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Glossary

A

Area Agency on Aging (AAA) - Nonprofit organizations that provide programs and services to promote the well being of older adults in their geographic region.

Abandonment - Relating to senior care, abandonment means the desertion of a vulnerable elder or dependent adult by anyone who has assumed the responsibility for care or custody of that person.

Active Lifestyle Senior Centers - Community-based programs that provide a variety of services that can include social activities, nutrition, and educational and recreational opportunities for older adults.

Accreditation - A seal of approval given by an autonomous, non-government body to a housing and/or service provider. To become accredited, the community or provider must meet specific requirements set by the accreditation entity and is then generally required to undergo a thorough review process by a team of evaluators to ensure certain standards of quality.

ADA (Americans with Disabilities Act) - The Law passed by Congress in 1980, establishing a clear and comprehensive prohibition of discrimination on the basis of disability.

ADLs - Activities of Daily Living is a term used in Home Based Care service that refers to assisting clients with, including, but not limited to

Administrator - A licensed professional who manages the day-to-day operation of a care facility such as a nursing home or assisted living facility.

Adult Care Homes - (See also Assisted Living). Homes provide custodial care for persons who do not need medical intervention but cannot live alone unsupervised. Room and board, activities, administration of medications, medical transportation, assistance with personal hygiene, and 24-hour supervision are provided. Whether a nursing facility, adult care home (also called rest home or assisted living), family care home, or DDA home (group home for developmentally disabled adults) most must be licensed in the state of Virginia.

Adult Day Care - Community-based care designed to meet the needs of functionally and/or cognitively impaired adults who, for their own safety and well-being, can no longer be left at home alone during the day. This care includes structured programs with stimulating social activities and health-related and rehabilitation services. Specialized programs for individuals with Alzheimer's disease or related disorders also exist.

Adult Day Care Respite - A Home-Based Care service for frail older adults in one of the following settings: licensed Adult Day Health Care; licensed Adult Day Care; Alzheimer's Day Care Resource Center, to provide respite for a family caregiver.

Adult Lifelong Learning - Programs offering the continual search for knowledge and skills by seniors and typically affiliated with local universities that offer a wide range of non-credit classes and seminars.

Age Discrimination - Any form of discrimination in the workplace on the basis of age.

Ageism - Any form of prejudice based on age from stereotyping the elderly as incapacitated to denying older people jobs or excluding them from other activities based on age.

Aging in Place - Concept which advocates allowing a resident to choose to remain in his/her living environment despite the physical and or mental decline that may occur with the aging process of aging.

Alzheimer's Disease - (See also Dementia and Memory Impairment). A degenerative age-related disease that impairs an individual's cognitive ability and is characterized by decreased memory, reasoning and the ability to care for oneself. Symptoms may include forgetfulness, wandering, and inability to recognize others. The disease is caused by neuron dysfunction and death in specific brain regions responsible for cognitive functions. Both genetic and environmental factors likely play a role in the development of Alzheimer's.

Alzheimer's/Dementia Care - A treatment center that specializes in providing care for those with Alzheimer's disease with more of the care geared towards supervision of the patient in a safe and controlled environment.

Ambulatory - Describes ability to walk freely and independently, not bedridden or hospitalized.

Arbiter or Arbitrator - A neutral person helping two parties to come to an agreement and resolve a difference or dispute between them. An Arbiter gathers, hears and reviews evidence from opposing parties in order to help them come to a decision and resolve their dispute.

Arbitration - A legal means for resolving a dispute outside of the court system. Arbitration is a voluntary, adjudicative process in which a neutral person conducts a hearing, receives spoken and/or written evidence from the disputants and their witnesses, and renders a decision that may be binding or nonbinding depending on the consent of the disputants. The parties in dispute agree to be bound by their decision.

Assessment - An evaluation, usually performed by a physician, of a person's mental, emotional, and social capabilities.

Assisted Living - A state-licensed program offered at a residential community with services that include meals, laundry, housekeeping, medication reminders, and assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

B

Behavioral Health - Services and treatment for those with mental health issues, intellectual disabilities and substance abuse disorders. Regional Community Service Boards serve as the single point of entry into the Virginia public mental health system.

Board and Care Home - Small to medium-sized group residence that provides residents with a private or shared room, and meals. These homes offer some assistance with activities of daily living, but not skilled nursing.

C

Care Custodian - An individual entrusted with the care and maintenance of another person.

Caregiver - Anyone who provides care (medical, mental or spiritual) to another individual. This individual is typically an adult family member or friend who provides unpaid assistance to another adult who can no longer independently attend to his or her personal needs and/or perform his or her normal activities of daily living. See also Family Caregiver.

Caregiver Education - Instruction, training or study of those who care for someone who is sick, disabled, or otherwise unable to care for themselves.

Caregiver Resources - The “Senior Resource Guide” produced by Senior Advocate, LLC is one of the most complete resources available to caregivers. Information is web based and in printed form. The website Senior Advocate Resources is www.senioradvocateonline.com. A hardcopy of the Senior Advocate Resource Guide is available in many locations and by, request, by calling (757)897-3075.

Additionally, many local churches and non-profits have support and outreach programs that can be invaluable resources for caregivers. There is also a wide array of information available on the web.

Caregiver Training - Workshops and conferences that provide family caregivers with the tools to increase their ability and confidence to handle difficult situations, emotions, and decisions.

Care Management - When care for an older adult becomes necessary, family members may be unaware of the services existing in the community, or may be attempting to coordinate and monitor care from a distance. Care managers can assist the family with this information.

Care Manager - A health care professional, typically a nurse or social worker, who arranges, monitors, or coordinates long-term care services (also referred to as a care coordinator or case manager). A care manager may also assess a patient's needs and develop a plan of care, subject to approval by the patient's physician.

