Glossary

Activities of Daily Living (ADL)
Physical functions that an independent person performs each day, including bathing, dressing, eating, using the restroom, walking or wheeling, and transferring into and out of bed.

Acute
A sudden and sometimes severe condition.

Adaptive/Assistive Equipment
An appliance or gadget which assists users in the operation of self-care, work or leisure activities.

Advanced Directives
A written statement of an individual's preferences and directions regarding healthcare. Advanced Directives protect a person's rights even if he or she becomes mentally or physically unable to choose or communicate his or her wishes.

Alzheimer's Disease
A progressive and irreversible organic disease, typically occurring in the elderly and characterized by degeneration of the brain cells, leading to dementia, of which Alzheimer's is the single most common cause. Progresses from forgetfulness to severe memory loss and disorientation, lack of concentration, loss of ability to calculate numbers and finally to increased severity of all symptoms and significant personality changes.

Ambulate
To walk.

Aphasia
The loss of ability to express oneself and/or understand language.

Apraxia
Inability to carry out a complex or skilled movement due to deficiencies in cognition.

Assessment
Determination of a resident's care needs, based on a formal, structured evaluation of the resident's physical and psychological condition and ability to perform activities of daily living.

Assisted Living
Senior housing that provides individual apartments, which may or may not have a kitchenette. Facilities offer 24-hour on-site staff, congregate dining, and activity programs. Limited nursing services may be provided for an additional fee.

Audiologist/Audiology
Healthcare professionals specializing in the measurement of hearing and the correction of hearing impairment or hearing loss.

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Bed Sores
See pressure ulcers.

Bedfast
To be bedridden.

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Caregiver
Any individual who takes care of an elderly person or someone with physical or mental limitations.

Case Management
Asystem in which one individual helps the insured person and his or her family determine and coordinate necessary healthcare services and the best setting for those services.

Certificate of Medical Necessity
A document completed and signed by a physician to certify a resident's need for certain types of durable medical
equipment (i.e., wheelchairs, walkers).

Certified Nursing Assistant (CNA)
The CNA provides personal care to residents such as bathing, dressing, changing linens, transporting and other essential activities. CNAs are trained, tested, certified and work under the supervision of an RN or LPN.

Chronic
A lasting, lingering or prolonged illness or symptom.

Chronic Disease
A disease which is permanent, or leaves residual disability, or is caused by non-reversible pathological alteration.

Chronic Obstructive Pulmonary Disease (COPD)
A group of chronic respiratory disorders characterized by the restricted flow of air into and out of the lungs. The most common example is emphysema.

Cognition
The process of knowing and of being aware of thoughts. The ability to reason and understand.

Cognitive Impairment
A diminished mental capacity, such as difficulty with short-term memory.

Co-morbidities
Multiple disease processes.

Companion Care
Nonmedical services that are provided in the resident's home. Examples include, but are not limited to: helping the senior with everyday activities, making meals, grooming and ensuring safety. No medical care is provided.

Congestive Heart Failure (CHF)
A common type of heart disease characterized by inadequate pumping action of the heart.

Conservator
Person appointed by the court to act as the legal representative of a person who is mentally or physically incapable of managing his or her affairs.

Custodial Care
Board, room and other personal assistance services (including assistance with activities of daily living, taking medicine and similar personal needs) that may not include a skilled nursing care component.

CVA
Refers to a cerebrovascular accident or stroke in which an area of the brain is damaged due to a sudden interruption of blood supply.

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Decubitus
See pressure ulcers.

Dementia
Progressive mental disorder that affects memory, judgement and cognitive powers. One type of dementia is Alzheimer's disease.

Developmental Disability (DD)
Refers to a serious and chronic disability, which is attributable to a mental or physical impairment or combination of mental and physical impairments. Those affected have limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity of independent living, economic self-sufficiency. Those who have a developmental disability often require long-term treatment and care-planning.

Diagnostic Related Groups (DRGs)
DRGs are used to determine the amount that Medicare reimburses hospitals for in-patient services. The hospital is reimbursed a fixed amount based on the DRG code for the patient.

Discharge Planner
A social worker or nurse who assists patients and their families with healthcare arrangements following a hospital stay.

Distinct Parts
Separate units in a nursing facility where beds are available only for people whose care is paid for by a specific
payment source, such as Medicare.

Durable Power of Attorney for Health Care (DPAHC)
Alegal document in which a competent person gives another person (called an attorney-in-fact) the power to make healthcare decisions for him or her if unable to make those decisions. A DPA can include guidelines for the attorney-in-fact to follow in making decisions on behalf of the incompetent person.

Dysphagia
A swallowing disorder often depicted by difficulty in oral preparation for swallowing. The person has difficulty moving material from the mouth to stomach.

