Glossary of Nursing Home Abuse Law Terms
Abuse (Emotional/Verbal): Emotional and verbal abuse occurs when a person says or does something that harm’s the nursing home resident’s self-esteem, such as humiliating, ignoring, or frightening the resident.
Abuse (Financial): Financial abuse occurs when a person illegally or improperly uses a nursing home resident’s money, property, and/or possessions for personal gain.
Abuse (Mental): Mental abuse is sometimes referred to as psychological or emotional abuse. Mental abuse is the intentional infliction of anguish, degradation, fear, or distress through verbal or nonverbal acts.
Abuse (Personal): Action by one person purposely does something to another person that causes mental or physical pain.
Abuse (Physical): The intentional use of physical force that may result in bodily injury or pain.
Abuse (Sexual): Any form of nonconsensual sexual contact, including unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment.
Access: A person’s ability to get necessary medical care and services.
Accessibility of Services: A person’s ability to get necessary medical care and services when needed.
Accredited or Accreditation: A facility is accredited when a private, independent group has met certain quality standards.
Act: Legislation passed by congress.
Action: A formal complaint brought to court.
Activities of Daily Living: Activities done in a normal day, such as walking, eating, dressing, bathing, grooming, and using the toilet.
Actual Charge: The dollar amount charged for medical services or supplies.
Adjudication: The process of being decided by a judge.
Admitting Physician: The doctor that admits a person to a hospital or other in-patient health facility.
Advance Directives: Advanced instructions telling how a person wants his or health care administered in the event that the person is unable to make decisions for himself. Also called a “Living Will.”
Advocate: A person or group that supports and/or protects another person’s rights.
Allegation: The claim made in a pleading by a party to an action setting out what he or she expects to prove.
Alzheimer’s Disease: A disorder involving deterioration of mental functions resulting from changes in brain tissues, including shrinkage of brain tissues. The cause is unknown.
Ambulatory Care: Those health services that do not require in-patient hospital care.
Ambulatory Surgical Center: The place in a hospital where outpatient surgeries are performed.
Ancillary Services: Services given by a hospital or other inpatient health program, such as x-rays, lab testing, and drug administration.
Appeal: Request to a superior or higher court to review and change the result in a case decided by an inferior or lower court.
Appellate Court: A court having jurisdiction to hear an appeal and review the decisions of a lower or inferior court.
Approved Amount: The dollar amount Medicare finds reasonable for a covered medical service.
Area Agency on Aging: Local programs that offer help to older people, including transportation services, meals, personal care, day health care, and skilled nursing care. Pennsylvania residents can click here to find their Local Agencies on Aging.
Assault: A willful attempt or threat to harm another person, coupled with the present ability to inflict injury on that person, which causes apprehension in that person.
Assessment: The gathering of information in order to evaluate a person’s health and health-care needs.
Assignment: When a doctor agrees to accept Medicare’s fee as full payment under the original Medicare plan. You must still pay your share of the fee for the doctor’s visit.
Assisted Living Facility: A residence for people needing assistance with certain such as dressing or eating. Assisted Living Facilities provide a lesser skilled level of care than a person would get in a nursing home. They also live more independently. Usually, residents pay a monthly rent, plus additional fees for the services they require and Medicare usually will not cover these expenses.
Attorney-Client Privilege: Client’s privilege to refuse to disclose and to prevent any other person from disclosing confidential communications between the client and his or her attorney.
Battery: The unlawful use of force resulting in the injury of another. Battery always includes assault.
Bedsore: A pressure-induced skin ulceration involving the death of living tissue and sometimes deep muscular infection and penetration of internal organs. Bedsores occur during long confinements in bed when there is prolonged pressure on an area of the body that has a bony prominence and a thin covering of flesh, like the tailbone, heals, elbows, and shoulder blades. Bedsores are also known as pressure sores and decubitus ulcers.
Beneficiary: In the context of Medicare and Medicaid programs, the name for the person who has insurance through Medicare or Medicaid.