Care Planning - A specific project or definite purpose in regards to those in need of attentive assistance or treatment.

Case Management - A term used to describe formal services planned by care professionals.

Case Monitoring - Describes an individual, group or agency who assists in the creation, implementation and monitoring of a plan of care for an individual.

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, including help with eating, bathing and dressing.

Charge Nurse - A Registered Nurse (RN), or Limited Practice Nurse (LPN) who is responsible for the supervision of a unit within a nursing facility. The charge nurse schedules and supervises nursing staff and provides care to facility residents.

Chronic Diseases - Category of illnesses that have an extended duration, are not typically transmitted by infectious agents, often come on slowly, and are either never fatal or cause death only after considerable period has elapsed.

Chronically Ill Individual - According to federal law, a person who, within the preceding 12-month period, has been certified by a licensed health care practitioner as:

  • being unable to perform, without substantial assistance from another person, at least two activities of daily living, for a period of at least ninety consecutive days, due to a loss of functional capacity or
  • requiring substantial supervision to protect such a person from threats to health and safety due to severe cognitive impairment.

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 and is often associated with disability.

Client Rights Advocate - Individual or organization that ensures the rights of people with developmental disabilities and provides information and training to assist residential and health providers in understanding their responsibilities. Advocate investigates and facilitates resolution of all complaints of violation, withholding or denial or rights made by or on behalf of clients, and makes recommendations for resolution to appropriate parties. Also provides referrals to legal agencies and/or attorneys who can assist in enforcing legal rights that have been violated.

CMS - Centers for Medicare and Medicaid Services is the official repository for information on Medicare and Medicaid. Medicare and Medicaid programs were signed into law on July 30, 1965 by President LBJ. For more history and information go to: http://www.cms.hhs.gov

Codicil - A written amendment to a Will.

Cognitive - Term referring to thinking and reasoning ability. A person that is experiencing cognitive issues will seem forgetful, absent minded and will have difficulty completing tasks that in the past were simple for them to perform. See Alzheimer's disease for more information.

Cognitive Impairment - (See Dementia). 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 senile dementia. The existence of cognitive impairment is determined by clinical evidence and standardized tests that reliably measure the person's impairment.

Coinsurance - For Medicare, it is the percentage of the Medicare-approved amount that you have to pay after you pay the deductible for Part A and/or Part B. For other types of health insurance, it is usually a percentage of billed charges after you pay the deductible. For example, if you have paid the deductible and the insurance company then pays 70 percent of the remaining amount of your claim, your coinsurance is 30 percent.

Community-Based Services - Services designed to help older people live independently in their own homes, such as adult day care and senior centers.

Community Centers - Each local jurisdiction has a community center. Some Senior Centers are independent and some are within the community centers.

Companion Care - (Also Supervision Respite). This Home Based Care service provides companion care and/or protective supervision to frail seniors in their home while the family caregiver is temporarily absent.

Companionship - The state of being with someone.

Companionship Services - Companions visit isolated and homebound elders for conversation, reading, and light errands. Also referred to as "friendly visitor" services.

Complainant - Also called a plaintiff, this person brings an action in a court of law against an entity.

Conciliation - This is a process of independent communications between the disputants and a neutral person over the phone. Conciliation is only one of many forms of mediation whereby disputes may be settled outside a court of law. Other forms of mediation are arbitration and facilitation. The conciliation only becomes legally binding if all parties agree to the decision.

Conflict of Interest - Someone who experiences a conflict of interest cannot be unbiased and therefore is not considered neutral or impartial.

Conflict Resolution – This refers to the broader category of techniques for promoting agreement or a mutual understanding between individuals or groups.

Congregate Housing - Is similar to independent living except that it usually provides convenience or supportive services like meals, housekeeping, and transportation in addition to rental housing.

Congregate Meals Program - Nutritional programs that provide lunches for older adults Monday through Friday in senior centers, community centers and schools. In many cases, these lunches represent the only social outlet for those in attendance and a nominal donation is suggested. This program is also called ‘Meals on Wheels’ with home delivery.

Conservator - A protector, someone appointed by a court to assume responsibility for a child, or for an adult who is not capable of managing his or her own affairs. A court appointed individual for financial matters.

Continence - The ability to maintain control of bowel and bladder function. Or, when unable to maintain control these functions, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).

Continuing Care Retirement Community (CCRC) - Housing that is planned and operated to provide a continuum of accommodations and services for seniors including, but not limited to, independent living, congregate housing, assisted living, and skilled nursing care. A CCRC resident contract often involves either an entry fee or buy-in fee in addition to the monthly service charges, which may change according to the medical services required. Entry fees may be partially or fully refundable and are used primarily as a method of privately financing the development of the project and for payment for future healthcare. CCRCs are typically licensed by the state.

Continuum of Care - Full spectrum of care available at Continuing Care Retirement Communities which may include Independent Living, Assisted Living, Nursing Care, Home Health, Home Care, and Home and Community Based Services.

Convalescent Home - (See also Nursing Home, Skilled Nursing Facility, or Long-Term Care). A state-licensed residential facility that provides room and meals, 24-hour nursing care and activities for convalescent residents and those with chronic and/or long-term care illnesses. In level of care, nursing care is considered one step below hospital acute care. Regular medical supervision and rehabilitation therapy are mandated to be available, and nursing homes are eligible to participate in the Medicaid program.

Copayment - A charge you pay for a specific medical service. For example, you may pay $10 for an office visit or $15 for a prescription and your health plan pays the remainder of the medical charges.

Co-residence - When the extended family lives in a share household as adults.