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Edema
A collection of fluid in the tissues which causes swelling.

Emergency Response Systems
Electronic monitors on a person or in a home that provide automatic response to medical or other emergencies.

End-Stage Renal Disease (ESRD)
Medical condition in which a person's kidneys no longer function, requiring the individual to receive dialysis or a kidney transplant to sustain his or her life.

Exclusion
Any condition or expense for which a policy will not pay.

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Foley Catheter
A tube which is inserted into the bladder in order to drain urine. The urine drains through a tube and is collected in a plastic pouch.

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Geriatrics
The branch of medicine that focuses on providing healthcare for the elderly and the treatment of diseases associated with the aging process.

G Tube
A tube inserted surgically through an opening in the stomach. G tubes offer another means of nutritional sustenance for those individuals unable to use their mouths.

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Healthcare Directive
A written legal document which allows a person to appoint another person (agent) to make healthcare decisions should he or she be unable to make or communicate decisions.

Healthcare Power of Attorney
The appointment of a healthcare agent to make decisions when the principal becomes unable to make or communicate decisions.

Health and Human Services, Department of
An executive department of the federal government that is responsible for the oversight of the Medicare and Medicaid programs.

Hospice
Hospice/palliative care is provided to enhance the life of the dying person. Often provided in the home by health professionals, today there are many nursing facilities and acute care settings that also offer hospice services. Hospice care, typically offered in the last six months of life, emphasizes comfort measures and counseling to provide social, spiritual and physical support to the dying patient and his or her family.

Hospice Care
The provision of short-term inpatient services for pain control and management of symptoms related to terminal illness.

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Incompetence
Determined by a legal proceeding. Requires that the individual is incapable of handling assets and exercising certain legal rights.

Incontinent
Partially or totally unable to control bladder and/or bowel functions.

IV/Infusion Therapies
The way that liquid solutions or liquid medications are administered directly into the blood stream through an intravenous catheter inserted in a vein in the body. Infusion therapies can include total parenteral nutrition, antibiotics or other drugs, blood, and chemotherapy.

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Length of Stay
The time a patient stays in a hospital or other healthcare facility.

Living Will
A legal document in which a competent person directs (in advance) that artificial life-prolonging treatment not be used if he or she has or develops a terminal and irreversible condition and becomes incompetent to make healthcare decisions.

Long-Term Care (LTC)
The broad spectrum of medical and support services provided to persons who have lost some or all capacity to function on their own due to a chronic illness or condition, and who are expected to need such services over a prolonged period of time. Long-term care can consist of care in the home by family members who are assisted with voluntary or employed help, adult day healthcare, or care in assisted living or skilled nursing facilities.

Long-Term Care Facilities
A range of institutions that provide healthcare to people who are unable to manage independently in the community. Facilities may provide short-term rehabilitative services as well as chronic care management.

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Medicaid
The federally supported, state-operated public assistance program that pays for healthcare services to people with low incomes, including elderly or disabled persons who qualify. Medicaid pays for long-term nursing facility care, some limited home health services, and may pay for some assisted living services, depending on the state.

Medical Records Director/Coordinator
Plans and directs the activities and personnel of the department. Coordinates the management of resident medical records and the clerical needs of the nursing department.

Medically Necessary
Medical necessity must be established (via diagnostic and/or other information presented on the claim under consideration) before the carrier or insurer will make payment.

Medicare
The federal program providing primarily skilled medical care and medical insurance for people aged 65 and older, some disabled persons and those with end-stage renal disease.

Medicare Part A
Hospital insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care, and some home healthcare. Most people get Medicare Part A automatically when they turn 65.

Medicare Part B
Medical insurance that helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover (like some home health care). Part B helps pay for these covered services and supplies when they are medically necessary. A monthly premium must be paid to receive Part B.

Medicare-Certified Bed
A nursing home bed in a building or part of a building, which has been determined to meet federal standards for serving Medicare patients requiring skilled nursing care.

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Nasogastric Tube (NG Tube)
A tube that passes through a patient's nose and throat and ends in the stomach. This tube allows for direct 'tube feeding' to maintain the nutritional status of the patient or to remove stomach acids.

Nursing Home
A facility licensed with an organized professional staff and inpatient beds, and that provides continuous nursing and other health-related, psychosocial, and personal services to residents who are not in an acute phase of illness, but who primarily require continued care on an inpatient basis.

Nurse, Licensed Practical (LPN)
A graduate of a state-approved practical nursing education program, who has passed a state examination and been licensed to provide nursing and personal care under the supervision of a registered nurse or physician. An LPN administers medications and treatments and acts as a charge nurse in nursing facilities.

