Long Term Care Glossary - kcentv.com - KCEN HD - Waco, Temple, and Killeen

Long Term Care Glossary

Accreditation
A process whereby a program of study or an institution is recognized by an external body as meeting certain predetermined standards. For facilities, accreditation standards are usually defined in terms of physical plant, governing body, administration, and medical and other staff. Accreditation is often carried out by organizations created for the purpose of assuring the public of the quality of the accredited institution or program. The state or federal governments can recognize accreditation in lieu of, or as the basis for licensure or other mandatory approvals. Public or private payment programs often require accreditation as a condition of payment for covered services. Accreditation may either be permanent or may be given for a specified period of time.

Activities of Daily Living
Basic personal activities which include bathing, eating, dressing, mobility, transferring from bed to chair, and using the toilet. ADLs are used to measure how dependent a person may be on requiring assistance in performing any or all of these activities.

Acute Care
Care that is generally provided for a short period of time to treat a certain illness or condition. This type of care can include short-term hospital stays, doctor's visits, surgery, and X-rays.

Acute Illness
Illness that is usually short-term and that often comes on quickly.

Adult Care
Home Residence which offers housing and personal care services for 3 to 16 residents. Services (such as meals, supervision, and transportation) are usually provided by the owner or manager. May be single family home. (Also called board and care home or group home.)

Adult Day Care
A daytime community-based program for functionally impaired adults that provides a variety of health, social, and related support services in a protective setting.

Alzheimer's Disease
A progressive, irreversible disease characterized by degeneration of the brain cells and serve loss of memory, causing the individual to become dysfunctional and dependent upon others for basic living needs.

Ambulatory Care
All types of health services which are provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services which do not require an overnight stay.

Area Agency on Aging
A local (city or county) agency, funded under the federal Older Americans Act, that plans and coordinates various social and health service programs for persons 60 years of age or more. The network of AAA offices consists of more than 600 approved agencies.

Assisted Living
Residences that provide a 'home with services' and that emphasize residents' privacy and choice. Residents typically have private locking rooms (only shared by choice) and bathrooms. Personal care services are available on a 24-hour-a-day basis.

Assistive Devices
Tools that enable individuals with disabilities to perform essential job functions, e.g., telephone headsets, adapted computer keyboards, enhanced computer monitors.

Board and Care
Home Residence which offers housing and personal care services for 3 to 16 residents. Services (such as meals, supervision, and transportation) are usually provided by the owner or manager. May be single family home. (Also called adult care home or group home.)

Care/Case Management
Offers a single point of entry to the aging services network. Care/case management assess clients' needs, create service plans, and coordinate and monitor services; they may operate privately or may be employed by social service agencies or public programs. Typically case managers are nurses or social workers.

Care Plan
Written document which outlines the types and frequency of the long-term care services that a consumer receives. It may include treatment goals for him or her for a specified time period. (Also called service plan or treatment plan.)

Caregiver
Person who provides support and assistance with various activities to a family member, friend, or neighbor. May provide emotional or financial support, as well as hands-on help with different tasks. Caregiving may also be done from long distance.

Chore Services
Help with chores such as home repairs, yard work, and heavy housecleaning.

Chronic Care
Care and treatment given to individuals whose health problems are of a long-term and continuing nature. Rehabilitation facilities, nursing homes, and mental hospitals may be considered chronic care facilities.

Chronic Illness
Long-term or permanent illness (e.g., diabetes, arthritis) which often results in some type of disability and which may require a person to seek help with various activities.

Co-insurance
The specified portion (dollar amount or percentage) that Medicare, health insurance, or a service program may require a person to pay toward his or her medical bills or services. (Also called co-payment.)

Cognitive Impairment
Deterioration or loss of intellectual capacity which requires continual supervision to protect the insured or others, as measured by clinical evidence and standardized tests that reliably measure impairment in the area of (1) short or long term memory, (2) orientation as to person, place and time, or (3) deductive or abstract reasoning. Such loss in intellectual capacity can result from Alzheimer's disease or similar forms of senility or Irreversible Dementia.

Community-based Services
Services designed to help older people remain independent and in their own homes; can include senior centers, transportation, delivered meals or congregate meals site, visiting nurses or home health aides, adult day care, and homemaker services.

