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Saturday, November 22, 2014
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 Glossary

Here you will find definitions of terms and phrases frequently used in eldercare, senior housing and geriatric medicine. To find a specific word, click on the first letter below to go to that section or use your browser’s “Find” feature (usually “CTRL+F”).

Glossary Index: 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


24-hour Controlled Access: Facility provides control of all points of entry/exit 24-hrs a day for the security of the residents.

Accreditation: A designation issued by an independent body to an organization. The accrediting body establishes standards and requirements for organizations in a field or industry. To become accredited, the provider implements practices that meet the established standards and requirements. Providers are generally required to complete some type of self-assessment process and undergo an on-site review conducted by representatives of the accrediting body to verify that the standards and requirements are applied. Accrediting bodies typically also have procedures for sanctioning and removing accreditation from those organizations that are not meeting standards and requirements. Accreditation bodies are not government agencies or regulatory bodies. Some examples of accreditation bodies for the senior housing and care industry include, but are not limited to, CARF (Commission on Accreditation of Rehabilitation Facilities), CARF-CCAC (Continuing Care Accreditation Commission), and JCAHO (The Joint Commission on the Accreditation of Healthcare Organizations).

ACHCA: The American College of Health Care Administrators (ACHCA) aspires to be the leading force in promoting excellence in leadership among long-term care administrators. Founded in 1962, ACHCA is a non-profit membership organization which provides superior educational programming, certification in a variety of positions, and career development for its members. Guided by the vision that dynamic leadership forges long term health care services that are desired, meaningful, successful, and efficient, ACHCA identifies, recognizes, and supports long term care leaders, advocating for their mission and promoting excellence in their profession.

Activities of Daily Living (ADLs): Physical functions that an independent person performs each day, including bathing, dressing, eating, toileting, walking or wheeling, and transferring into and out of bed.

ADA (Americans with Disabilities Act): Passed by Congress in 1980, this law establishes a clear and comprehensive prohibition of discrimination on the basis of disability.

Adaptive / Assistive Equipment: An appliance or gadget that assists user in the operation of self-care, work or leisure activities.

Administration on Aging: An agency of the U.S. Department of Health and Human Services. AOA is an advocate agency for older persons and their concerns at the federal level. AOA works closely with its nationwide network of State and Area Agencies on Aging (AAA).

Administrator: In most cases, a licensed professional who undertakes the duty of managing day-to-day operations of a senior housing facility such as a skilled nursing facility or assisted living facility.

Adult Day Care: Structured programs with stimulating social activities as well as health-related and rehabilitation services for the elderly who are physically or emotionally disabled and need a protective environment. The participant is usually brought to the care facility in the morning and leaves in the evening. Transportation may be provided.

Adult Day Health Care: Provision of care and services in a residential health care facility or approved extension site, on an outpatient basis, under the medical direction of a physician. Services are in accord with a comprehensive assessment of care needs and individualized health care plan.

Adult Family Home: Facility that provides a more private, home-like setting, typically in a residential neighborhood and serves a limited number of residents who receive care from live-in caretakers. Group meals are served and help is given with ADLs. Usually housekeeping and laundry is taken care of and some activities are provided. Amenities and nursing services vary widely in these facilities, so it’s best to check each location for specifics. (Also called Group Home, Personal Care Home, Board and Care Home, Residential Care Facility and Adult Foster Care.)

Advanced Directives: A written statement of an individual's preferences and directions regarding health care. Advanced Directives protect a person's rights even if he or she becomes mentally or physically unable to choose or communicate his or her wishes.

Area Agencies on Aging: An Area Agency on Aging (AAA) is a public or private non-profit agency, designated by the state to address the needs and concerns of all older persons at the regional and local levels. “Area Agency on Aging” is a generic term — specific names of local AAAs may very. AAAs are primarily responsible for a geographic area, also known as a PSA, that is either a city, a single county or a multi-county district. AAAs may be categorized as: county, city, regional planning council or council of governments, or private, non-profit.

AAAs coordinate and offer services that help older adults remain in their home - if that is their preference - aided by services such as Meals-on-Wheels, homemaker assistance and whatever else it may take to make independent living a viable option. By making a range of options available, AAAs make it possible for older individuals to choose the services and living arrangement that suit them best.

