• Bathing, Dressing, Grooming, Eating, Bed mobility, Transferring, Toileting, and Walking.

Advanced Directives
These are ways for an individual to accept or refuse medical care. They can protect one's rights even if one becomes mentally or physically unable to choose or communicate wishes. Living Wills and Durable Power of Attorney for Health Care are two examples of
advanced directives.

Alzheimer’s Disease
Alzheimer’s Disease ("AD") is the most common of the dementia disorders. It is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior. Symptoms include:

• Gradual memory loss,
   
• Decline in ability to perform routine tasks,
   
• Disorientation in time and space,
   
• Impairment of judgment,
   
• Personality change,
   
• Difficulty in learning, and
   
• Loss of language and communication skills.

Assisted Living (Non-Medical Senior Housing)
Assisted living is a general term for living arrangements in which some services are available to residents (meals, laundry, medication reminders), but residents still live independently within the assisted living complex. In most cases, assisted living residents pay a regular monthly rent, and then pay additional fees for the services that they require.

Board and Care Homes
These are group living arrangements (sometimes called group or domiciliary homes) that are designed to meet the needs of people who cannot live independently, but do not require nursing home services. In some states, these may be considered similar to assisted living programs. These homes offer a wider range of services than independent living options. Most provide help with some of the activities of daily living, including:

• Eating,
   
• Walking,
   
• Bathing, and
   
• Toileting.

Capitation
A method of compensation for health care services under which doctors and other health care providers are paid a fixed monthly fee for each HMO member under their care, rather than for each service or treatment they perform.

Case Manager (Care Manager)
A social worker or healthcare professional who evaluates, plans, locates, coordinates and monitors services with an older person and the family.  A private geriatric care manager is a wonderful resource if you live a long distance away from your loved ones.

A care manager is defined by the National Association of Professional Geriatric Care Managers as a "professional with a graduate degree in the field of human services or a substantial equivalent, certified or licensed at the independent practice level of his or her state or profession, who is trained and experienced in the assessment, coordination, monitoring, and direct delivery of services to the elderly and their families."

These professionals have access to your loved one's needs and home situation and they coordinate and monitor the necessary care and services. They work closely with you and other family members, making it possible to stay involved even if you live far away.

Chore/Housekeeping Services
These types of services include yard and house maintenance, home and appliance repair, housekeeping, meal preparation, shopping and transportation. No personal care is provided. This service is not covered by Medicare.

Companion
A companion provides assistance with shopping, meal preparation, escorting, companionship, and home upkeep. No personal care or nursing care is provided.

Conservator
Person appointed by the court in a legal proceeding to act as the legal representative of a person who is mentally or physically incapable of managing his or her own affairs.

Continuing Care Retirement Communities (CCRCs)
CCRCs are housing communities that provide different levels of care based on the needs of their residents--from independent living apartments to skilled nursing in an affiliated nursing home. Residents move from one setting to another based on their needs, but continue to remain a part of their CCRC's community. Many CCRCs require a large payment prior to admission and charge monthly fees beyond that. For this reason, many CCRCs are too expensive for older people with modest incomes. more

Co-payment
This is the portion of a medical expense that is the member's financial responsibility.  HMOs generally have fixed low co-payments, usually around $5-$10.

Creutzfeldt-Jakob Disease
Creutzfeldt-Jakob Disease is a rare, fatal brain disease (sometimes referred to as "mad cow" disease) caused by a transmissible infectious organism, probably a virus.

Deductible
A common cost-sharing arrangement of traditional indemnity insurers under which a policyholder must pay a set amount toward covered services before the insurer is required to pay claims.  Typically, HMO members do not pay deductibles.

Dementia
Dementia is characterized by the loss of intellectual functions such as thinking, remembering and reasoning to the extent that a person’s daily functioning is affected. It is not a disease in itself, but rather a group of symptoms which may accompany certain diseases or physical conditions. The cause and rate of progression of dementia vary. Some of the well-known diseases that produce it include:

• Alzheimer’s Disease,
   
• Multi-infarct Dementia,
   
• Huntington’s Disease,
   
• Pick’s Disease,
   
• Creutzfeldt-Jakob Disease, and
   
• Parkinson’s Disease.

