Glossary of Assisted Living Terms

When you’re already under stress trying to find appropriate care for an older loved one, it’s easy to be overwhelmed by the avalanche of information. Making it even worse is the fact that the industry is not standardized, so many types of facilities and care are known by several different names. Our glossary is designed to help you understand the terminology, types of care and other information you’ll need to know in order to make the right decision for your family.

To start, Assisted Living is the term used to describe a type of long-term care facility for people who are elderly or who have disabilities. As opposed to a nursing home, assisted living centers are designed for people who can move around on their own but may require extra help with some daily living activities, such as bathing, getting dressed or preparing a meal. These facilities can be small, with fewer than a half-dozen residents, on up to large, full-service apartment complexes. In either case, most residents have the option of eating in a central cafeteria or preparing meals in their own apartment. They also are usually encouraged to socialize through meals and regularly scheduled activities. Nursing care normally is not provided; however, medical personnel are on call in case of an accident or medical emergency. As the American population continues to age, assisted living centers are becoming increasingly popular. Most (but not all) are licensed by the state, and the range of services varies from facility to facility. Terms that are sometimes used interchangeably with assisted living facilities are Boarding Homes, Board and Care Homes, Independent Living, Personal Care and Residential Care.

Other terms you may encounter when working with or caring for senior citizens include:

Accessory Apartment. This is basically a small apartment set up inside a regular single-family home. It’s a popular choice, since it enables a friend, family member or other caregiver to be nearby, while still allowing the older resident a measure of privacy. Confining expenses to a single home also can be financially helpful for all parties.

Accreditation. Accreditation is an official “seal of approval” that is given to an agency, such as a nursing home or assisted living center, by an independent professional or governing agency. Accreditation is awarded only after a facility meets a stringent list of criteria governing its standards of operation, the quality of care provided, and the training/performance of its employees. If a facility is accredited, you can be reassured that it has met current professional standards and is subject to ongoing regular evaluations by an independent accreditation panel of experts. Specific to the senior housing industry, accreditation is usually provided by the Continuing Care Accreditation Commission (CCAC), the Commission on Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission on Accreditation of Health care Organizations (JCAHO).

Activities of Daily Living (ADLs). These include daily tasks such as bathing, dressing, grooming, eating, using the toilet, shopping, managing money and taking medications.

Activities of Daily Living Assessment. A thorough analysis of an individual’s physical and mental functioning, these assessments are done to determine if the person can still adequately perform daily living activities. They are conducted by social workers, geriatric case managers and similar types of professionals.

Adaptive/Assistive Equipment. These are appliances and devices that help individuals to care for themselves and to perform work or leisure activities. Magnifying glasses and bathtub chairs are only two of many examples.

Administration on Aging (AOA). This is a federal agency that administers the Older Americans Act, which provides resources and education to senior Americans and their caregivers.

Administrator. A licensed professional who manages the day-to-day operation of a care-providing facility such as a nursing home or assisted living center. Often these individuals have a medical/nursing or other relevant professional background.

Adult Day Care. These are structured programs within an individual community that provide daytime care for senior citizens who need company and/or some physical assistance during the day. They can be very useful for families with an older member living at home. These programs provide companionship and activities while family members are at work or otherwise busy.

Aging in Place. A new concept, this philosophy encourages a senior adult to remain in his or her current living environment for as long as possible, despite any physical or mental decline caused by aging.

Alzheimer’s Facilities. Larger nursing homes and other facilities often contain a licensed special unit that provides full-spectrum care for people diagnosed with Alzheimer’s disease and other types of dementia. The goal is to provide a safer and more controlled environment.

Ambulatory. This designation indicates that a person is able to walk around and is not bedridden or confined to a wheelchair.
Ambulatory Aids. These include devices that help people to move safely and independently, such as walkers, crutches, canes, scooters and wheelchairs.

American Association of Retired Persons (AARP). The AARP is a prominent, nonprofit, nonpartisan organization for people age 50 and older. It is politically active on behalf of senior issues, and provides its members with information, benefits, advocacy and other services.

