quality measures aren't benchmarks, thresholds, guidelines, or standards of care. They are based on care provided to the population of residents in a facility, not to any individual resident, and aren't appropriate for use in a lawsuit.

Resident and family councils can facilitate communications with staff. The law requires nursing homes to allow councils to be set up by residents and families. If a nursing home doesn’t have a resident and family council, ask the administrator why. Ask to talk with a council president to get a sense of how the nursing home has acted on their concerns.

A Special Focus Facility (SFF) is a nursing home with a recent history of persistent poor quality of care, as indicated by the findings of state or Federal inspection teams. Based on inspection findings for the most recent three-year period, CMS selects a group of nursing homes with the worst repeated inspections as SFFs.

Sometimes a nursing home will fix a sufficient number of problems in order to pass one inspection, only to fail the next one. Often, many of these same problems show up in inspections again and again. This is a sign that the nursing home didn't address the underlying problems that were causing these repeated serious deficiencies.

Many SFFs respond to the recognition of their past poor performance by making concerted efforts to improve. CMS records indicate that approximately 50% of SFFs significantly improve their quality of care within the subsequent 30 months.

The total number of residents is the number of residents in the nursing home during the 3-week period prior to the recent inspection. This number is used in the nursing home staffing calculations. This number only captures a specific point in time.

Nursing homes can be run by private for-profit corporations, non-profit corporations, religious affiliated organizations or government entities. Quality can vary in nursing homes within each of the different types of ownership. Each nursing home needs to be judged on its own merits.