Activities of Daily Living (ADLs)
Basic actions that independently functioning individuals perform on a daily basis:
- Bathing
- Dressing
- Transferring (moving to and from a bed or a chair)
- Eating
- Caring for incontinence
Many public programs determine eligibility for services according to a person's need for help with ADLs. Many long-term care insurance policies use the inability to do a certain number of ADLs (such as 2 of 6) as criteria for paying benefits.
Acute Care
Recovery is the primary goal of acute care. Physician, nurse, or other skilled professional services are typically required and usually provided in a doctor's office or hospital. Acute care is usually short term.
Advanced Directive (also called Health Care Directive, Advanced Health Care Directive, Living Will, or Health Care Directive)
Legal document that specifies whether you would like to be kept on artificial life support if you become permanently unconscious or are otherwise dying and unable to speak for yourself. It also specifies other aspects of health care you would like under those circumstances.
Assessment
The gathering of information to rate or evaluate your health and needs.
Attending Physician
The licensed physician who would normally be expected to certify and recertify the medical necessity of the number of services rendered and/or who has primary responsibility for the patient's medical care and treatment.
Benefits
Monetary sum paid by an insurance company to a recipient or to a care provider for services that the insurance policy covers.
Caregiver
A caregiver is anyone who helps care for an elderly individual or person with a disability who lives at home. Caregivers usually provide assistance with activities of daily living and other essential activities like shopping, meal preparation, and housework.
Care Plan
A written plan for your care. It tells what services you will get to reach and keep your best physical, mental, and social well-being.
Case Manager
A nurse, doctor, or social worker who arranges all services that are needed to give proper health care to a patient or group of patients.
Chain of Trust
A term used in the HIPAA Security NPRM for a pattern of agreements that extend protection of health care data by requiring that each covered entity that shares health care data with another entity require that that entity provide protections comparable to those provided by the covered entity, and that that entity, in turn, require that any other entities with which it shares the data satisfy the same requirements.
Chronically Ill
Having a long-lasting or recurrent illness or condition that causes you to need help with Activities of Daily Living and often other health and support services. The condition is expected to last for at least 90 consecutive days. The term used in tax-qualified long-term care insurance policies to describe a person who needs long-term care because of an inability to do a certain number of Activities of Daily Living without help, or because of a severe cognitive impairment such as Alzheimer's Disease.
Cognitive Impairment
Deficiency in short or long-term memory, orientation to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness. Alzheimer's Disease is an example of a cognitive impairment.
Community-Based Services
Services and service settings in the community, such as adult day services, home delivered meals, or transportation services. Often referred to as home- and community-based services, they are designed to help older people and people with disabilities stay in their homes as independently as possible.
Confidentiality
Your right to talk with your health care provider without anyone else finding out what you have said.
CPR (Cardiopulmonary Resuscitation)
Combination of rescue breathing (mouth-to-mouth resuscitation) and chest compressions used if someone isn't breathing or circulating blood adequately. CPR can restore circulation of oxygen-rich blood to the brain.
Custodial Care (also called personal care)
Non-skilled service or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom.
Dementia
Deterioration of mental faculties due to a disorder of the brain.
Disabled
For Medicaid eligibility purposes, a disabled person is someone whose physical or mental condition prevents him or her from doing enough work or the type of work needed for self-support. The condition must be expected to last for at least a year or be expected to result in death. Persons receiving disability benefits through Supplemental Security Income (SSI), Social Security, or Medicare automatically meet this criterion.
Discharge Planning
A process used to decide what a patient needs for a smooth move from one level of care to another. This is done by a social worker or other health care professional. It includes moves from a hospital to a nursing home or to home care. Discharge planning may also include the services of home health agencies to help with the patient's home care.
Do Not Resuscitate Order (DNR)
Written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR order may be instituted on the basis of an Advance Directive from a person, or from someone entitled to make decisions on the person's behalf, such as a health care proxy. In some jurisdictions, such orders can also be instituted on the basis of a physician's own initiative, usually when resuscitation would not alter the ultimate outcome of a disease. Any person who does not wish to undergo lifesaving treatment in the event of cardiac or respiratory arrest can get a DNR order, although DNR orders are more common when a person with a fatal illness wishes to die without painful or invasive medical procedures.
Durable Medical Equipment
Medical equipment that is ordered by a doctor for use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds. DME is paid for under both Medicare Part B and Part A for home health services.
Durable Power of Attorney
A legal document that enables you to designate another person, called the attorney-in-fact, to act on your behalf, in the event you become disabled or incapacitated.
Financial Eligibility
Assessment of a person's available income and assets to determine if he or she meets Medicaid eligibility requirements.
Functional Eligibility
Assessment of a person's care needs to determine if he or she meets Medicaid eligibility requirements for payment of long-term care services. The assessment may include a person's ability to perform Activities of Daily Living or the need for skilled care.
General Medicaid Eligibility Requirements
You must be:
- A resident of the state in which you are applying
- Either a United States citizen or a legally admitted alien
- Age 65 or over
- Or meet Medicaid's rules for disability, or blind
Health Care Proxy
Legal document in which you name someone to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions for yourself.