Community Health Center
An ambulatory health care program usually serving a catchment area which has scarce or nonexistent health services or a population with special health needs. These centers attempt to coordinate federal, state, and local resources in a single organization capable of delivering both health and related social services to a defined population. While such a center may not directly provide all types of health care, it usually takes responsibility to arrange all medical services needed by its patient population. (Also called neighborhood health center.)

Congregate Housing
Individual apartments in which residents may receive some services, such as a daily meal with other tenants. (Other services may be included as well.) Buildings usually have some common areas such as a dining room and lounge as well as additional safety measures such as emergency call buttons. May be rent-subsidized (known as Section 8 housing).

Continuing Care Retirement Community
Communities which offer multiple levels of care (independent living, assisted living, skilled nursing care) housed in different areas of the same community or campus and which give residents the opportunity to remain in the same community if their needs change. Provide residential services (meals, housekeeping, laundry), social and recreational services, health care services, personal care, and nursing care. Require payment of a monthly fee and possibly a large lump-sum entrance fee.

Continuum of Care
The entire spectrum of specialized health, rehabilitative, and residential services available to the frail and chronically ill. The services focus on the social, residential, rehabilitative and supportive needs of individuals as well as needs that are essentially medical in nature.

Co-payment
The specified portion (dollar amount or percentage) that Medicare, health insurance, or a service program may require a person to pay toward his or her medical bills or services. (Also called co-insurance.)

Custodial Care
Care that does not require specialized training or services.

Deinstitutionalization
Policy which calls for the provision of supportive care and treatment for medically and socially dependent individuals in the community rather than in an institutional setting.

Dementia
Term which describes a group of diseases (including Alzheimer's Disease) which are characterized by memory loss and other declines in mental functioning.

Discharge
A formal termination of inpatient care.

Durable Medical Equipment
Equipment such as hospital beds, wheelchairs, and prosthetics used at home. May be covered by Medicaid and in part by Medicare or private insurance. (Also called home medical equipment.)

Escort Services
Provides transportation for older adults to services and appointments. May use bus, taxi, volunteer drivers, or van services that can accommodate wheelchairs and persons with other special needs. (Also called transportation services.)

Estate Recovery
By law states are required to recover funds from certain deceased Medicaid recipients' estates up to the amount spent by the state for all Medicaid services (e.g., nursing facility, home and community-based services, hospital, and prescription costs).

Geriatrician
Physician who is certified in the care of older people.

Geriatrics
Medical specialty focusing on treatment of health problems of the elderly.

Gerontology
Study of the biological, psychological and social processes of aging.

Group Home
Residence which offers housing and personal care services for 3 to 16 residents. Services (such as meals, supervision, and transportation) are usually provided by the owner or manager. May be single family home. (Also called adult care home or board and care home.)

Health Insurance
Financial protection against the medical care costs arising from disease or accidental bodily injury. Such insurance usually covers all or part of the medical costs of treating the disease or injury. Insurance may be obtained on either an individual or a group basis.

Health Insurance Portability & Accountability Act
Federal health insurance legislation passed in 1996, which sets standards for access, portability, and renewability that apply to group coverage--both fully insured and self-funded--as well as to individual coverage. HIPAA allows under specified conditions, for long-term care insurance policies to be qualified for certain tax benefits under Section 7702(b) of the Internal Revenue Code.

Home and Community-based Waivers
Section 2176 of the Omnibus Reconciliation Act permits states to offer, under a waiver, a wide array of home and community-based services that an individual may need to avoid institutionalization. Regulations to implement the act list the following services as community and home-based services which may be offered under the waiver program: case management, homemaker, home health aide, personal care, adult day health care, habilitation, respite care and other services.

Home Health Agency
A public or private organization that provides home health services supervised by a licensed health professional in the patient's home either directly or through arrangements with other organizations.

Home Health Aide
A person who, under the supervision of a home health or social service agency, assists elderly, ill or disabled person with household chores, bathing, personal care, and other daily living needs. Social service agency personnel are sometimes called personal care aides.

Home Health Care
Includes a wide range of health-related services such as assistance with medications, wound care, intravenous (IV) therapy, and help with basic needs such as bathing, dressing, mobility, etc., which are delivered at a person's home.

Home Medical Equipment
Equipment such as hospital beds, wheelchairs, and prosthetics used at home. May be covered by Medicaid and in part by Medicare or private insurance. (Also called durable medical equipment.)

Homemaker Services
In-home help with meal preparation, shopping, light housekeeping, money management, personal hygiene and grooming, and laundry.