Depression
Depression is a psychiatric disorder marked by sadness, inactivity, feelings of hopelessness, and sometimes suicidal tendencies. Many severely depressed individuals will have some mental deficits including poor concentration and attention. When dementia and depression are present together, intellectual deterioration may be exaggerated. Depression, whether present alone or in combination with dementia, can be reversed with proper treatment.

Delirium 
A state of temporary but acute mental confusion that comes on suddenly. Symptoms may include:

• Anxiety,
   
• Disorientation,
   
• Tremors,
   
• Hallucinations,
   
• Delusions, and
   
• Incoherence.

Durable Medical Equipment (DME)
Medical equipment that is ordered by a doctor for home use.  These items must be reusable, such as walkers, wheelchairs, or hospital beds.

Durable Power of Attorney
A power of attorney that stays in effect even after the person whom the document represents becomes incompetent.

Emergency Response Systems
Allows for 24-hour monitoring and response to medical or other emergencies.

Enrollment Area
HMOs specify that an individual must reside in a particular area in order to be eligible for plan coverage.

Estate Planning
Steps you can take while living to determine what happens to your property when you die.

Federally Qualified HMO
An HMO that has met certain standards established by the federal government pertaining to quality of care, financial soundness, member services, and similar criteria.

Fee-for-service
Method of payment under which providers are paid for each service performed.

Gatekeeper
A term sometimes used to refer to HMO primary care physicians or nurse practitioners because of their responsibility for referring members to specialists or other services.

Group Practice HMO
An HMO that contracts with medical groups to provide healthcare to HMO members.

Guardianship
Similar to a conservatorship, yet severely restricts the legal rights of an elder based on a court's finding of legal incompetence.

Centers for Medicare and Medicaid Services (CMS)
The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Program, and works to make sure that the beneficiaries in these programs have access to high quality health care.

Health Care Power of Attorney
Allows a designated representative to decide on the health care of an incompetent person.

HMO (Health Maintenance Organization)
A health plan that both pays for and provides--or arranges to provide--access to comprehensive medical services. HMOs are reimbursed for services on a fixed monthly basis.

Home and Community Care
Most people want to remain at home as long as possible. A person who is ill or disabled and needs help may be able to get a variety of home services that might prevent one from having to move into a nursing home. Home services include:

• Meals on Wheels programs,
   
• Friendly visiting,
   
• Shopper services, and
   
• Adult day care.

Homebound
A term meaning one is normally unable to leave home or cannot leave home without considerable and taxing effort.  A person may leave home for medical treatment or short, infrequent absences for nonmedical reasons, such as a trip to the barber.

Home Health Agency
An organization that provides home care services, including skilled nursing care, physical therapy, occupational therapy, speech therapy, and care by home health aides.

Home Health Aide
A home health aide does not have a nursing license.  The aide provides services that support any services that the nurse provides.  These services include help with personal care, such as bathing, using the toilet, or dressing.  These types of services do not need the skills of a licensed nurse.  Medicare does not cover home health aide services unless one is also getting skilled care such as nursing care or other therapy.

Hospice
Medical and social programs for terminally ill patients and families either at home or in a facility.

Huntington’s Disease
Huntington’s Disease ("HD") is an inherited, degenerative brain disease which affects the mind and body. It currently affects more than 25,000 Americans. HD usually begins during midlife, and is characterized by intellectual decline, and irregular and involuntary movements of the limbs or facial muscles. Other symptoms of HD include:

• Personality change,
   
• Memory disturbance,
   
• Slurred speech,
   
• Impaired judgment, and
   
• Psychiatric problems.

Incapacity
Can be mental or physical, temporary or permanent. A person can be incapacitated without being incompetent.

Incompetence
Requires a legal declaration of being found incapable of handling assets and exercising certain legal rights.

Independent Practice Association (IPA)
HMOs that contract with individual physicians in private practice who provide care to HMO members within a private office setting.

Intermittent Care
Skilled nursing and home health aide services furnished up to 28 hours per week any number of days per week so long as they are less than 8 hours per day.

For example:  If a patient receives one nursing visit every day along with a home health aide for 2 hours each day, this would equal 21 hours for the week.   (7 nursing visits + 14 home health aide hours = 21)

Living Will
A document that makes known a person’s wishes regarding medical treatments at the end of life.

Long-Term Care Facilities
Institutions that provide nursing care to people who are unable to care for themselves and who may have health problems ranging from minimal to serious. These facilities are often used for short-term rehabilitation after hospitalization.

