Glossary - Selecting a Nursing Home in New York State

Advance Directive

An Advance Directive is an instruction plan that is prepared in writing or orally in advance of an incapacitating illness of 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" order (DNR) recorded in the resident's medical record and a living will.

Baseline Services

Baseline services are those services that are included in the daily nursing home rate. At the time of admission, a written copy of the following basic services must be made available to the resident:

• the daily, weekly or monthly rate;
• board, including therapeutic or modified diets, as prescribed by a physician;
• lodging -- a clean, healthful, sheltered environment, properly outfitted;
• dietary services;
• 24-hour-per-day nursing care;
• pharmacy services;
• diagnostic services;
• the use of all equipment, medical supplies and modalities used in the care of nursing home residents, including but not limited to catheters, hypodermic syringes and needles, irrigation outfits, dressings and pads, etc.;
• fresh bed linen, as required, changed at least twice weekly, including sufficient quantities of necessary bed linen or appropriate substitutes changed as often as required for incontinent residents;
• hospital gowns or pajamas as required by the clinical condition of the resident, unless the resident, family member or designated representative elects to furnish them, and laundry services for these and other launderable personal clothing items;
• general household medicine cabinet supplies, including but not limited to nonprescription medications, materials for routine skin care, dental hygiene, care of hair, etc., except when specific items are medically indicated and prescribed for exceptional use for a specific resident;
• assistance and/or supervision, when required, with activities of daily living, including but not limited to toileting, bathing, feeding and assistance with getting from place to place;
• services, in the daily performance of their assigned duties, by members of the nursing home staff assigned to resident care;
• use of customarily stocked equipment, including but not limited to crutches, walkers, wheelchairs or other supportive equipment, including training in their use when necessary, unless such items are prescribed by a physician for regular and sole use by a specific resident;
• activities program, including but not limited to a planned schedule of recreational, motivational, social and other activities together with the necessary materials and supplies to make the resident's life more meaningful;
• social services as needed;
• provision of optician and optometrist services;
• physical therapy, occupational therapy, speech pathology services audiology services and dental services, on either a staff or fee-for-services basis, as prescribed by a physician, administered by or under the direct supervision of a licensed and currently registered physical therapist, occupational therapist, speech pathologist, qualified audiologist or registered dentist.

Designated Representative

A designated representative is the individual(s) designated to receive information and to assist and/or act on behalf of a 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/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.

Health Care Agent

A Health Care Agent is a person appointed by the resident to decide about treatment if the resident becomes incapable of making decisions for him/herself. The resident has the right to appoint a Health Care Agent by completing a Health Care Proxy.

Health Care Proxy

A Health Care Proxy is 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.

Medical Orders for Life-Sustaining Treatment

To complement the use of traditional advance directives and facilitate the communication of medical orders impacting end-of-life care for patients with advanced chronic or serious illness, the Medical Orders for Life-Sustaining Treatment (MOLST) program was created. The MOLST program is based on the belief that patients have the right to make their own health care decisions, including decisions about life-sustaining treatment, to describe these wishes to health care providers and to receive comfort care while wishes are being honored.

Minimum Data Set

The Minimum Data Set (MDS) is a Federal government tool for facilitating care management in nursing homes. The MDS includes a core set of screening and assessment elements that is part of a Resident Assessment Instrument (RAI). The RAI provides a comprehensive and standardized assessment of each resident's functional capabilities and helps staff to identify health problems and formulate each resident's individualized plan of care. This assessment is performed on every resident in a Medicare and/or Medicaid-certified nursing home within specific guidelines and time frames. MDS information is handled confidentially. Regulations governing MDS are found in the Code of Federal Regulations, Title 42, Part 483, Subpart C, at www.ecfr.gov/.

Nursing Home

Nursing homes are places to live where care is available for people of all ages who need 24-hour nursing care and supervision outside of a hospital pursuant to Article 28 of the New York State Public Health Law.

