GLOASSARY
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GLOSSARY
OF LONG TERM CARE INSURANCE TERMS!
Long Term Care Terms
This glossary is available to give you general information about words and terms associated with aging, disability or long-term care. Many sources have been used to compile this list. To find a term, select the first letter of the word/term you are seeking.
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |



A

Accessibility
As required by the Americans with Disabilities Act, removal of barriers that would hinder a person with a disability from entering, functioning, and working within a facility. Required restructuring of the facility cannot cause undue hardship for the employer.

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 (ADLs)
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.

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.

Age Discrimination in Employment Act (ADEA)
A 1967 federal law that prohibits employers with 20 or more employees from discriminating on the basis of age in hiring, job retention, compensation, and benefits. ADEA also sets requirements for the duration of employer-provided disability benefits.

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 (AAA)
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.

B

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.

C

Capitation
A method of payment for health services in which the provider is paid a fixed amount for each patient without regard to the actual number or nature of services provided. Capitation payments are charactistic of health maintenance organizations (HMOs). Also, a method of public support of health professional schools in which eligible schools receive a fixed grant for each student enrolled.

Care Plan
(Also called service plan or 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.

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.

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.

Case Mix
A method by which a health care provider measures the service needs of the patient population, and may be based on age, medical diagnosis, severity of illness, or length of stay. A nursing home or hospital's actual case mix influences cost and scope of the services provided by the facility to the patient, and case mix reimbursement systems adjust payment rates accordingly.

Certificate of Need (CON)
A certificate issued by a government body to a health care provider who is proposing to construct, modify, or expand facilities, or to offer new or different types of health services. CON is intended to prevent duplication of services and overbedding. The certificate signifies that the change has been approved.

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.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
A Department of Defense program supporting private sector care for military dependents.

Co-Insurance
(Also called 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.

Co-Payment
(Also called 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.

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 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.

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.

Conditions of Participation (COP)
Standards a facility or supplier of services, desiring to participate in the Medicare or Medicaid program, is required to meet. These conditions include meeting a statutory definition of the particular institution or facility, conforming with state and local laws and having an acceptable utilization review plan. Surveys to determine whether facilities meet conditions of participation are made by the appropriate state health agency.

Congregate Housing
Individual apartments in which residents may receive some services, such as a daily meal with other tenants. Buildings usually have some common areas such as a dining room and lounge as well as additional safety measures such as emergency call buttons.

Continuing Care Retirement Community (CCRC)
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.

Cost Containment
A set of steps to control or reduce inefficiencies in the consumption, allocation, or production of health care services which contribute to higher than necessary costs. Inefficiencies in consumption can occur when health services are inappropriately utilized; inefficiencies in allocation exist when health services could be delivered in less costly settings without loss of quality; and inefficiencies in production exist when the cost of producing health services could be reduced by using a different combination of resources.

Cost of Living Adjustment (COLA)
increase to a monthly long-term disability benefit, usually after the first year of payments. May be a flat percentage (e.g., 3%) or tied to changes in inflation. In some states, workers' compensation income replacement benefits also include annual COLAs.

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

D

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.

Developmental Disability (DD)
A disability which originates before age 18, can be expected to continue indefinitely, and constitutes a substantial handicap to the disabled's ability to function normally.

Diagnostic and Statistical Manual of Mental Disorders (DSM)
A tool used by the medical and psychological communities to identify and classify behavioral, cognitive, and emotional problems according to a standard numerical coding system of mental disorders.

Direct Cost
A cost which is identifiable directly with a particular activity, service, or product of the program experiencing the costs. These costs do not include the allocation of costs to a cost center which are not specifically attributable to that cost center.

Disability
The limitation of normal physical, mental, social activity of an individual. There are varying types (functional, occupational, learning), degrees (partial, total), and durations (temporary, permanent) of disability. Benefits are often available only for specific disabilities, such as total and permanent (the requirement for Social Security and Medicare).

Discharge
A formal termination of inpatient care.