Counseling - Means to advise, give advice, consult, exchange information and ideas. Mental Health -Many older adults can benefit from counseling sessions for depression, anxiety, grief, interpersonal difficulties, and other mental health concerns. Treatment options include counseling/therapy sessions, education, support groups and/or medication. Medicare, Medicaid, and other insurance may pay for some services.

Covered Benefit or Service - A health service or item that is included in an insurance plan or policy, and that is paid for either partially or fully.

Cueing - Directing or supervising the actions of someone with cognitive impairment, such as showing them how to eat, reminding them which medications to take at the appropriate times, giving visual or verbal reminders for dressing or toileting, etc.

Custodial Care - (See also Personal Care). Care to help individuals meet personal needs such as bathing, dressing, eating, and other non-medical care that most people do themselves, such as using eye drops. Someone without professional training may provide this type of care. Medicare does not pay for custodial care and Medicaid pays very little.

D

Daily Benefit - The insurance benefit amount (in dollars) that a person selects as the basis for their long-term care insurance. However, the daily benefit may not be the actual amount paid for each day an insured person is eligible for a benefit. There are three different methods of computing benefits, but, each insurance policy will use only one of them.

Day Care - (See Respite and Home Health Care). A service for disabled adults in which the person gets care during the day at a center outside of their home.

Deductible - The amount you must pay, usually every year, before your health insurance or Medicare begins to pay benefits.


  1. Expense-Incurred Method - After you qualify for benefits, the insurance will pay the lower of: (1) the expenses you incurred for eligible long-term care services, or (2) the dollar limit of your policy. Most policies bought today pay benefits using the expense-incurred method. Some expense-incurred policies protect a covered person from the situation where expenses exceed the daily limit on some days and are less than the daily limit on other days, by setting up a weekly pool of benefits. That is, the daily benefit is multiplied by 7 to establish a weekly pool of money that can be used to pay all eligible expenses until the pool is exhausted for that week. Under the pool of money approach, any unspent money is often added to the end of the policy to extent the period of coverage. (A few policies use a monthly pool of money.)
  2. Indemnity Method - This method is not based on the specific service received or on the actual expenses incurred. After you qualify for benefits and receive eligible long-term care services, the insurance company will pay a fixed amount directly to you, up to the limit of the policy. The fixed amount is pre-determined by your insurance policy.
  3. Disability Method - After you qualify for benefits, you will receive your full daily benefit even if you don't receive any specific long-term care services. These benefits are yours to spend as you wish.

Dementia - Progressive neurological, cognitive, or medical disorder that affects memory, judgment, and cognitive powers. To properly diagnosis dementia you must obtain a complete medical and neuropsychological evaluation.

Depression - One of the most undiagnosed conditions among seniors, depression is a reversible psychiatric condition. Symptoms include a persistent sad, anxious or "empty" mood, loss of interest or pleasure in activities once enjoyed, and difficulty sleeping.

Developmental Disability (DD) - Affliction characterized by chronic physical and mental disabilities which may include: cerebral palsy, retardation, thyroid problems, seizures, and quadriplegia.

Discharge Planner - A social worker or other health care professional who assists hospital patients and their families in transitioning from the hospital to another level of care such as rehabilitation in a skilled nursing facility, home health care in the patient's home, or long-term care in a nursing home.

Domicile - A person's permanent legal residence for tax purposes and, typically, this is also the address where the person maintains his or her voter's registration.

Donee - A person or organization who receives a gift.

Donor - A person or organization who gives a gift.

Downsizing – The process of relocation for seniors from their primary adult residence to a retirement community and typically a smaller environment with less maintenance.

Director of Nursing (DON) - One who oversees all nursing staff in a nursing home and is responsible for formulating nursing policies and monitoring the quality of care delivered, as well as the facility's compliance with federal and state regulations pertaining to nursing care.

Dressing - The third activity of daily living - Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.

Durable Medical Equipment - Medical equipment that is ordered by a doctor for use in the home. These items, such as walkers, wheelchairs, and hospital beds, must be reusable. Durable medical equipment is paid for under Medicare, subject to a 20% coinsurance of the Medicare-approved amount.

Durable Power of Attorney - (See Power of Attorney).

E

Eating - This is the fourth activity of daily living involving feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table). It does not include preparation of meals.

Elder - Similar to the term senior. People in the 65+ age group become eligible for social Security benefits and are thought of as senior citizens.

Elderhostel - Very popular, older-adult education program in which people over age 62 take short-term courses on college campuses or in educational settings around the world.

Elder Abuse - Elder abuse, of an elder or a dependent adult, takes many forms, including physical, sexual or financial abuse, isolation, neglect, or self-neglect. If you suspect abuse you should make a report to Adult Protective Services (APS). Referrals are received through the Elder Abuse Hotline or from other entities. Situations could involve elders (65 or older) and/or dependent adults (18-64 and physically or mentally impaired) who are reported to be endangered.

Elder Care - A wide range of services provided at home, in the community, and in residential care facilities, including assisted living facilities and nursing homes. Care 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. 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. Most elder care is custodial care, and not paid for by Medicare.

Elder Law - A specialty in legal practice covering issues that affect older people such as estate planning, wills, trusts, and retirement benefits.

Elimination Period - The length of time an insured person must pay for covered services before the insurance company will begin to pay benefits. Unless otherwise noted in the insurance policy, no benefits are payable for any days of an elimination period.

Estate - All of a person's assets and debts at the time of his or her 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. Medicare excludes coverage for most prescription drugs, long-term care, and custodial care in a nursing or private home.

Executor - The person or institution appointed in a will, or by a court, to settle the estate of a deceased person.