Hospice
A program which provides palliative and supportive care for terminally ill patients and their families, either directly or on a consulting basis with the patient's physician or another community agency. The whole family is considered the unit of care, and care extends through their period of mourning.

Hospice Care
Services for the terminally ill provided in the home, a hospital, or a long-term care facility. Includes home health services, volunteer support, grief counseling, and pain management.

Hospital
An institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and nonsurgical.

Independent Living Facility
Rental units in which services are not included as part of the rent, although services may be available on site and may be purchased by residents for an additional fee.

Inpatient
A person who has been admitted at least overnight to a hospital or other health facility (which is therefore responsible for his or her room and board) for the purpose of receiving diagnostic treatment or other health services.

Institutional Health Services
Health services delivered on an inpatient basis in hospitals, nursing homes, or other inpatient institutions. The term may also refer to services delivered on an outpatient basis by departments or other organizational units of, or sponsored by, such institutions.

Instrumental Activities of Daily Living
Household/independent living tasks which include using the telephone, taking medications, money management, housework, meal preparation, laundry, and grocery shopping.

Intermediate Care
Occasional nursing and rehabilitative care ordered by a doctor and performed or supervised by skilled medical personnel.

Intermediate Care Facility
A nursing home, recognized under the Medicaid program, which provides health-related care and services to individuals who do not require acute or skilled nursing care, but who, because of their mental or physical condition, require care and services above the level of room and board available only through facility placement. Specific requirements for ICF's vary by state. Institutions for care of the mentally retarded or people with related conditions (ICF/MR) are also included. The distinction between 'health-related care and services' and 'room and board' is important since ICF's are subject to different regulations and coverage requirements than institutions which do not provide health-related care and services.

Level of Care
Amount of assistance required by consumers which may determine their eligibility for programs and services. Levels include: protective, intermediate, and skilled.

Long-Term Care
Range of medical and/or social services designed to help people who have disabilities or chronic care needs. Services may be short- or long-term and may be provided in a person's home, in the community, or in residential facilities (e.g., nursing homes or assisted living facilities).

Long-Term Care Insurance
Insurance policies which pay for long-term care services (such as nursing home and home care) that Medicare and Medigap policies do not cover. Policies vary in terms of what they will cover, and may be expensive. Coverage may be denied based on health status or age.

Long-Term Care Ombudsman
An individual designated by a state or a substate unit responsible for investigating and resolving complaints made by or for older people in long-term care facilities. Also responsible for monitoring federal and state policies that relate to long-term care facilities, for providing information to the public about the problems of older people in facilities, and for training volunteers to help in the ombudsman program. The long-term care ombudsman program is authorized by Title III of the Older Americans Act.

Medicaid
Federal- and state-funded program of medical assistance to low-income individuals of all ages. There are income eligibility requirements for Medicaid.

Medical Necessity
Services or supplies which are appropriate and consistent with the diagnosis in accord with accepted standards of community practice and are not considered experimental. They also can not be omitted without adversely affecting the individual's condition or the quality of medical care.

Medically Indigent
People who cannot afford needed health care because of insufficient income and/or lack of adequate health insurance.

Medicare
Federal health insurance program for persons age 65 and over (and certain disabled persons under age 65). Consists of 2 parts: Part A (hospital insurance) and Part B (optional medical insurance which covers physicians' services and outpatient care in part and which requires beneficiaries to pay a monthly premium).

Medicare Supplement Insurance
Insurance supplement to Medicare that is designed to fill in the 'gaps' left by Medicare (such as co-payments). May pay for some limited long-term care expenses, depending on the benefits package purchased. (Also called Medigap.)

Medigap
Insurance supplement to Medicare that is designed to fill in the 'gaps' left by Medicare (such as co-payments). May pay for some limited long-term care expenses, depending on the benefits package purchased. (Also called Medicare supplement insurance.)

Neighborhood Health Center
An ambulatory health care program usually serving a catchment area which has scarce or nonexistent health services or a population with special health needs. These centers attempt to coordinate federal, state, and local resources in a single organization capable of delivering both health and related social services to a defined population. While such a center may not directly provide all types of health care, it usually takes responsibility to arrange all medical services needed by its patient population. (Also called community health center.)

Nurse
An individual trained to care for the sick, aged, or injured. Can be defined as a professional qualified by education and authorized by law to practice nursing.

