|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
|NOTE:||Definitions may differ from company to company. Make sure you read and understand any definitions and how they are defined in any contract you are considering.|
Activities of Daily Living
everyday activities used to measure a persons ability to live independently. ADLs
include such things as eating, dressing, bathing, toileting, transferring and continence.
|Top||Acute Care:||Care for
illness or injury that has developed rapidly, has pronounced symptoms and is finite in
|Top||Adult Day Care:||
recreational and/or rehabilitative services provided in the daytime for persons who cannot
remain alone. It includes health and custodial care, and other related support. This care
an alternative to care in the home or in an institution is given in specific
centers on a less than 24-hour basis.
|Top||Adult Day Care Facility:||
facility designated to provide custodial and/or minimum health care assistance to persons
unable to remain alone, often during daytime working hours when the caregiver is employed.
|Top||Adult Foster Care:||A live-in
arrangement where one adult lives with, and is provided care and / or services, by an
unrelated person or family. These arrangements may be certified by the state or managed
against people because of their age.
|Top||Aging in Place:||An older person continues to live at home or within the community, not in an institution.|
|Top||Alternate Care Benefit:||A long-term
care insurance policy provision, which allows for a special arrangement of services
specifically designed to allow the person to reside in a setting other than a nursing
|Top||Alternate Care Facility:||A licensed
residence other than a nursing facility where care services are delivered. Examples: a
hospice, an assisted living facility, an Alzheimers facility or Christian Science
|Top||Alternate Plan of Care:||A plan of care
which is developed to provide services to a policyholder receiving benefits under an
alternate care benefit agreement.
|Top||Alzheimers Disease:||A form of
organic dementia resulting in cognitive impairment first described in 1906 by German
neurologist Alois Alzheimer. Specified levels of impairment trigger benefits under the
long term care insurance policy.
units within nursing facilities or alternate care facilities specifically providing care
and services for those with Alzheimers disease.
services provided on an outpatient (non-hospitalized) basis. Services may include
diagnosis, treatment, surgery and rehabilitation.
services conducted by providers other then primary care physicians.
|Top||Aphasia:||Loss of the
ability to use or understand language.
of physical and / or mental status by a health professional. The assessment is a central
component in long term care insurance coverage and payment of claims. Upon the initiation
of benefits due either to the loss of two or more of the activities of daily living
(ADLs), or a cognitive impairment, an assessment is performed by a healthcare
professional, usually an R.N. This assessment, together with the attending physician
notes, determines the level of functional incapacity and plan of care to be followed in
assisting the policyholder in performing ADLs.
|Top||Assisted Living Facility:||A facility
providing room, board, laundry, some form of personal care such as help with bathing or
dressing, and usually recreation and social services. Licensed by state departments of
social services, theyre known in some states as Community-Based Residential
Facilities or Board and Care Homes. Generally they are less costly than nursing homes.
Assisted living facilities designed specifically for the care of dementia.
|Top||Benefit:||The amount payable by the insurance company to the claimant when the policyholder suffers a loss covered by the policy.|
|Top||Benefit Increase Option:||Also
known as Automatic Increase Benefit and Cost of Living Adjustment Benefit. These are
optional benefits that provide for annual increases in the benefit amount to offset the
effects of inflation. Benefit Increase Options are paid for at the time of issue and
increase the daily policy benefits by either 5 percent compounded or simple interest
factor. Increases begin at the first policy anniversary and continue for the duration of
the insurance policy, except where the insurance carrier caps the increase at
a predetermined amount.
maximum length of time for which benefits will be paid.
certain conditions occur or requirements are met, they will trigger a company to begin
paying on a policy.
person providing assistance to a dependent person because of medical reasons or the
persons inability to conduct routine activities of daily living. A primary caregiver
is the key person usually a relative overseeing and providing care for the
incapacitated person. Secondary caregivers are relatives or others who assist in giving
care to the person.