Exploitation - The illegal or improper use of an individual or the individual's property and resources without permission. While normally one person exploits another for monetary gain, they may also exploit another to gain a non-monetary advantage over them.

F

Facilitate - To guide a discussion between affected participants in order to get all parties involved in reaching an agreement. See facilitation below.

Facilitation - This process uses an individual, known as a facilitator, to guide the discussion between affected participants in order to get all parties involved in reaching an agreement. Other forms of mediation are arbitration, and conciliation.

Family Caregiver Program - Family Caregivers provide almost 80% of all care needed by frail elderly relatives.

Family Support Groups - Self-help groups for family members caring for loved ones with dementia disorders.

Financial Abuse - This broad category of financial exploitation and misuse of funds includes:

  1. Taking, secreting, appropriating, or retaining real or personal property of an elder or dependent adult for a wrongful use, or with intent to defraud.
  2. Assisting in the above
  3. Taking money or property, forging an older person's signature, getting an older person to sign a deed, will or power of attorney through deception, coercion or influence.
  4. Using an older person's property or possessions without permission.
  5. Promising care in exchange for money or property and not following through.
  6. Confidence crimes, scams, fraud, telemarketing scams, or other acts done under false pretense for financial gain.

Financial Counseling Programs - Help seniors with managing their finances, bills, and completing Medicaid, Medicare or insurance forms.

Frail - Having delicate health, being fragile or weak.

Functional impairment - In gerontology, the term for disability.

G

Gerontology – The study of the aging process and of older people.

Geriatric medicine – The branch of medicine specializing in the problems of elderly people.

Geriatrician - A physician who specializes in the care of the elderly, primarily those who are frail and have complex medical and social problems.

Gift Tax - A tax on gifts to non-charitable beneficiaries. For gifts that exceed the annual gift tax exclusion, the donor is required to file a gift tax return and pay all applicable taxes. The person who receives the gift does not have to pay any gift tax.

Grantor - Also called a trustor, this person is one who creates a trust.

Guaranteed Renewable - Most Medicare Supplement and long-term care insurance policies are guaranteed renewable. That is, the policy cannot be cancelled by the insurance company unless:

  1. You committed fraud in your application for the policy.
  2. You have not paid the required premium and the policy has lapsed, or
  3. benefits have been exhausted. However, the insurance company may increase premiums, but only on an entire class of policies, not just on your policy, and never because of any claims paid to you.

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, concerning personal, not financial matters.

Guardianship - This legal proceeding, by which a person can be declared incompetent to manage their own affairs, involves a representative who is appointed to make decisions on that person’s behalf. A guardian, unlike a person who holds a power of attorney, can overrule a person’s decision, if necessary to care for the person’s needs.

H

Hands-On Assistance - A type of physical assistance without which an individual would not be able to perform an activity of daily living.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) - This act became a law on January 1, 1997. The act states the requirements that a long term care policy must follow in order that the premiums paid may be deducted as medical expenses and benefits not paid be considered as taxable income.

Health Practitioner - One who practices medicine. "Health Practitioner" means a physician, surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, licensed nurse, dental hygienist, licensed clinical social worker or associate clinical social worker, marriage, family, and child counselor, or any other person who is currently licensed.” Source Welfare and Institutions Code (WIC) 15610.37)

Heir - Someone who inherits assets from an estate of another person who has died. The heir does not have to pay income tax or estate tax on the value of the inheritance received.

HMO - Health Maintenance Organization is a type of Medicare managed care plan where a group of doctors, hospitals and other health care providers agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. An HMO is an organized system for providing comprehensive health care in a specific geographic area to a voluntarily enrolled group of members. In an HMO, qualifying individuals must get all of their care from the providers that are part of the plan. If using providers that are outside the HMO plan, services must be paid for out of pocket.

Homebound - Someone who is unable to leave their home, for whatever reason, is said to be Homebound. See also, Home Based Care Program

Home Delivered Meals Program - The Home Delivered Meals Program is designed specifically for home-bound individuals.

Home Health Aides - Individuals who provide non-medical health care to people at home. 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.

Home Health Care - (See also Day 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 in their own homes.

Homemaker Services - Household services done by someone other than yourself because you are unable to do them. These services include shopping, laundry, light cleaning, meal preparation and transportation assistance. Homemakers cannot provide hands-on care.

Hospice Care - Continuous care provided for a terminally-ill person, and his or her family, during the final stages of life. Care and comfort measures provided to those with a terminal illness and their families can include medical, counseling, physical care, support and social services. Hospice care can be provided at home, in a facility with a homelike setting, a hospital or a nursing home. Most hospice care is furnished in-home. The care does not include an attempt to cure any illness.

I

Independent Living - Is a residential living setting for elderly, senior adults or disabled persons that may or may not provide supportive services such as meals, housekeeping, social activities, and transportation. This living arrangement typically encourages socialization by provision of meals in a central dining area and scheduled social programs. Generally referred to as elderly housing in the government-subsidized environment, independent living also includes rental assisted or market rate apartments or cottages where residents usually have complete choice in whether to participate in a community's services or programs.

Instrumental Activities of Daily Living (IADLs) - A secondary level of activities different from ADLs, such as eating, dressing, and bathing. Day-to-day tasks such as preparing meals, shopping, managing money, taking medication, using the telephone, laundry, bill paying and housekeeping. These are tasks that, in addition to activities of daily living, you must be able to perform in order to live independently (without the assistance or substantial supervision of another person.) Most long-term care insurance policies will not pay benefits for the loss of ability to perform IADLs.

Incontinence - The inability to control urination, bowel movements or both. Also see Continence.

Inheritance Tax - A tax that is levied by a state or local government upon those who inherit property; paid by the recipient.

