N C H S - National Home and Hospice Care Survey - Home Health Definitions of Terms

Current patient–is a patient on the home health agency's roster as of the night before the survey.

Discharge–is a patient formally discharged from care by the home health agency during a designated month randomly selected for each agency prior to data collection. Both live and dead discharges are included. A patient can be counted more than once if the patient was discharged more than once during the reference period; therefore, discharges represent episodes of care rather than patients.

Home health care–is provided to individuals and families in their places of residence for the purpose of promoting, maintaining, or restoring health or for maximizing the level of independence while minimizing the effects of disability and illness, including terminal illness.

Certification–refers to agency certification by Medicare and/or Medicaid. Both programs can certify home health agencies as meeting agency conditions for participation. Conditions for participation address patients’ rights, release of patient identifiable Outcome and Assessment Information Set (OASIS) data, compliance with Federal, State, and local laws, acceptance of patients, plan of care and medical supervision, reporting OASIS information, maintaining clinical records, and staffing of qualified personnel. Specific information Title 42, Part 484, Subparts A–D on each of these areas and several others can be found at Title 42, Part 484, Subparts A–D.

Medicare–is the medical assistance provided in Title XVIII of the Social Security Act. Medicare is a health insurance program administered by the Centers for Medicare and Medicaid Services for persons 65 years and over and for disabled persons who are eligible for benefits.

Medicaid–is the medical assistance provided in Title XIX of the Social Security Act. Medicaid is a Federal/State administered program for the medically indigent.

Geographic region–refers to the four geographic regions of the United States that correspond to those used by the U.S. Census Bureau.

Northeast–Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont

Midwest–Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin

South–Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.

West–Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, Washington, and Wyoming.

Location–is classified as inside a metropolitan statistical area (MSA) or outside an MSA.

Metropolitan statistical area–is established by the U.S. Office of Management and Budget with advice of the Federal Committee on Metropolitan Statistical Areas. Generally speaking, an MSA consists of a county or group of counties containing at least one city (or twin cities) having a population of 50,000 or more plus adjacent counties that are metropolitan in character and are economically and socially integrated with the central city. In New England, towns and cities rather than counties are the units used in defining MSAs. There is no limit to the number of adjacent counties included in the MSA as long as they are integrated with the central city, nor is an MSA limited to a single State; boundaries may cross State lines. The metropolitan population in this report is based on MSAs as defined in the 1980 census and does not include any subsequent additions or changes.

Ownership–refers to the type of organization that controls and operates the home health agency.

For profit–is operated under private commercial ownership, including individual or private ownership, partnerships, or corporations.

Nonprofit and others–includes voluntary or nonprofit (including church‑related and nonprofit corporations); Federal, State, or local government; all other types of ownership; and unknown.

Age–is the patient's age at the time of the interview (for current patients) or at the time of discharge (for discharges). Age is calculated as the difference in years between the date of birth and the date of interview or discharge. Age is reported in whole years.

Race–refers to the patient's race background as reported by agency staff. The race categories listed in this report consist of the categories “White,” “Black and other,” and “Black.” “Other races” includes Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaska Native, and multiple races. All race categories include persons of Hispanic and not Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999, race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. Only a small number of records had multiple races indicated.

Hispanic or Latino origin–refers to a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race, as reported by agency staff.

Marital status–refers to the marital status at the time of the interview (for current patients) or at the time of discharge (for discharges).

Residence–is where the patient is currently living (for current patients) or was living during the episode of care before discharge (for discharges).

Private or semiprivate residence–includes private residence (house or apartment, rented or owned); rented room or boarding house (open to anyone as defined by the landlord for rental payment); and retirement home (a facility that provides room and board to elderly or impaired persons).

Board and care or residential care facility–includes a facility that has 3 beds or more that provides 24-hour supervision, provision and oversight of personal and supportive services (assistance with activities of daily living and instrumental activities of daily living), and health-related services.

Health facility–includes nursing homes, hospitals, or other inpatient health facilities (including mental health facility).