|Top||Care Management Services:||A
service that may arrange for, coordinate and monitor long term care services. Those
providing the service are usually professional nurses or social workers.
illness resulting in a sudden change or significant disruption to a persons normal
lifestyle. Such changes may be temporary or permanent.
for illness continuing over a long period of time or recurring frequently. Chronic
conditions often begin inconspicuously and symptoms are less pronounced than acute
conditions Long term care insurance is designed to assist people who have loss of capacity
due to chronic illnesses.
|Top||Cognitive Loss:||The deterioration or loss of ones intellectual capacity, confirmed by clinical evidence and standardized tests, in the areas of: (1) short and long term memory; (2) orientation to person, place and time; and (3) deductive or abstract reasoning. This is a trigger for long term care benefits.|
portion of incurred medical expenses, usually a fixed percentage, that a policyholder must
pay out of pocket. Also referred to as co-payment.
houses or group accommodations that provide health care and other support services to
functionally impaired older persons who do not need routine nursing care.
Care Retirement Community (CCRC):
called "life care" communities, these organizations provide living arrangements
and services ranging from independent to assisted to institutional care. Often, CCRCs
require a large initial cash payment, ongoing maintenance fees, assignment of assets or a
combination of all three.
The most common type of long term care services rendered, it
provides assistance with the activities of daily living and generally is performed by a
trained aide, most often in the home. These are services mostly personal care
that can be given safely and reasonably by a person not medically skilled.
Theyre designed mainly to assist with activities of daily living or instrumental
activities of daily living.
daily dollar amount that will be paid to a policyholder when policy requirements are
impairment of cognitive functions (e.g., thinking, memory and personality). Of the elderly
population, 5 to 6 percent have dementia. Alzheimers disease causes about one-half
of these cases; vascular disorders (multiple strokes) cause one-fourth;
other dementias are caused by heart disease, infections, toxic reactions to medicines,
alcoholism and other rarer conditions according to the National Association of Health
Underwriters. Most dementias are not reversible.
classifications of illnesses into which hospital inpatients are grouped. Under Medicare,
hospitals are reimbursed a fixed amount that is determined in advance for each patient
admitted for an illness in a given classification.
of an inpatients medical condition for the purpose of arranging for appropriate
continuing care upon leaving the facility. This planning includes the length of time the
patient will be in the hospital, the expected outcome and whether there are special needs
or requirements on discharge.
devices, equipment and supplies which enable a person to maintain functional ability.
Examples include wheel chairs, walkers and hospital beds.
Power of Attorney:
persons appointment of a representative to act on his or her legal behalf via a
legal document that remains in effect in the event of incapacity of the grantor.
known as the waiting period or deductible. Its the number of days of service after
becoming eligible that the policyholder is responsible for all costs before benefits
become payable. In other words, the period during which no benefits are payable. In the
case of home care, this is the number of home care visits that must be provided as per the
plan of care before daily benefits will be paid. Elimination periods often range from 20
to 100 days.
persons whose physical and emotional abilities or social support system is compromised in
such ways that maintaining a household or social contacts is difficult without regular
assistance from others.
assessment of age based on physical or mental performance rather than on chronological
who need assistance from another person to manage daily tasks.
drugs have the same active chemical ingredients as brand name drugs (the trade name given
to a drug by its manufacturer) but at a lower cost.
study of physical and mental changes in persons as they age including diagnostic
treatment and prevention of disorders.
length of time (usually 31 days) after a premium is due and unpaid that the policy and
applicable riders remain in force.
provision that precludes cancellation of a policy or change in its provisions as long as
the policy stays in force by timely payment of premium. The insurance carrier, however,
may adjust the policys premium by class of insured and/or by state, typically with
care Financing Administration (HCFA):
federal agency that administers Medicare.