In-Home Assessment - A health professional assessment of a person or situation in the home setting.

In-Home Care - (See Home Health Care).

In-Home Respite - Programs may be staffed by volunteers or paid staff and are intended to give the caregiver a break for a few hours. Typically the fees are modest and the programs are designed for participants with relatively mild impairment and are not equipped or staffed to meet the needs of those with complex or unstable medical conditions. Out-of-Home Respite is offered by some nursing homes for short stays on a cost-per-day basis, at a maximum of thirty days.

Institutionalization - The act of placing or confining an individual to an institution. Can be court directed with seniors who are unable to care for themselves due to poor health or mental illness.

Intestate - Dying without a legal will.

Irrevocable Trust - A trust that, once executed, cannot be revoked or changed without the consent of the beneficiary.

Isolation - The act of systematic exclusion of a victim from all real outside contact.

J

K

L

Legal Services and Advance Directives - Advance directives are documents such as living wills and healthcare powers of attorney that specify your wishes related to healthcare in the event you are unable to speak for yourself.

Licensed 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.

Limited Practice Nurse (LPN) - Trained to administer technical nursing procedures as well as provide a range of health care services, such as administration of medication and changing of dressings. One year of post high school education and passage of a state licensing exam is required.

Life Care Community - A Continuing Care Retirement Community (CCRC) which offers an insurance type contract and provides all levels of care. It often includes payment for acute care and physician's visits. Little or no change is made in the monthly fee, regardless of the level of medical care required by the resident, except for cost of living increases.

Life Tenancy - After the owner sells a home, he or she leases it back and receives a written guarantee (life tenancy) that he or she can continue to live in the home for the rest of his or her life. A life tenancy is often arranged with an annuity set up to pay the rent.

Living 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 re-titled so that the trust becomes the owner.

Living Will - A legal document in which a person states his or her wishes, and which life-prolonging medical measures he or she wants or does not want to be taken, if he or she becomes terminally ill or incapacitated.

Long Term - Covering a relatively lengthy period of time.

Long-Term Care - Provision of services to persons of any age, over an extended period of time, 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. It may also include training to help older people adjust to or overcome many of the limitations that often come with aging. 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 and families provide the majority of care to older relatives, either in the older adult’s home or in the home of the family caregiver.

Long-Term Care Insurance - Privately issued insurance policy which covers the cost of nursing home care, assisted living, and home health care. Premiums are based on age, health, length of deductible period, amount paid, and duration of benefits. Some long-term care insurance policies, which offer potential tax benefits, are called "Tax-Qualified Policies."

Long Term Care Ombudsman (LTCO) - (Also see ombudsman). Independent, nationwide, federally-funded services that work to resolve problems between residents and assisted living facilities, nursing homes and other residential care facilities.

M

Managed Care - Managed care is a combination of insurance and a health care delivery system. The basic goal of managed care 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. Providers include: specialists, hospitals, skilled nursing facilities, therapists, and home health care agencies.

Mandated Reporters - Mandated reporters include persons who have assumed full or intermittent responsibility for the care or custody of an elder or dependent adult, whether or not they are compensated for their services. Mandated reporters include, care custodians, health practitioners, clergy members, employees of county adult protective services agencies and local law enforcement agencies, and employees of financial institutions.

Meals on Wheels - Local agencies provide low cost, hot, nourishing meals to the elderly and disabled, allowing frail, homebound people to remain in their own homes. Call your local Meals on Wheels to see if you or your loved one qualify.

Mediator - A neutral third party who helps facilitate and negotiate a disagreement between parties in order to reach a mutually agreeable understanding of the issues. The desired outcome is a permanent resolution without involving the courts. This saves the parties and taxpayers time and money.

Mediation - Is a process in which a mediator facilitates communication between the disputants to assist them in reaching reconciliation and disputes are settled. Other forms of mediation are arbitration, conciliation, and facilitation.

Medicaid - A jointly funded medical financial Federal-State health insurance assistance program, offering benefits to individuals with limited financial resources, the disabled, and the elderly. Medicaid accounts for about 52 percent of the nation's care costs, and is the source of payment for almost 70 percent of residents in nursing homes. The person must have exhausted nearly all assets and be in a nursing facility that participates in this program. Medicaid can reimburse Nursing Facilities for the long-term care of qualifying seniors, and in some states, Medicaid pays for Assisted Living care through Medicaid waivers.

Medical Director - A staff medical director assumes overall responsibility for the formulation and implementation of all policies related to medical care. The medical director also coordinates with an individual's personal physician to ensure that the facility delivers the care that is prescribed. In some instances, the medical director may be a resident's primary physician.

Medical Supplies, Equipment, and Assistive Devices - There are many types of assistive products and equipment that make it easier for those with physical or cognitive impairments to manage in their home. Medicare Part B helps to pay for some durable medical equipment such as wheelchairs, oxygen equipment, etc. The equipment must be medically necessary, ordered by a physician, and supplied by a Medicare-approved provider. Medicare will usually pay 80% of a monthly rental cost.

Medicare - A federal health insurance program for people age 65 and older and individuals with disabilities. The Social Security Administration administers Medicare. It also provides for hospital and nursing community care (Part A) and physician services, therapies, home health care (Part B) and prescription drug coverage (Part D). The Medicare and Medicaid programs were signed into law on July 30, 1965 by President Johnson. For more history and information go to: www.cms.hhs.gov

Medicare-Certified Agencies - Private duty services by nurses or home health aids which can be paid for by the patient.