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

E

Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT)
A program mandated by law as part of the Medicaid program. The law requires that all states have in effect a program for eligible children under age 21 to ascretain their physical or mental defects and to provide such health care treatments and other measures to correct or ameliorate defects and chronic conditions discovered. The state programs also have active outreach components to inform eligible persons of the benefits available to them, to provide screening, and if necessary, to assist in obtaining appropriate treatment.

Emergency Medical Services (EMS)
Services utilized in responding to the perceived individual need for immediate treatment for medical, physiological, or psychological illness or injury.

Employee Retirement Income Security Act (ERISA)
A federal act, passed in 1974, that established new standards and reporting/disclosure requirements for employer-funded pension and health benefit programs.

Epidemiology
The study of the patterns of determinants and antecedents of disease in human populations. It utilizes biology, clinical medicine, and statistics in an effort to understand the etiology (causes) of illness and/or disease. The ultimate goal of the epidemiologist is not merely to identify underlying causes of a disease but to apply findings to disease prevention and health promotion.

Escort Services
(Also called 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.

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).

F

Family and Medical Leave Act (FMLA)
A 1993 federal law requiring employers with more than 50 employees to provide eligible workers up to 12 weeks of unpaid leave for birth, adoptions, foster care placement, and illnesses of employees and their families.

Fee Schedule
A list of physician services in which each entry is associated with a specific monetary amount that represents the approved payment level for a given insurance plan.

Fee-for-Service
The way traditional Medicare and health insurance work. Medical providers bill for whatever service they provide. Medicare and/or traditional insurance pay their share, and the patient pays the balance through co-payments and deductibles.

For-Profit
Organization or company in which profits are distributed to shareholders or private owners.

Functionally Disabled
A person with a physical or mental impairment that limits the individual's capacity for independent living.

G

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.

H

Handicapped
As defined by Section 504 of the Rehabilitation Act of 1973, any person who has a physical or mental impairment which substantially limits one or more major life activity, has a record of such impairment, or is regarded as having such an impairment.

Health
The state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. It is recognized, however, that health has many dimensions (anatomical, physiological, and mental) and is largely culturally defined. The relative importance of various disabilities will differ depending upon the cultural milieu and the role of the affected individual in that culture. Most attempts at measurement have been assessed in terms or morbidity and mortality.

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 and Accountability Act (HIPAA)
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.

Health Maintenance Organization (HMO)
Managed care organization that offers a range of health services to its members for a set rate, but which requires its members to use health care professionals who are part of its network of providers.

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 (HHA)
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.

Homebound
One of the requirements to qualify for Medicare home health care. Means that someone is generally unable to leave the house, and if they do leave home, it is only for a short time (e.g., for a medical appointment) and requires much effort.

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.

I

Impairment
Any loss or abnormality of psychological, physiological, or anatomical function.

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.

Indigent Care
Health services provided to the poor or those unable to pay. Since many indigent patients are not eligible for federal or state programs, the costs which are covered by Medicaid are generally recorded separately from indigent care costs.

Indirect Cost
Cost which cannot be identified directly with a particular activity, service or product of the program experiencing the cost. Indirect costs are usually apportioned among the program's services in proportion to each service's share of direct costs.

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 (IADLs)
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 (ICF)
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.

Intermediate Care Facility for the Mentally Retarded (ICF/MR)
An ICF which cares specifically for the mentally retarded.

International Classification of Diseases, ninth edition (Clinical Modification) (ICD-9-CM)
A list of diagnoses and identifying codes used by physicians and other health care providers. The coding and terminology provide a uniform language that permits consistent communication on claim forms.

Inventory
A detailed description of quantities and locations of different kinds of facilities, major equipment, and personnel which are available in a geographic area and the amount, type, and distribution of services these resources can support.

L

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

License/Licensure
A permission granted to an individual or organization by a competent authority, usually public, to a engage lawfully in a practice, occupation, or activity.

Long-Term Care (LTC)
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.

