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Activities
of Daily Living (ADLs): Everyday
functions and activities individuals usually do without help.
ADL functions include bathing, continence, dressing, eating,
toileting, and transferring. Many policies use the inability
to do a certain number of ADLs (such as 2 out of 6) to decide
when to pay benefits.
Acute
Care: Care for illness or injury that develops
rapidly, has pronounced symptoms, and is finite in length.
An example is medical care for a short time to cure a certain
illness and/or condition.
Adult
Day Care: Social, recreational and/or rehabilitative
care services provided for someone who can benefit from daytime
supervision. This is an alternative between care in the home
and in an institution. It refers to health support and rehabilitation
services provided in the community to people who are unable
to care for themselves independently during the day but are
able to live at home at night.
Adult
Foster Care: A live-in arrangement where one adult
lives with and is cared for by an unrelated individual or
family. This arrangement may be certified by the state or
managed independently.
Alternate
Care Facility: A licensed residence other than
a skilled nursing facility where care services are delivered
(e.g., hospice, assisted living or Alzheimer's facilities).
Alternate
Plan of Care Benefit: Payment for a special arrangement
or services to allow the insured to receive benefits for services
outside the coverage's of a long term care policy (e.g., in-home
safety devices, home delivered meals, stays in special types
of facilities, additional equipment benefits).
Alzheimer's
Disease: A progressive, degenerative form of dementia
that causes severe intellectual deterioration.
Alzheimer's
Units: Special living units within skilled nursing
facilities or assisted living facilities specifically providing
care and services for those with Alzheimer's disease.
Aphasia:
Loss of the ability to use or understand language.
Assessment:
A determination of physical and/or mental status by a health
professional based on established medical guidelines.
Assisted
Care Facility (ACF): A non-medical facility that
provides room, board, laundry, some forms of personal care,
and usually recreational services. Often licensed by state
departments of social services, these facilities exist under
several names including domiciliary care facility, sheltered
house, board and care home, community-based care facility,
and residential care facility.
Bed
Reservation Benefit: Pays for reserving your bed
in a care facility should you need to be hospitalized during
a covered stay.
Benefit
Period: The length of time that a policy will pay
the daily benefit (usually calculated by multiplying the daily
benefit amount times the days of covered care).
Care
Coordinator: A health care professional whose training
includes managing and arranging for long term care services.
This person can be a doctor, nurse, social worker or other
similarly trained and licensed professional.
Care
Management: Services typically provided by 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,
Primary: The key person (usually a relative) overseeing
and/or providing care for a person who is incapacitated.
Caregivers,
Secondary: Relatives or others who assist part-time
in giving care.
Catastrophic
Illness: An illness that causes sudden temporary
or permanent change or significant disruption to a person's
normal lifestyle.
Chronic
Care: Care for an illness continuing over a protracted
period of time or recurring frequently.
Cognitive
Impairment: A deficiency in a person’s short or
long term memory; orientation as to person, place and time;
deductive or abstract reasoning; or judgment as it relates
to safety awareness.
Continuing
Care Retirement Community (CCRC): A residential
community providing a variety of living arrangements and services,
which may range from independent living apartments to assisted
care facility (ACF) and skilled nursing facility (SNF) care.
Custodial
Care: Services that can be given safely and reasonably
by a trained or capable non-medical person, designed mainly
to assist with ADLs, such as bathing, eating, dressing, and
other routine activities.
Daily
Benefit: The amount of insurance benefit in dollars
per day a person chooses for long term care expenses (typically
between $50 and $250-selected by the applicant).
Dementia:
Deterioration of mental faculties due to a disorder of the
brain.
Elimination
Period: A type of deductible; the length of time
the insured must pay for long term care services before the
insurance policy begins to make payments. The longer the elimination
period in a policy, the lower the premium.
Home
Health Care: At home services for occupational,
physical, respiratory, speech therapy, or nursing care. Also
included are medical, social worker, home health aide, and
homemaker services.
Home
Modification: Physical adaptations to a home that
enable a person to stay and function in that environment.
Homemaker
Services: Services designed to provide household
support. They may include light housekeeping, laundry, shopping,
cooking, home management and similar services.
Inflation
Protection: A policy feature that provides for
increases in benefit levels over time to help pay for expected
inflation in the costs of long term care services.
Intermediate
Nursing Care: Assistance needed for stable conditions
that require daily, but not 24-hour, nursing supervision.
This care is initially ordered by a physician and supervised
by registered nurses. It is less specialized than skilled
nursing care, often involves more personal care, and is generally
needed for a longer period of time.
Lapse:
Termination of a policy when a renewal premium is not paid.
Means
Test: Measures of income and assets to determine
eligibility for government benefit programs such as Medicaid.
Medicaid:
A means-tested medical and health welfare program supported
by federal, state and local funds, and administered by each
state to provide health care for eligible poverty level individuals.
Medicare:
The federal program providing hospital and medical insurance
to people aged 65 or older and to certain younger ill or disabled
persons. Benefits for nursing home and home health care services
are limited.
Medicare
Supplement ("Medigap") Insurance: A private insurance
policy that supplements Medicare benefits by covering co-payments
and deductibles for medical and hospital expenses. These policies
do not provide coverage for personal or custodial care.
Nonforfeiture
Benefit: A reduced benefit that covers you if you
cancel your policy or let it lapse.
Nursing
Home: A licensed facility that provides room and
board and a planned, continuous medical treatment program,
including 24-hour-per-day skilled nursing care, personal care,
and custodial care.
Personal
Care: Assistance provided by another person to
help with walking, bathing, eating and other routine daily
tasks.
Plan
of Care: A written, individualized plan prescribed
by a physician or developed by other qualified health care
professionals that specifies the type and frequency of all
services required by the recipient of the care.
Pre-existing
Condition: An illness or disability for which you
were treated or advised within a time period before applying
for the policy.
Preferred
Health Discount: A discount received on policy
premiums available to applicants who are determined to be
in very good health.
Respite
Care: Long term care services provided at home
or in a facility to temporarily relieve the family or friends
who normally provide care for an impaired individual.
Skilled
Nursing Care: Nursing and rehabilitative care that
is performed by skilled medical personnel, usually available
24-hours-a-day and ordered by a physician under a treatment
plan. It can be either in a facility setting or at home. (Note:
Medicare and Medicaid both have their own definitions of "skilled
nursing care" which do not necessarily match those in long
term care insurance policies.)
Skilled
Nursing Facility (SNF): A state-licensed institutional
setting that provides skilled care by skilled medical personnel.
This care is available 24-hours-a-day and is ordered by a
physician under a treatment plan.
Spend-down:
The process whereby an individual uses up most of his or her
income and assets to meet Medicaid eligibility requirements.
Spousal
Discount: A discount applicable if both spouses
are eligible and apply for coverage.
Survivorship
Benefit Option: A benefit that waives premiums
due on a surviving spouse’s policy after both spouses have
had policies in force for a certain period of time and other
criteria are met.
Third-party
Notification: A process that lets you name someone
who the insurance company would notify if your coverage is
about to lapse due to a failure to pay premium. The notice
can go to a relative, friend, or professional such as a lawyer
or accountant, for example.
Unintentional
Lapse Protection: A policy provision to reinstate
coverage that has lapsed (providing that back premiums are
paid) when the lapse is due to cognitive impairment or loss
of functional capacity.
Waiver
of Premium: A provision in an insurance policy
that relieves the insured from having to pay premiums while
receiving benefits.
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