Benefit Period: The manner in which Medicare measures a beneficiaries use of hospital and skilled nursing facility services. The benefit period begins the day the beneficiary is admitted to the hospital or skilled nursing facility and ends when 60 days go by without hospital or skilled nursing care. The number of benefit periods a beneficiary can have is unlimited.
Benefits: In health plans, benefits are the health care that a person receives. In the insurance context, benefits are the money or services provided by an insurance policy.
Brief: Written document prepared by an attorney and submitted to the court about a case, containing summaries of the facts of the case, relevant laws, and an argument showing how the laws support that party’s position.
Burden of Proof or Standard of Proof: Degree of proof required in a specific kind of case to prevail. In the majority of civil cases, it is proof by a preponderance of the evidence.
C-Diff: A strong type of diarrhea that is contagious.
Carrier: A private company that enters into a contract with Medicare to pay a beneficiary’s Medicare Part B health care bills.
Case Manager: A person who arranges necessary health-care services for a patient or group of patients. The case manager could be a doctor, a nurse, another health care professional, or a social worker.
Catastrophic Limit: The highest amount of money a person would be required to pay out of his or her own pocket during a certain period of time for certain covered health-care charges.
Certified or Certification: A health-care facility is certified when it passes a survey conducted by a state governmental agency. Medicare only covers care in facilities that are certified or accredited.
Circumstantial Evidence: Evidence not based on actual personal knowledge or observation of the fact in dispute, but, rather, evidence of other personal knowledge or observation which allows a jury to infer the existence or nonexistence of the fact in dispute. An example would be a witness who was entering a resident’s room and saw another person walking out of the room with blood on their hands. When the witness entered the resident’s room, the witness saw that the resident had a bloodied nose.
Civil Action: Action brought to enforce private rights; does not generally involve criminal actions.
Civil Law: Body of law concerned with private rights and remedies, as contrasted with criminal law.
Coerce or Coercion: To compel by pressure, threat, or force.
Cognitive Impairment: A breakdown in a person’s mental state, which may affect the person’s ability to think clearly. It may also affect moods and induce fear and/or anxiety.
Complaint: In the legal sense, the document a plaintiff files with the court which contains allegations and damages sought. A complaint generally starts a lawsuit.
Comprehensive Assessment: Under the federal Nursing Home Reform Act of 1987 a facility must perform an initial comprehensive, accurate, standardized reproducible assessment of each resident’s functional capacity within 14 days of the resident’s admission to the nursing home. A second assessment must again be performed after significant changes in the resident’s physical or mental status and/or at least once every 12 months.
Confidentiality: A person’s right to speak freely with his or her health care provider without anyone else finding out what was said in the conversation.
Consent: Voluntary agreement of one who has sufficient mental capacity to make an intelligent choice to do something proposed by another person.
Contingent Fee Agreement: An agreement between an attorney and his or her client whereby the attorney agrees to represent the client for a percentage of the amount recovered. This fee agreement is frequently used in personal injury actions.
Contracture: The drawing together of muscle or scar tissue that results in distortion or deformity. Contractures can be caused by long periods of confinement in bed.
Contributory Negligence: Conduct which falls below the standard of care established by law for the protection of one’s self against unreasonable risk of harm.
Co-payment: The dollar amount some Medicare beneficiaries are required to pay for each medical service, such as a doctor’s visit.
Court: Refers to a specific court, such as The Supreme Court of Pennsylvania, or may also refer to a judge.
Court Reporter: The person who stenographically records and transcribes testimony during court proceedings or related proceedings such as depositions.
Covered Benefit: A health service or item that is paid partially or fully by a person’s health plan.
Covered Charges: A health service or benefit that is paid partially or fully by a person’s health plan.
Criminal Law: Criminal law declares what conduct is criminal and prescribes punishment to be imposed for criminal conduct. The purpose of criminal law is to prevent harm to society.
Custodial Care: Personal care given by one person to another. Personal care includes such services as shopping and cooking. Personal care costs are usually not covered by Medicare.