M

Managed Care
Method of organizing and financing health care services which emphasizes cost-effectiveness and coordination of care. Managed care organizations (including HMOs, PPOs, and PSOs) receive a fixed amount of money per client/member per month (called a capitation), no matter how much care a member needs during that month.

Medicaid (Title XIX)
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 (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).

Medicare HMOs
Under Medicare HMOs (health maintenance organizations), members pay their regular monthly premiums to Medicare, and Medicare pays the HMO a fixed sum of money each month to provide Medicare benefits (e.g., hospitalization, doctor's visits, and more). Medicare HMOs may provide extra benefits over and above regular Medicare benefits (such as prescription drug coverage, eyeglasses, and more). Members do not pay Medicare deductibles and co-payments; however, the HMO may require them to pay an additional monthly premium and co-payments for some services. If members use providers outside the HMO's network, they pay the entire bill themselves unless the plan has a point of service option.

Medicare Supplement Insurance (MedSupp)
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.

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.

Mental Health
The capacity in an individual to function effectively in society. Mental health is a concept influenced by biological, environmental, emotional, and cultural factors and is highly variable in definition, depending on time and place. It is often defined in practice as the absence of any identifiable or significant mental disorder and sometimes improperly used as a synonym for mental illness.

Mental Health Services
Variety of services provided to people of all ages, including counseling, psychotherapy, psychiatric services, crisis intervention, and support groups. Issues addressed include depression, grief, anxiety, stress, as well as severe mental illnesses.

Mental Illness/Impairment
A deficiency in the ability to think, perceive, reason, or remember, resulting in loss of the ability to take care of one's daily living needs.

Morbidity
The extent of illness, injury, or disability in a defined population. It is usually expressed in general or specific rates of incidence or prevalence.

Mortality
Death. Used to describe the relation of deaths to the population in which they occur.

N

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.

Nonprofit/Not-For-Profit
An organization that reinvests all profits back into that organization.

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 (NP)
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.

O

Occupancy Rate
A measure of inpatient health facility use, determined by dividing available bed days by patient days. It measures the average percentage of a hospital's beds occupied and may be institution-wide or specific for one department or service.

Occupational Health Services
Health services concerned with the physical, mental, and social well-being of an individual in relation to his or her working environment and with the adjustment of individuals to their work. The term applies to more than the safety of the workplace and includes health and job satisfaction.

Occupational Therapy (OT)
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 (OAA)
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.

Omnibus Budget Reconciliation Act (OBRA) of 1993
Federal legislation that limits the amount of compensation that can be paid to employees covered by long-term disability plans funded through voluntary employees' beneficiary association trusts. Any such plan with participants earning more than $150,000 could lose its tax-exempt status.

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.

P

Peer Review
Generally, the evaluation by practicing physicians or other professionals of the effectiveness and efficiency of services ordered or performed by other members of the profession.

Personal Care
Assistance with activities of daily living as well as with self-administration of medications and preparing special diets.

Physical Therapy (PT)
Designed to restore/improve movement and strength in people whose mobility has been impaired by injury and disease. May include exercise, massage, water therapy, and assistive devices. May be covered in part by Medicare.

Physician Assistant (PA)
A specially trained and licensed or otherwise credentialed individual who performs tasks, which might otherwise be performed by a physician, under the direction of a supervising physician.

Point of Service
A health insurance benefits program in which subscribers can select between different delivery systems (i.e., HMO, PPO and fee-for-service) when in need of medical services, rather than making the selection between delivery systems at time of open enrollment at place of employment.

Post-Acute Care (PAC)
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.

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.

Preferred Provider Arrangement (PPA)
Selective contracting with a limited number of health care providers, often at reduced or pre-negotiated rates of payment.

Preferred Provider Organization (PPO)
Managed care organization that operates in a similar manner to an HMO or Medicare HMO except that this type of plan has a larger provider network and does not require members to receive approval from their primary care physician before seeing a specialist. It is also possible to use doctors outside the network, although there may be a higher co-payment.