Cancer: Disease that develops when cells in the body begin to grow out of control. Normal cells grow, divide and die. Instead of dying, cancer cells continue to grow and form new abnormal cells. Cancer cells often travel to other body parts where they grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells get into the bloodstream or lymph vessels. Cancer cells develop because of damage to DNA. DNA is in every cell and directs all its activities. When DNA becomes damaged the body is able to repair it. In cancer cells, the damage is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. Many times, DNA becomes damaged by exposure to something in the environment, like smoking.

Caregiver: Any individual who takes care of an elderly person or someone with physical or mental limitations.

CARF International: CARF International is an independent, non-profit organization that promotes quality, value and optimal outcomes of services through a consultative accreditation process centered on enhancing the lives of the persons served. CARF, through the Continuing Care Accreditation Commission (CCAC) is the nation’s only accreditor of continuing care retirement communities (CCRC) and aging services networks.

Case management: A term used to describe formal services planned by care professionals who help the patient or the family determine and coordinate necessary health care services and the best setting for those services.

Catheter: A hollow flexible tube for insertion into a body cavity, duct or vessel to allow the passage of fluids or distend a passageway. Its uses include the drainage of urine from the bladder through the urethra or insertion through a blood vessel into the heart for diagnostic purposes.

Center for Medicare and Medicaid (CMS): Formerly the U.S. Health Care Financing Administration, CMS is the part of the Department of Health and Human Services that finances and administers the Medicare and Medicaid programs. Among other responsibilities, CMS establishes standards for the operation of nursing facilities that receive funds under the Medicare or Medicaid programs.

Certificate of Medical Necessity: A document completed and signed by a physician to certify a patient's need for certain types of durable medical equipment (i.e. wheelchairs, walkers, etc.).

Certified Home Health Care: An entity that provides, at a minimum, the following services which are of a preventative, therapeutic, health guidance and/or supportive nature to persons at home and/or at a senior housing facility: nursing services; home health aide services; medical supplies, equipment and appliances suitable for use in the home; therapies such as physical, occupational, speech/language pathology and respiratory therapy; nutritional services and social work services.

Certified Nursing Assistant (CNA): Provides personal care to residents or patients, such as bathing, dressing, changing linens, transporting and other essential activities. CNAs are trained, tested, certified and work under the supervision of an RN or LPN.

Certified Relocation and Transition Specialists (CRTS) are dedicated professionals who provide a spectrum of moving and age-in-place services for senior clients, their families and caregivers. While there is diversity in services, all CRTS professionals 1)provide a home assessment to determine client needs, 2) create transition timetables, 3) coordinate resources, 4) perform or supervise sorting, packing, moving, downsizing, organizing and resettlement services, and 5) produce a final project evaluation.

Charge Nurse: An RN or LPN who is responsible for the supervision of a unit within a nursing facility. The charge nurse schedules and supervises the nursing staff and provides care to facility residents.

Chronic Obstructive Pulmonary Disease (COPD): A group of chronic respiratory disorders characterized by the restricted flow of air into and out of the lungs. The most common example is emphysema.

Cognitive Impairment: A diminished mental capacity, such as difficulty with short-term memory.

Colostomy: A removable, disposable bag that attaches to the exterior opening of a colostomy (stoma) to permit sanitary collection and disposal of bodily wastes.

Concierge Service: Facility provides concierge service similar to that found in a hotel. Concierge will typically run errands, schedule transportation, help out with activities, etc.

Congestive Heart Failure (CHF): A common type of heart disease characterized by inadequate pumping action of the heart.

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

Continuing Care Retirement Community (CCRC): A residential community for the remainder of one's life, with a choice of services and living situations. Seniors can move between Independent Living, Assisted Living and Nursing Home Care based on changing needs at each point in time. These communities allow seniors to "age in place," with flexible accommodations that are designed to meet their health and housing needs as they change over time. It is different than other senior homes in that residents entering CCRCs sign a long-term contract (often a lifetime contract) that provides for housing, services and nursing care, usually all in one location, enabling seniors to remain in a familiar setting as they grow older. (Also called Life-Care Facility and Life-Care Community.)

Continuum of Care: Care services available to assist individuals throughout the course of a disease. This may include Independent Living, Assisted Living, Nursing Care, Home Health, Home Care and Home and Community Based Services.

