Glossary
These are GENERAL definitions and do NOT represent specific language that your long-term care policy might include. Always check your policy for the exact definition for the meaning of any term in question or for similar terms you might find here.
Activities of Daily Living (ADLs):
Activities that people do independently everyday - eating, bathing, dressing, moving about (mobility), transferring (for instance from a bed to a chair), using the toilet, and maintaining bladder and bowel continence - used to measure the ability to function.
Acute Care:
Care for illness or injury that develops rapidly, has pronounced symptoms and is finite in length. Medical care that is required for a short period of time to cure a certain illness and/or condition. Payment for this type of care is normally provided by Health Insurance or Medicare.
Adult Day Care:
Social, recreational and/or reahabilitative services provided for persons who benefit from daytime supervision. An alternative between care in the home and in an institution. Refers to health support and rehabilitation services provided in the community to people who are unable to care for themselves independently during the day but are able to live at home at night.
Adult Foster Care:
A live-in arrangement where one adult lives with and is provided care and/or services by an unrelated individual or family. Such arrangements may be certified by the state or managed independently.
Alternate Facility: A licensed residence other than a skilled nursing facility where care services are delivered (i.e. hospice, assisted living, Alzheimer's or Christian Science setting).
Alternate Plan of Care Benefit:
Payment for a special arrangement of services specifically designed to allow the person to reside in a setting other than a nursing facility (i.e. services to provide assistance and capital improvements such as ramps, grab bars and/or durable medical equipment).
Alzheimer's Disease:
A form of organic dementia resulting in premature mental deterioration, first described in 1906 by German neurologist, Alois Alzheimer.
Alzheimer's Units:
Special living units within skilled nursing facilities or assisted living facilities specifically providing care and services for those with Alzheimer's disease.
Assessment:
A determination of physical and/or mental status by a health professional based on established medical guidelines.
Asset Protection:
Willful legal planning to achieve protection from Medicaid ""spend-down" requirements, typically provided by irreversible trusts - recently outlawed by Congress except under specific conditions.
Assisted Living Facility (ALF):
A non-medical institution providing room, board, laundry, some forms of personal care, and usually recreational services. Licensed by state departments of social services, these facilities exist under several names including domiciliary care facility, sheltered house, board and care home, community-based care facility, residential care facility, etc.
Bankruptcy:
An event we are trying to avoid by utilizing the insurance mechanism.
Bed Reservation Benefit:
Pays the cost of reserving you place in a care facility should you need to be hospitalized during a covered stay.
Benefit Period:
The maximum time, usually in days, that a policy will pay the daily benefit. The average stay in a skilled nursing facility is 2.8 years, so many people choose either a 3 year plan (1095 days) or 4 year plan (1465 days) to cover the average stay plus a little time to spare. Others feel safest with an unlimited benefit period.
Capital Improvements:
Permanent physical adaptations to a residence which enables an individual to remain and function in that environment.
Care Coordinator:
A health care professional whose training includes managing and arranging for long-term care services. This person can be a doctor, nurse, social worker or other similarly trained and, licensed professional.
Care Management:
Services provided by a professional, typically a nurse or social worker, to assess, coordinate, and monitor the overall medical, personal, and social services needed by an individual requiring long-term care.
Caregiver, Primary:
The key person (usually a relative) overseeing and providing the care for a person who is incapacitated.
Caregiver, Secondary:
Relatives or others who assist part-time in giving care.
Chronic Care:
Care for an illness continuing over a protracted period of time or recurring frequently. Chronic conditions often begin inconspicuously and symptoms are less pronounced than acute conditions. This is typically the type of health care that is provided through a long-term care policy.
Cognitive Impairment:
Refers to the loss or deterioration of mental capacity in people suffering from conditions such as Alzheimer's disease.
Cognitive Reinstatement:
A provision to continue a policy which has lapsed (providing that back premiums are paid) when the cause of the lapse was due to cognitive impairment.
Continuing Care Retirement Community:
A residential community providing a variety of living arrangements and services from independent living apartments to ALF and SNF care.
Custodial Care:
Services that can be given safely and reasonably by a non-medical person, designed mainly to assist with ADLs, including bathing, eating, dressing and other routine activities.