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).

Preventive Medicine
Care which has the aim of preventing disease or its consequences. It includes health care programs aimed at warding off illnesses (e.g., immunizations), early detection of disease (e.g., Pap smears), and inhibiting further deterioration of the body (e.g., exercise or prophylactic surgery). Preventive medicine is also concerned with general prevention measures aimed at improving the healthfulness of the environment.

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

Probability (P value)
The likelihood that an event will occur.

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).

Provider Sponsored Organization (PSO)
Managed care organization that is similar to an HMO or Medicare HMO except that the organization is owned by the providers in that plan and these providers share the financial risk assumed by the organization.

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

Q

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.

R

Registered Nurse (RN)
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.

Respiratory Therapy
The diagnostic evaluation, management, and treatment of the care of patients with deficiences and abnormalities in the cardiopulmonary (heart-lung) system.

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.

Risk Management
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.

S

Screening
The use of quick procedures to differentiate apparently well persons who have a disease or a high risk of disease from those who probably do not have the disease.

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.

Severity of Illness
A risk prediction system to correlate the "seriousness" of a disease in a particular patient with the statistically "expected" outcome (e.g., mortality, morbidity, efficiency of care).

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

Social Security Disability Insurance (SSDI)
A system of federally provided payments to eligible workers (and, in some cases, their families) when they are unable to continue working because of a disability. Benefits begin with the sixth full month of disability and continue until the individual is capable of substantial gainful activity.

Social Services Block Grant (SSBG) Services
(Formerly known as Title XX services.) Grants given to states under the Social Security Act which fund limited amounts of social services for people of all ages.

Social Health Maintenance Organization (SHMO)
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.

Speech Therapy
Designed to help restore speech through exercises. May be covered by Medicare.

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.

Standard Error
In statistics, the standard error is defined as the standard deviation of an estimate. That is, multiple measurements of a given value will generally group around the mean (or average) value in a normal distribution. The shape of this distribution is known as the standard error.

State Unit on Aging
Authorized by the Older Americans Act. Each state has an office at the state level which administers the plan for service to the aged and coordinates programs for the aged with other state offices.

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.

Supplemental Security Income (SSI)
A program of support for low-income aged, blind and disabled persons, established by Title XVI of the Social Security Act. SSI replaced state welfare programs for the aged, blind and disabled in 1972, with a federally administered program, paying a monthly basic benefit nationwide of $284.30 for an individual and $426.40 for a couple in 1983. States may supplement this basic benefit amount.

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.

Survey
An investigation in which information is systematically collected.

T

Technology Assessment
A comprehensive form of policy research that examines the technical, economic, and social consequences of technology applications.

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

Title XVIII (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).

Title XX Services
(Now known as Social Services Block Grant services.) Grants given to states under the Social Security Act which fund limited amounts of social services for people of all ages.

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.

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.

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.

U

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.

Undue Hardship
With respect to the provision of accommodation for an individual with a disability under the Americans with Disabilities Act....significant difficulty or expense, considered in light of the employer's financial resources, facilities, workforce, and business operations.

V

Visiting Nurse Association (VNA)
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.

Vital Statistics
Statistics relating to births (natality), deaths (mortality), marriages, health, and disease (morbidity).

W

Wellness
A dynamic state of physical, mental, and social well-being; a way of life which equips the individual to realize the full potential of his or her capabilities and to overcome and compensate for weaknesses; a lifestyle which recognizes the importance of nutrition, physical fitness, stress reduction, and self-responsibility.

Workers' Compensation Program
State-mandated system under which employers assume the cost of medical treatment and wage losses for employees who suffer job-related illnesses or injuries, regardless of who is at fault. In return, employees are generally prohibited from suing employers, even if the disabling event was due to employer negligence. U.S. government employees, harbor workers, and railroad workers are not covered by state workers' compensation laws, but instead by various federally administered laws.

 
 
 
     
     
 
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