Convalescent Home: See Skilled Nursing Facility.

Custodial Care: Board, room and other personal assistance services (including assistance with activities of daily living and taking medicine) that may not include a skilled nursing care component.

Dementia: Describes a group of symptoms that are caused by changes in brain function. Dementia symptoms may include asking the same questions repeatedly; becoming lost in familiar places; being unable to follow directions; getting disoriented about time, people and places; and neglecting personal safety, hygiene and nutrition. People with dementia lose their abilities at different rates. Dementia is caused by many conditions. Some conditions that cause dementia can be reversed and others cannot. The two most common forms of dementia in older people are Alzheimer’s disease and multi-infarct dementia (sometimes called vascular dementia.) These types of dementia are irreversible, which means they cannot be cured.
Reversible conditions with symptoms of dementia can be caused by a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland or a minor head injury. Sometimes older people have emotional problems that can be mistaken for dementia. Feeling sad, lonely, worried or bored may be more common for older people facing retirement or coping with the death of a spouse, relative or friend. Adapting to these changes leaves some people feeling confused or forgetful. Emotional problems can be eased by supportive friends and family, or by professional help from a doctor or counselor. (NIA, NIH)

Depression (Depressive Disorder): An illness that involves the body, mood and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months or years. Appropriate treatment, however, can help most people who suffer from depression.

Developmental Disability (DD): Refers to a serious and chronic disability, which is attributable to a mental or physical impairment or combination of mental and physical impairments. Those affected have limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity of independent living, economic self-sufficiency. Afflictions included in this category include cerebral palsy, retardation, thyroid problems, seizures and quadriplegia.

Diabetes: Disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

Dialysis: A treatment that removes waste and fluid from the body when kidneys no longer work well enough to keep the body healthy. When kidneys go below 15% of their normal function, dialysis or kidney transplant is necessary to remove waste and fluid from the body.

Director of Nursing (DON): 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.

Dual Eligibles: Someone who is qualified for both Medicaid and Medicare.

Durable Power of Attorney for Health Care (DPAHC): A legal document in which a competent person gives another person (called an attorney-in-fact) the power to make healthcare decisions for him or her if unable to make those decisions. A DPA can include guidelines for the attorney-in-fact to follow in making decisions on behalf of the incompetent person.

Dysphagia: A swallowing disorder often depicted by difficulty in oral preparation for swallowing. The person has difficulty moving material from the mouth to stomach.

Emergency Call System: Facility provides some or all units with an emergency call system such as call buttons in important locations in the unit.

Emphysema: One of the two most common forms of chronic obstructive pulmonary disease (COPD), which are disorders that persistently obstruct bronchial airflow in and out of the lungs. Emphysema is marked by an abnormal accumulation of air in the lung's many tiny air sacs, a tissue called alveoli. As air continues to collect in these sacs, they become enlarged and may break or be damaged and form scar tissue. The result is labored breathing and an increased susceptibility to infection. The other common COPD is bronchitis.

Enriched Housing: A licensed adult care facility established and operated for the purpose of providing long-term residential care to five or more adults, primarily persons 65 years of age or older, in community-integrated settings resembling independent housing units. Such programs must provide or arrange for the provision of room, board, housekeeping, personal care and supervision.

Family-Style Food: Facility has set-meals and meal times that are served family style in a group dining setting.

Financial Counseling Program: Helps seniors with managing their finances, bills and completing Medicaid, Medicare or insurance forms. (from LTC Insurance)

Foot Care: Facility provides assistance to residents with foot care such as nail clipping, applying ointments, etc.

Fully-Fenced and Gated: Facility is fully fenced and gated for purposes of controlled entry and exit.

Full-Service Kitchen: Facility provides units with a full-service kitchen for seniors who can live independently and operate a kitchen safely.

