IMPORTANT TERMS

Persons entering into a nursing home contract should understand the meaning of the words and phrases relevant to the contractual stipulations. The following definitions give a brief description of some of the more common and/or important terms.

Adult Care Residences
An adult care residence in Virginia is a long term care residence for persons needing some help with their activities of daily living, but not the kind of daily medical services available in nursing homes. Depending upon the level of care needed services in adult care residences are categorized as either Residential Living or Assisted Living. The Virginia Department of Social Services is responsible for regulating adult care residences. 

Nursing Home
A nursing home is a long term care facility for those who need less care than that provided in a hospital, but more care than is available in their home or local community. Services can include administering medicines, special diets, treatments and therapies as prescribed by a doctor, and total nursing care. While many adult care residences have nurses on staff, nursing homes provide more comprehensive medical care than adult care residences.

The state of Virginia, through the Virginia Department of Health, regulates nursing homes. Minimum standards are established for the physical facilities, staffing qualifications, and services to be made available to residents. The federal government also regulates nursing homes receiving federal Medicare or Medicaid funding, which includes most nursing homes. The federal Omnibus Budget Reconciliation Act of 1987 enacted many regulations aimed at nursing homes, and were intended to correct problems faced by nursing home residents. 

Private Pay Residents
Many residents of nursing homes can afford to pay for their care out of their own financial resources. This is called “private pay.” Long term care insurance is another source of private pay.

Medicaid Residents
Residents who must rely on the federal Medicaid program to pay part or all of the bill are often referred to as “Medicaid residents.” Medicaid provides benefits for disabled persons who need long term nursing home care but cannot afford it themselves. Charges and billing for Medicaid recipients can differ from the charges to and billing for private pay residents.

Medicare Residents
Some patients in nursing homes are there receiving temporary “skilled care” under Medicare coverage. Medicare provides limited coverage for nursing home care (see the section “MEDICAID and LONG TERM CARE” for more information).

Residents’ Rights
Federal law, and the laws of most states, including Virginia, include an extensive and detailed list of specified “residents’ rights,” a set of rights nursing home residents are granted by law. There is also a series of obligations on the part of nursing homes to provide certain services and care for their residents. Nursing homes are required by law to inform all residents of these statutory and regulatory rights.

Incapacitated Person
An incapacitated person is an adult who has been found by a court of law to be incapable of handling some or all of his or her own financial and/or personal affairs, and needs someone else to make some or all decisions for them. If a person is determined to be incapacitated they cannot legally execute a Durable Power of Attorney. 
A finding by a court that an individual displays poor judgment is, by itself, not sufficient evidence that the individual is an incapacitated person.

Guardian
A guardian is a person appointed by the court who is responsible for the personal affairs of an incapacitated person, including the responsibility for making health care and medical treatment decisions. The guardian also has authority to decide where the incapacitated person lives. 

Conservator
A conservator is an individual appointed by the court who is responsible for managing the estate and financial affairs of an incapacitated person. A court might appoint the same person, or two different people, to serve as guardian and conservator for an incapacitated person.

Power of Attorney
A power of attorney is a document signed by a person (the “Principal”) giving another individual (the “Agent”) the authority to handle some or all of the Principal’s legal affairs. Such affairs can include receiving income, paying bills, buying and selling property, and other matters. 

A power of attorney becomes void if the Principal loses his or her capacity or competence, but a “Durable Power of Attorney” is one which remains in force even after the Principal becomes incapacitated or incompetent. 

A “Medical Power of Attorney” specifically grants the authority for the Agent to make decisions concerning the Principal’s medical treatment.

A “Health Care Declaration” is a document executed by an individual that specifies what treatment the doctor is to provide or not provide under certain medical conditions when the individual is unable to speak for him or herself. It is the same as a “Living Will” and it usually provides direction as to end of living decisions made by the declarant. 

Guarantor
A Guarantor is an individual who agrees to accept liability for the debt of another in the event that the debt might not get paid. Such a person (often called a “Co-Signer”) assures a third party “I will pay this obligation if my friend cannot.” 

“Responsible Party” 
The term “responsible party” has no set legal definition; its intended meaning must be construed by the context of the contract in which it is used. 

When entering a nursing home or retirement community, the administration of the home or community might wish to have available a third party to help in the caring of the resident (to make decisions in the event that the elderly person becomes incapacitated or incompetent, for example). Such a person (often a family member or long time friend) can be referred to as the “responsible party.” This relationship is not as formal as that of a Guardianship or a Power of Attorney, and does not require a court order or the execution of a legal document.

Transfer
A change of living arrangements within a nursing facility is called a “transfer.” Such a change might be for medical purposes, transferring a resident from a skilled care floor of the facility to a non-skilled care part of the facility.

Discharge
A discharge occurs when the resident leaves the nursing facility, either by choice or involuntarily.

The Department of Medical Assistance Services
The Department of Medical Assistance Services (“DMAS”) is the state agency in Virginia which administers the Medicaid program, and has a number of other regulatory responsibilities important to nursing home residents. For example, a nursing home resident who wishes to appeal an adverse discharge decision by the nursing home should contact the “Appeals Division” of DMAS.

Elder Law
“Elder law” is the area of legal practice that specifically addresses the concerns of elderly clients. Elder law attorneys specialize in serving aged persons, assisting with such matters as estate and legal capacity planning, health and long term care issues, Medicare and Medicaid, and other matters of concern for the elderly.

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