Americans with Disabilities Act (ADA). Enacted by the United States Congress in 1990, this act made it illegal to discriminate against any individual on the basis of disability. The practical applications of the law require that people with disabilities have equal access to all public buildings and places of employment. Additional amendments to the act outline accommodations that must be made concerning telecommunications, Internet access and other technological issues.

Area Agency on Aging (AAA). Local agencies that administer government-funded programs for older adults.
Caregiver. A term that includes any individual who provides care to another person who is unable to care for himself or herself due to a physical or mental disability. Caregivers provide anything from nonmedical care such as bathing and assistance with eating, on up to changing dressings, monitoring medications and other treatment. Often caregivers are relatives, friends or neighbors of the person who’s ill. Of, they may be a paid professional, such as a home health aide, a nurse or a therapist.

Case Manager. Also known as a care manager, these professionals locate, plan, monitor and coordinate appropriate medical and social services for individuals who are not able to fully care for themselves because of a disability or physical impairment. Case managers often are nurses or social workers.

Charge Nurse. The charge nurse is a registered nurse (RN) or licensed practical nurse (LPN) who is responsible for supervising a unit within a nursing facility. He or she is responsible for scheduling and supervising nursing staff, as well as providing care to the residents.

Congregate Housing. (See Independent Living or Supportive Housing.)

Conservator. A person, or a public or private agency, appointed by a court to provide legal representation for an individual who is no longer able to manage his or her own affairs.

Continuing Care Retirement Community (CCRC). These communities are a specialized form of housing which provides a wide range of assisted living-type accommodations for senior residents, up to and including skilled nursing care. CCRC residents typically pay an entry fee or buy-in fee when they move in, along with a monthly service fee, which changes if and when the resident requires additional care. These fees may be partially or fully refundable, and are used primarily as a way to privately finance the facility and as payment for the tenant’s future health care. CCRCs are usually licensed by the state, and may also be referred to as a Life Care Community.

Continuum of Care. A term describing the full spectrum of care available at Continuing Care Retirement Communities. This can include independent and assisted living, nursing care, home health, home care and home- and community-based services.
Convalescent Home. (See Nursing Home.)

Director of Nursing (DON). These individuals oversee all nursing staff in a nursing home, including the charge nurses. Responsibilities include overseeing the quality of care delivered at the facility, as well as formulating nursing policies and making sure the home is in compliance with all applicable federal and state regulations.

Durable Medical Equipment. This is medical equipment that’s prescribed by a doctor for use in the patient’s home. Most are reusable items such as hospital beds, wheelchairs, oxygen equipment and lifts.

Elder Cottage Housing Opportunities (ECHO). These are small, temporary homes that are installed on the same grounds as a single-family residence, usually that of the future tenant’s adult child or other relative. ECHO units keep seniors close to their family and friends, while still providing the support they need to maintain a fair level of independence.

Entry Fee or Buy-In. An entry fee is a significant lump sum payment made at the time of occupancy to a retirement community that builds long-term care into its pricing. Generally, part of that sum is refundable to the Resident or his/her estate after residency ends. A buy-in has been a synonym for entry fee until recently; it now may also describe the outright purchase of a home in an age-restrictive community, where services are added á la carte.

Family & Medical Leave Act (FMLA). Under this federal law, an employer is required to allow employees up to 12 weeks of unpaid leave during any calendar year to care for an immediate family member or to take medical leave if the employee is unable to work because of a serious health condition.

Geriatric Care Manager (GCM). Geriatric care managers are professionals who have specialized expertise and knowledge in the care of senior adults. Usually they hold an advanced degree in gerontology, nursing, psychology, social work or some other related health and human services field. They are responsible for evaluating a senior’s situation, outlining solutions and working with family members to design a care plan that keeps the individual as independent and productive as possible. They can be extremely helpful, especially in situations where an elderly person’s adult children or other near relatives live far away.