Homebound
Normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious service. A need for adult day care doesn't keep you from getting home health care.
Home Health Agency
An organization that gives home care services, like skilled nursing care, physical therapy, occupational therapy, speech therapy, and personal care by home health aides.
Home Health Care
Limited part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.
Homemaker or Chore Services
Help with general household activities such as meal preparation, routine household care, and heavy household chores such as washing floors or windows or shoveling snow.
Hospice
Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. Hospice care is covered under Medicare Part A (Hospital Insurance).
Hospice Care
Short-term, supportive care for individuals who are terminally ill (have a life expectancy of six months or less). Hospice care focuses on pain management and emotional, physical, and spiritual support for the patient and family. It can be provided at home or in a hospital, nursing home, or hospice facility. Medicare typically pays for hospice care. Hospice care is not usually considered long-term care.
Hospitalist
A doctor who primarily takes care of patients when they are in the hospital. This doctor will take over your care from your primary doctor when you are in the hospital, keep your primary doctor informed about your progress, and will return you to the care of your primary doctor when you leave the hospital.
Improvement Plan
A plan for measurable process or outcome improvement. The plan is usually developed cooperatively by a provider and the Network. The plan must address how and when its results will be measured.
Instrumental Activities of Daily Living
Activities that are not necessary for basic functioning, but are necessary in order to live independently. These activities may include:
- Doing light housework
- Preparing and cleaning up after meals
- Taking medication
- Shopping for groceries or clothes
- Using the telephone
- Managing money
- Taking care of pets
- Using communication devices
- Getting around the community
- Responding to emergency alerts such as fire alarms
Living Will (also called Health Care Directive, Advanced Health Care Directive, Living Will, or Health Care Directive)
Legal document that specifies whether you would like to be kept on artificial life support if you become permanently unconscious or are otherwise dying and unable to speak for yourself. It also specifies other aspects of health care you would like under those circumstances.
Long-Term Care
Services and supports necessary to meet health or personal care needs over an extended period of time.
Long-Term Care Services
Services that include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assists people with Activities of Daily Living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility. For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility.
Medicaid
Joint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services.
Medical Power of Attorney
Legal document that allows you to name someone to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions for yourself.
Medicare
Federal program that provides hospital and medical expense benefits for people over age 65, or those meeting specific disability standards. Benefits for nursing home and home health services are limited.
Medicare Part A (Hospital Insurance)
Hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Medicare medical insurance that helps pay for doctors’ services, outpatient hospital care, durable medical equipment, and some medical services that aren’t covered by Part A.
Medicare Supplement Insurance (also called Medigap coverage)
Private insurance policy that covers gaps in Medicare coverage.
Medigap Insurance (also called Medicare Supplement Insurance)
Private insurance policy that covers gaps in Medicare coverage.
Nutrition
Getting enough of the right foods with vitamins and minerals a body needs to stay healthy. Malnutrition, or the lack of proper nutrition, can be a serious problem for older people.
Occupational Therapy
Services given to help you return to usual activities (such as bathing, preparing meals, housekeeping) after illness.
Periods of Care (Hospice)
A set period of time that you can get hospice care after your doctor says that you are eligible and still need hospice care.
Personal Care
Non-skilled, personal care, such as help with activities of daily living like bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom. It may also include care that most people do themselves, like using eye drops. The Medicare home health benefit does pay for personal care services.
Physical Therapy
Treatment of injury and disease by mechanical means, such as heat, light, exercise, and massage.
Plan of Care
Your doctor's written plan saying what kind of services and care you need for your health problem.
Referral
A written OK from your doctor for you to see a specialist or receive home care services.
Rehabilitation
Rehabilitative services are ordered by your doctor to help you recover from an illness or injury. These services are given by nurses and physical, occupational, and speech therapists. Examples include working with a physical therapist to help you walk and with an occupational therapist to help you get dressed.
Respite Care
Temporary or periodic care provided in a nursing home, assisted living residence, or other type of long-term care program so that the usual caregiver can rest or take some time off.
Skilled Care
Nursing care such as help with medications and caring for wounds, and therapies such as occupational, speech, respiratory, and physical therapy. Skilled care usually requires the services of a licensed professional such as a nurse, doctor or therapist.
Skilled Care Needs
Services requiring the supervision and care of a nurse or physician, such as assistance with oxygen, maintenance of a feeding tube, or frequent injections.
Skilled Nursing Care
A level of care that includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
Speech-Language Therapy
Treatment to regain and strengthen speech skills.
Supervisory Care
Long-term care service for people with memory or orientation problems. Supervision ensures that people don't harm themselves or others because their memory, reasoning, and orientation to person, place, or time are impaired.
Supplemental Security Income (SSI)
Program administered by the Social Security Administration that provides financial assistance to needy persons who are disabled or aged 65 or older. Many states provide Medicaid without further application to persons who are eligible for SSI.
Telemedicine
Professional services given to a patient through an interactive telecommunications system by a practitioner at a distant site.
Sources: U.S. Department of Health and Human Services and Centers for Medicare & Medicaid Services
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