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Activities of Daily Living (ADLs): People are able to do these activites independently everyday - eating, bathing, dressing, etc.
Acute Care: When an injury develops rapidly that has pronounced
symptoms and has a finite length of 
time,
Acute Care is called for.
Adult Day Care: Services such as social or recreational activities for persons who benefit from daytime supervision. An alternative between care in the home and in an institution.
Ageism: If there is prejudice against people because of their age.
Aging in Place: When an older individual continues to live at home or within the community.
Alternate Facility: Other than a skilled nursing facility, this is a licensed residence where care services are delivered (i.e. hospice, assisted living, Alzheimer's, etc).
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.
Alzheimer's Disease: First described in 1906, this is a form of organic dementia resulting in premature mental deterioration.
Aphasia: Unable to use or understand language.
Assessment: Using established medical guidelines, an assessment is a determination of physical and/or mental status by a health professional.
Asset Protection: The use of methods to achieve protection from Medicaid ""spend-down" requirements, typically provided by irreversible trusts.
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.
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(s) - Secondary: Relatives or others who assist part-time in giving care.
Catastrophic Illness: Illness resulting in sudden temporary or permanent change or significant disruption to a person's normal lifestyle.
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.
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.
Co-payment or Co-pay: Refers to the payment that must be made
at the time of service for Physician Office Visits.
Coinsurance: The amount you are required to pay after you have
met your deductible. The coinsurance
rate is usually an expressed percentage. Example: If the insurance company
pays 80% of the claim. You pay 20%.
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.
Deductible: Is a specified dollar amount which must be paid by the covered individual in each deductible accumulation period before payment of benefits will be made by the insurance company.
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.
Emergency Services: Services provided within 48 hour of an injury or medical emergency.
Exclusions: Specific conditions or circumstances for which the policy will not provide benefits.
Home Health Care: Referst 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: Increases the daily benefit amount on an annual basis.
If elected, increases benefits in order to protect against the effects
of inflation. Most common is the Compound 5% Inflation Rider which increases
the daily benefit amount each year by 5% of the previous years daily benefit
amount. The compound effect really begins to take off around the 20th
year, so if you are younger when you buy, this seems to be the best choice.
If you are in retirement, it's a toss-up between paying for the extra
protection or simply starting out with a higher daily benefit at the beginning.
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 are private insurance policies that supplement Medicare benefits by covering co-payments and deductibles for medical and hospital expenses. These policies do not provide coverage for personal or custodial care.
Medical Necessary: Describes health care treatments, services or supplies which are appropriate and consistent with the diagnosis and treatment of a medical condition according to generally accepted medical standards.
Non forfeiture Benefit: This benefit returns some of the investment if the coverage is eventually lapsed or dropped. 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. The extra cost can add from 10 - 100% to the premium cost depending upon your specifications.
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.
Out-of-pocket expenses: Refers to the amount a covered person will have to pay “Out of their pocket” in a calendar year.
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.
Pre-existing
condition: Condition for which a person received medical care, treatment,
services, medication, diagnosis, or consultation 12 months prior to the
insured person’s effective date of coverage or a condition that produced
symptoms that are distinct and significant enough to establish the onset
of a condition or that the condition manifested itself, where a person
learned in medicine would be able to diagnose the condition because of
those symptoms.
Premium: The amount you pay in exchange for insurance coverage.
Provider: Any person (Doctor, Nurse, Dentist) or institution (hospital or clinic) that provides medical care.
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. Can be 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.
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 which allows you to stop paying
premiums once you are in a period of covered care. Usually applies to
only to a facility stay, although some policies do waive premiums for
approved home health care as well. Date when premium stoppage begins varies
with each company.
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