Nurse Practitioner
A registered nurse working in an expanded nursing role, usually with a focus on meeting primary health care needs. NPs conduct physical examinations, interpret laboratory results, select plans of treatment, identify medication requirements, and perform certain medical management activities for selected health conditions. Some NPs specialize in geriatric care.

Nursing Home
Facility licensed by the state to offer residents personal care as well as skilled nursing care on a 24 hour a day basis. Provides nursing care, personal care, room and board, supervision, medication, therapies and rehabilitation. Rooms are often shared, and communal dining is common.

Nursing Home Care
Full-time care delivered in a facility designed for recovery from a hospital, treatment, or assistance with common daily activities.

Occupational Therapy
Designed to help patients improve their independence with activities of daily living through rehabilitation, exercises, and the use of assistive devices. May be covered in part by Medicare.

Older Americans Act
Federal legislation that specifically addresses the needs of older adults in the United States. Provides some funding for aging services (such as home-delivered meals, congregate meals, senior center, employment programs). Creates the structure of federal, state, and local agencies that oversee aging services programs.

Ombudsman
A representative of a public agency or a private nonprofit organization who investigates and resolves complaints made by or on behalf of older individuals who are residents of long-term care facilities.

Outpatient
A patient who is receiving ambulatory care at a hospital or other facility without being admitted to the facility. Usually, it does not mean people receiving services from a physician's office or other program which also does not provide inpatient care.

Personal Care Assistance with activities of daily living as well as with self-administration of medications and preparing special diets. (Also called custodial care.)

Post-acute Care
Type of short-term care provided by many long-term care facilities and hospitals which may include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between the hospital and home. Residents on these units often have been hospitalized recently and typically have more complicated medical needs. The goal of subacute care is to discharge residents to their homes or to a lower level of care. (Also called subacute care or transitional care.)

Pre-admission Certification
A process under which admission to a health institution is reviewed in advance to determine need and appropriateness and to authorize a length of stay consistent with norms for the evaluation.

Pre-existing Condition
Illnesses or disability for which the insured was treated or advised within a stipulated time period before making application for a life or health insurance policy. A pre-existing condition can result in cancellation of the policy.

Premium
The periodic payment (e.g., monthly, quarterly) required to keep an insurance policy in force.

Prepayment
Usually refers to any payment to a provider for anticipated services (such as an expectant mother paying in advance for maternity care).

Primary Care
Basic or general health care focused on the point at which a patient ideally first seeks assistance from the medical care system.

Prospective Payment
Any method of paying hospitals or other health programs in which amounts or rates of payment are established in advance for a defined period (usually a year).

Provider
Individual or organization that provides health care or long-term care services (e.g., doctors, hospital, physical therapists, home health aides, and more).

Public Health
The science dealing with the protection and improvement of community health by organized community effort.

Quality of Care
Can be defined as a measure of the degree to which delivered health services meet established professional standards and judgments of value to the consumer.

Registered Nurse
A nurse who has graduated from a formal program of nursing education and has been licensed by an appropriate state authority. RNs are the most highly educated of nurses with the widest scope of responsibility, including all aspects of nursing care. RNs can be graduated from one of three educational programs: two-year associate degree program, three-year hopsital diploma program, or four-year baccalaureate program.

Rehabilitation
The combined and coordinated use of medical, social, educational, and vocational measures for training or retaining individuals disabled by disease or injury to the highest possible level of functional ability. Several different types of rehabilitation are distinguished: vocational, social, psychological, medical, and educational.

Rehabilitation
Services Services designed to improve/restore a person's functioning; includes physical therapy, occupational therapy, and/or speech therapy. May be provided at home or in long-term care facilities. May be covered in part by Medicare.

Reimbursement
The process by which health care providers receive payment for their services. Because of the nature of the health care environment, providers are often reimbursed by third parties who insure and represent patients.

Residential Care
The provision of room, board and personal care. Residential care falls between the nursing care delivered in skilled and intermediate care facilities and the assistance provided through social services. It can be broadly defined as the provision of 24-hour supervision of individuals who, because of old age or impairments, necessarily need assistance with the activities of daily living.

Respite Care
Service in which trained professionals or volunteers come into the home to provide short-term care (from a few hours to a few days) for an older person to allow caregivers some time away from their caregiving role.

Secondary Care
Services provided by medical specialists who generally do not have first contact with patients (e.g., cardiologist, urologists, dermatologists).