Damages: Money payment recovered in the courts for an injury or loss caused by an unlawful act or omission or negligence of another.
Decedent: A deceased person.
Deductible: The dollar amount a person covered under a health plan must pay before the insurance plan begins to pay.
Defendant: In civil law the party defending a lawsuit; the party against whom the plaintiff seeks to recover damages from.
Deficiency: The federal government issues a deficiency to a nursing home when it fails to meet a federal regulation. State governments can also issue deficiencies when a nursing home fails to meet a state requirement.
Dehydration: This serious medical condition occurs when a person’s loss of bodily fluid is more than his or her intake of fluid.
Dementia: The irreversible deterioration of mental faculties with emotional disturbance resulting from organic brain disorder.
Deposition: Testimony of a witness taken under oath, which is used in the discovery process of trial preparation.
Diagnosis: The specific name for a person’s medical problem.
Direct Evidence: Generally, eyewitness evidence.
Discharge Planning: The procedure used by a health-care professional or social worker to determine the needs of a patient moving from one level of care to another, such as a move from a hospital to a nursing home.
Dual Eligibles: People entitled to Medicare and also eligible for Medicaid.
Durable Medical Equipment: Reusable medical equipment ordered by a physician for a person to use in a nursing home. Examples include wheelchairs, walkers, and hospital beds.
Duty: An obligation to conform to a particular standard of care which is considered reasonable by most.
Edema: Excessive accumulation of water in the tissues.
Elder Law: Laws regarding the rights of elderly people.
Eldercare: Programs, support systems, laws, and funding that meet the needs of the elderly. Examples include Social Security, health insurance, and elder law.
Elder Abuse: Any physical, sexual, verbal, psychological, or financial abuse perpetrated against an older adult. Elder abuse is most often committed by caretakers, whether they are family members or nursing home staffers. Many victims do not report violations because they are scared or ashamed.
Elopement: The ability of a nursing home resident who is not capable of self-preservation to successfully leave the nursing home unsupervised and undetected and enters into a harmful situation.
End-Stage Renal Disease: Permanent kidney failure requiring lifetime dialysis or a kidney transplant.
Error: In the legal sense, a mistaken interpretation of facts or application of the law that can prove grounds for an appeal.
Exemplary Damages or Punitive Damages: Compensation greater than what is necessary to cover losses received by the plaintiff. These damages are awarded to punish the defendant for his behavior.
Evidence: Proof of a probative matter presented at trial for the purpose of inducing belief in the minds of the jury or judge. Evidence comes in a variety of forms, including testimony, writings, tangible objects, and exhibits.
Gerontology: The study of older people and the aging process.
Grievance: A complaint concerning the way a person’s Medicare health plan is giving care, including complaints regarding the cleanliness of a nursing home and staff behavior. Grievances are not used to complain about medical treatment decisions or services that are not covered by Medicare.
Gross Negligence: Intentional failure to use a reasonable duty of care that results in negative consequences experienced by another person.
Health Care Financing Administration: The federal agency responsible for overseeing Medicare and Medicaid programs and assessing the quality of health care facilities and services and taking appropriate enforcement actions.
Health-Care Provider: A person trained and licensed to give health care. A health-care provider is also a place licensed to provide health care. Examples include doctors, nurses, and nursing homes.
Homebound: When a person is generally unable to leave home due to health problems.
Home Health Care: Generally, skilled nursing care that a person receives in his or her home for the treatment of an illness or injury.
Hospice: A place where the terminally ill patients are cared for.
Incontinent: Incapable of controlling excretory or waste elimination functions.
Informed Consent: Person’s agreement to allow something to happen, such as a medical procedure, which is based on full disclosure of the facts necessary to make an intelligent decision.
In-patient Care: The health care given to people admitted to a hospital.
Inspection Report: Specific written findings that support a federal or state determination that a nursing home failed to meet certain federal regulations or state requirements. The inspection report also offers a plan for correcting any problems
Internist: A physician who identifies and treats health problems in adults.
