Term
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Definition
| Centers that provide a variety of health and social services to specific client populations who live alone or with family in the community. |
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Definition
| Attractive long-term care setting with a homier environment and greater resident autonomy. |
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Term
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Definition
| Method of paying a physician, hospital, or managed care system for annual services based on a fee per client. |
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Definition
| Set of decisions and activities involved in providing continuity and coordination of nursing care when a client is discharged from a health care agency. |
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Definition
| Institution providing medical, nursing, or custodial care for clients over a prolonged period. |
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Definition
| The provision of medically related professional and paraprofessional services and equipment to clients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation. |
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Term
| integrated delivery networks |
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Definition
| A set of providers and services organized to deliver a coordinated continuum of care to the population of clients served at a capitated cost. |
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Term
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Definition
| Health care system in which there is administrative control over primary health care services. Redundant facilities and services are eliminated, and costs are reduced. Preventive care and health education are emphasized. |
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Term
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Definition
| State medical assistance based on Title XIX of the Social Security Act. States receive 50% in matching federal funds to provide medical care and services to people meeting categorical and income requirements; covers home care services based on Medicare guidelines. Many innovative home care programs can be covered by Medicaid, as long as they meet the recipient's needs and cost less than institutionalization. |
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Term
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Definition
| Federal government insurance coverage for persons over 65 years of age (or disabled and under 65) who have paid into the Social Security or Railroad Retirement system; covers inpatient hospital charges and some home care services. |
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Term
| professional standards review organization |
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Definition
| Organization that focuses on the evaluation of nursing care provided in a health care setting. The quality, effectiveness, and appropriateness of nursing care for the client are the foci of evaluation. |
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Term
| prospective payment system |
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Definition
| Method of reimbursement for health care services. It involves a fixed reimbursement for a medical condition/procedure regardless of client's length of stay. |
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Term
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Definition
| Restoration of an individual to normal or near-normal function following a physical or mental illness, injury, or chemical addiction. |
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Term
| resource utilization groups |
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Definition
| A system for reimbursement used in the long term care setting. |
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Term
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Definition
| Care that gives the primary care provider the opportunity to have time away. Respite care services can take place in the client's home, a hospital, or an extended care setting. |
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Term
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Definition
| Care settings that include but are not limited to inpatient and outpatient rehabilitation facilities, subacute care facilities, clinics, and home care agencies. The services provided in restorative care settings are designed to bring the client to the maximal level of health and function. |
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Term
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Definition
| Institution or part of an institution that meets criteria for accreditation established by the sections of the Social Security Act that determine the basis for Medicaid and Medicare reimbursement for skilled nursing care, including rehabilitation and various medical and nursing procedures. Law requires that policies designate which level of caregiver is responsible for the implementation of each policy; that the care of every client be under the supervision of a physician; that a physician be available on an emergency basis; that records be maintained regarding the condition and care of every client; that nursing service be available 24 hours a day; and that at least one full-time registered nurse be employed. |
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Term
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Definition
| Assessment of the appropriateness and economy of an admission to a health care facility or continued hospitalization. |
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Term
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Definition
| Clients who are more likely to develop specific health problems. |
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Term
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Definition
| Secondary and tertiary care; short-term care for medical conditions |
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Term
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Definition
| The ability of health care providers to make their services more accessible globally. |
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Term
| Independent Practice Association (IPA) |
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Definition
| Managed care organization contract physicians who are not members of the group and whose practices include fee-for-service and capitated patients |
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Term
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Definition
| Part of the Resident Assessment Instrument (RAI) discussing the most appropriate health care interventions to support the health care needs of the residential population. |
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Term
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Definition
| Clients with extended lengths of stay, well beyond allowed inpatient DRG days. |
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Term
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Definition
| Care for clients who need a greater intensity of care that usually provided in a skilled nursing facility who no longer require acute care. |
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Term
| utilization review committees |
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Definition
| Committee that reviews the admissions, diagnostic testing, and treatments provided by physicians for clients receiving Medicare. |
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Term
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Definition
| The redesign of nursing units to make more services available on those units minimizing the need to transfer and transport clients across multiple diagnostic and treatment areas |
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Term
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Definition
| The integration of best research evidence with clinical expertise and patient values taking into account a nurse's clinical experience, practice trends, and individual client preferences. |
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Term
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Definition
| First contact in a given episode of illness that leads to a decision regarding a course of action to resolve the health problem. |
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Term
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Definition
| Process of assigning another member of the health care team aspects of client care (e.g., assigning nurse assistants to bathe a client). |
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Term
| diagnostic related groups |
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Definition
| Groups of clients classified for purposes of measuring a hospital's delivery of care. |
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Term
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Definition
| A system of family-centered care designed to allow clients to live and remain at home with comfort, independence, and dignity while alleviating the strains caused by terminal illness. |
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Term
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Definition
| Tool used in managed care that incorporates the treatment interventions of caregivers from all disciplines who normally care for a client. Designed for a specific case type, a pathway is used to manage the care of a client throughout a projected length of stay. |
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Term
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Definition
| Model of care; the case manager advises nursing staff on specific nursing care issues, coordinates the referral of clients to services provided by other disciplines, ensures that client education has been implemented, and monitors the client's progress through discharge. |
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