Selecting a Nursing Home in New York State

Glossary

Advance Directives

An instruction plan that is prepared in writing or orally in advance of an incapacitating illness or injury. The plan ensures that the resident's wishes about treatment will be followed. This includes, but is not limited to a health care proxy, a do-not-resuscitate (DNR) order recorded in the resident's medical record and a living will.

Baseline & Special Services

Designated Representative

The individual or individuals designated to receive information and to assist and/or act on behalf of a particular resident to the extent permitted by New York State law. The representation occurs by a court of law if sought; by the resident if he or she has the capacity to make such a designation; or by family members and others who have an interest in the well being of the resident. The name of the designated representative must be noted in the resident's clinical record at the facility.

The designated representative: (1) receives any written and verbal information required to be provided to the resident if the resident lacks the capacity to understand or make use of the information, and receives any information required to be provided to both the resident and the designated representative; (2) participates (to the extent authorized by New York State law) in decisions and choices regarding the care, treatment and well-being of the resident if such resident lacks the capacity to make decisions and choices. These decisions are not the same as those made by a health care agent, unless the same person has been appointed both the designated representative and the health care agent.

Governing Body

The governing body of the facility constitutes the board of directors or trustees of the facility or the owner or owners of the facility.

Health Care Agent

Someone appointed by the resident to decide about treatment if the resident becomes incapable of making decisions for himself or herself. The resident has the right to appoint someone by filling out a form called a Health Care Proxy. These forms should be available at the facility, should be kept at the facility and made known to the medical staff.

Health Care Proxy

A document that delegates the authority to another individual known as a Health Care Agent to make health care decisions on behalf of the resident when that resident is incapacitated.

Minimum Data Set

The Minimum Data Set (MDS) a tool that nursing homes that receive Medicare or Medicaid payment, are required to use to assess all residents in the facility. This tool provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems. Resident Assessment Protocols (RAPs), another part of the process that nursing homes must follow, provide the foundation upon which a resident's individual care plan is formulated.

MDS assessment forms are completed for all residents in certified nursing homes, regardless of who pays for the individual's care. MDS assessments are required for residents on admission to the nursing facility and then periodically, within specific guidelines and time frames. In most cases, participants in the assessment process are licensed health care professionals employed by the nursing home. MDS information is transmitted electronically by nursing homes to the MDS database in their respective States. MDS information from the State databases is captured into a national MDS database maintained by the federal government.

The MDS includes a comprehensive assessment of many factors concerning a resident's care during a stay in a nursing home facility. The initial basic assessment tracking form may be considered by some to be similar to a long-form tax form of about 11 pages, in which information on a resident is categorized by section. Each section addresses a different aspect of the resident's status, from head to toe, including physical and psychological issues.

The MDS is used by nursing home staff to formulate each resident's individualized plan of care. The MDS and care plan should updated if there is a significant change in the resident's status. The basic assessment covers the following areas:

  • resident demographics
  • customary routine, cognitive patterns
  • communication / hearing / vision patterns
  • psychosocial well-being
  • physical functioning and structural problems
  • continence
  • disease diagnoses and health conditions
  • oral / dental / nutritional status
  • skin condition
  • activity pursuit patterns
  • medications
  • special treatments and procedures
  • discharge potential, and
  • influenza and pneumococcal vaccine immunization status.

The Minimum Data Set is an important tool that nursing homes use to evaluate each resident and develop a plan to provide the services that best meet the resident's needs. The State uses the MDS information when it inspects nursing homes to ensure that each resident's assessment is accurate, that the services being provided reflect the resident's needs, and that services are being provided appropriately. MDS information must be handled confidentially, due to the personal and medical information. For more detail on the MDS, please see 42 C of the Federal Register, Part 483, Subpart F.

Nursing Home

A facility (subject to Article 28 of the New York State Public Health Law) providing lodging for 24 or more consecutive hours to three or more nursing home residents who are not related to the facility operator by marriage or by blood, who need regular nursing services or other professional services, but who do not need the services of a general hospital.

Patient Review Instrument (PRI)

The Patient Review Instrument (PRI) is an assessment tool developed by the New York State Department of Health to assess selected physical, medical, and cognitive characteristics of nursing home residents, as well as to document selected services that they may receive. Each of the State's nursing facilities are visited bi-annually and all residents in the facility are assessed with the PRI. The PRI includes assessment items in each of the following general areas:

  • Administrative Data, used to identify and track both the resident being assessed (name, social security number, date of birth, etc.) and the facility in which the assessment takes place;
  • Medical Conditions and Treatments, whether or not the resident has any of twelve conditions (for example, whether or not the resident has diabetes or a urinary tract infection), and whether or not the resident is receiving any of thirteen medical treatments (for example, wound care, transfusions, etc.);
  • Activities of Daily Living, the degree to which the resident is independent in each of four areas: eating, mobility, ability to transfer between positions (for example, move from bed to chair), and toileting;
  • Selected Behaviors, the frequency which the resident has exhibited any of the following behaviors: verbally disruptive, physically aggressive, disruptive or socially inappropriate behavior, or has had hallucinations
  • Specialized Services, the frequency and level that the resident has received any physical or occupational therapies, the frequency of physician visits the resident has had in the past month, and the monthly average number of medications and psychoactive medications that have been ordered for the resident; and
  • Diagnosis, the medical condition that requires the largest amount of nursing time.

The information collected from the PRI is used to determine Medicaid reimbursement for nursing homes in New York State. These data are audited after they are submitted in order to ensure their accuracy.

Pre-Admission Screening and Resident Review (PASRR)

Anyone who applies to a nursing home must be evaluated to determine if the nursing home can provide the services the individual needs. One of the tools that is used to conduct this evaluation is the Pre-Admission Screening and Resident Review (PASRR).

Resident

A resident is an individual who has been admitted to and who resides in a long-term care facility (nursing home) and is entitled to receive care, treatment and services required by New York State law.

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