Health Care Surrogate:
person designated as having a medical durable power of attorney to make medical decisions
on behalf of another person.
|Top||Health Insurance Portability and Accountability Act (HIPPA), also known as the Kassebaum-Kennedy law:||Milestone
legislation passed by Congress and signed into law in 1996. It sends a strong message that
the federal government wants Americans to plan for their own long term care protection.
The law clarifies tax treatment of qualified long term care policies. It also includes a
provision that makes it a federal crime to willfully dispose of assets to qualify for
Medicaid coverage of nursing home and other long term care services.
or personal care services provided in the home or assisted living facilities. Professional
services include skilled nursing care and physical, speech and occupational therapy.
|Top||Home Health Aide:||Professional,
skilled and personal services delivered in a persons residence.
|Top||Home Health Care:||A
person certified to provide personal care such as bathing and dressing, and who works
under the direction of a registered nurse in a home care agency.
Health Care Agency:
organization providing home health care or home care. Agencies are state licensed as
required, keep clinical records of all patients, and are supervised by a qualified
physician or registered nurse.
coordinated program for control of pain and symptoms for the terminally ill. It also may
provide support services for the family.
to voluntarily control bowel or bladder function.
option within a long-term care insurance policy that will provide an increase in benefits,
as the expected increased costs occur to provide long term care services. The options are
usually simple / compound inflation.
persons admission to an institution, such as a nursing home.
more complex tasks associated with independent living. IADLs include light housekeeping,
taking medications, using the telephone, meal preparation, moving about outside, shopping
|Care requiring intermittent, less intense skilled professional and personal care services.|
|Top||Joint Commission on Accreditation of Healthcare Organizations (JCAHO):||A
private, voluntary accrediting organization for all types of health care providers.
of policy due to non-payment of premiums.
document which enables a person to declare his or her wishes in advance concerning the use
of life-sustaining procedures in the event of a terminal illness or injury when the person
has become incompetent.
Long Term Care:
physical, mental and social care given to individuals who have severe, chronic
impairments. The types of long term care available include nursing home care; alternate
facilities and community care options such as adult day care and home health care.
establishment of control mechanisms before during and after delivery of services that
ensure high quality and cost effective care.
|Top||Meals on Wheels:||A
program designed to deliver meals to the homebound.
national health insurance plan for people over 65, and for some under 65 who are disabled.
It includes two parts; A) covers hospital costs and some short-term skilled nursing care
stays, and B) the supplemental portion for which the person pays premiums covering a
portion of the physicians fee as well as various types of therapy.
type of Medicare supplement coverage where the Medicare recipient "assigns" his
or her benefits to an HMO. The HMO contracts with the federal government to provide
medical services to the Medicare recipient at a capitated rate from the government.
|Top||Medicare Risk Plan:||A
federally funded, state-managed program of medical aid for persons of any age who are
unable to afford regular medical services. Commonly called Title 19.
Supplement Plan (Medigap):
private insurance program designed to pay Medicare coinsurance amounts and other benefits.
Association of Insurance Commissioners (NAIC):
national organization of state officials charged with regulating insurance. NAIC has no
official power but wields considerable influence. The association was formed to promote
national uniformity in insurance regulations.
provision that precludes a cancellation of a policy or a change of any of its terms or
rates by the insurance company, as long as the policy remains in force. The policyholder
need only make timely payments of premiums.
Long Term Care Plans:
do not need certification from a health care professional to receive insurance benefits
under these plans. However, the U.S. Treasury Department has not yet clarified whether
benefits under this plan are taxable as income or whether or not premiums are
taxdeductible. Its a clarification thats long overdue. (See
Tax-Qualified Long Term Care Plans)
through the teaching of an art or a specific occupation for persons physically or mentally
impaired, with the intent to restore functional ability.
Out-of Pocket Expenses:
health care costs that must be paid for by the policyholder because they are not covered
under an insurance contract.
|Top||Over-the Counter Drugs:||Non-prescription medications|
state-level joint public/private sector program that allows consumers to buy an approved
long term care insurance policy to conserve some assets before qualifying for Medicaid.