Joint and Several Liability: Refers to a plaintiff’s ability to sue one or more defendants separately or all together at his or her option. Permits a group of defendants to be held both individually and collectively liable for all damages suffered by the plaintiff. The plaintiff can recover the entire amount of damages from one defendant, even if all of the defendants are liable.
Judgment: Decision by the court.
Judicial: Pertaining to a judge.
Judicial Notice: The procedure by which a judge recognizes the existence of the truth of a certain fact having bearing on the case without the production of evidence because such fact is established by common notoriety. For example, if the accident happened on Thanksgiving, the judge can take judicial notice that the accident happened on a Thursday.
Jurisdiction: The legal right by which judges exercise their authority.
Lawsuit: A court action brought by one person against another seeking compensation for damages or cost incurred based on another’s actions.
Leading Case: Case regarded as having determined the law on a particular point, thus becoming a guide for later decisions.
Legal Cause: Substantial factor in bringing about the harm.
Liability: An obligation that one is bound in law to perform; usually involves the payment of money damages.
Long-Term Care: Custodial care given in a person’s home or in a nursing home when a person has a chronic disability or a long illness.
Long-Term Care Ombudsman: A supporter for nursing home residents who helps solve problems between the residents and the nursing home.
Malfeasance: Commission of a wrongful act; evil doing; wrongful conduct.
Malnourished: Suffering from malnutrition.
Malnutrition: A serious health problem caused by poor nutrition due to an insufficient or poorly balanced diet.
Manipulation: This occurs when one person deviously influences another for his or her own advantage.
Material Fact: Generally, a fact essential to a case or a defense without which said case or defense could not be supported.
Medicaid: A joint federal and state program that helps with medical costs for many low-income people. Medicaid programs vary from state to state, but if you qualify for both Medicaid and Medicare, most health-care costs are covered.
Medically Necessary: Health-care services and supplies are medically necessary when they are proper and necessary to diagnose and/or treat a medical condition and not merely used for the convenience of the physician or the patient.
Medicare: A federal health insurance program for persons 65 or older. Medicare also covers some people under 65 who suffer from certain disabilities as well as people with End-Stage Renal Disease
Medicare Managed Care Plan: A plan permitting you to go to specific doctors, specialists, and hospitals on the plan’s list. Medicare Managed Care Plans must cover all Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) health care. The plan may or may not cover extras, like prescriptions.
Medicare Part A (Hospital Insurance): Medicare Part A pays for in-patient hospital stays, skilled nursing home care, home health care, and hospice care.
Medicare Part B (Medical Insurance): Medicare Part B pays for doctor’s services, out-patient hospital care, and other services not covered by Medicare Part A.
Medigap: A Medicare supplemental health insurance policy offered by private insurance companies that fills the gaps in the original Medicare plan.
Misfeasance: Improper performance of a lawful act.
Neglect: In the nursing home context, when a care taker fails to give a person the care, services or goods necessary to avoid harm or illness.
Negligence: In its broadest sense, carelessness. More precisely, conduct which falls below the standard of care established by law for the protection of others against unreasonable risks of harm. In order to prevail in a negligence action, the plaintiff must prove, by a preponderance of the evidence, the following four elements: (1) that the defendant owed the plaintiff a duty of care; (2) that the defendant breached that duty; (3) that the defendant’s breach of his or her duty of care caused the plaintiff’s injury; (4) that the plaintiff suffered injury.
Nurse: A person trained to take care of the sick, injured, or disabled under the supervision of a doctor.
Nurse’s Aide: A nurse’s assistant.
Nurse Practitioner: A nurse having two or more years of advanced training and who has passed a specific exam.
Nursing Home: A residential facility that gives nursing care or custodial care to an ill or injured person. A nursing home also provides a room, meals, rehabilitative care, medical services, and help with daily living and recreational activities.
Nursing Home Abuse: Any physical, sexual, verbal, psychological, or financial abuse perpetrated against residents of a residential care facility. Although nursing home abuse is a growing problem, many victims do not report violations because they are scared or ashamed.