Geriatrician. A medical professional, usually an internal medicine or family practice doctor, who specializes in treating older adults. Geriatricians must have completed additional training and certification, in addition to their regular medical education.
Guardianship. This legal procedure grants an individual adult guardian status over another adult who can no longer make decisions for himself or herself. It is considered a last-resort step, and is often granted in instances when an adult child must take care of a parent with dementia or other extreme medical problems.
Health Maintenance Organization (HMO). HMOs are established by insurance companies, and are an organized system for providing full-spectrum health care in a designated geographic area. Members of the HMO are voluntarily enrolled, usually through an employer.

Home Care. Companion care companies are springing up in which a non-medical professional assists seniors in their home with daily activities like cooking, housekeeping, laundry, errands, bathing, medication reminders, etc.

Home & Community Based Services (HCBS). An umbrella term, HCBS covers all home health care, adult day care, respite care, personal care and assisted living facilities which help people with disabilities in their local community. Each of the 50 states contains a unique mixture of programs, funded by a combination of Medicaid, federal, state and local agencies.

Home Health Care. Accredited medical and nursing services are provided within a person’s home by licensed nurses and other medical professionals. This is especially helpful for seniors with chronic medical conditions who need to be closely monitored.

Hospice Care. Similar to home health care, hospice care professionals provide in-home care and comfort to patients with a terminal illness, along with their families and friends. They typically provide counseling and social services, as well as medical care, and work closely with the patient’s physicians and caregivers.

Independent Living. (See Assisted Living.)

Instrumental Activities of Daily Living (ADLs). (See ADLs)

Kitchenette. Included in most assisted living facility apartments, this mini-kitchen typically includes a sink, cabinet space, a mini-refrigerator and microwave oven.

Licensed Practical Nurse (LPN). LPNs are nurses who are trained to provide a wide range of health care services, including changing dressings and administering medication. Their training includes at least one year of post high school education and passage of a state licensing exam.

Life Care Community. Similar to a Continuing Care Retirement Community, these facilities usually offer an insurance type of contract and provide a wide range of levels of care, including acute care and physician visits. The monthly fee normally does not change, regardless of the level of care required by the resident, with the exception of cost-of-living increases.

Living Will. This legal document outlines an individual’s wishes concerning life-saving medical treatments. It’s put into action if the patient becomes unable to communicate his or her wishes directly.

Long-term Care. This describes any and all services provided to any person, young or old, who has chronic, serious health problems.

Long-term Care Insurance. Long-term care insurance consists of policies issued by a private company that cover the cost of long-term care, including assisted living, home care and home health care. Premiums generally are based on the policy holder’s age and health, plus the length of the deductible payment period, the amount paid in to date, and the duration of benefits. This type of insurance currently pays for a mere 2 percent of national nursing home costs.

Long-term Care Ombudsman. A professional, usually a state employee, who investigates and resolves complaints related to improper care in nursing homes and other long-term care facilities.

Managed Care. There’s no generally accepted definition of managed care, but it’s usually considered to be a collaboration of private insurance combined with a specific health care delivery system. The goal of managed care is to coordinate all the health care services received by a single patient, in order to keep costs at a minimum. Most managed care plans operate with a specific set of health care providers, and require approval from a primary care doctor before authorizing any procedures or specialist care. Managed care providers usually include physicians, hospitals, nursing facilities, therapists and home health care agencies.

Medicaid. Medicaid is a medical financial health insurance assistance program that is jointly funded by the federal and state governments. It is designed to help low-income citizens, especially the elderly and people with disabilities. There are stringent income eligibility requirements, and a person must have exhausted virtually all their financial assets before qualifying for Medicaid. Most, but not all, nursing homes participate in the Medicaid program, which pays for approximately 70 percent of nursing home residents nationwide. In some states, Medicaid also will pay for assisted living care.

