Glossary

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These are terms typically utilized by insurance providers, when they are detailing policy language.
It will be useful to read and understand policy comparisons.

Activities of Daily Living (ADLs) - Eating, dressing, bathing, toileting, abulating (walking with or without assistance of a mechanical device), transferring (ability to control bowel or bladder functions, and ability to maintain reasonable level of personal hygiene, with or without the use of medical supplies, protective undergarments, or catheters). Functional ability can be measured by the type and number of ADLs which a patient can perform. Knowing about ADLs is important for a very practical reason: Most insurance policies base their payments for a long-term care upon an elderly person's inability to perform 2 or 3 activities of daily living. In order to put in a claim, a doctor must verify this. In the beginning stages of dementia, patients can usually perform ADLs, but often patients cannot adequately perform IADLs (see: Instrumental Activities of Daily Living).

Acute Care - Usually short-term medical care at a hospital for a patient with an acute disease or trauma.

Acute Disease - A disease which has a rapid onset and severe symptoms, but is not prolonged. (The opposite of Chronic Disease )

Adult Foster Care - Long-term care in a group or private facility that is more like a residence, than a nursing home. Such facilities may be subject to fewer licensing regulations than nursing homes.

Advance Medical Directives - (Declaration under the Natural Death Act, the Patient Self Determination Act, Health Care Proxy, "Living Will"). Such directives should be signed when the patient is competent. They permit a patient to specify the kind and extent of medical measures to be given,or to choose to receive no life-saving medical treatment, when they become severely ill or profoundly disabled.

Age-Associated Memory Impairment - Mild memory loss that slowly increases with age, e.g. forgetting where you left your glasses, where you parked the car, or names of acquaintances. While embarrassing, it doesn't greatly interfere with daily living, and eventually, you'll remember. Such minor temporary memory glitches are completely different than dementia, which is progressive major memory loss that interferes with everyday functioning.

Alexia - The inability to read and understand words, not caused by eye problems or illiteracy.

Alzheimer's Disease - Alzheimer's disease is not a normal part of aging. It is a progressive, degenerative disease, usually with a gradual onset, which affects an estimated 4 million Americans. The cause of AD is still unknown, but studies are being done to investigate possible environmental, viral, and genetic factors. No one factor is believed to be the cause of the disease, but rather a combination of factors, to which individuals react differently. After proper evaluation of a patient's symptoms and testing by experienced professionals, a diagnosis of "probable" Alzheimer's can correctly be made 80-90% of the time. However only an autopsy can definitely prove the existence the disease. A tiny piece of brain tissue showing abnormal clumps (neuritic/senile plaques, amyloid plaques), tangled bundles of fibers (neurofibrillary tangles), and other characteristics directly related to AD, allows a 100% determination of Alzheimer's, if analyzed within 12 hours after death. Alzheimer's is the most common cause of dementia. The disease attacks the brain, resulting in severely impaired memory, reasoning, and behavior: Approximately 3% of men and women ages 65 to 74 have Alzheimer's disease, 10% of those between ages 75-84 have AD, which rises steeply to 47% of people over age 85. The life span of an Alzheimer's victim usually ranges between 8-20 years. The disease is the fourth leading cause of death in the U.S. At thi time, only one drug, Cognex, may help alleviate some of the cognitive symptoms of Alzheimer's. It must be closely monitored by a doctor experienced with the medication, because of possible side-effects which can damage the liver. Other medications may help control symptoms such as depression, wandering, sleeplessness, anxiety, and agitation. In addition, you and your EFM may wish to participate in clinical trials which are being done on experimental drugs. Some typical signs of early Alzheimer's may include: memory loss, problems finding the right words and completing thoughts which hamper communication, confusion about times and dates, everyday tasks, impaired judgement, shifts in mood, changes in personality and behavior, and depression. Since these possible indications of Alzheimer's may also have other causes which might be treatable, the person should get a complete work-up (a series of physical, psychiatric, and neurological evaluations), done by physicians who are experienced in treating the elderly.

Alzheimer's Unit - (See: Dementia Unit )

Aphasia - The impairment or absence of the ability to communicate by speaking or writing, due to brain dysfunction.

