Glossary of Terms
It’s important to familiarize yourself with the wording and terms associated with Home Healthcare. Below you will find a list associated with Home Care by Black Stone.
AAccelerated Death Benefit A life insurance policy benefit that lets the insured person use some of the policy's death benefit prior to death for purposes such as long-term care. Activities of Daily Living (ADLs) Everyday functions and activities that people usually do without help. Examples of ADLs are:
- Bathing, Dressing, Grooming, Eating, Bed mobility, Transferring, Toileting, and Walking.
- Many insurance policies use the inability to perform a certain number of ADLs (such as 2 of 6) to determine eligibility for benefits.
- Gradual memory loss,
- Decline in ability to perform routine tasks,
- Disorientation in time and space,
- Impairment of judgment,
- Personality change,
- Difficulty in learning, and
- Loss of language and communication skills.
BBoard and Care Homes These are group living arrangements (sometimes called group or domiciliary homes) that are designed to meet the needs of people who cannot live independently, but do not require nursing home services. In some states, these may be considered similar to assisted living programs. These homes offer a wider range of services than independent living options. Most provide help with some of the activities of daily living, including:
- Bathing, and
CCapitation A method of compensation for health care services under which doctors and other health care providers are paid a fixed monthly fee for each HMO member under their care, rather than for each service or treatment they perform. Care Manager (Case Manager) A social worker or healthcare professional who evaluates, plans, locates, coordinates and monitors services with an older person and the family. A care manager is defined by the National Association of Professional Geriatric Care Managers as a "professional with a graduate degree in the field of human services or a substantial equivalent, certified or licensed at the independent practice level of his or her state or profession, who is trained and experienced in the assessment, coordination, monitoring, and direct delivery of services to the elderly and their families." Centers for Medicare and Medicaid Services (CMS) The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Program, and works to make sure that the beneficiaries in these programs have access to high quality health care. Certified A long-term care facility, home health agency, or hospice agency that meets the requirements imposed by Medicare and Medicaid is said to be certified. Being certified is not the same as being accredited. Medicare, Medicaid and some long-term care insurance policies only cover care in a certified facility or provided by a certified agency. Certified Nursing Assistant (CNA) CNAs are trained and certified to help nurses by providing non-medical assistance to patients, such as help with eating, cleaning and dressing. Chore/Housekeeping Services These types of services include yard and house maintenance, home and appliance repair, housekeeping, meal preparation, shopping and transportation. No personal care is provided. This service is not covered by Medicare. Chronic Illness or Condition An illness or other condition with one or more of the following characteristics: permanency, residual disability, requires rehabilitation training, or requires a long period of supervision, observation, or care. Typically, it is a disease or condition that lasts over a long period of time and cannot be cured. Cognitive Impairment Deterioration of intellectual ability, such as disorientation as to people, places or time; impairment of short-term or long-term memory; and/or impairment of one's ability to reason; that has progressed to the extent that a person requires substantial supervision by another person. Cognitive impairment includes Alzheimer's disease and other types of dementia. Coinsurance For Medicare, it is the percentage of the Medicare-approved amount that one has to pay after paying the deductible for Part A and/or Part B. For other types of health insurance, it is usually a percentage of billed charges after the deductible is paid. For example, if the deductible was paid and the insurance company then pays 70 percent of the remaining amount of the claim, the coinsurance is 30 percent. ComCare Funded by the Human Services Tax Levy, a county funded program in Montgomery County, Ohio, this program assists in paying for in-home services to keep frail elders out of nursing facilities and living independently as long as possible. The program is for seniors who need supervision or limited assistance to remain independent at home. Once enrolled a case manager works with them to assure needs are met with quality services and that the plan of care is adjusted as needs change. Community-Based Services Services designed to help older people live independently in their own homes, such as adult day care, in-home care and senior centers. Companion A companion provides assistance with shopping, meal preparation, escorting, companionship, and home upkeep. No personal care or nursing care is provided. Conservator Person appointed by the court in a legal proceeding to act as the legal representative of a person who is mentally or physically incapable of managing his or her own affairs. Continuing Care Retirement Communities (CCRCs) CCRCs are housing communities that provide different levels of care based on the needs of their residents--from independent living apartments to skilled nursing in an affiliated nursing home. Residents move from one setting to another based on their needs, but continue to remain a part of their CCRC's community. Many CCRCs require a large payment prior to admission and charge monthly fees beyond that. For this reason, many CCRCs are too expensive for older people with modest incomes. Co-payment This is the portion of a medical expense that is the member's financial responsibility. HMOs generally have fixed low co-payments. Creutzfeldt-Jakob Disease Creutzfeldt-Jakob Disease is a rare, fatal brain disease (sometimes referred to as "mad cow" disease) caused by a transmissible infectious organism, probably a virus.