Medical Director. A medical director has final responsibility for the policies and procedures used in providing medical care to the patients of a particular facility, especially a nursing home or other health care agency. One of his or her duties is to coordinate with a patient’s primary care doctor, to ensure that the facility delivers the patient’s treatment exactly as prescribed. Sometimes a facility’s medical director is also its primary physician.
Medicare. Medicare is the health insurance program provided by the federal government’s Social Security Administration for people age 65 and older, regardless of their income level. It’s also available to younger adults with severe disabilities, and to people with End-Stage Renal Disease (ESRD), which results in permanent kidney failure. Hospital and nursing facility care is financed under Medicare Part A; Medicare Part B covers physician services, medical treatments and home health care. Medicare Part D, also known as the Medicare Prescription Drug Plan, is an elective program that gives participants discounts on some prescription medications.

Medication Management/Administration. Within any facility that provides medical care, this is a formal, written procedure outlining the institution’s policy for managing medicines that the resident or patient is responsible for taking. This can include recording the timing and dosage of a patient’s medication and coordinating with the person’s personal physician. Common in an assisted living environment, medication management is used in cases where the patient is still responsible for taking his or her own medication. Employees can remind patients when they need to take medication or administer an injection, but the patient alone bears final responsibility.

Medigap Insurance. These are private health insurance policies designed to supplement Medicare coverage, paying for health care costs that are not reimbursed by Medicare Part A or Part B. Policies do not cover long-term care, but focus instead on hospital and doctor bills.

Memory Care Services. Usually include secured living area for safety, licensed nurse on-duty 24/7, medication management, daily assistance with bathing, dressing and grooming , restroom reminders and assistance with continence products, supervised scheduled activities, life enrichment stations - Memory Stations, supervised Nourishment Center stocked with juice, fruit, snacks, etc. housekeeping and laundry services, daily room tidy-up services, reviews by Medical Director.

Non-Ambulatory. This term describes anyone who is unable to get up and/or walk around. It’s most often used to refer to patients who are hospitalized or completely bedridden.

Nurse Assistant. These professionals provide personal care to residents, including bathing, dressing and toileting, and work under the direct supervision of a registered nurse (RN) or licensed practical nurse (LPN). Nurse assistants must be trained, tested and certified in order to work in any nursing facility that participates in Medicare and Medicaid programs. Also known as a Certified Nursing Assistant (CNA).

Nursing Home. A state-licensed facility providing 24-hour nursing care, room and board for older and convalescing adults who have chronic and/or long-term illnesses, such as dementia. Regular, round-the-clock medical supervision is in place at these homes, along with rehabilitation therapy, a central cafeteria and social activities. Most are eligible for the federal government’s Medicaid program, which pays fees for residents who do not have the financial means to pay for their own care. These establishments are sometimes referred to as a Skilled Nursing Facility or a Convalescent Home.

Occupational Therapy. A type of therapy designed to help a person relearn daily living activities, such as dressing, grooming, cooking and housekeeping. Occupational therapists work with many elderly patients, especially those who have had a stroke or other muscle-affecting medical disorder.

Physical Therapy. Physical therapists use an individualized exercise program to improve a patient’s physical condition, strength and mobility. Like occupational therapy, it’s often administered to seniors in the wake of a stroke, fall or accident.

Registered Nurse (RN). RNs are college-degreed nurses who have passed a state board examination and are licensed by a state agency. RNs develop care plans to monitor a patient’s care, in conjunction with doctors and therapists. They also are responsible for administering complex and skilled nursing treatments.

Rehabilitation. This term covers all types of therapeutic care for people who need intensive physical, speech or occupational therapy.

Residential Care. (See Assisted Living.)

Respite Care. These professionals provide a break for the caregivers of a senior citizen or other ailing individual. The care may be provided for several hours up to several days, and may take place in the patient’s home or in a residential care setting, such as an assisted living facility or nursing home. After surgery, recovering from an illness or accident, while a caregiver is on vacation or a necessary leave of absence . . . any time someone needs care for a period of time.

Senior Apartments. These are self-contained living units for older adults who are still able to care for themselves. Usually restricted to individuals who are past retirement age, they do not provide meals, transportation or other services.

Supplement Security Income (SSI). SSI is a federal income supplement program that is designed to help older, blind and disabled people who have little or no income. It provides cash to meet basic survival needs, including food, clothing and shelter.

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