Apraxia -A growing inability to do movements or use objects properly, although there are no physical problems which cause the condition.

Ateriosclerosis - (Also called Hardening of the Arteries). Dementia symptoms can be associated with this condition, but only when multiple strokes have occured.

Assesment - The cornerstone of a comprehensive care plan developed by a Geriatric Care Manager.

Assignment - When a physician or health supplier agrees to accept Medicare's fee rate as payment in full (except when the patient has co-insurance and a deductible). Medicare usually pays far less than the professional's normal fee.

Assisted Living - A wide-range of facilities and programs that an elderly family member and their caregiving family can choose from, including: retirement hotels, and board and care homes. Services may include 24-hour supervision, companionship, help with dressing and toileting, bathing, personal care, transportation, giving medications, and nursing care.

Benefit Period - The length of time an insurance policy will pay for a specific illness or hospitalization.

Benign Forgetfulness / Benign Senescence - (See: Age-Associated Memory Impairment )

Board and Care Home - A small facility, frequently 6-12 beds, which cares for elderly people who need extra assistance on a more personal basis. It is less expensive than a nursing home (although Medicaid may cover the cost of a nursing home, but often will not cover the cost of a small board and care home). Licensed by many, but not all states.

Board and Care Hotel - (See: Retirement Hotel )

Capitation - A fixed amount of money per patient, per month, that a health plan pays to a provider of medical services. This fee is the final, total amount that a doctor or medical group receives to render all care, no matter how extensive it may be. If less medical care is needed and, thus, billing is lower, the provider can keep the difference. Such as pre-payment system puts pressure on a doctor to keep medical costs as low as possible, by switching the financial risk from the insurer to the doctor. This potentially places a doctor in a "conflict of interest" position, since the "least" care he gives a patient, the more money he gets to keep.

Caregiver - The person, whether adult child, relative, friend, or hired help, who takes care o an elderly person in need. Doing the job properly requires enormous time, energy patiences, and courage. Ideally, caregiving also takes love, but not all caregivers love their elderly charges, and vice-versa. The consequences can be peace-of-mind, guilt, moral imperative, anger, intimacy, stress, personal satisfaction, physical deterioration, deep fullfilment, a sense of imprisonment, renewed closeness, martyrdom, confrontation with one's future, a deeper reverence for life, or a combination of al of these. Those who caretake as well as they can are blessed, and so are the recipients of their kindness.

Carrier - (See: Intermediary )

Chronic Care - Long-term health care, such as at an assisted living facility or nursing home.

Chronic Disease - A disease which shows little change and usually progresses very slowly over a longer period of time. Since the disease doesn't go away, a patient has to learn to cope and live with it. (The opposite of Acute Disease )

Clinical Diagnosis - Based upon actual observations, tests, and responses to treatment, rather than pathological facts. It is the only practical way to diagnose Alzheimer's disease.

Cognition - Normal awareness and insight, using reasoning, judgment, intuition, knowledge, and intellectual functioning.

COLAs - Cost of living adjustments ("inflation protection") which either increases your EFM's daily benefit by a fixed percentage each year, or by an amount tied to the Consumer Price Index. You can purchase a cola rider a health policy, but is expensive. COLAs are continuously being used as a bargaining chip in Congress' never-ending, futile fight to balance the budget, so they will probably be decreased or even eliminated in the future.

Community Care Facility - (See: Board and Care Home )

Congregate Housing / Congregate Living - (See: Life-care Home )

Continuing Care Retirement Community - (See: Life-care Home )

Convalescence Home - (See: Nursing Home)

Custodial Care - Assistance that is not skilled nursing care. A worker helps an elderly person with the activities of daily living which are not medically necessary, but necessary for functioning, such as bathing, feeding, toileting, and dressing. This is the type of care that most elderly people need in order to remain living at home, yet it usually is not covered by insurance or Medicare. Long-term health insurance may cover custodial care.

