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Terms To Better Understand Your Nursing Home

Better Understand Your Nursing HomeFor families seeking information on a particular nursing home or additional information about a specific event, the need for such information usually comes at a time when external pressures abound.  In order to fully appreciate such information, it is important to have a complete grasp of the terms involved.

I was happy to find concise definitions of many nursing home terms that pop up both in the nursing home selection process and beyond recently published by the Detriot Free Press. I frequently receive inquiries from blog readers about such terms, so I decided it would be worthwhile to include them here.

Violations: Though nursing homes face federal and state violations, the violations in this database track federal violations only. They can range from unacceptable noise levels to dangerous food or water temperatures to staff abuse.

Serious violations: Federal citations that caused “actual harm” to residents or placed residents in immediate jeopardy of serious injury or death.

CMS 5-star rankings: The federal rating system for nursing homes, based on health inspections, staffing levels and quality measures. Scores range from 1 (much below average) to 5 (much above average). Each of the three measures is combined for an overall star-rating.

Overall: Geared for consumers, this overall rating by the U.S. Centers for Medicare & Medicaid Services (CMS) is based on a number of variables drawn from health inspections, how well a facility is staffed with nurses, and information about residents’ health and well-being.

The rating should be used only as a starting point when choosing a nursing home. Follow up with questions and at least one visit, preferably more, before making a choice.

Health inspection: To receive Medicare or Medicaid funds, nursing homes must meet over 180 regulatory standards designed to protect nursing home residents. An inspection team makes regular inspections and responds to complaints.

Staffing: This is based on numbers of registered nurses, licensed practical nurses and nurse aides who worked in the two weeks before an inspection. It does not include other staff, like clerical or dietary aides.

The rating takes into account that some nursing homes have sicker residents who may require more care.

R.N. staffing: This star rating is based on the number of hours worked by registered nurses each day in two weeks before an inspection.

The rating takes into account that some nursing homes have sicker residents who may require more care.

Quality measure: Nursing homes must regularly assess residents about health, physical functioning, mental status, and general well-being.

Certified: Often used in connection with a “certified” bed or facility, this means that the home follows standards developed by state inspectors and the U.S. Centers for Medicare & Medicaid Services (CMS) and therefore may accept Medicare and Medicaid funds to pay for resident care.

Resident and family councils: Resident or family councils meet with nursing home staff to discuss problems and exchange ideas for quality improvement.

Rank in state: Rankings are generated by U.S. Centers for Medicare and Medicaid Services (CMS) in June 2011 based on three years of health violations and site visits. Two Michigan homes have not yet been ranked.

Continuing care retirement community: A community or complex that includes a range of services for the aging, from assisted living that offers minimal help to seniors to around-the-clock skilled nursing to end-of-life care. Often, seniors may move here while still independent, and remain for the rest of their lives.

Special focus facility: A watch list of troubled nursing homes as determined by states and the U.S. Centers for Medicare & Medicaid Services (CMS). It places the facility under greater scrutiny by inspectors. In Michigan, there are four. If one is added to the list, another “graduates.”

Medicare: In nursing homes, these funds are generally used for short-term stay residents undergoing rehab.

Medicaid: In nursing homes, these funds can cover extended stays for those who are financially-eligible.

Civil money penalties: Fines levied against nursing homes for violations.

Denial of payment for new admissions: One of the ways to leverage better care from nursing homes, the U.S. Centers for Medicare & Medicaid Services will temporarily or permanently cut off funds to nursing homes as they take in new residents.

Total number of residents: This is drawn from a two-week period prior to inspection.

Total number of staff hours per resident per day: These hours are based on licensed staffing levels — registered nurses and licensed practical nurses — in a two-week period prior to an inspection. Certified nurse aides are not licensed.

The hours are reported by nursing homes to the state.

Number of CNA hours per resident per day: These hours are based on certified nurse aide staffing levels in a two-week period prior to an inspection. The hours are reported by nursing homes to the state.

Number of RN hours per resident per day: These are based on registered nurse staffing levels in a two-week prior to inspection.

These hours are reported by the nursing homes to the state.

For more information about nursing home terms, check out the glossary at our Nursing Home Injury Laws site.

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