Glossary beginning with S

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Systems, used by Medicare and some Medicaid programs, to adjust amounts paid as prospective provider rates to actual costs as reported in the facilityÂ’s year end cost report. Settlements may be amounts due to or from the program.

Shared Housing

Programs that help older people find other people to live with them and share a home. Sometimes a younger, healthier person will live with an older person and provide housekeeping or other light assistance and general supervision in exchange for free food and board.

Skilled Care

A level of care which requires the training and skills and 24 hour-a-day supervision of a Registered Nurse, is prescribed by a doctor, and which may not be provided by less skilled or less intensive care.

Skilled Care may be defined differently by Medicare than by insurance companies. Medicare will generally pay for Skilled Care only for limited periods of time, when such care is expected to improve the medical condition of the patient, and when it is delivered in a Participating Skilled Nursing Facility. Medicare will not pay for such care when no medical improvement is expected, as is the case in many Chronic Conditions.

Skilled Nursing Facility

A Nursing Home qualified to provide around-the-clock nursing care to residents who need Skilled Care, extensive medical care and supervision and/or therapy and rehabilitation. SNFs may be Medicare-certified and/or Medicaid-certified, or neither.

Skilled Nursing Unit

A section of a hospital which is licensed to provide skilled nursing services for longer periods of time than the usual hospital stay. SNUs are generally Medicare-certified, and may or may not be Medicaid-certified. They are sometimes called Step-Down Units, to reflect the fact that patients are moved there subsequent to the original hospital stay, once hospital level care is no longer required.

Social Security

A program of the United States, established in 1935, which includes a retirement income program, as well as disability and survivors benefits.

Specified Low-Income Medicare Beneficiary

Individuals who would be a Qualified Medicare Beneficiary, except for their higher incomes of up to 120% of the Federal Poverty Level.


The process whereby a person who is nearly destitute enough to qualify for Medicaid uses up their remaining assets. In many states, nursing home residents may be put on spenddown, and their assets which exceed the allowable resource limit are applied against the cost of their nursing home care, until the limit is reached. In effect, the resident is paying the private fees for a period of time, even though they have been accepted into the Medicaid program. Income Cap states do not allow any spenddown.

Stand-By Assistance

When a person occasionally requires the physical assistance of another person to perform one or more Activities of Daily Living (ADLs), and needs someone to be available when they perform those activities. The presence of another person within arm's reach of the individual that is necessary to prevent by physical intervention injury while the individual is performing an ADL. In some cases, this help is needed for a person who is physically capable of performing the ADL who forgets how to do it correctly because of cognitive impairments.


A care level below acute care, but more intense than long term care, usually needed subsequent to a hospital stay. Many nursing homes and hospitals have developed sub acute care services, which are generally provided for a limited period of time, as a part of rehabilitation or recovery from acute care problems. For example, a person who suffered a stroke acute care episode may require a intense period of physical and speech therapy during the recovery period. Sub acute care services are generally coverable under both Medicare and Medicaid programs.

Supplemental Security Income

Supplemental Security Income (SSI) is a federal supplemental income program for low income elderly or disabled persons that was established in 1972. Many states supplement it with additional state SSI. In most states, SSI recipients are also automatically eligible for Medicaid.
<p>The SSI program makes monthly payments to people who have limited income and resources if they are 65 or older or if they are blind or have another disability. To get SSI, countable resources must not be worth more than $2,000 for an individual, or $3,000 for a couple. Countable resources are assets like cash and investments, but they exclude some things, like the value of a personal residence. The income limits for SSI eligibility differ from state to state, but the base requirement is income below 100% of the Federal Poverty Guidelines.


An investigation conducted by an entity that has given a provider a License, Certification, or Accreditation. For instance, states conduct licensure surveys of Nursing Homes where the state surveyors spend several days in the facility observing patients and reviewing records and procedures to determine if the facility is in compliance with licensure requirements.

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