Medicare Supplement Insurance - A private insurance policy that covers many of the gaps in Medicare coverage, also known as Medigap Insurance or Medicare Supplemental Insurance. Medicare Supplement Insurance policies work only if you are enrolled in the Original Medicare Plan. Medicare Supplement policies can minimize Medicare copayments and deductibles for covered services, but generally do not offer expanded coverage such as long-term care services or prescription drugs.

Medigap Insurance - (Also see Medicare Supplement Insurance). Private health insurance policies that supplement Medicare coverage, covering health care costs above those covered by Medicare Part A or Part B.

Mentally Incompetent - Someone whose mind has deteriorated so badly that they can no longer be counted on to protect themselves, others or to know right from wrong.

Morbidity - A medical term for illness.

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National Association of Insurance Commissioners (NAIC) - A national organization made up of state officials who are in charge of regulating insurance. They have considerable influence and strive to promote national uniformity in insurance regulations.

Network - A group of doctors, hospitals, pharmacies, and other health care professionals hired by a managed healthcare plan to take care of its members.

Neglect - A person's intentional failure to fulfill a care giving obligation needed to maintain an elder or dependent adult's health and wellbeing.

Neutral Third Party - This is one additional individual, a neutral person or entity who has no interest in the issue being mediated or the outcome of the mediation.

Non-Ambulatory - Ones inability to ambulate, walk around, and usually is bedridden or hospitalized.

Non-Forfeiture Benefits - After a long-term care insurance policy has been in force for a sufficient period of time, your will be entitled to a non-forfeiture benefit if you let the policy lapse. Instead of cancelling the policy, the non-forfeiture benefit allows you to keep it in force as a paid-up policy. Non-forfeiture benefits vary from policy-to-policy and usually include (1) keeping the same benefit amounts, but making the benefit period shorter, or (2) keeping the same benefit period, but with reduced benefit amounts.

Non-Profit (Also Not-for-Profit) - Status of ownership and/or operation characterized by government by community-based boards of trustees who are all volunteers. Board members donate their time and talents to ensure that a not-for-profit organization's approach to caring for older people responds to local needs. Not-for-profit homes and services turn any surplus income back into improving or expanding services for their clients or residents. Many not-for-profit organizations are often associated with religious denominations and fraternal groups. Not-for-profits may also interact with Congress and federal agencies to further causes that serve the elderly.

Normal Age Change - Physical change that is deleterious, is progressive, and normally occurs as people age.

Nurse Assistant - A nurse assistant provides the most personal care to residents, including bathing, dressing, and toileting. Must be trained, tested, and certified to provide care in nursing facilities that participate in the Medicare and Medicaid programs. Nurse assistants work under the supervision of a Registered Nurse or Licensed Practical Nurse.

Nursing Home - (See also Convalescent Home, Skilled Nursing Facility, or Long-Term Care). A state-licensed residential facility that provides a room, meals, help with activities of daily living, recreation, and general nursing care to people who are chronically ill or unable to take care of their daily living needs. A facility that provides 24-hour nursing care and activities for convalescent residents and those with chronic and/or long-term care illnesses. In level of care, nursing care is considered one step below hospital acute care. Regular medical supervision and rehabilitation therapy are mandated to be available, and nursing homes are eligible to participate in the Medicaid program.

Nursing Home Abuse - Abuse and fraud in nursing homes and licensed board and care facilities are to be referred to the Ombudsman Program. All other abuse should be referred to the Elder Abuse Hotline.

Nursing Home Ombudsman - A volunteer who regularly visits nursing homes acting as an advocate for residents and mediating their complaints.

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OAA- Older American Act - The purpose of this Act is to serve the elderly with the greatest social and economic need, giving particular attention to low-income minority individuals and providing services and programs that assist them in maintaining their independence as well as their dignity. Many of the 9 million elderly helped by the Act are able to avoid institutionalization because of the services provided. For more information go to: http://www.aoa.gov

Occupational Therapist - A rehabilitation professional who teaches people to compensate for functional limitations as a result of an injury, illness or disability by learning skills and techniques needed to perform activities of daily living and optimize independence.

Occupational Therapy - A creative activity prescribed for its effect in promoting recovery or rehabilitation. A process to help individuals relearn activities of daily living, generally administered by a licensed therapist.

Older American - An Older American is defined as anyone who is a citizen of the United States of America and at least 55 years of age or older.

Older Worker Programs - The Senior Community Service Employment Program (SCSEP) was established under Title V of the Older Americans Act (OAA). While the SCSEP is authorized by the OAA, it is administered by the U.S. Department of Labor. Program provides part-time employment (and training opportunities) for low-income adults age 55 and older. For more information go to: http://www.aoa.gov

Ombudsman Program - Ombudsman services are free and confidential. Programs provide information related to long-term care issues and investigates complaints involving suspected abuse, neglect, and exploitation of individuals who reside in nursing homes and assisted living facilities.

Out-of-Home Care - Any place, institution, home or facility where a person lives that is not the home they grew up in or lived prior to being moved to the facility. Both Nursing homes and Assisted Living Facilities are examples of Out-of-Home Care types of facilities that provide around the clock care for those in need.

Out-of-Pocket Maximum - The maximum amount of money, in addition to your premiums, that you will be required to pay per year for your health insurance plan's deductibles and coinsurance. This maximum may apply to each family member, or to an entire family.

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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.

Partnership Policy - A type of long-term care insurance policy that allows you to protect (keep) some of your assets if you apply for Medicaid after using your policy's benefits. Only a few states have these policies.

Patients' Rights Advocate - Investigates and resolves complaints received from mental health recipients regarding violations or abuse of rights in licensed health or community care facilities. Advocate for mental health recipients who are unable or afraid to register a complaint. Represent clients during the dispute resolution process.