Geriatric Care Manager: A geriatric care manager is a professional who specializes in assisting older adults and their families with long-term care arrangements. Care managers have extensive knowledge about costs, quality and availability of services in their community and can connect you with the services which will be right for you or a loved one.
Services provided by geriatric care managers include:
• Individualized care-planning assessments to identify issues and need for services.
• Assistance with development of a comprehensive plan of care which meets the needs of your specific situation.
• Guidance in anticipating and planning for future needs.
• Assistance in evaluating eligibility for benefits and referral to appropriate legal/financial professionals.
• Assistance with implementation of the care plan, including in-home assistance or relocation to an appropriate senior living setting.
• Functioning as liaison for families at a distance to ensure that needs are being met and families are kept informed.
• Ongoing education, support and advocacy for clients utilizing any part of the health care or long-term care delivery system.
Benefits of Care Management Services
The benefits of utilizing care management services are many and may include:
• Personalized services, either short-term or ongoing to meet your needs.
• Accessibility (24 hour availability).
• Continuity of care management.
• Cost effectiveness: the care manager's knowledge and expertise can help you avoid costly mistakes by carefully matching appropriate services to client's needs.
Selecting a Care Manager
There are a variety of agencies which provide Care Coordination or Geriatric Care Management. In selecting the agency you wish to work with, you may want to ask about the following:
• Staff Training and Qualifications.
• What is staff's educational and work background?
• How long have they been providing care management services?
• What are their professional credentials and affiliations? (i.e., membership in the National Association of Professional Geriatric Care Managers)
Health Care Directive: A written legal document that allows a person to appoint another person (agent) to make health care decisions should he or she be unable to make or communicate decisions.

Health Care Power of Attorney: The appointment of a health care agent to make decisions when the principal becomes unable to make or communicate decisions.

Heart Disease: Any disorder that affects the heart's ability to function normally. The most common cause of heart disease is narrowing or blockage of the coronary arteries, which supply blood to the heart itself. This happens slowly over time and is known as Coronary Artery Disease or CAD.

Heart Failure (HF) (Congestive Heart Failure): The inability of the heart to pump enough blood to meet the needs of the body’s other organs. This can cause fluid to build up in the body, which is seen as swelling (edema), most commonly in the lower legs and ankles. Heart failure (HF) also reduces the kidneys' ability to dispose of sodium and water, making edema worse. Fluid can also collect in the lungs and interfere with breathing, causing shortness of breath. HF is almost always a chronic, long-term condition, although it can sometimes develop suddenly. It may affect the right side, the left side, or both sides of the heart. Most areas of the body can be affected when both sides of the heart fail. In HF, the failing heart keeps working, but inefficiently. The most common causes of HF are coronary artery disease (CAD), previous heart attack and hypertension (high blood pressure).

HIPAA (The Health Insurance Portability and Accountability Act of 1996): 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 are considered as taxable income.

HMO (Health Maintenance Organization): An organization that, for a prepaid fee, provides a comprehensive range of health maintenance and treatment services (including hospitalization, preventive care, diagnosis, and nursing).

Home Health Services: Skilled nursing care and medical services provided in a home setting. Services may be provided by a nurse, therapist (occupational, speech or physical), social worker or home health aide. (Also called Home Health Agency or HHA.)

Hospice Care (Palliative Care): Care provided to enhance the life of a person in the end stages of life rather than the use of heroic lifesaving measures. Today, many senior housing facilities and acute care settings offer hospice services. Hospice care, typically offered in the last six months of life, emphasizes comfort measures and counseling to provide social, spiritual and physical support to the dying patient and his or her family.

HUD Subsidy: HUD (Housing and Urban Development) is a federal program that provides affordable independent housing for the elderly and disabled. Most individuals that qualify for HUD must pay approximately 30% of their monthly income to rent. HUD takes care of the remaining 70%. Eligibility requirements may include income, assets and age. (Also called HUD Senior Housing.)

Incompetence: Determined by a legal proceeding. Requires that the individual is incapable of handling assets and exercising certain legal rights.

Incontinent: Partially or totally unable to control bladder and/or bowel functions.

Independent Living Communities: A residential living setting for elderly or senior adults who are very independent and have few medical problems. Residents live in fully equipped private apartments or cottages from studios to large two-bedroom units that may be rental-assisted or market-rate depending on the community. Social activities and fine-dining meals are often available and residents can select the services they want, often at an additional fee. Generally referred to as elderly housing in the government-subsidized environment. (Also called Senior Apartments, Elderly Housing, Congregate Care and Senior Housing.)