Patient Review Instrument

The Patient Review Instrument (PRI) is an assessment tool developed by NYS DOH to assess selected physical, medical and cognitive characteristics of all nursing home residents, as well as to document selected services they may receive.

Person-Centered Care

Person-centered care means that nursing home residents are supported in achieving the level of physical, mental and psychosocial well-being that is individually practicable. This goal honors the importance of keeping the person at the center of the care planning and decision-making process. In person-centered care, staff places a premium on active listening and observing, so staff can adapt to each resident's changing needs regardless of cognitive abilities.

Pre-Admission Screening and Resident Review

The Pre-Admission Screening and Resident Review (PASRR) is a Federal government tool for determining if prospective a nursing home resident has a possible mental illness, intellectual disability and/or developmental disability. Any individual that applies for admission to a nursing home must be evaluated to determine if the nursing home can provide the services so the individual is not inappropriately placed. Regulations governing PASRR are found in the Code of Federal Regulations, primarily at 42 CFR 483, Subpart C.

Resident

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

Special Services

Special services are those that may be offered in addition to those which are considered standard.

Adult Day Health Care

Adult Day Health Care programs provide health care services and activities for individuals who are not residents of a residential health care facility, but are functionally impaired and not homebound and require supervision, monitoring, preventive, diagnostic, therapeutic, rehabilitative or palliative care services. Adult Day Health Care services help participants maintain their health status and enable them to remain in the community.

AIDS

AIDS programs provide comprehensive and coordinated health services; provide or make arrangements for case management services, substance abuse services (if appropriate), mental health services, HIV prevention and counseling services, pastoral counseling, TB screening and ongoing follow up, and specialized medical services, including gynecology (as needed).

AIDS Adult Day Health Care

AIDS Adult Day Health Care programs are designed to assist individuals with HIV disease to live more independently in the community or eliminate the need for residential health care services. AIDS Adult Day Health Care programs provide comprehensive and coordinated health services; provide or make arrangements for case management services, substance abuse services (if appropriate), mental health services, HIV prevention and counseling services, pastoral counseling, TB screening and ongoing follow up, and specialized medical services, including gynecology (as needed).

Alzheimer's Disease and Other Dementias

The design and promotion of services for Alzheimer's Disease and other dementias are driven by the individual needs of each resident to maximize their physical and mental well-being (person-centered care). These services fall within general care standards. While a nursing home may assert to provide specialized services for Alzheimer's Disease and other dementias or operate a designated unit, NYS DOH does not license such services as a separate category. However, the Department partners with nursing homes to assure the highest quality of care for all residents, including those with Alzheimer's Disease and other dementias, as guided by Federal standards. This may include specialized staff training, services and activities, physical space and safety features.

Behavioral Intervention

The facility has a discrete unit with a planned combination of services with staffing, equipment and physical facilities designed to serve individuals whose severe behavior cannot be managed in a less-restrictive setting. The program provides goal-directed, comprehensive and interdisciplinary services directed at attaining or maintaining the individual at the highest practicable level of physical, affective, behavioral and cognitive functioning.

Clinical Laboratory

The facility provides microbiological, serological, chemical, hematological, biophysical, cytological or pathological examination of materials derived from the human body, for the purposes of obtaining information for the diagnosis, prevention or treatment of disease or the assessment of a health condition.

Coma Recovery

The facility provides a planned combination of services to medically stable, traumatically brain-injured individuals. Goal-oriented, comprehensive, interdisciplinary and coordinated services are directed at restoring the individual to the optimal level of physical, cognitive and behavioral functioning.

Diagnostic Radiology

Radiographic procedures requiring the use of contrast media or fluoroscopic interpretation and control are performed with the active participation of a qualified specialist in diagnostic radiology or a physician qualified in a medical specialty related to the radiographic procedure.