Personal Care - This Home Based Care service assists clients with activities o daily living including, but not limited to, bathing, dressing, grooming, feeding and toileting.

Personal Emergency Response System - Personal emergency response systems can be lifesavers for persons who live alone, or are frequently home alone. Most systems consist of a button that can be worn as a pendant around the neck or on a wristband. Pressing the button sends a signal via a toll-free number to a national monitoring center which then contacts the subscriber and/or their designated responders (family members, neighbors, 911) and maintains contact until help arrives. Subscribers pay an initial installation/equipment fee and typically $30 to $40 per month for monitoring. Services are usually not covered by Medicare or other insurance companies, but, a number of private companies offer these systems.

Physical Abuse - (See also Abuse). The intentional use of physical force causing pain or bodily harm.

Power of Attorney - A legal document giving someone else, called your “agent” or “attorney-in-fact”, the power to act on your behalf in certain circumstances. A specific power of attorney is for one special purpose, often a single transaction such as buying a house. A general power of attorney gives the person the power to act for you in a variety of transactions, which are usually listed in the document. A durable general power of attorney is one that stays in effect even if you become incompetent. This is a very important document to have in place BEFORE it is needed so someone you trust can manage you affairs. It is important to remember that a power of attorney gives the “power to” do things that you would choose to do yourself, not “power over” you to do things against your will. As long as you are competent, you can overrule your agent’s decisions and you can revoke the power of attorney.

Power of Attorney for Health Care - A written legal document in which one person (the principal) appoints another person to make health care decisions on behalf of the principal in the event the principal becomes incapacitated (the document defines incapacitation). This instrument can contain instructions about specific medical treatment that should be applied or withheld. While its purpose remains essentially the same from state-to-state, the name of this document can var. In Virginia, it is called an Advance Directive.

Psychological Abuse - (See also Abuse). Psychology abuse is the intentional infliction of mental anguish/suffering by use of threat, intimidation, humiliation, or other abusive conduct.

Physical Therapist- A rehabilitation professional who utilizes various therapies to help people maximize mobility, and restore strength and body movement, after an illness or injury such as a stroke, fall, back injury.

Physical Therapy - Process that includes individualized programs of exercise to improve physical mobility, often administered following a stroke, fall, or accident. Physical therapists plan and administer prescribed physical therapy treatment programs for residents to help restore their function and strength.

Plan of Care - The written plan that describes the services and care you need for your health problem. Your plan of care must be prepared or approved by your doctor.

Pre-Existing Condition - An illness or disability for which you were treated or advised about within a certain time period (typically 6-12 months) before applying for an insurance policy. Any pre-existing condition would not be covered during a designated time period (again typically 6-12 months) after the effective date of the policy.

Preferred Provider Organization (PPO) - A type of managed care plan where members have a choice of utilizing healthcare providers in the PPO network, or, hospitals, doctors and other healthcare professionals outside the plan, for an additional cost. Beginning in 2003, PPO plans were available to Medicare beneficiaries in 23 states.

Primary Care Physician - A doctor trained to give you basic care. Your primary care doctor is the one you see first for most health problems. He or she makes sure you get the care you need to stay healthy. He or she also may talk with other more specialized doctors and healthcare providers and refer you to them. In many Medicare managed care plans, you must see your primary care doctor before you see other healthcare providers.

Primary Caregiver - Usually the spouse or adult child, who takes on the primary day-to-day responsibility of caring for the physical, psychological, and social needs of another person.

Probate - The process by which an executor (if there is a will), or a court-appointed administrator (if there is no will), manages and distributes a decedent's property to heirs or beneficiaries.

Provider - A properly-licensed doctor, health care professional, hospital, or other health care facility, including a home health agency, that provides health care or related social services.

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Qualified Long-Term Care Services - Defined by federal law, these are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, and rehabilitative services, and maintenance or personal care services, that are required by a chronically ill individual, and are provided pursuant to a plan of care prescribed by a licensed health care practitioner. Maintenance or personal care services means any care the primary purpose of which is to provide needed assistance with any of the disabilities as a result of which the individual is a chronically ill individual (including the protection from threats to health and safety due to severe cognitive impairment.)

Quality Care - Term used to describe care and services that allow recipients to attain and maintain their highest level of mental, physical, and psychological function, in a dignified and caring way.

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Reasonable Suspicion - An objectively reasonable suspicion of abuse that a person should entertain, based upon the facts, and drawing upon the person's training and experience.

Reinstatement - If a long-term care insurance policy lapses as a result of the insured person's cognitive impairment, it can usually be reinstated in most states retroactive to the date of lapse as though no lapse occurred, with no application required for reinstatement. The request for reinstatement must be made to the insurance company within six months following the date of lapse; the insurance company's requirements for cognitive impairment must be met; and all past due premiums must be paid.

Registered Dietitian - A person who is a certified expert in nutrition or dietetics.

Registered Nurse (RN) - Graduate trained nurse who has both passed a state board examination and is licensed by a state agency to practice nursing. The RN plans for resident care by assessing resident needs, developing and monitoring care plans in conjunction with physicians, as well as executing highly technical, skilled nursing treatments. A minimum of two years of college is required in addition to passage of the state exams.

Rehabilitation - Therapeutic care for persons requiring intensive physical, occupational, or speech therapy.

Rescind - When the insurance company voids (cancels) a policy retroactive to its effective date. Legally, it is as though the policy was never issued.

Residential Care - (See also Assisted Living).

Residential Care Facility - A generic term for a group home, specialized apartment complex or other institution that provides care services where individuals live. The term is used to refer to a range of residential care options including assisted living facilities, board and care homes and skilled nursing facilities. (see Assisted Living.)