Instrumental Activities of Daily Living (IADLs): Secondary level of activities (different from ADLs, such as eating, dressing, and bathing) important to daily living, such as cooking, writing and driving.

Intermediate Care Facility/Mentally Retarded (ICF/MR): A licensed facility with the primary purpose of providing health or rehabilitative services for people with mental retardation or people with developmental disabilities.

IV / Infusion Therapies: The way that liquid solutions or liquid medications are administered directly into the blood stream through an intravenous catheter inserted in a vein in the body. Infusion therapies can include total parenteral nutrition, antibiotics or other drugs, blood and chemotherapy.

Kitchenette: Facility has small, limited-service kitchen in some units so the residents can prepare their own meals. Appliances vary, so check with each facility for specifics.

Licensed Nursing Care: Care provided by registered nurses (RN), licensed practical nurses (LPN), delegation nurses and nurses’ aides. Some facilities such as Nursing Homes and Skilled Nursing Facilities are designed for those who need 24-hour nursing care and have on-site medical teams that set them apart from other types of senior housing. Part-time licensed nursing care may also provided at Assisted Living and Adult Family Home facilities and can be contracted to serve Independent Living Communities.

Licensed Practical Nurse (LPN): LPNs are trained to administer technical nursing procedures as well as provide a range of healthcare 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) that 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. (Also called Life-Care Facility and Continuing Care Retirement Community or CCRC.)

Living Will: A legal document in which a competent person directs in advance that artificial life-prolonging treatment not be used if he or she has or develops a terminal and irreversible condition and becomes incompetent to make healthcare decisions.

Long-Term Care: Care given in the form of medical and support services to persons who have lost some or all of their capacity to function due to an illness or disability.

Long-Term Care Facilities: A range of institutions that provide health care to people who are unable to manage independently in the community. Facilities may provide short-term rehabilitative services as well as chronic care management.

Long-Term Care Insurance: An insurance policy designed to help alleviate some of the costs associated with long-term care. Benefits are often paid in the form of a fixed dollar amount (per day or per visit) for covered expenses and may exclude or limit certain conditions from coverage.

Managed Care: Can best be described as the partnership of insurance and a healthcare 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 healthcare 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 healthcare agencies.

Massage Therapy: The manipulation of muscle and connective tissue to enhance the function of those tissues and promote relaxation and well being. Therapeutic massage can ease tension and reduce pain. Massage therapy is a form of physical therapy. It can be highly effective for reducing the symptoms of arthritis, back pain, carpal tunnel syndrome and other disorders of the muscles and/or nervous system.

Medicaid: The federally supported, state operated public assistance program that pays for health care services to people with a low income, including elderly or disabled persons who qualify. Medicaid pays for long term nursing facility care, some limited home health services, and may pay for some assisted living services, depending on the state.

Medical Director: The medical director 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. A staff medical director assumes overall responsibility for the formulation and implementation of all policies related to medical care.

Medicare: The federal program providing primarily skilled medical care and medical insurance for people aged 65 and older, some disabled persons and those with end-stage renal disease.

Medicare Part A: Hospital insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care and some home health care. Most people get Medicare Part A automatically when they turn 65.

Medicare Part B: Medical insurance that helps pay for doctors' services, outpatient hospital care and some other medical services that Part A does not cover (like some home health care). Part B helps pay for these covered services and supplies when they are medically necessary. A monthly premium must be paid to receive Part B.

Medicare Supplemental Insurance: This is private insurance (often called Medigap) that pays Medicare's deductibles and co-insurances and may cover services not covered by Medicare. Most Medigap plans will help pay for skilled nursing care, but only when Medicare covers that care.

Medications Management / Medication Administration: Formalized procedure with a written set of rules for the management of self-administered medicine, as in an Assisted Living setting. A program may include management of the timing and dosage for residents and could include coordination with a resident's personal physician. In most cases, the medication cannot be administered by staff; the resident must take the medication by him/her self. However, if licensed nursing staff is available, injections can be arranged for residents.

Medigap Insurance: A term commonly used to describe Medicare supplemental insurance policies available from various companies. Medigap is private insurance that may be purchased by Medicare-eligible individuals to help pay the deductibles and co-payments required under Medicare. Medigap policies generally do not pay for services not covered by Medicare.