Long-Term Care Insurance
Long-Term Care Insurance is private insurance designed to cover long-term care costs. Plans vary widely, and it is wise to do some research before purchasing any long-term care policy. Generally, only relatively healthy people may purchase long-term care insurance.

Managed Care
A method of delivering and paying for health care through a system of networks of providers.  Managed care seeks to ensure the quality and contain the cost of comprehensive medical care.  Managed care plans include HMOs, preferred provider organizations, point of service plans, and similar coordinated care networks.

Medicaid/Medical Assistance
A joint Federal and State program that helps with medical costs for some people with low incomes.  Programs vary from state to state, but most health care costs are covered if one qualifies for both Medicare and Medicaid.

Medicare
Federal program providing health care coverage/insurance for people over 65 years of age, certain younger people with disabilities, and people with End-Stage Renal Disease (ERSD) (permanent kidney failure that must be treated with dialysis or a transplant). Part A covers inpatient care, skilled nursing facility, hospice and short-term health care. Part B covers doctors’ services, outpatient hospital care, and durable medical equipment. It does not provide for long-term care of the elderly except under limited conditions.

Medically Necessary
Services or supplies that:

• Are proper and needed for diagnosis, or treatment of a medical condition;
   
• Are provided for the diagnosis, direct care, and treatment of a medical condition;
   
• Meet the standards of good medical practice in the medical community of one's local area; and
   
• Are not mainly for the convenience of the beneficiary or his/her doctor. 

Medical Social Services
Help with social and emotional concerns one may have related to one's illness.  This might include counseling or help in finding community resources

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 that care is covered by Medicare.

Medigap Policies
A Medigap policy is the most common way that a health insurance policy helps one pay for some nursing home costs. A Medigap policy pays for the ‘gaps,’ or co-insurance, left by Medicare such as the Co-Pay owed for days 21 through 100 of a Medicare Benefit period. Premium payments for new Medigap policies usually range from approximately $50.00 to $150.00 per month.

Multi-Infarct Dementia
Multi-Infarct Dementia, or vascular dementia, is a deterioration of mental capabilities caused by multiple strokes (infarcts) of the brain. These strokes may damage areas of the brain responsible for a specific function and may produce generalized symptoms of dementia.

Network
The doctors, clinics, health centers, medical group practices, hospitals, and other providers that an HMO or other managed care plan employs or contracts with to care for its members.

Nursing Home
A nursing home is a residence that provides room, meals, recreational activities, help with daily living, and protective supervision to residents. Generally, nursing home residents have physical or mental impairments which keep them from living independently. Nursing homes are certified to provide different levels of care, from custodial to skilled nursing (services that can only be administered by a trained professional).

Occupancy Agreement
Generally, assisted living facilities have occupancy agreements that outline terms of residency.  The terms should clearly define specific living arrangements for the community and for individuals. 

Occupational Therapy
Occupational therapy helps one to perform daily activities independently. An occupational therapy patient might learn new ways to eat, put on clothes, comb one's hair, and new ways to do other usual daily activities.

Ombudsman
One of the best sources of information is your local long-term care ombudsman. Nationwide, there are more than 500 local ombudsman programs. Ombudsmen visit nursing homes on a regular basis. The ombudsman's job is to investigate complaints, advocate for residents, and mediate disputes. Ombudsmen often have very good knowledge about the quality of life and care inside each nursing home in their areas.

Open Enrollment Period
A one-month period during which employees can enroll in or switch health plans.

Opt-out
An option available in some types of managed care networks, such as point-of-service plans, in which members can seek treatment from providers outside the network and pay more to do so.

Out-of-Pocket Costs
Costs for medical services not covered by an insurer or an HMO.  Unlike persons with conventional insurance, HMO members incur minimal out-of-pocket costs.

Paraprofessional
A trained aide who assists a professional person.

Parkinson’s Disease
Parkinson’s Disease ("PD") is a progressive disorder of the central nervous system which affects more than one million Americans. Individuals with PD lack a substance called dopamine, which is important in the central nervous system’s control of muscle activity. PD is often characterized by:

• Tremors,
   
• Stiffness in limbs and joints,
   
• Speech impediments, and
   
• Difficulty in initiating physical movement.

Respiratory Therapy
Respiratory therapy consists of exercises and/or treatments that are designed to help patients regain lung function.