Hospice

A coordinated program of home and inpatient care which treat the terminally ill patient and family as a unit, employing an interdisciplinary team acting under the direction of an autonomous hospice administration. The program provides palliative and supportive care to meet the special needs arising out of physical, psychological, spiritual, social and economic stresses, which are experienced during the final stages of illness and during dying and bereavement. A resident of a nursing home who becomes terminally ill may receive hospice services. In order to establish eligibility for hospice care, the resident's physician and the hospice medical director must certify that the resident is terminally ill. The resident (or authorized representative) must elect the hospice benefit in writing, and a hospice plan of care must be established. Terminal illness is defined as a medical life expectancy of six months or less if the illness runs its normal course.

Limited Transfusion

The facility transfuses blood and may temporarily store blood and distribute it within its own organization, but relies on a blood bank holding a permit in blood services transfusion to perform laboratory tests.

Outpatient Services

Occupational Therapy

Teaches manual skills and independence in personal care to stimulate mental and emotional activity. This includes the utilization of modalities and tests of occupational therapy and rehabilitative nursing in a coordinated and integrated program of services under the direction of a physician. This consists of instructing patients in prescribed academic subjects to prevent mental deconditioning, improving patients' mental and physical conditions and aiding in the attainment of knowledge and skills that will further patients' progress toward vocational objectives.

Physical Therapy

Employs therapeutic exercises and massage and utilizing effective properties of heat, light, cold water and electricity for diagnosis and rehabilitation of patients with neuromuscular, orthopedic and other impairments. Such services are provided in a coordinated and integrated program under the direction and prescription of a physician or a registered physical therapist. Additional activities include, but are not limited to the provision of clinical and consultative services; the direction of patients in the use, function and care of braces, artificial limbs and other devices; prescribing therapeutic exercises; counseling patients and their relatives; organizing and conducting medically prescribed physical therapy programs; applying diagnostic muscle tests; administering whirlpool and compact baths; changing linen on physical therapy department beds and treatment tables; assisting patients in changing clothes and other personal needs and participating in discharge coordination.

Speech Language Pathology

Identifies individuals with communicative or oropharyngeal disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills; referral for medical or other professional services necessary for the habilitation or rehabilitation of individuals with communicative or oropharyngeal disorders and delays in development of communication skills; and provision of services for the habilitation, rehabilitation, or prevention of communicative or oropharyngeal disorders and delays in development of communication skills.

Pediatric

Provides extensive age-specific nursing, medical, psychological and counseling support to infants and children up to 21 years of age with diverse and complex medical, emotional and social problems in a program recognized and approved by NYS DOH to provide these services.

Respite Care (Short-Term)

Provides temporary relief to the caregiver(s) while providing nursing home care for the resident. Schedules for short-term care are generally pre-arranged and limited to one or more periods of from one to 30 days, and shall not exceed 42 days in any one year except in extraordinary circumstances.

Traumatic Brain Injury (TBI)

A program designed to serve medically stable, traumatically brain-injured individuals with an expected length of stay from three to 12 months. Goal-oriented, comprehensive, interdisciplinary and coordinated services are directed at restoring the individual to the optimal level of physical, cognitive and behavioral functioning. The program is not targeted to individuals with degenerative, structural brain damage resulting in residual deficits and disability or those who are determined to be a danger to self or others. An individual admitted for long-term rehabilitation is a person who has suffered a traumatic brain injury with structural non-degenerative brain damage, is medically stable, is not in a persistent vegetative state, demonstrates potential for physical, behavioral and cognitive rehabilitation and may evidence moderate to severe behavior abnormalities. The resident must be capable of exhibiting at least localized responses by reacting specifically, but inconsistently, to stimuli. Education and counseling services are available and offered to the residents and families.

Ventilator Dependent

A program intended to serve residents who require nursing home care and continuous or intermittent use of a ventilator. Services are directed at restoring each resident to his/her optimal level of functioning and assisting each resident to achieve maximum independence from mechanical ventilation.