In some life-insurance policies, a benefit payable to the insured’s survivors or estate if the insured dies before a specified age, often 65 or 70. The benefit amount is a refund of premiums the insured paid, minus the amount of any benefits the insured received while living.
See pressure ulcers
A policy that calls for supportive care and treatment for medically and socially dependent individuals in the community rather than in an institutional setting, such as a nursing home.
A request for a fiscal intermediary (FI) review from a beneficiary upon receiving notification of noncoverage from the facility.
Term that describes a group of diseases (including Alzheimer's) that are characterized by memory loss and other declines in mental functioning.
Notification of denied insurance coverage. A facility is required to issue a denial letter as soon as a resident is denied coverage either at the time of admission or when skilled care is no longer needed. A denial letter must also offer the resident the option to request a claim be reviewed by a fiscal intermediary.
Developmental disability (DD)
A disability that originates before age 18, can be expected to continue indefinitely and constitutes a substantial handicap to the disabled's ability to function normally.
Diagnosis related groups (DRGs)
A classification system that uses diagnosis information to establish hospital payments under Medicare. This system groups a patient’s status into 467 categories, based upon the coding system of the International Classification of Disease, Ninth Revision-Clinical Modification (ICD-9-CM).
A series of codes that represent or classify diagnoses and conditions. Typically, these codes are used for reimbursement when billing a third-party payer as justification for services, for patient assessment, for statistical purposes in the analysis of health care programs and policy, to comply with state laws, and for many other reasons.
Director of nursing (DON)
All nursing functions in a healthcare facility fall under the responsibility of this administrator. The DON is also sometimes called the nurse executive, chief nurse or vice president of patient care.
The limitation of normal physical, mental, social activity of an individual. There are varying types (functional, occupational, learning), degrees (partial, total) and durations (temporary, permanent) of disability. Benefits are often available only for specific disabilities, such as total and permanent (the requirement for Social Security and Medicare).
A formal termination of inpatient care.
A social worker or nurse who assists patients and their families with healthcare arrangements following a hospital stay, such as at a nursing or rehabilitation facility.
Separate units in a nursing facility where beds are available only for people whose care is paid for by a specific payment source, such as Medicare.
DNR (Do Not Resuscitate)
A care preference that is made, before a threatening event occurs, to reject life-sustaining treatment. The decision is made when the family, resident and doctor believe that resuscitation will not result in the prolonging of meaningful life.
See diagnosis related groups
Diagnostic and Statistical Manual of Mental Disorders - A tool used by the medical and psychological communities to identify and classify behavioral, cognitive, and emotional problems according to a standard numerical coding system of mental disorders.
Individuals who are qualified for both Medicaid and Medicare coverage. Most nursing home residents are dual eligibles.
Durable medical equipment (DME)
Also called “home medical equipment.” Equipment such as hospital beds, wheelchairs, and prosthetics used at home. May be covered by Medicaid and in part by Medicare or private insurance.
Durable Power of Attorney for Health Care (DPAHC)
A legal document in which a competent person gives another person (called an attorney-in-fact) the power to make health care decisions for him or her if unable to make those decisions. A DPA can include guidelines for the attorney-in-fact to follow in making decisions on behalf of the incompetent person.
A swallowing disorder often depicted by difficulty in oral preparation for swallowing. The person has difficulty moving material from the mouth to stomach.