Nurse, Registered (RN)
Nurses who have graduated from a formal program of nursing education (two-year associate degree, three-year hospital diploma, or four-year baccalaureate) and passed a state-administered exam. RNs have completed more formal training than licensed practical nurses and have a wide scope of responsibility including all aspects of nursing care.

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Occupational Therapist
Occupational therapists evaluate, treat and consult with individuals whose abilities to cope with the tasks of everyday living are threatened or impaired by physical illness or injury, psychosocial disability, or developmental deficits. Occupational therapists work in hospitals, rehabilitation agencies, long-term care facilities and other healthcare organizations.

Ombudsman
The Ombudsman Program is a public/government/community-supported program that advocates for the rights of all residents in 24-hour long-term care facilities. Volunteers visit local facilities weekly, monitor conditions of care and try to resolve problems involving meals, finances, medication, therapy, placements and communication with the staff.

Outpatient
A patient who receives care at a hospital or other healthcare facility without being admitted to the facility. Outpatient care also refers to care given in organized programs, such as outpatient clinics.

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Private Pay Patients
Patients who pay for their own care or whose care is paid for by their family or another private third party, such as an insurance company. The term is used to distinguish patients from those whose care is paid for by governmental programs (Medicaid, Medicare, and Veterans Administration).

Personal Care
Involves services rendered by a nurse's aide, dietitian or other healthcare professional. These services include assistance in walking, getting out of bed, bathing, toileting, dressing, eating and preparing special diets.

Physical Therapy
Services provided by specially trained and licensed physical therapists to relieve pain, restore maximum function, and prevent disability or injury.

Power of Attorney
A legal document allowing one person to act in a legal matter on another's behalf pursuant to financial or real estate transactions.

Pre-Admission Screening
An assessment of a person's functional, social, medical, and nursing needs, to determine if he or she should be admitted to a nursing facility or other community-based care services available to eligible Medicaid recipients. Screenings are conducted by trained preadmission screening teams.

Preexisting Conditions
Medical conditions that existed, were diagnosed or were under treatment before an insurance policy was taken out. Long-term care insurance policies may limit the benefits payable for such conditions.

Pressure Ulcers
A breakdown of the skin, to which older, bed-ridden persons are especially susceptible. Also referred to as pressure sores or decubitus ulcers. For bed-ridden persons, prevention includes turning every two hours if tolerated by the resident.

Provider
Someone who provides medical services or supplies, such as a physician, hospital, X-ray company, home health agency, or pharmacy.

Psychotrophic Drugs
Term usually applied to medications that affect a resident's mental state.

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Range of Motion (ROM)
The movement of a joint to the extent possible without causing pain.

Reasonable and Necessary Care
The amount and type of health services generally accepted by the health community as being required for the treatment of a specific disease or illness.

Resident
A person living in a long-term care facility. Since nursing facilities are licensed healthcare facilities, residents are often also referred to as patients.

Resident Assistant (RA)
RAs generally work in assisted living residences and provide direct personal care services to residents, but they are not certified CNAs. Depending on the state, this position is also available in some nursing facilities.

Resident Care Plan
A written plan of care for nursing facility residents developed by an interdisciplinary team which specifies measurable objectives and timetables for services to be provided to meet a resident's medical, nursing, mental and psychosocial needs.

Respiratory Therapy
Assists patients with breathing difficulties to reduce fatigue and increase tolerance in performing daily activities.

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Senile Dementia
Dated term for organic dementia associated with old age. Now referred to as dementia and/or Alzheimer's.

Side Rail
Rails on a hospital-type bed that are meant to protect a patient.

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

Skilled Nursing Facility (SNF)
Provides 24-hour nursing care for chronically ill or short-term rehabilitative residents of all ages.

Speech Therapy
This type of service helps individuals overcome communication conditions such as aphasia, swallowing difficulties and voice disorders. Medicare may cover some of the costs of speech therapy after the client meets certain requirements.

Sub-Acute Care
A level of care designed for the individual who has had an acute event as a result of an illness, and is in need of skilled nursing or rehabilitation, but does not need the intensive diagnostic or invasive procedures of a hospital.

Sub-Acute Care Facilities
Specialized units often in a distinct part of a nursing facility. Provide intensive rehabilitation, complex wound care, and post-surgical recovery for persons of all ages who no longer need the level of care found in a hospital.

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Total Parenteral Nutrition (TPN)
Nutrition administered through a large vein in the body because of its high concentration of ingredients, including vitamins and minerals. This type of nutritional procedure is complex and expensive, and usually not appropriate for extremely frail or elderly residents.

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Ventilator
A ventilator, also known as a respirator, is a machine that pushes air into the lungs through a tube placed in the trachea (breathing tube). Ventilators are used when a person cannot breathe on his or her own or cannot breathe effectively enough to provide adequate oxygen to the cells of the body or rid the body of carbon dioxide.