DDeductible A common cost-sharing arrangement of traditional indemnity insurers under which a policyholder must pay a set amount toward covered services before the insurer is required to pay claims. Typically, HMO members do not pay deductibles. Dementia Dementia is characterized by the loss of intellectual functions (e.g., vocabulary, abstract thinking, judgment, memory loss, physical coordination) to the extent that a person’s daily functioning is affected. It is not a disease in itself, but rather a group of symptoms which may accompany certain diseases or physical conditions. The cause and rate of progression of dementia vary. Some of the well-known diseases that produce it include:
- Alzheimer’s Disease,
- Multi-infarct Dementia
- Huntington’s Disease,
- Pick’s Disease,
- Creutzfeldt-Jakob Disease, and
- Parkinson’s Disease.
- Delusions, and
EElder Care A wide range of services provided at home, in the community and in residential care facilities, including assisted living facilities and nursing homes. It includes health-related services such as rehabilitative therapies, skilled nursing, and palliative care, as well as supervision and a wide range of supportive personal care and social services. Typically, elder care is provided over an extended period of time to people who need another person's assistance to perform normal activities of daily living because of cognitive impairment or loss of muscular strength or control. Elderly Services Program (ESP) A taxpayer-supported program funded by county tax dollars and administered by the Area Agencies on Aging in some Ohio counties for those who do not qualify for Medicaid, but still cannot afford to pay privately for in-home care. ESP clients can have a higher income level (some ESP clients have a co-payment) and a less-severe level of disability than PASSPORT clients. ESP is reserved for those who have no other options; it is the payer of last resort. In other words, ESP clients may not be eligible for services through another source such as Medicare, Medicaid or private insurance. In-home care services, including housekeeping, personal care, medical transportation and home-delivered meals are offered. Emergency Response Systems Allows for 24-hour monitoring and response to medical or other emergencies. Enrollment Area HMOs specify that an individual must reside in a particular area in order to be eligible for plan coverage. Estate All of a person's assets and debts at the time of his or her death. Estate Planning Steps one takes while living to determine what happens to property at death. Estate Tax A tax levied on a person's estate after that person's death. Exclusion A health condition, situation, item, service or expense that an insurance policy does not cover.
FFederally Qualified HMO An HMO that has met certain standards established by the federal government pertaining to quality of care, financial soundness, member services, and similar criteria. Fee-for-service Method of payment under which providers are paid for each service performed. Fiduciary Someone, such as a trustee or guardian, who holds the assets of another person, often with the legal authority and duty to make decisions regarding financial matters on behalf of the other party.
GGatekeeper A term sometimes used to refer to HMO primary care physicians or nurse practitioners because of their responsibility for referring members to specialists or other services. Geriatrician A physician who specializes in the care of the elderly, primarily those who are frail and have complex medical and social problems. Group Practice HMO An HMO that contracts with medical groups to provide healthcare to HMO members. Guardian A person who is appointed by a court and charged with the legal duty to care for another person who is unable to care for himself or herself. Guardianship Similar to a conservatorship, yet severely restricts the legal rights of an elder based on a court's finding of legal incompetence.