Delirium - A serious, through transient and treatable condition of mental disorientation. Deliurium can be caused by a simple intoxication, medications, infection, or more complex metabolic deficiencies, electrolute imbalance, and/or hypoxia (deficiency of oxygen). Symptoms may wax and wane. The patient becomes disoriented, over-excited, and might experience hallucinations, illusions, or paranoia. Speech is often incoherent, as the mind wanders.

Dementia - (Previously labeled "senility") Dementia is a global term for impaired cognitive functioning. It is not a disease, but a group of symptoms reflecting a serious disease or medical condition that disrupts the way the brain works. Symptoms gradually become so severe as to interfere with an aging person's ability to perform routine activities, their social life, and their very existance. Dementia can be reversible or irreversible. Reversible dementia, or dementia-like symptoms, may result from many other causes, such as: TIAs (transient ischemic attacks, i.e. temporary interference with blood supply to the brain), thyroid or metabolic imbalance, depression, reactions to medications, fever, nutrional deficiencies, chronic alcoholism, excessive use of drugs, cerebral hemorrhaging or tumors, brain injuries, epilepsy, syphilis, infectious diseases, and long-term dialysis. Irreversible dementia (primary dementia) is most commonly caused by Alzheimer's disease. Many people confuse Alzheimer's and dementia, but irreversible dementia may be caused by a number of other conditions and diseases, including: Multi-Infarct Dementia (MID), Parkinson's disease, Huntington's (Lou Gehrig's/Woody Guthrie's) disease, Creutzfeldt-Jakob's disease, Pick's disease, and AIDS. A good work-up and correct diagnosis are essential to determine the type and nature of the dementia, to determine if it can be treated.

Denial - The defensive, protective quality in the human psyche which initially rejects facing tremendously stressful and painful situations, such as caring for a demented elderly family member. With professional supportive help and personal courage, a caregiver can confront the truth and deal with it.

EFM - Elderly family member, usually cared for by a spouse, adult child, or other close relative.

Elder Law Attorney - An attorney who specializes and is experiences in financial preperation for long-term care, estate planning, asset conservation, and the special legal needs of seniors. This includes preservation and transfer of assets to avoid spousal impoverishment when one spouse enters a nursing home; Medicaid, Medicare, Social Security, and disability claims and appeals; supplemental and long-term health insurance; Durable Powers of Attorney, Living Wills, Conservatorships, and Guardianships; living trusts, probate, pensions, reitrement and survivor benefits; patients' rights, elder abuse, fraud recovery, age and housing discrimination; home equity conversions; health and mental health law. Often a member of the National Academy of Elder Law Attorneys.

Elimination Period - (Also known as the deductible period) The number of days a patient must pay for their medical care, before an insurance policy kicks in. The longer the elimination period, the lower the premium.

Exclusive Provider Organization (EPO ) - A variation of a PPO managed care plan. Patients must use specified medical and health providers in order to receive insurance coverage. (See: Preferred Provider Organization )

Fee-For-Service - The traditional form of medical care. A patient goes to any doctor or hospital of their choice, and pays whatever is charged. If the patient has good private health insurance, the policy will pay all or part of the bill.

Geriatric Care Manager - A professional who has extensive training and experience working with older people and their families who need help with caregiving. The geriatric care manager, often a gerontologist, social worker, psychotherapist, or nurse, offers understanding and compassion, information, assistance, moral support, and referrals, which may make the difference between a sucessful old age and traumatic one.

Geriatric Psychiatric Unit - (Also known as a Psych Unit) Seperate area of a hospital, with a specially trained psychiatric staff, used for evaluation and treatment of older patients with mental diseases and dementia. The unit must be secured for patients who wander.

Geriatric Psychiatrist - A psychiatrist who specializes in the mental diseases of the elderly.

Guilt - An unncessary, unproductive accumulation of blame from the past (usually childhood), which only serves to render a well meaning caregiver physically and mentally exhausted. A clear examination of the facts, however traumatic, usually proves there is little cause in reality to feel guilt. Instead, and adult chlid's focus and energy can be put to better use, caring for themselves, their family, and their elderly family member.