States with federally authorized partnerships include Connecticut, New York, Indiana and
California. Other states with partnership programs must recover Medicaid costs from the
estates of deceased policyholders, i.e. assets are only protected during the
representative of the nursing facility resident who reviews care, addresses concerns and
provides advocacy support for a patient and his or her family.
|Top||Personal Care Services:||A
component of home care, these services provide assistance with activities of daily living
or instrumental activities of daily living.
for disease or impaired motion through the use of physical methods such as heat,
hydrotherapy, massage, exercise or mechanical devices.
|Top||Physician Assistant:||A person who works under the supervision of a physician and performs tasks such as taking medical histories and making routine examinations.|
legal contract issued by the insurer to the insured that contains all the conditions and
terms of the insurance.
diagnosed injury or sickness for which medical advice or treatment was sought prior to the
effective date of a long term care insurance product.
Provider Organization (PPO):
arrangement in which an insurance company contracts with a number of medical care
providers to furnish services at lower than usual fees in return for prompt payment and a
certain volume of patients.
payment to keep an insurance policy in force.
drug that can be obtained only by means of a physicians written order.
that must be delivered or supervised by a health care professional such as a registered
nurse, therapist or physician.
goal of restoring disabled policyholders to maximum physical, mental and vocational
independence, and productivity commensurate with their limitations.
method of payment in long term care insurance policies. A reimbursement method pays for
incurred expenses up to the limits of the policy.
services for respiratory impairments, such as emphysema and chronic bronchitis.
intermittent relief for family member or other person providing the primary ongoing care
for a person who is functionally or cognitively impaired. These services can be provided
by a home health care agency or other state-licensed facility and may be reimbursable
under long term care insurance policy.
|Top||Restoration of Benefits:||This benefit restores the original policy maximums if an insured has recovered for a stated period, normally 180 days|
attachment to a policy that changes the provisions of that policy.
caring for both dependent children and parents or relatives.
|Top||Senescence:||The normal process of aging|
outdated term for dementia, used when dementia was thought to be a normal part of the
aging process. Likewise, senility also is an outdated term.
|Top||Short Term Stay:||Residence
in a nursing facility usually for rehabilitative or convalescent purposes.
highest degree of medical care. The patient is under the supervision of a physician, care
is provided 24 hours a day, and the facility has a transfer arrangement with a hospital.
Its the only type of care eligible for reimbursement in a skilled nursing facility
and counseling services usually provided by social workers to assist persons with problems
that concern housing, transportation, meals, etc.
services for those with speech impairments.
requirement that a person uses up most of their income and assets in order to meet
eligibility requirements for Medicaid.
provided by nursing homes for health services such as stroke rehabilitation and cardiac
care for post-surgery that offers a lower cost alternative to hospital treatment of the
|Top||Tax-Qualified Long Term:||These
require a 90-day certification period before insurance benefits can be paid. In other
words, a health care professional must certify that a condition is expected to last for
three months or more. This requirement was included in the 1996 Health Insurance
Portability and Accountability Act to help ensure that tax-qualified long term care
insurance provides protection only for "chronically ill persons". (The federal
government anticipates that Medicare Supplement policies will cover many of the costs
associated with shorter term medical conditions.) The tax implications: long term care
premiums are tax deductible if a policyholder itemizes his or her medical expenses and
they total at least 7.5 percent of the persons annual gross income. Benefits
received are not taxable as income.
|Top||Third Party Notice:||An
individual that would be notified by an insurance company if your coverage was about to
end due to lack of premium payment. This person would usually be a relative, close friend,
attorney or an accountant.
professionals who determine if and on what basis an insurer will accept an application for
|Top||Waiver of Premium:||A policy provision of a long term care insurance contract that suspends premium payment after a specified period of time, during which the policyholder is receiving policy benefits for long term care services. The suspension continues until recovery, at which time the resumption of premium payment is expected.|
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