HHands-On Assistance The physical assistance of another person without whom the person needing assistance would be unable to perform an activity of daily living. Health Care Power of Attorney Allows a designated representative to decide on the health care of an incompetent person. HMO (Health Maintenance Organization) A health plan that both pays for and provides--or arranges to provide--access to comprehensive medical services. HMOs are reimbursed for services on a fixed monthly basis. Home Health Care (Home Care) Supportive services in the home ranging from skilled nursing care and occupational, physical, respiratory and speech therapy ... to assistance with activities of daily living and housekeeping. This support allows many older people to remain living somewhat independently in their own homes. Homebound A term meaning one is normally unable to leave home or cannot leave home without considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for nonmedical reasons, such as a trip to the barber. Home Health Agency An organization that provides home care services, including skilled nursing care, physical therapy, occupational therapy, speech therapy, and care by home health aides. Home Health Aide A home health aide provides services that support any services that the nurse provides. These services include help with personal care, such as bathing, using the toilet, or dressing. These types of services do not need the skills of a licensed nurse. Medicare does not cover home health aide services unless one is also getting skilled care such as nursing care or other therapy. Training or certification requirements vary from state-to-state, but typical services include assistance with activities of daily living, managing medications and some household tasks. In some states, only licensed home health aides can provide hands-on assistance. Hospice Medical and social programs for terminally ill patients and families either at home or in a facility. The care includes physical care, counseling and support services, but does not attempt to cure any illness. Huntington’s Disease Huntington’s Disease ("HD") is an inherited, degenerative brain disease which affects the mind and body. It currently affects more than 25,000 Americans. HD usually begins during midlife, and is characterized by intellectual decline, and irregular and involuntary movements of the limbs or facial muscles. Other symptoms of HD include:
- Personality change,
- Memory disturbance,
- Slurred speech,
- Impaired judgment, and
- Psychiatric problems.
IIncapacity Can be mental or physical, temporary or permanent. A person can be incapacitated without being incompetent. Incompetence Requires a legal declaration of being found incapable of handling assets and exercising certain legal rights. Incontinence The inability to control urination, bowel movements or both. Independent Practice Association (IPA) HMOs that contract with individual physicians in private practice who provide care to HMO members within a private office setting. Irrevocable Trust A trust that, once executed, cannot be revoked or changed without the consent of the beneficiary. Instrumental Activities of Daily Living (IADLs) These are tasks that, in addition to activities of daily living, one must be able to perform in order to live independently (without the assistance or substantial supervision of another person). Examples include grocery shopping, meal preparation, using the telephone, laundry, light housekeeping, bill paying, and managing medications. Most long-term care insurance policies will not pay benefits solely for the loss of ability to perform IADLs. Intermittent Care Skilled nursing and home health aide services furnished up to 28 hours per week any number of days per week so long as they are less than 8 hours per day. For example: If a patient receives one nursing visit every day along with a home health aide for 2 hours each day, this would equal 21 hours for the week. (7 nursing visits + 14 home health aide hours = 21) Intestate Dying without a legal will.
LLicensed Health Care Practitioner A physician (as defined by the Social Security Act) or a registered professional nurse, licensed social worker, or any other health care worker who meets the requirements of the U.S. Treasury Department. Live-in Service When appropriate, a round-the-clock homemaker can be placed in the home for long or short- term care needs. This Live-in service is perfect when a primary caregiver needs to be away so peace of mind is created for all involved in care. MJ Nursing provides this service in the Black Stone Family of care services. Living Trust A trust created during someone's lifetime to hold assets during that person's lifetime, thereby removing those assets from probate at death. A living trust can be either revocable or irrevocable. It avoids probate and therefore gets assets distributed significantly faster than a will. Assets that a person wants to move to a living trust, such as real estate and bank or brokerage accounts, must be retitled so that the trust becomes the owner. Living Will A legal document that makes known a person’s wishes regarding medical treatments at the end of life. Long Term Care A variety of services provided over an extended period of time to people who need help to perform normal activities of daily living because of cognitive impairment or loss of muscular strength or control. Care may include rehabilitative therapies, skilled nursing, and palliative care, as well as supervision and a wide range of supportive personal care and social services. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Regardless of where it is provided, most long-term care is custodial care, the type of care that is not paid for by Medicare. Long-Term Care Facilities Institutions that provide nursing care to people who are unable to care for themselves and who may have health problems ranging from minimal to serious. These facilities are often used for short-term rehabilitation after hospitalization. Long-Term Care Insurance Long-Term Care Insurance is private insurance designed to cover long-term care costs. Plans vary widely, and it is wise to do some research before purchasing any long-term care policy. Generally, only relatively healthy people may purchase long-term care insurance. Because Medicare generally does not pay for long-term care, this type of insurance policy may help pay for long-term care needed in the future.