Primary caregiver–is an individual or organization that is responsible for providing personal care assistance, companionship, and/or supervision to the patient.

Activities of daily living–refers to six activities (bathing, dressing, transferring, using the toilet room, eating, and walking) that reflect the patient's capacity for self-care. The patient's need for assistance with these activities is measured by the receipt of help from agency staff at the time of the survey (for current patients) or the last time service was provided prior to discharge (for discharges). Help that a patient may receive from persons that are not staff of the agency (for example, family members, friends, or individuals employed directly by the patient and not by the agency) is not included.

Instrumental activities of daily living–refers to six daily tasks (light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money) that enables the patient to live independently in the community. The patient's need for assistance with these activities is measured by the receipt of help from agency staff at the time of the survey (for current patients) or the last time service was provided prior to discharge (for discharges). Help that a patient may receive from persons who are not staff of the agency (for example, family members, friends, or individuals employed directly by the patient and not by the agency) is not included.

Primary expected source of payment–is the one payment source expected to pay the greatest amount of the patient's charges.

Private insurance, own income, or family support–includes private health insurance (health maintenance organization, independent practice association, preferred provider organization), family income, Social Security (including Supplemental Security Income), retirement funds, or welfare. It does not include Veterans Administration (VA) contracts, pensions, or other VA compensation.

Medicare–is money received under the Medicare program for home health care and may be obtained through fee-for-service Medicare or Medicare health maintenance organization (HMO). Medicare is a health insurance program for people 65 years of age and over, some disabled people under 65 years of age, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). More specific information can be found on the Centers for Medicare & Medicaid Services Web site.

Medicaid–is money received under the Medicaid Program for home health care and may be obtained through fee-for-service Medicaid or Medicaid HMO. Medicaid provides medical assistance for certain individuals and families with low incomes and resources. Medicaid eligibility is limited to individuals who fall into specific categories. Although the Federal government establishes general guidelines for the program, Medicaid requirements are established by each State. Whether a person is eligible for Medicaid will depend on the State of residence. More specific information can be found on the Centers for Medicare & Medicaid Services Web site.

All other sources–includes religious organizations, foundations, Veterans Administration contracts, pensions, or other VA compensation, and other military medicine. This category also includes no charges for care, payment sources not yet determined, and unknown sources.

Length of service–is the period of time from the date of most recent admission to the date of the survey interview (for current patients) or to the date of discharge (for discharges). Length of service for current patients tends to be underestimated for several reasons. Patients with a very short length of service are underestimated in the sample because they are less likely to be enrolled with the agency on any given day than are long-term users. Length of service for discharges tends to underestimate patients who receive care for long periods of time because they are less likely to be on the agency discharge list on any given day than are those with short lengths of service.

Average length of service–is computed by summing the number of days of service and dividing the result by the number of residents or discharges within the particular category. This statistic is sensitive to extreme values (e.g., very low or very high values) and, therefore, best used with data that are symmetrically distributed. The distribution for length of service is skewed; therefore, both mean and median values are presented.

Median length of service–is determined by identifying the midpoint of the distribution (50 percent of the cases fall above and below this value). This statistic is not sensitive to extreme values and is used when data are skewed. The distribution for length of service is skewed; therefore, both mean and median values are presented.

Recovered–occurs when the condition or disease responsible for the patient/discharge’s need for home care services is resolved.

Stabilized–occurs when the condition or disease responsible for the patient/discharge’s original need for home care services persists but the patient has improved and no longer needs assistance.

Family/friends resumed care–occurs when the condition or disease responsible for the patient/discharge’s need for home care services assistance persists but the patient now receives informal home care managed by family/friends.

Services no longer needed/treatment plan completed–occurs when the reason for the patient/discharge’s need for home care is resolved (e.g., physical therapy, health care training).

No longer eligible for service/no longer homebound–occurs when the patient/discharge is no longer eligible for home care services (e.g., no longer meets definition of homebound or has exceeded the health insurance plans’ covered benefits).