Nursing Home Negligence: The failure of any person having the care or custody of a nursing home resident to exercise that degree of care which a reasonable person in a like position would exercise by failing, for example, to give the resident the care, services, or goods necessary to avoid harm or illness.
Nursing Home Reform Act of 1987: Federal law that governs nursing homes and gives nursing home residents certain rights.
Order: Written direction or command made by a court or judge, and not included in a judgment.
Out-of-Court Settlement: An agreement reached between a plaintiff and a defendant to resolve a lawsuit privately and without a judge’s authorization or approval.
Participating Physician: A doctor who agrees to accept assignment on all Medicare claims. A participating physician may only bill you for the Medicare deductible and/or coinsurance amounts.
Participating Supplier: A medical supplier who agrees to accept assignment on all Medicare claims. A participating supplier may only bill you for the Medicare deductible and/or coinsurance amounts.
Peer Review Organization: Groups of doctors and other health-care experts paid by the federal government to check and improve upon the care provide to Medicare patients. Peer Review Organizations must review complaints concerning the quality of care given by hospitals, nursing homes, and home health care agencies.
Personal Representative: One who stands in the place of another.
Physical Therapy: Treatment given for an injury or a disease by mechanical means, such as exercise or massage.
Physician’s Assistant: A person with two or more years advanced training and who has passed a specific exam. Physician’s assistants work with doctors and can do some of the things that a doctor can do.
Plaintiff: In civil law, the person who brings an action or starts a lawsuit.
Plan of Care: Under the federal Nursing Home Reform Act of 1987, nursing homes are required to develop comprehensive individualized care plans for residents. This is a written plan stating what kinds of services and care a person needs for a specific health-care problem. The assessment must be completed within 14 days of admission. A periodic review is done.
Pleading: A document filed in a court that pertains to a case.
Power of Attorney: Written document authorizing one person to take certain legal actions on behalf of the person giving the power of attorney.
Precedent: Decision by a court that provides an example or authority for later cases involving a similar question of law.
Premium: Monthly payment for health-care coverage to Medicare, an insurance company, or a health-care plan.
Preponderance of the Evidence: The amount of evidence needed for a plaintiff to win in a civil action. A preponderance of the evidence is the greater weight of the evidence or the more convincing evidence in comparison to the evidence offered in opposition. A plaintiff can win by a preponderance of the evidence even if plaintiff’s evidence merely tips the scales in plaintiff’s favor.
Primary Care Physician (PCP): A doctor trained to give basic health care. A PCP is the first doctor seen for a specific health problem. The PCP then coordinates with other health-care professionals for future care and/or preventative health care.
Privileged Communication: Statement protected from forced disclosure in court because the statement was made within a “protected” relationship such as attorney/client.
Procedural Law: Generally, the body of law establishing the method or procedure of enforcing rights or obtaining redress for invasion of rights.
Provider: A doctor or other health-care professional or a hospital or other health care facility that provides health-care services.
Proximate Cause: The proximate cause of an injury is the primary or moving cause that produces the injury and without which the accident could not have happened, if the injury is one which might be reasonably anticipated or foreseen as a natural consequence of the wrongful act.
Psychoactive Drug: A medication that alters the mental process.
Punitive Damages or Exemplary Damages: Compensation greater than is necessary to pay a plaintiff for a loss. These damages are awarded because the loss was aggravated by violence, oppression, malice, fraud or wanton and wicked conduct on the part of the defendant. Such damages are intended to punish the defendant for his evil behavior or make an example of him or her.
Rape: Unlawful sexual intercourse with a female who did not consent to engaging in the sexual act.
Reasonable Care: The degree of care that a prudent or careful person would exercise under the same or similar circumstances.
Reasonable Man Doctrine or Reasonable Man Standard: The standard which a person must adhere to in order to avoid civil liability for negligence is the standard of the reasonable man under all of the circumstances, including the foreseability of harm to other persons, including the plaintiff.
Recovery: Generally, compensation or restriction of a right obtained as a result of the formal judgment, or decree, entered by a judge.