Daily Benefit Amount:
A specified, maximum, daily, dollar amount payable on a covered period of care. Policies offer a range of choices in ten-dollar increments. Your choice should take into account the local costs of care, how much you could pay for care out of your own resources (without dipping into savings), and how much money or care you could count on from your family. Some policies offer a monthly benefit.
Elimination Period:
A deductible. A specified time period of covered care where no benefits are payable. Ideally, should be selected as the longest period that you could sustain care costs using your available, expendable assets.
Home Health Care:
Refers to a wide range of services, from skilled care and physical therapy to personal care delivered at home or in a residential setting.
Homemaker Services:
Assistance given in managing and maintaining household activities that allows you to remain safely in your home when you can not manage those activities on your own. May include meal preparation, laundry, cleaning, chores, etc.
Inflation Protection:
A rider offered in long-term Care policies which increases the daily benefit amount on an annual basis to guard against the rising cost of care. The most common type is the 5% Compound Inflation Rider which increases the daily benefit amount each year by 5% of the previous years daily benefit amount. This is the best protection of the common riders offered. Other common types of Inflation Protection include 5% Simple Inflation and well as CPI type of inflation options.
Intermediate Nursing Care:
Assistance needed for stable conditions that require daily, but not 24-hour, nursing supervision. Such care is ordered by a physician and supervised by registered nurses. It is less specialized than skilled nursing care, often involves more personal care, and is generally needed for a long period of time.
Long-term Care (LTC ):
Also called custodial care. Assistance, expected to be provided over a long period of time, to people with chronic health conditions and/or physical disabilities who are unable to care for themselves without the help of another person.
Long-term Care Insurance (LTCI):
Insurance available through private insurance companies as a means for individuals to protect themselves against the high costs of long-term care. Medicaid is a means-tested program supported by federal, state, and local funds and administered by each state to provide health care for eligible low-income individuals
Medicare:
A federal government insurance program to assist those age 65 and over and the disabled with medical and hospital expenses. Medicare covers only skilled care in a skilled nursing facility and limited skilled nursing care at home. It does not provide benefits for personal or custodial care. Medicare requires co-payments and deductibles.
Medicare Supplement or Medigap:
Policies offered by private insurance companies that supplement Medicare benefits by covering co-payments and deductibles for medical and hospital expenses. These policies do not provide coverage for strictly personal or custodial care.
Non-forfeiture Benefit:
This benefit offered in some long-term Care policies returns some of the investment if the coverage is eventually lapsed or dropped. This benefit varies significantly though it usually takes the form of a paid-up coverage with reduced benefits. Sometimes this benefit is offered in the form of a "return of premium" which returns all or some of your premium payments after a period of time or upon death. This rider typically increases the annual premium substantially.
Nursing Home:
A facility that provides room and board and a planned, continuous medical treatment program, including 24-hour-per-day skilled nursing care, personal care, and custodial care.
Personal Care:
Refers to assistance provided by another person to help with walking, bathing, eating, and other routine daily tasks. It is provided by aides who are not medical professionals but are trained to help with these tasks.
Respite Care:
Is nursing home or home care that temporarily replaces the existing level of support received from an informal, non paid caregiver for the purpose of providing care and supervision to the patient while relieving the caregiver.
Skilled Nursing Care:
Nursing and rehabilitative care provided by or under the direction of skilled medical personnel - available 24-hours a day & ordered by a physician under a treatment plan. Care can be provided either in a facility setting or at-home. Note: Medicare and Medicaid both have their own definitions of "skilled nursing care" which do not necessarily match those found in LTC policies.
Skilled Nursing Facility (SNF):
A state licensed institutional setting which provides nursing and rehabilitative care provided by or under the direction of skilled medical personnel - available 24-hours a day & ordered by a physician under a treatment plan.
Spend-down:
Depleting almost all assets to meet eligibility requirements for Medicaid.
Survivorship Benefits:
A rider or feature in a long-term Care policy that generally provides that the “surviving” spouse will have no further premium obligations upon the death of the other spouse after both have held the policies for a specific period of time (10 years for example).
Third-Party Notification:
Gives you the option of having the "premium overdue" notice sent to a third party as a precaution to insure that the policy does not unintentionally lapse.
Waiver of Premium:
A provision in a long-term Care policy whereby premiums are “waived” after you go on claim and have received covered care for a specified period of time. Usually applies to only to a facility stay, although some policies do waive premiums for approved home health care as well.
