Activities of Daily Living (ADL's): These are activities that healthy people do everyday without the need of assistance. They include: eating, dressing, bathing, toileting, transferring (like from a bed to a chair), and continence (bladder and bowel control).
Adult Day Care: A daily program of health and social services for people needing daytime supervision, in a group setting outside of the home, to support weak, elderly, or other adults with impairments.
Alternate Facility: A non-nursing home, licensed residence where a variety of personal care services are provided. Examples include: Alzheimer's Facilities, Assisted Living Facilities (ALF's), and Hospices.
Alternate Plan of Care: A benefit in some Long Term Care insurance policies that provides for a negotiated agreement between the insurance company, the policyholder, and the policyholder's doctor, to allow the policyholder to receive care in a setting other than a nursing home. The plan of care will specifically provide the agreed-upon services, which may be changed to suit the changing needs of the policyholder.
Alzheimer's Disease: A progressive form of dementia that results in premature mental deterioration involving loss of memory and cognitive ability. Patients eventually require 24/7 supervision and assistance with activities of daily living.
Alzheimer's Units: Specially designed residences found in skilled nursing facilities and assisted living facilities that provide appropriate care and services for those with Alzheimer's disease.
Assessment: A determination of a person's physical ability or mental capability, conducted by a health professional, based on established medical guidelines.
Assisted Living Facility (ALF): A residence facility that provides personal assistance with activities of daily living, as well as a variety of services that may include meals, laundry, housekeeping, transportation, and medication reminders, as well as social and recreational activities.
Bed Reservation Benefit: This benefit pays for the daily cost of your room and board charges for a limited period of time, when you are in the hospital, or traveling, etc., to prevent losing your room in your absence.
Benefit Period: The maximum amount of time, usually expressed in days or years, that the LTC insurance company will pay the daily benefit amount. Most modern LTC insurance plans allow the benefit period to be extended beyond the original amount to reimburse the policyholder for any unused daily benefits that occur along the way.
Benefit Triggers: Eligibility to receive insurance benefits (claims payments) requires "tripping" the benefit triggers contained in the Long Term Care insurance policy. Typical benefit triggers include: requiring assistance with 2 out of 6 ADL's, or having a significant cognitive impairment (dementia, memory loss, Alzheimer's, etc.
Benefits: The money paid by the insurance company to the policyholder (claimant) for care received, as promised in the Long Term Care insurance policy.
Benefit Limit: The amount that represents the maximum amount of money available to the LTC policyholder. This amount is calculated by multiplying the daily benefit (including any inflation additions) by the number of days in your benefit period.
Caregiver: A person who takes care of someone with a disability or illness.
Care Coordinator: A doctor, a nurse, a social worker, or any other licensed professional whose training includes managing and arranging for long term care services. They are often employed by the insurance company to handle matters pertaining to the welfare of the policyholder/claimant, in the hope that this assistance will also be cost-effective for the company.
Care Plan (Plan of Care): This is a written plan formulated by a health care professional after an assessment has been done on the individual with a chronic illness or disability. The plan provides a detailed outline of the persons needs and which health services are needed to meet those needs, and is approved in writing before the start of care.
Chronically Ill Individual: A physician verifies that the person is unable to perform at least two of the Activities of Daily Living (ADL's) for at least 90 days, which requires the individual to have Substantial Supervision or Hands On Assistance to protect themselves from threats to health or safety.
Cognitive Impairment: Loss of the ability to think, reason or remember, often associated with conditions such as senility, dementia, Alzheimer's, etc.
Cognitive Reinstatement: A provision to continue a policy which has lapsed (providing that back premiums are paid) when the cause of the lapse was due to cognitive impairment.
Continuing Care Retirement Community (CCRC): A residential community for those 55 years and older, providing three levels of living arrangements: Independent Living Units (or apartments), Assisted Living Facilities (or apartments), and Skilled Nursing Home. This arrangement allows residents to remain independent as long as possible, then, when a need arises, they can move up to a higher level of care without moving out of the community.
Custodial Care: Non-medical care for patients needing help with their ADL's, including; eating, dressing, bathing, toileting, transferring, and continence.
Daily Benefit Amount: A specified, maximum, daily dollar amount payable for a covered period of care. Long Term Care insurance policies offer a wide range of choices, in $10. increments, which can be indexed for the rising cost of care with an Inflation Rider.
Elimination Period: (Also known as a deductible) A specified period of time between the initial need for care and the beginning of the payments from the insurance company.
Free-Look Period: Once you are approved for a Long Term Care policy and have received your policy, you have 30 days from the date you received the policy to change any benefit levels up or down, or you can receive a full refund of any monies paid to the insurance company.
