Long Term Care Glossary
Activities of daily living (ADLs)
- the basic activities of caring for oneself: eating, dressing, bathing, using the bathroom ("toileting"), moving back and forth from a bed to a chair ("transferring"), and remaining continent. Insurance companies use the inability to perform a specified number of ADLs to help determine eligibility for long-term care insurance benefits.
Adult day care
- a place that provides a program of activities and services to individuals in need of long-term care. It is a helpful option for individuals living at home whose family caregivers work during the day and who require someone to be with them throughout the day.
- care provided by a doctor or other health care professional designed to treat or cure an illness, wound, or condition. Long-term care is not acute care.
Alternate plan of care
- in certain circumstances, the care coordinators may authorize benefits for services that are not specifically covered under a plan. For example, services to make your home wheelchair-accessible may be approved.
- a progressive neurological disease that affects brain functions, including short-term memory loss, inability to reason, and the deterioration of language and the ability to care for oneself.
- Special living units within skilled nursing facilities or assisted living facilities specifically providing care and services for those with Alzheimer's disease.
Assisted living facility (ALF)
- a licensed residential facility that provides room, board and 24 hour personal care to individuals with long-term care needs. It is an important care option for individuals who are not able to manage at home but do not need the level of skilled care provided in a nursing home.
automatic inflation option - a method of protecting the value of insurance over time. The increase choices are usually compound or simple inflation.
Bed reservations - if you are in a nursing home, assisted living facility, or hospice facility, and you leave that facility, the policy will pay for actual charges you incur to hold a space to enable you to return to that facility.
Benefit - payment an insurance company makes for a service covered under the plan.
Benefit period -the length of time your insurance will last if you receive care every day at a cost equal to or more than your daily maximum benefit amount. If your care costs less, your insurance will last longer than the benefit period. The benefit period is used together with your daily maximum
Benefit amount- your lifetime maximum benefit.
Benefit trigger - a term used by insurance companies for the requirements you must meet in order to become eligible for benefits. Benefits would actually be payable after you meet the benefit trigger and satisfy the required waiting period. Triggers can vary, but there are usually two possible benefit triggers in LTC plans: (1) the inability to perform at least 2 out of 6 activities of daily living for an expected period of at least 90 days or (2) requiring substantial supervision due to a severe cognitive impairment.
Care coordination services - services such as information, advice, and arranging of long-term care by a professional care coordinator.
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 - a caregiver is the person who helps you accomplish the basic everyday activities you can no longer manage without assistance, due to illness, injury, or cognitive impairment. A caregiver could be a friend, neighbor, family member, certified home health aid or nurse.
Cognitive impairment - a deterioration or loss in intellectual capacity that results in impairment in some or all of the following: short and long-term memory, orientation to people, place, and time, deductive or abstract reasoning (including judgment), and ability to perform activities of daily living.
Community-based services - services, such as meals on wheels and adult day care, designed to help people remain independent and in their own homes.
Continence - an activity of daily living (ADL)- the ability of the body to control urination or bowel movements or both.
Custodial care - services aimed at maintaining your health and/or preventing deterioration in your functional status, provided on an extended basis. Long-term care includes custodial care.
Daily benefit amount - A specified, maximum, daily, dollar amount payable on a covered period of care. Policies usually 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.
Eligible group - individuals who are eligible to apply for long-term care insurance coverage under an employer sponsored plan.
Elimination period - the time between becoming eligible for benefits and when your long-term care insurance actually begins paying those benefits. It helps keep premiums affordable: the longer the waiting period, the lower the premiums. Most plans require only one qualification period per insured. If an insured recovers form an ailment and later goes back into claim, that insured does not need to wait through another elimination period.
Exclusions - specific conditions or circumstances for which your insurance will not provide benefits.
Formal care - care which is provided by a home health aide or homemaker arranged or supervised by a home care agency, or provided by a nurse or therapist.
Free look period - a protection which allows you to cancel coverage within 30 days after you receive your benefit booklet and receive a complete refund of any premium you paid.
Full underwriting - the type of underwriting that you would undergo if you applied for an individual policy in the private market. This means that you would have to answer numerous health-related questions It may also include a review of medical records and/or an interview with a nurse.
Future purchase option - an inflation protection feature that allows you to periodically purchase additional coverage without proof of good health.
Guaranteed acceptance - During the initial enrollment period on employer sponsored group plans, all actively at work employees may enroll in the plan without answering any health questions.
Guaranteed renewable - a feature of tax-qualified long-term care insurance plans, whereby an insurance company cannot cancel or fail to renew coverage because of a change in a person's health or age. As long as premiums are paid and benefits have not been exhausted, coverage will continue. When a plan is guaranteed renewable, premiums may be changed on a group basis only.