Memory Loss: Unusual forgetfulness that can be caused by brain damage due to disease, injury or severe emotional trauma. Can be known as impaired memory or amnesia. The cause determines whether memory loss comes on slowly or suddenly and whether it is temporary or permanent. Normal aging may result in trouble learning new material or requiring a longer time to recall learned material. However, it does not lead to dramatic memory loss unless diseases are involved.

Mental Health Counseling: A collaborative effort between a counselor and a patient to: help patients identify goals and potential solutions to problems that cause emotional turmoil; seek to improve communication and coping skills; strengthen self-esteem; and promote behavior change and optimal mental health.

Multiple Sclerosis (MS): A chronic, unpredictable neurological disease that affects the central nervous system (CNS). The CNS consists of the brain, spinal cord and the optic nerves. Surrounding and protecting the nerve fibers of the CNS is a fatty tissue called myelin, which helps nerve fibers conduct electrical impulses. In MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis. These damaged areas are also known as plaques or lesions. Sometimes the nerve fiber itself is damaged or broken. Myelin not only protects nerve fibers, but also makes their job possible. When myelin or the nerve fiber is destroyed or damaged, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted, and this produces the various symptoms of MS.

Music Therapy: The use of music in therapy; the therapeutic use of music. Music can be used to aid in relaxation and to restore, maintain and improve emotional, physical, physiological and spiritual health and well being.

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. (from LTC Insurance)

Non-Ambulatory: Inability to walk independently, usually bedridden or hospitalized.

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.

Nurse Assistant: Work under the supervision of a Registered Nurse or Licensed Practical Nurse. 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.

Nursing Facility (NF): Licensed to provide custodial care, rehabilitative care (such as physical, occupational or speech therapy) or specialized care for Alzheimer's patients. Additionally, nursing facilities offer residents planned social, recreational and spiritual activities. See ‘Skilled Nursing Facility’

Occupational Therapist: Evaluate, treat and consult with individuals whose abilities to cope with the tasks of everyday living are threatened or impaired by physical illness or injury, psychosocial disability or developmental deficits. Occupational therapists work in hospitals, rehabilitation agencies, long-term-care facilities and other health-care organizations.

Occupational Therapy: A creative activity prescribed for its effect in promoting recovery or rehabilitation. This is done to help individuals relearn activities of daily living and is generally administered by a licensed therapist.

Ombudsman: A public/government/community-supported program that advocates for the rights of all residents in senior housing facilities. Volunteers visit local facilities weekly, monitor conditions of care and try to resolve problems involving meals, finances, medication, therapy, placements and communication with the staff.

Osteoporosis:Disease in which bones become fragile and more likely to break. If not prevented, or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine and wrist.

Parkinson’s Disease: A chronic, progressive disorder of the central nervous system (CNS) that belongs to a group of conditions called motor system disorders. Parkinson's is the direct result of the loss of cells in a section of the brain called the substantia nigra. Those cells produce dopamine, a chemical messenger responsible for transmitting signals within the brain. Loss of dopamine causes critical nerve cells in the brain, or neurons, to fire out of control, leaving patients unable to direct or control their movement in a normal manner.

Patient Assessment: Also called resident assessment. A standardized tool that enables senior housing facilities to determine a patient's abilities, what assistance the patient needs and ways to help the patient improve or regain abilities. Patient assessment forms are completed using information gathered from medical records, discussions with the patient and family members and direct observation.

Personal Care: Involves services rendered by a nurse's aide, dietician or other health professional. These services include assistance in walking, getting out of bed, bathing, toileting, dressing, eating and preparing special diets.

Pet Therapy: Animal-assisted therapy (AAT), also known as pet therapy, utilizes trained animals and handlers to achieve specific physical, social, cognitive, and emotional goals with patients. Studies have shown that physical contact with a pet can lower high blood pressure and improve survival rates for heart attack victims. There is also evidence that petting an animal can cause endorphins to be released. Endorphins are chemicals in the body that suppress the pain response. These are benefits that can be enjoyed from pet ownership, as well as from visiting therapeutic animals.

Physical Therapy: Services provided by specially trained and licensed physical therapists in order to relieve pain, restore maximum function, and prevent disability or injury. These can include massage, regulated exercise and treatments involving water, light, heat and electricity.