MMedigap Insurance Private health insurance policies that supplement Medicare coverage, covering health care costs above those covered by Medicare Part A or Part B. Does not provide benefits for long term care, covering primarily hospital and doctor bills. Managed Care A method of delivering and paying for health care through a system of networks of providers that is a combination of insurance and a health care delivery system. Managed care seeks to ensure the quality and contain the cost of comprehensive medical care, the basic goal of which is to coordinate all health care services received to maximize benefits and minimize costs. Managed care plans use their own network of health care providers and a system of prior approval from a primary care doctor in order to achieve this goal. Managed care plans include HMOs, preferred provider organizations, point of service plans, and similar coordinated care networks. Providers include: specialists, hospitals, skilled nursing facilities, therapists, and home health care agencies. Medicaid/Medical Assistance A jointly funded medical financial Federal-State health insurance assistance program, offering benefits to individuals with limited financial resources, the disabled, and the elderly. Programs vary from state to state, but most health care costs are covered if one qualifies for both Medicare and Medicaid. Medicare Federal program providing health care coverage/insurance for people over 65 years of age, certain younger people with disabilities, and people with End-Stage Renal Disease (ERSD) (permanent kidney failure that must be treated with dialysis or a transplant). Part A covers inpatient care, skilled nursing facility, hospice and short-term health care. Part B covers doctors’ services, outpatient hospital care, and durable medical equipment. It does not provide for long-term care of the elderly except under limited conditions. Medically Necessary Services or supplies that:
- Are proper and needed for diagnosis, or treatment of a medical condition;
- Are provided for the diagnosis, direct care, and treatment of a medical condition;
- Meet the standards of good medical practice in the medical community of one's local area; and
- Are not mainly for the convenience of the beneficiary or his/her doctor.
NNetwork The doctors, clinics, health centers, medical group practices, hospitals, and other providers that an HMO or other managed care plan employs or contracts with to care for its members. Non-Ambulatory Inability to ambulate, walk around, and usually bedridden or hospitalized. Nursing Home A nursing home is a residence that provides room, meals, recreational activities, help with daily living, and protective supervision to residents. Generally, nursing home residents have physical or mental impairments which keep them from living independently. Nursing homes are certified to provide different levels of care, from custodial to skilled nursing (services that can only be administered by a trained professional). One step below hospital acute care, a nursing home provides regular medical supervision and rehabilitation therapy.
OObserved Tasks of Daily Living Observing older adults performance in three IALD domains. Adherence to medication, use of the telephone, self feeding and preparing hot foods are among the most important tasks for independent living for older adults. Occupancy Agreement Generally, assisted living facilities have occupancy agreements that outline terms of residency. The terms should clearly define specific living arrangements for the community and for individuals. Occupational Therapy Occupational therapy helps one to perform daily activities independently. An occupational therapy patient might learn new ways to eat, put on clothes, comb one's hair, and new ways to do other usual daily activities. Ombudsman Independent, nationwide, federally-funded services that work to resolve problems between residents and assisted living facilities, nursing homes and other residential care facilities. Nationwide, there are more than 500 local ombudsman programs. Ombudsmen visit nursing homes on a regular basis. The ombudsman's job is to investigate complaints, advocate for residents, and mediate disputes. Ombudsmen often have very good knowledge about the quality of life and care inside each nursing home in their areas. Open Enrollment Period A one-month period during which employees can enroll in or switch health plans. Opt-out An option available in some types of managed care networks, such as point-of-service plans, in which members can seek treatment from providers outside the network and pay more to do so. Out-of-Pocket Costs Costs for medical services not covered by an insurer or an HMO. Unlike persons with conventional insurance, HMO members incur minimal out-of-pocket costs.
PParaprofessional A trained aide who assists a professional person. Paratransit Services Specialized transportation, such as a wheelchair accessible van, for seniors and other people with disabilities. These services may offer transportation to senior centers, medical care, shopping malls, or specific appointments. Parkinson’s Disease Parkinson’s Disease ("PD") is a progressive disorder of the central nervous system which affects more than one million Americans. Individuals with PD lack a substance called dopamine, which is important in the central nervous system’s control of muscle activity. PD is often characterized by:
- Stiffness in limbs and joints,
- Speech impediments, and
- Difficulty in initiating physical movement.