Hardening of the Arteries - (See: Arteriosclerosis )

Health Maintenance Organization (HMO) - A managed care plan which provides a complete range of health services at a fixed monthly rate. The HMO receives the same premium, whether or not a patient needs help. Thus, its motivation is to stress prevention and keep actual medical care under control, often by using a patient's primary care doctor as a "gatekeeper" (or some variation of that title).

Hospice - A facility or a caregiving service for terminally ill patients, providing relief and support for their physical, social, financial, and spiritual needs as they are dying. Supportive services may also be given to the patients' families.

Incontinence - The inability to retain urine or feces, because of loss of sphincter control or brain lesions. There are many possible causes for incontinence, but most cases can be controlled, corrected, or cured. Only 1 in 10 elderly people have incontienence, but despite the fact that the condition is fairly common, it frequently is a source of great embarrassment and even recrimination. Incontinence is often a medical problem and should be discussed with your EFM's physician.

Independent Practice Assocation (IPA) - A managed care plan in which a patient sees specialists who are all associated with a specific medical office. The doctors agree to see the patient on a pre-negotiated fee scale.

Insidious - The onset of a disease, without noticeable symptoms, which leaves a patient and their family initially unaware of what is taking place. With Alzheimer's disease, the onset is slow, with no obvious symptoms. Only upon looking back, does a family realize that beginning mild symptoms were indeed evident, perhaps causing some suspicion, but they were overlooked or emotionally denied.

Instrumental Activities of Daily Living (IADLs) - Preparing meals, shopping, ability to use the telephone and TV, doing housework and laundry, managing money and paying bills, using transportation, and taking medications.

Insurance - It is important to look for the hidden exclusions and barriers, buried in pages of verbiage in most insurance policies. Some key terms to identify include: ADLs, Bed Reservation Benefit, Benefit Period, COLAs, Elimination Period, Maximum Daily Benefit, Medical Necessity, Non-Forfeiture, Waiver of Premium. Compare the definitions and conditions with those policies from other companies.

Integrated Model - A managed care plan established by a physician group of hospital, which provides all in-patient and out-patient health needs, including in-home and nursing home care. This type of plan both pays for an delivers the medical services, since it frequently owns the hospital, facilities, agencies, and even the hospitals that service the patient.

Intergenerational Programs - Brings together young and old people in regularly planned activities which benefit both age gourps, and the community as a whole. Participants support each other, sharing their different perspectives, talents, and abilities. These programs attempt to substitute for the traditional extended family that is vanishing in our fast-paced society, where so many would-be family caregivers live a long distance away.

Intermediary - A private insurance company which contracts with the U.S. government to handle billing claims for Medicare Part A and / or Part B. The function of these insurance companies is rapidly being replaced by managed care plans.

Life-Care Home - (Also known as Continuing Care Retirement Community or Congregate Housing) A combination of health care housing and insurance for seniors, often expensive. The EFM signs a contract, which remains in effect as long as the person lives. There is an entrance fee and regular monthly charges, as well as additional charges for added services. Various levels of long-term care are offered, often including catastrophic nursing care. Starting with almost independent living, according to their condition, the patient may be moved to an intermediate care facility, or if necessary, the home's skilled nursing center.

Locked Nursing Home - (See: Secured Nursing Home )

Managed Care - The philosophy which is rapidly taking over the cost of medical care for the 21st century, based on the need to provide medical services, while reducing and controlling costs. Under managed care, these costs (which are considered financial losses by insurance companies and governmental plans like Medicare and Medicaid), are spread between the payee and the provider. In this way, everyone shares both the responsibility and the incentive to contain costs. Ideally, managed care will provide health and medical services efficiently and effectively, without a decrease in the quality or humaneness of care.

MedicAid - A program to provide medical care for the poor, jointly funded by the federal and state governments, administered by the states. (Called Medi-Cal in California) This vital program, like Medicare, is under attack and subject to continuing major revisions.