Power of Attorney: A legal document allowing one person to act in a legal matter on another's behalf pursuant to financial or real-estate transactions.

Pre-Admission Screening: An assessment of a person's functional, social, medical and nursing needs to determine if the person should be admitted to nursing facility or other community-based care services available to eligible Medicaid recipients. Trained pre-admission screening teams conduct screenings.

Private Funds (Private Pay Patients): Patients who pay for their own care out of private funds, either their own, from family or from another third party such as an insurance company. The term is used to distinguish patients from those whose care is paid for by governmental programs (Medicaid, Medicare, and Veterans Administration).

Program of All-Inclusive Care for the Elderly (PACE): Programs that serve individuals with long-term care needs by providing access to the entire continuum of health care services, including preventive, primary, acute and long-term care. A basic tenet of the PACE philosophy is that it is better for both the senior with long-term care needs and the healthcare system to focus on keeping the individual living as independently as possible in the community for as long as possible.

Prospective Payment System (PPS): Method by which skilled nursing facilities are paid by Medicare.

Provider: Someone who provides medical services or supplies, such as a physician, hospital, x-ray company, home health agency or pharmacy.

Psychotropic Drugs: Antidepressants, anti-anxiety drugs, and anti-psychotic drugs used for delusions, extreme agitation, hallucinations or paranoia. They are often referred to as mind or behavior altering drugs.

Qualified Medicare Beneficiaries (QMB): A federally required program where states must pay the Medicare deductibles and co-payments as well as Part B premiums for Medicare beneficiaries who qualify, based on income and resources.

Quality Assurance Director: Coordinates quality assurance programs and policies for the facility. This person is responsible for quality assurance only and must be a licensed nurse.

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 manner.

Reasonable and Necessary Care: The amount and type of health services generally accepted by the health community as being required for the treatment of a specific disease or illness.

Registered Nurse (RN): Graduate trained nurse who has both passed a state board examination and is licensed by a state agency to practice nursing. A minimum of two years of college is required in addition to passage of the state exams. 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.

Rehabilitation: Therapeutic care for persons requiring intensive physical, occupational or speech therapy in order to restore to the patient to a former capacity.

Resident Assistant (RA): Generally work in assisted living residences and provide direct personal care services to residents but they are not certified CNAs. Depending on the state, this position is also available in some nursing facilities.

Residential Care Facility: Group living arrangements that are designed to meet the needs of people who cannot live independently but do not require nursing facility services. These homes offer a wider range of services than independent living options. Most provide help with some of the activities of daily living. In some cases, private long-term care insurance and medical assistance programs will help pay for this type of service. (Also called Board and Care Home.)

Resident Care Plan: A written plan of care for nursing facility residents developed by an interdisciplinary team that specifies measurable objectives and timetables for services to be provided to meet a resident's medical, nursing, mental and psychosocial needs.

Respiratory Therapy: Assists patients with breathing difficulties to reduce fatigue and increase tolerance in performing daily activities.

Respite Care: Scheduled short-term care provided on a temporary basis to an individual who is normally cared for by family or support groups at home. The goal of scheduled short-term care is to provide relief (respite) for the caregivers while providing supervised and/or nursing care for the individual. Respite care is also used while transitioning persons from in-patient hospital stay to home.

Restaurant-Style Food: Facility offers restaurant-style dining where residents can select items from a menu.

Restorative Therapy: Therapy services that are performed with a reasonable expectation that the individual’s function will improve significantly in a reasonable and predictable period of time, based upon an assessment of the individual’s restoration potential made by a physician or mid-level practitioner in consultation with the licensed therapist. Therapy services are not restorative therapy if the individual’s expected restoration potential would be insignificant in relation to the extent and duration of services required. Therapy services are no longer restorative therapy if at any time after commencement of treatment, it is determined that the reasonable expectation of significant improvement in function will not materialize. (from Montana Medicaid Therapy Service Provider Manual)

Seek Exits: A tendency to look for ways to exit the building that is part of the “wandering” trait associated with dementia and Alzheimer’s disease. It is important that seniors who exhibit this trait be cared for in facilities that have locked doors and, if possible, alarms on exits that will alert staff if someone exits the facility.