Senility
The generalized characterization of progressive decline in mental functioning as a condition of the aging process. Within geriatric medicine, this term has limited meaning and is often substituted for the diagnosis of senile dementia and/or senile psychosis.

Senior Center
Provides a variety of on-site programs for older adults including recreation, socialization, congregate meals, and some health services. Usually a good source of information about area programs and services.

Service Plan
Written document which outlines the types and frequency of the long-term care services that a consumer receives. It may include treatment goals for him or her for a specified time period. (Also called care plan or treatment plan.)

Skilled Care
Higher level of care (such as injections, catheterizations, and dressing changes) provided by trained medical professionals, including nurses, doctors, and physical therapist.

Skilled Nursing Care
Daily nursing and rehabilitative care that can be performed only by or under the supervision of, skilled medical personnel.

Skilled Nursing Facility
Facility that is certified by Medicare to provide 24-hour nursing care and rehabilitation services in addition to other medical services.

Social Health Maintenance Organization
A managed system of health and long-term care services geared toward an elderly client population. Under this model, a single provider entity assumes responsibility for a full range of acute inpatient, ambulatory, rehabilitative, extended home health and personal care services under a fixed budget which is determined prospectively. Elderly people who reside in the target service area are voluntarily enrolled. Once enrolled, individuals are obligated to receive all SHMO covered services through SHMO providers, similar to the operation of a medical model health maintenance organization (HMO).

Special Care Units
Long-term care facility units with services specifically for persons with Alzheimer's Disease, dementia, head injuries, or other disorders.

Spend-down
Medicaid financial eligibility requirments are strict, and may require beneficiaries to spend down/use up assets or income until they reach the eligibility level.

Spousal Impoverishment
Federal regulations preserve some income and assets for the spouse of a nursing home resident whose stay is covered by Medicaid.

Subacute Care
Type of short-term care provided by many long-term care facilities and hospitals which may include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between the hospital and home. Residents on these units often have been hospitalized recently and typically have more complicated medical needs. The goal of subacute care is to discharge residents to their homes or to a lower level of care. (Also called post-acute care or transitional care.)

Support Groups
Groups of people who share a common bond (e.g., caregivers) who come together on a regular basis to share problems and experiences. May be sponsored by social service agencies, senior centers, religious organizations, as well as organizations such as the Alzheimer's Association.

Title III Services
Services provided to individuals age 60 and older which are funded under Title III of the Older Americans Act. Include: congregate and home-delivered meals, supportive services (e.g., transportation, information and referral, legal assistance, and more), in-home services (e.g., homemaker services, personal care, chore services, and more), and health promotion/disease prevention services (e.g., health screenings, exercise programs, and more).

Title XIX
Federal- and state-funded program of medical assistance to low-income individuals of all ages. There are income eligibility requirements for Medicaid.

Title XVIII
Federal health insurance program for persons age 65 and over (and certain disabled persons under age 65). Consists of 2 parts: Part A (hospital insurance) and Part B (optional medical insurance which covers physicians' services and outpatient care in part and which requires beneficiaries to pay a monthly premium).

Transitional Care
Type of short-term care provided by many long-term care facilities and hospitals which may include rehabilitation services, specialized care for certain conditions (such as stroke and diabetes) and/or post-surgical care and other services associated with the transition between the hospital and home. Residents on these units often have been hospitalized recently and typically have more complicated medical needs. The goal of subacute care is to discharge residents to their homes or to a lower level of care. (Also called subacute care or post-acute care.)

Transportation Services
Provides transportation for older adults to services and appointments. May use bus, taxi, volunteer drivers, or van services that can accommodate wheelchairs and persons with other special needs. (Also called escort services.)

Treatment Plan
Written document which outlines the types and frequency of the long-term care services that a consumer receives. It may include treatment goals for him or her for a specified time period. (Also called care plan or service plan.)

Uncompensated Care
Service provided by physicians and hospitals for which no payment is received from the patient or from third party payers.

Underinsured
People with public or private insurance policies that do not cover all necessary medical services, resulting in out-of-pocket expenses that exceed their ability to pay.

Visiting Nurse Association
A voluntary health agency which provides nursing and other services in the home. Basic services include health supervision, education and counseling; beside care; and the carrying out of physicians' orders. Personnel include nurses and home health aides who are trained for specific tasks of personal bedside care. These agencies had their origin in the visiting or district nursing provided to sick poor in their homes by voluntary agencies.

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