Home Health Care: Refers to a wide range of services, from skilled care and physical therapy to personal care--delivered at home or in a residential setting.
Home Health Aid: A licensed individual that performs daily care for those in need of assistance in their homes. These aides provide help with one's Activities of Daily Living (ADL's); eating, dressing, bathing, toileting, transferring, and continence.
Homemaker Services: Assistance with regular household chores and maintenance that may include meal preparation, errands, laundry, shopping, cleaning chores, etc.
Hospice: Provides a variety of services (pain relief, counseling, spiritual, etc) to help ease the pain of terminally ill patients in the last stages of their terminal disease. Hospice also provides support for the family and the primary caregiver.
Inflation Riders: A very important benefit option to consider when purchasing Long Term Care insurance that increases the Daily Benefit (or monthly benefit) annually, either on a simple or compounded basis, to keep up with the ever-increasing cost of LTC services.
Instrumental Activities of Daily Living (IADL's): Includes such activities as: shopping, telephone use, housekeeping, laundry, taking medications, and managing finances.
Intermediate Nursing Care: Assistance provided for stable conditions that require daily, but not 24 hour, nursing supervision. Such care is ordered by the physician and supervised by registered nurses. It is less specialized than skilled nursing care, and is generally needed for a long period of time.
Long Term Care: Medical and support services for persons who have lost some or all of their ability to function due to an illness or disability. LTC services are generally provided away from the hospital, at nursing homes, assisted living facilities, adult day care centers, or in their own homes.
Long Term Care Insurance: Insurance specifically designed to protect individuals and couples from the high cost of long term care services. This insurance pays for care at skilled nursing and convalescent centers (SNF's), assisted living facilities (ALF's), adult day care centers, and in the comfort of your own home--as you choose when the need for daily care arises.
Maximum Lifetime Benefit: The total amount (or limit) that a Long Term Care insurance policy can pay you for covered benefits during your lifetime. LTC insurance policies can also be purchased that provide an unlimited amount of benefits.
Medicaid: State funded welfare system for those meeting poverty guidelines, who cannot afford to pay for needed health care.
Medicare: A government program, administered by the Social Security Administration, which provides health insurance to individuals over the age of 65 and those who are disabled, for hospital and medical expenses. Medicare doesn't not cover long term care expenses.
Medicare Supplement (or Medigap): Private insurance policies that supplement Medicare benefits by covering co-payments and deductibles for medical and hospital expenses. These policies do not pay benefits for custodial or personal care needs, and they do do pay for long term care expenses.
Nursing Home: A licensed facility that provides room and board, with a planned, continuous medical treatment program, including 24/7 skilled, intermediate, and custodial levels of care.
Personal Care: Assistance provided to help an individual with their Activities of Daily Living (ADL's), such as: eating, dressing, bathing, toileting, transferring, and continence. Such assistance is generally provided by trained aides, rather than medical professionals.
Plan of Care: This is a written plan formulated by a health care professional after an assessment has been done on an individual with a chronic illness or disability. The plan provides a detailed outline of the persons needs and which health services are needed to meet those needs, and is approved in writing before the start of care.
Pre-Existing Conditions: Medical conditions that existed 6 months (or more) prior to the effective date of the insurance policy. Some older policies may exclude claims that are the direct result of a pre-existing condition for a specified period of time. Virtually all of today's modern (1995 & later) LTC policies cover pre-existing conditions immediately.
Respite Care: A built-in benefit for virtually all modern (1995 & later) LTC insurance policies, which pays the policyholder for nursing home or home care services specifically designed to temporarily replace the informal, unpaid caregiver for a short period of time--generally 2 to 4 weeks per year.
Skilled Level of Care: Medical and rehabilitative care provided by or under the direction of a physician or other skilled medical personnel available 24/7, and ordered a physician under a Plan of Care.
Skilled Nursing Facility (SNF): A state-licensed institutional setting that provides the Skilled Level of Care. Many SNF's also provide care at the Intermediate or Custodial levels. Not all SNF's are certified by Medicare to provide Skilled Level services.
Spend-Down: Depleting almost all of one's assets, eventually meeting the poverty guidelines for Medicaid eligibility.
Third Party Notification: A built-in benefit for virtually all modern (1995 & later) LTC insurance policies, which gives the policyholder the option of automatically sending any "overdue" premium notices to a third party, as a precaution to prevent the unintentional lapsing of the policy.
Waiver of Premium: A built-in benefit for virtually all modern (1995 & later) LTC insurance policies, which allows you to stop paying premiums while you are receiving facility care (also home health care in some policies) that is covered by the policy.