Senior Apartment: Age-restricted multi-unit housing for older adults who are able to care for themselves. Usually no additional services such as meals or transportation are provided. (Similar to Independent Living.)

Senior Citizen Policies: Insurance policies for those over the age of 65. In many cases these policies are in combination with coverage provided by the government under the Medicare Program.

Senior Housing: Independent living units, generally apartments. Any supportive services, if needed, are through contract arrangement between tenant and service provider.

Skilled Nursing Care: Nursing and rehabilitative care that can be performed only by, or under the supervision of, licensed and skilled medical personnel.

Skilled Nursing Facility: A facility that is staffed with 24-hour on-site licensed professionals for the care of the frail elderly who require a high level of medical care and assistance. Services include medical care, psychosocial and personal services. Residents typically share a room and take group meals in a dining area unless they are too ill to participate. Activities are also available for those who can participate. Some facilities have special units for Alzheimer’s residents and for short-term rehabilitative stays for those recovering from an illness or accident. (Also called Convalescent Care, Nursing Center and Long-Term Care Facility.)

Speech Therapy: This type of service helps individuals overcome communication conditions such as aphasia, swallowing difficulties and voice disorders. Medicare may cover some of the costs of speech therapy after client meets certain requirements.

Stroke (Apoplexy, Cerebrovascular Accident): An interruption of blood flow to the brain causing paralysis, slurred speech and/or altered brain function. It may be caused by a blood clot blocking circulation or by bleeding into brain tissue causing tissue damage. A stroke can happen when a blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke. A hemorrhagic stroke occurs when a blood vessel breaks open due to trauma or an aneurysm ruptures causing blood to leak into the brain.

Sub-Acute Care: A level of care designed for the individual who has had an acute event as a result of an illness and is in need of skilled nursing or rehabilitation but does not need the intensive diagnostic or invasive procedures of a hospital.

Sub-Acute Care Facilities: Specialized units often in a distinct part of a nursing facility. Provide intensive rehabilitation, complex wound care and post-surgical recovery for persons of all ages who no longer need the level of care found in a hospital.

Subsidized Senior Housing: A program that accepts Federal and State money to subsidize housing for older people with low to moderate incomes.

Sundown Syndrome: Also known as Sundowning or Sundowner’s. An ailment that causes symptoms of confusion after "sundown." These symptoms appear in people who suffer from Alzheimer's disease or other forms of dementia. Not all patients who suffer from dementia or Alzheimer's exhibit Sundowner's symptoms, however. Conversely, some people exhibit symptoms of dementia all day, which grow worse in the late afternoon and evening, while others may exhibit no symptoms at all until the sun goes down.

Supplemental Security Income (SSI): A federal program that pays monthly checks to people in need who are 65 years or older or who are blind or otherwise disabled. The purpose of the program is to provide sufficient resources so that any one who is 65 or older, blind or otherwise disabled can have a basic monthly income. Eligibility is based on income and assets.

Support group: Facilitated gathering of caregivers, family, friends or others affected by a disease or condition for the purpose of discussing issues related to the disease.

Tax Qualified: The tax deductibility of long-term care insurance premiums depending upon meeting the federal government's threshold of personal adjusted gross income.

Total Parenteral Nutrition (TPN): Typically administered through a large vein in the body because of its high concentration of ingredients. Individuals who are unable to eat or who do not receive enough calories, essential vitamins and minerals from eating can receive enough nutrients from TPN to maintain their weight. This type of nutrition requires a doctor's order.

Traumatic Brain Injury (TBI): Usually the result of a sudden, violent blow to the head. Such a blow can launch the brain on a collision course with the inside of the skull. The skull itself can often withstand a forceful external impact without fracturing. The result — an injured brain inside an intact skull — is known as a closed-head injury.

Urostomy Pouch: A pouch that is worn to collect urine if a patient has had a urostomy. This is a surgery done to create an opening in the abdomen that urine passes through. This is performed when a bladder has to be removed or isn't functioning properly.

VA Benefits: Benefits allowed to veterans for housing and care.

Ventilator: Also known as a respirator, is a machine that pushes air into the lungs through a tube placed in the trachea (breathing tube). Ventilators are used when a person cannot breathe on his or her own or cannot breathe effectively enough to provide adequate oxygen to the cells of the body or rid the body of carbon dioxide.

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