Medicare - Federally-funded medical and hospital care for the elderly. "Part A" hospital insurance usually pays for inpatient care in a skilled nursing facility, as well as some home health care and hospice care. "Part B" medical insurance pays predetermined amounts for doctors' fees, outpatient hospital bills, certain diagnostic tests, necessary permanent medical equipment, ambulance service, and also for some services and supplies which Part A does not cover. The rules for Medicare are currently under contention in Washington, and are subject to major changes in the future. The major push now by government and private corporations is to convince the elderly to voluntarily switch to managed health care plans, such as HMOs. In the future, this may become mandatory. To avoid potentially costly wrong decisions, be sure to find out the very latest information on Medicare, keep abreast of politics and the news, and research the "experts" future projections.

Medicare Risk Contract - A way for financially-strapped Medicare to get out from under the burden of paying the high costs of medical help. Medicare contracts with one of many licensed HMOs to provide health care to an elderly recipient. The HMO gets a per capita amount, based upon a complex formula, which costs the government much less. Upon enrolling, a patient must now abide by the rules of the particular HMO, not the previous Medicare policy. If it is up to Congress, and it seems to be, all medicare patients will have to be enrolled in such HMOs in the not-too-distant future.

Neurologist - A specialist in the diseases of the nervous system.

Neuropharmacologist - A pharmacologist concerned with the effects of medications on the nervous system.

Neuropsychiatrist - A psychiatrist who deals with the physical and chemical aspects of brain dysfunction that affect behavior.

Neuropsychophamacology - The study of how medications effect mental illness.

Nursing Home - (See: Skilled Nursing Facility )

Osteoporosis - A disease resulting in the reduction of bone mass, so a bone cannot support the weight put upon it. It has been repoted that the danger of osteoporosis can be of greater risk than cancer for older women and people on steroids, as well as for the sedentary. About 20% of elderly people who fall and suffer hip fractures die within a year, another 25% lose their independence and may end up in nursing homes. Frequently, a compression fracture of a bone comes first, then the fall. Even a "safe" environment cannot guarantee that bone breakage will not occur, which is the reason why prevention is so important. Prevention should begin way prior to bone loss, since attempts to restore bone are only in the early stage. Prevention and treatment may include: bone density scans, taking supplemental calcium and Vitamin D, estrogen (for menopausal women), quitting smoking, and regular exercise, which can decrease the risk of hip fracture by about half. An elderly patient should see a doctor who is really knowledgeable about the newest research.

Palliative - Medical services intended to relieve and alleviate, keeping patients comfortable, rather than curing them.

Parkinson's Disease - A chronic disease of the nervous system resulting in tremors, muscle weakness, contortion, and rigidity (often lack of facial expression), slow speech, falling, and awkward movements. The onset is generally insidious, although it may be abrupt, duration is indefinite, and recovery virtually non-existent. Appriximately 50% of Parkinson's patients may develop dementia.

Pathological - Diseased or caused by disease, or behavioral disorder.

Point of Service Plan (POS) - A variation of managed care, combining the benefits of lower health costs with freedom of choice. A patient is permitted to receive medical services from "outside" doctors and providers who are not members of the plan, but must pay part of the fees.

Pre-existing Condition - Any medical or psychological problem for which a patient received medical advice, treatment, or drugs. Insurance cmpanies and managed care plans usually will not cover such a condition, if it occured within a specified amount of time prior to coverage. The policies' fine print tries to eliminate coverage of such conditions.

Preferred Provider Organization - (PPO) A group of physicians or institutional providers who service a group of patients on a fixed, lower-cost fee-for-service basis. Everyone seems to benefit: Patients pay less and have the choice of any doctors within the PPO, while the doctors are guaranteed volume. Problems in scheduling enough time may arise if the PPO accepts too many patients.

Progressive Disease - A disease, or symptoms of a disease, which grow worse over time.

Pseudo-Dementia - Major depression, which is normally treatable, but which is left untreated because of misdiagnosis as dementia.

Psych Unit - (See: Geriatric Psychiatric Unit )

Psychotropic Drugs - Drugs which intentionally or unintentionally affect the functioning of a person's mind, behavior, or experiences. These include antidepressants, anti-anxiety drugs, and anti-psychotic drugs for hallucinations, delusions, paranoia, extreme agitation.