Resource Guide - The Senior Advocate Resource Guide is produced by Senior Advocate LLC . Senior Advocate is a Limited Liability Corporation providing resources and information to seniors. Information is web based and in printed form. The web site Senior Advocate Resources is www.Senioradvocateonline.com. In hardcopy, the resource guides are available in many locations. To request a copy, call (757)897-3075.

Respite - (Also called Respite Care, or Respite Services). Permits caregivers to have a break from daily care giving needs by placing a professional caregiver in the home of the care-receiver while the caregiver goes out for a while. It is a State option to allow direct payments, e.g. cash or vouchers, to family caregivers for the purchase of services provided through the National Family Caregiver Support Program. For more information go to: http://www.aoa.gov

Respite Care - Temporary or periodic relief from duties for caregivers, ranging from several hours to several days. Care provided by a third party for people with disabilities, illnesses, dementia or other health problems while their usual caregivers take an occasional break from their care giving responsibilities. Respite care can be provided at home, in the community (e.g., adult day care centers or special respite programs) or overnight in a facility such as a nursing home or assisted living residence.

Reverse Mortgage - A home equity loan for those over 62, which allow a senior to use the equity from his/her home while still living in it. The loan does not usually have to be repaid during the homeowner’s lifetime unless they move.

Revocable Trust - A trust in which a Grantor reserves the right to revoke or change. To protect the final wishes of the Grantor, a trust can become irrevocable upon the death of the Grantor.

Rider - An addition to an insurance policy that changes the provisions of the policy.

S

Self Neglect - A person's failure to provide himself or herself with the necessities of life, such as food, clothing, shelter, adequate medication, and reasonable financial management.

Senior Advocate LLC - Senior Advocate is a Limited Liability Corporation providing information to seniors. Information is web based and in printed form. The web site Senior Advocate Resources is www.Senioradvocateonline.com. A hardcopy of the Senior Advocate Resource Guides are available in many locations and, by request, by calling (757)897-3075.

Senior - A person of advanced age, typically thought of as someone of retirement age, although the most widely definition of a senior is 60 years and older.

Senior Centers - Community-based programs that provide a variety of services that can include social activities, nutrition, and educational and recreational opportunities for older adults.

Senior Apartment - Age-restricted multiunit housing with self-contained living units for older adults who are able to care for themselves. Usually no additional services such as meals or transportation are provided.

Senior Citizen - An elderly person, especially one who is retired.

Skilled Care - Daily nursing and rehabilitative care that can be performed only by, or under the supervision of, skilled medical personnel. This care is usually needed 24 hours a day, must be ordered by a physician, and must follow a plan of care. Individuals usually get skilled care in a nursing home but may also receive it in other places.

Skilled Nursing Care - Skilled care that must be given or supervised by Registered Nurses. Examples of skilled nursing care are intravenous injections, tube feeding, and changing sterile dressings on a wound. Any service that could be safely done by a non-medical person without the supervision of a Registered Nurse is not considered skilled care.

Skilled Nursing Facility (SNF) - A nursing facility (in most cases, a nursing home or sometimes a special unit inside a hospital) that has been certified by Medicare, with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.

Speech Therapist - A rehabilitation professional that provides therapy to overcome speech and communication problems, such as speech difficulties following a stroke. A speech therapist may also provide assistance for managing swallowing problems.

Spend Down - A term used to explain the requirement that an individual use up most of his or her income and assets to meet Medicaid eligibility requirements.

Sub-Acute Care - Typically following a stay in a hospital, this is maintenance care for serious medical conditions that are not urgent or life-threatening. Hospitals typically do not provide sub-acute care on an ongoing basis. Sub-acute care may include long-term ventilator care or other procedures provided on a routine basis either at home or by trained staff at a skilled nursing facility.

Substantial Assistance - Means either hands-on assistance or standby assistance.

Supervision Respite - (Also Companion Care). This Home Based Care service provides companion care and/or protective supervision to frail elderly in the home while the family caregiver is temporarily absent.

Substantial Supervision - Means the continual supervision (which may include cuing by verbal prompting, gestures, or other demonstrations) by another person to protect someone who needs assistance from threats to their health or safety (such as may result from wandering).

Support Groups - A group of people with a common experience, such a disease, disorder, care giving, etc., where one can share one's thoughts, feelings and concerns and receive information and support from other members of the group. Led by a competent facilitator, and having the purpose of providing the members with a forum to exchange "histories," information, encouragement, and hope.

Survivor - In the case of a husband and wife, the surviving spouse.

T

Testate - Dying with a legally valid will.

Testator - The person who makes a will.

Toileting - The fifth activity of daily living is getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

Transferring - The sixth activity of daily living is moving into and out of a bed, a chair or wheelchair.

Trust - A legal arrangement in which an individual (the trustor) gives fiduciary control of property to a person or institution (the trustee) for the benefit of one or more beneficiaries.

Trustee - An individual or organization designated in a trust document to manage the assets held in the trust for the benefit of the trust's beneficiary or beneficiaries.

Trustor - Also called a grantor, a person who creates a trust.

TTY - A text telephone system that allows a hearing-impaired user to type messages to another person and read responses on a small screen. Similar to today's text messaging, a "read only" conversation can exist between two people who each use TTY equipment. Otherwise, a non-hearing-impaired caller can use a relay service where a special operator acts as a go-between to translate the speaker's words into text and text print into voice communication.

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V

Vascular Dementia - A cardiovascular dementing illness of later life characterized by small strokes.

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Waiting Period - (See Elimination Period).

Waiver of Premium - If an insurance policy contains this provision, premiums do not have to be paid while an insured person is receiving benefits if the specified conditions are met.

Will - A written document through which a person disposes of property after death.

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