Registered Nurse: A nurse who has passed a state registration exam.
Restraint: A physical or chemical means to stop a patient from being able to move about freely.
Ruling: Broadly, a determination made by a judge.
Side Effect: A problem caused by medical treatment or medication. For example, if you take medication to relieve a headache, your stomach may become upset.
Skilled Nursing Care: Health-care services given by or under the supervision of licensed nurses and also under the general direction of a doctor.
Skilled Nursing Facility: A facility that provides skilled nursing care or rehabilitation services.
Sodomy: Generally, oral or anal sex without consent.
Specialist: A doctor who treats only specific illnesses, body parts, or persons within a certain age group.
Standard of Care: In the law of negligence, the degree of care which a reasonable, prudent or careful person should exercise under the same or similar circumstances. If the standard falls below that established by law for the protection of others against unreasonable risk of harm, the person may be liable for damages resulting from such conduct.
Standard of Proof or Burden of Proof: Degree of proof required in a specific kind of case to prevail. In the majority of civil cases, it is proof by a preponderance of the evidence.
Stare Decisis: Policy of the courts to not overturn precedents; adherence to precedents.
Statute: Law passed by congress.
Statute of Limitations: The time prescribed by statute in which a plaintiff can bring a lawsuit.
Subpoena: Command to appear at a certain place and time to give testimony on a matter.
Subpoena Duces Tecum: Command to produce some document or paper.
Substantive Law: The body of law that creates, defines and regulates right.
Sue: The act of bringing a lawsuit.
Suit or Lawsuit: Generally, a court action brought by one person, the plaintiff, against another, the defendant, seeking compensation for some injury or enforcement of a right.
Summons: Formal document beginning a civil action or special proceeding which is a means to gain jurisdiction over a party. Also, a document directed to a sheriff or other authorized person ordering him to serve the person named on the summons that must appear at a certain place and time to respond to the action.
Supplier: A company, person, or agency that provides a certain medical item or service, such as a hospital bed or wheelchair.
Survival Action: A survival action is brought by the administrator of a deceased person’s estate in order to recover loss to the estate resulting from a tort. A survival action, unlike a wrongful death action, is not a new cause of action. Where death is caused by negligence, both a survival action and a wrongful death action may be brought.
Survival Statutes: Statutory law that provides for a legal action to continue after the death of a person involved in the action.
Testimony: Evidence delivered by a witness at trial either orally at trial or in the written form of an affidavit or deposition.
Tort: In civil law, generally, a wrong or injury committed against a person or property. A tort does not include breach of contract.
Tortfeasor: One who commits a tort.
Tortious: Having the quality of a tort; the wrongdoer.
Transcript: Official written copy of proceedings in a case, including hearings, depositions, and trial. Usually made by a court reporter.
Treatment: What a heath-care professional provides to help a medical problem.
Treatment Options: The choices a sick or injured person has when there is more than one way to treat a medical problem.
Trial: The judicial examination and determination of issues between the parties to an action.
Undue Influence: Abuse of position of trust or authority in order to induce a person to do or refrain from doing something to the advantage of the person exerting the influence.
Verdict: The jury’s decision in a case.
Void: Having no binding effect or legal force; null.
Wandering: The ability of a nursing home resident to move about within the nursing home aimlessly and/or without a rational purpose or appreciation of personal safety needs.
Waiver: Knowing and voluntary relinquishment, or release, of a right.
Willful Negligence: Intentional performance of an unreasonable act in disregard of a known risk, that causes harm. There is no clear distinction between willful negligence and gross negligence.
Writ: A court order requiring the performance of some act or giving authority to have the act done.
Wrongful Death Action: An action brought to recover damages for the death of a person caused by a wrongful act or neglect or unlawful violence or negligence of another; provided that no recovery for the same damages claimed in the wrongful death action was obtained by the deceased during his lifetime.
Wrongful Death Statute: Statutory law that provides the representative of a decedent to bring suit alleging that the decedent’s death was caused by someone’s negligent act and to seek compensation for monetary loss suffered.