Quality of Life - The type of experience which a concerned adult child (and staff members) can gift to an elderly family member, that goes way beyond simple existence. By investing a little more time, sensitivity, concern, and educated awareness, the waning days of an aging human being can be made more joyful and meaningful. In return, such generosity of the spirit usually comes back to the caregiver as love and a sense of deep inner-satisfaction.

Reverse Mortgage - Quick cash for house-rich / cash-poor seniors. Allows an elderly homeowner over age 62 to convert the equity in their home to cash, without needing to sell it. If the mortgage is nearly or completely paid off, your EFM can borrow against the equity, getting regularly payments, one large sum of money, or a line of credit. The loan is paid off only after the borrower moves out or dies.

Residential Care Facility - An alternative living facility for elderly pepole who cannot live alone or with a family caregiver, but don't need a skilled nursing facillity.

Respite Care - A service which gives an adult caregiver relief, allowing for independence, freedom, and much-deserved time to get away from the pressures of caring for their elderly family member. In the service, during wartime, it is known as R&R (rest and recovery).

Retirement Community - Designed primarily for people who are totally or nearly independent and wish to live in a community with other seniors. Recreational activities, organized social programs, meal service, transportation to doctors, banks, and shopping are usually offered, but not nursing services, although such in-home help can be hired privately.

Retirement Hotel - A larger facility, ranging from an unlicensed hotel for independent seniors (which privdes only room, meals, and housekeeping), to a similar-looking licensed facility for people who need assistance (which provides a range of care and services, adding to the cost). Such as hotel is for elderly people who may use canes, walkers, or even wheelchairs, but are not bed-ridden, and do not have advanced dementia or severe medical problems that require a skilled nursing facility.

Secured Nursing Home - A facility which has been built and set-up for the safety of dementia patients who wander, so they cannot get out clandestinely. There is some form of electronic monitoring system installed, such as "Wander Guard". Better facilities also have protected garden area so patients can get visual stimulation, exercise, fresh air, and satisfy their need to move.

Senility - (See: Dementia )

Skilled Nursing Facility (SNF) - A nursing home, licensed for skilled care, which has specificially trained staff, as well as the necessary equipment to provide 24-hour nursing and rehabilitation care. Many patients are confined to a bed or wheelchair, and are incontinent. Medical treatment is supervised by a registered nurse, at least during the day.

Special Care Unit - (See: Dementia Unit )

SSI - A federal program for the elderly poor who do not have Social Security or any other retirement income. It provides limited monthly income at the poverty level. Previously, the small amount has been increased to offset rises in the cost of living, but this policy may change in the near future.

Subacute Care - An alternative to hospitals or nursing homes, for patients who have severe illness or injury, but don't need such intense care. Patients ready for subacute care need about 4-7 hours of skilled nursing care / day.

Support Group - A family support group consists of caregivers, family members, strangers (soon to be friends), and health care professionals. Groups meet at private homes, senior centers, hospitals, libraries, churches, and care facilities.

TLC - Tender loving care. That which we all need... especially our elderly family members. They are going through the changes in life we cannot begin to imagine, at the worst possible time when they are least able to deal with such momentous challenges.

Wanderer - A dementia patient who, for reasons, we do not yet understand, has an irresistable need to walk. The patient manages to disappear from the premises, and with good fortune, is often found far away, with no awareness about their dangerous, epic journey. There seem to be two kinds of wanderers: those who are easily distracted from the urge, and those who, like Houdini, always manage to escape. Only in a properly secured facility is there any chance of containing this latter type. One patient who couldn't resist the instinct to get out, jumped through a plate glass window.

Work-Up - A series of medical and psychological tests used to obtain all necessary information for the correct diagnosis and treatment of an elderly patient. To be most accurate, the tests which are administered by various speicalists, should be carefully given in the proper sequence, so that clues are overlooked. This is especially important for a patient who exhibits symptoms of dementia and is suspected of having Alzheimer's disease, in order to rule out pseudo-dementia and treatable diseases.

Information from: Mama Can't Remember Anymore: Care Management of Aging Parents and Loved Ones , Nancy Wexler, Geriatric Care Manager / Gero Team is essential to preserve the rights of patients and their families.
This glossary research was developed by her team of professionals.