Hands-on assistance - when you require physical help by another person without whom you would not be able to perform the activities of daily living. Some insurance companies measure the inability to perform activities of daily living based on the need for hands-on assistance only.
Health Insurance Portability and Accountability Act (HIPAA) - Federal health insurance legislation passed in 1996 that specifies conditions under which certain long-term care insurance policies qualify for tax advantages.
Home care - services provided at home which may include nursing care; occupational, physical, respiratory or speech therapy; personal care; and homemaker services.
Home health aides - individuals who provide care to older adults or people with disabilities at home. Training or certification may vary for home health aides, but typical services they provide include assistance with activities of daily living, managing medications, and some household tasks.
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.
Hospice care - care for those individuals who have been diagnosed with a terminal illness is covered at home if the services meet the certain requirements of the plan.
Inflation protection - a feature or option of long-term care insurance coverage that increases the value of benefits over time to keep pace with increasing costs of care.
Informal care - care provided by an unlicensed caregiver whose services are not arranged and supervised by a home care agency.
Lapse - termination of insurance coverage when premium is not paid.
Lifetime maximum benefit - this is the maximum amount of benefits that your insurance coverage could pay. The maximum lifetime benefit can also be referred to as a "pool of money". Your maximum lifetime benefit is calculated by multiplying your daily maximum benefit amount times the number of days in the benefit period you selected.
Long-term care (LTC) - personal care and other related services provided on an extended basis to people who need help with activities of daily living or who need supervision due to a severe cognitive impairment. It can be provided at home, in a nursing home, assisted living facility, or an adult day care center.
Long-term care insurance - insurance that helps defray the costs of assistance with the activities of daily living or the costs of supervision due to a severe cognitive impairment and allows you to receive the type of care you need in the setting that's right for you.
Medicaid - the joint Federal-state program that pays for health care services for individuals who meet their state's poverty guidelines.
Medicare - a Federal health care program for most adults age 65 and older and certain disabled individuals. It pays for long-term care under limited circumstances and for limited periods of time.
Medicare Supplement Insurance (Medigap) - private insurance to help pay hospital and medical costs Medicare does not cover. It pays for long-term car under limited circumstances and for limited periods of time
Nonforfeiture - a feature that provides some value in the event coverage is cancelled.
Nursing home - a licensed facility that provides 24-hour-a-day room and board, nursing care and personal care services. Nursing homes also provide medical care, therapy, and other health related services.
Personal care - care to help you meet personal needs such as bathing, dressing and eating.
Plan of care - a plan prescribed by a licensed health care practitioner that identifies ways of meeting your need for long-term care services.
Pool of money - see Maximum Lifetime Benefit.
Portable coverage - Once you have long-term care insurance coverage, you can keep it, even if you are no longer a member of the eligible group, as long as you continue to pay the required premium and have not exhausted your maximum lifetime benefit.
Premium - the money paid to an insurance company for coverage. Most companies offer a handful of ways you can pay premium (monthly, quarterly, semi-annual and annual). Often times there are accelerated premium payment options (10-Pay, Paid up at 65, Double Pay first year, Reduced pay at 65, etc…)
Reduced paid-up benefit - a provision that allows an insured to stop premium payment and retain a portion of his or her benefits.
Respite services - services by a substitute provider, from a few hours to a few days, to give time off to the regular caregiver.
Return of premium at death - a provision that allows for the return of a portion of the insured's premium, less any benefits paid or payable.
Simplified underwriting - in this type of underwriting, the long-term care insurance application has a reduced amount of health-related questions designed to determine who may be immediately eligible for benefits, or eligible for benefits within a short period of time.
Spend down - depletion of income and assets to meet eligibility requirements for Medicaid (Medi-Cal in California).
Spousal benefits - options offered by some long-term care insurance programs to spouses. The options may include allowing spouses who both qualify for the insurance to pay premiums that are less than if each person had purchased individual coverage and/or allowing spouses to use each other's benefits.
Standby assistance - when you require the presence of another person, within arms reach of you, to help you perform the activities of daily living. Some insurance companies measure the inability to perform activities of daily living based on the need for standby assistance, rather than or in addition to hands-on assistance.
Substantial assistance - hands-on or standby help required to perform activities of daily living.
Substantial supervision - continual monitoring of a cognitively impaired person.
Tax-qualified - conforming to Federal standards that enable the enrollee in a long-term care insurance plan to receive Federal tax advantages.
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.
Toileting - an activity of daily living -- getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene related tasks.
Transferring - an activity of daily living -- the ability to move in or out of a bed, chair or wheelchair.
Underwriting - the process of reviewing an individual's health status to determine eligibility for coverage under a long-term care insurance plan.
Waiver of premium - a provision of most long-term care insurance plans that allows you to stop paying premiums while you are receiving benefits.