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a

Accreditation - A seal of approval given by a governing body to a housing and/or service provider. To become accredited, the community or provider must meet specific requirements set by the accreditation entity and is then generally required to undergo a thorough review process by a team of evaluators to ensure certain standards of quality. The accrediting organizations are not government agencies or regulatory bodies. Examples of some accreditation bodies for the senior housing and care industry include CCAC (Continuing Care Accreditation Commission), CARF (Commission on Accreditation of Rehabilitation Facilities) and JCAHO (Joint Commission on Accreditation of Healthcare Organizations).

Activities of Daily Living (ADLs) - Everyday activities such as bathing, grooming, eating, toileting, and dressing.

ADA (American with Disabilities Act) - A law passed by Congress in 1990, which established a clear and comprehensive prohibition of discrimination on the basis of disability. The law requires equal access to public buildings and places of employment for people with disabilities. Subsequent amendments have extended the access requirement to telecommunications, information on the Internet, etc.

Administrator - Generally, a licensed professional who manages the day-to-day operation of a care facility such as a nursing home or assisted living facility.

Adult Day Care - Daily structured programs in a community setting with activities and health-related and rehabilitation services to elderly who are physically or emotionally disabled and need a protective environment. This care is provided for during the day, the individual returning home for the evening.

Alzheimer's - Degenerative age-related disease that impairs an individual's cognitive ability. Symptoms may include forgetfulness, wandering, and inability to recognize others. The disease is caused by neuron dysfunction and death in specific brain regions responsible for cognitive functions. Both genetic and environmental factors likely play a role in the development of Alzheimer's.

Ambulatory - Describes ability to ambulate, walk around, not bedridden or hospitalized.

Assisted Living - In general, state-licensed program offered at a residential community with services that include meals, laundry, housekeeping, medication reminders, and assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The exact definition will vary from state to state, and a few states do not license assisted living facilities. Generally regarded as one to two steps below skilled nursing in level of care. Approximately 90 percent of the country's assisted living services are paid for with private funds, although some states have adopted Medicaid waiver programs. Might also be referred to as Personal Care, Board and Care, Residential Care, Boarding Home, etc., although some states differentiate between their definition of "Assisted Living" and these other terms (e.g., Washington state recognizes and licenses "Assisted Living" facilities as well as "Boarding Homes"; Although licensed by the State of Washington, a Boarding Home does not meet the higher physical plant and service requirements necessary to be considered an Assisted Living facility).

c

Charge Nurse - An RN or LPN who is responsible for the supervision of a unit within a nursing facility. The charge nurse schedules and supervises nursing staff and provides care to facility residents.

Continuing Care Retirement Community (CCRC) - Housing planned and operated to provide a continuum of accommodations and services for seniors including, but not limited to, independent living, congregate housing, assisted living, and skilled nursing care. A CCRC resident contract often involves either an entry fee or buy-in fee in addition to the monthly service charges, which may change according to the medical services required. Entry fees may be partially or fully refundable. The fee is used primarily as a method of privately financing the development of the project and for payment for future healthcare. CCRCs are typically licensed by the state. See also Life Care Community.

Continuum of Care - Full spectrum of care available at Continuing Care Retirement Communities which may include Independent Living, Assisted Living, Nursing Care, Home Health, Home Care, and Home and Community Based Services.

Convalescent Home - See Nursing Home.

d

Dementia - Progressive neurological, cognitive, or medical disorder that affects memory, judgment, and cognitive powers.

Developmental Disability (DD) - Affliction characterized by chronic physical and mental disabilities, which may include: cerebral palsy, retardation, thyroid problems, seizures, quadriplegia

Director of Nursing (DON) - A DON oversees all nursing staff in a nursing home, and is responsible for formulating nursing policies and monitoring the quality of care delivered, as well as the facility's compliance with federal and state regulations pertaining to nursing care.

h

HMO - A Health Maintenance Organization (HMO) is an organized system for providing comprehensive health care in a specific geographic area to a voluntarily enrolled group of members.

Home Health Care - Provision of medical and nursing services in the individual's home by a licensed provider.

Hospice Care - Care and comfort measures provided to those with a terminal illness and their families- it can include medical, counseling, and social services. Most hospice care is furnished in-home, while specialized hospices or hospitals also provide this service.

i

Independent Living - Multi-unit senior housing development that may provide supportive services such as meals, housekeeping, social activities, and transportation (Congregate Housing, Supportive Housing, Retirement Community). Independent Living typically encourages socialization by provision of meals in a central dining area and scheduled social programs. May also be used to describe housing with few or no services (Senior Apartment).

Instrumental Activities of Daily Living (IADLs) - Day-to-day tasks such as preparing meals, shopping, managing money, taking medication, and housekeeping.

l

Licensed Practical Nurse (LPN) - LPNs are trained to administer technical nursing procedures as well as provide a range of health care services, such as administration of medication and changing of dressings. One year of post high school education and passage of a state licensing exam is required.

Life Care Community - A Continuing Care Retirement Community (CCRC) which offers an insurance type contract and provides all levels of care. It often includes payment for acute care and physician's visits. Little or no change is made in the monthly fee, regardless of the level of medical care required by the resident, except for cost of living increases.

Long-Term Care - Provision of services to persons of any age who are afflicted with chronic health impairments.

Long-term Care Insurance - Privately issued insurance policy which covers the cost of nursing home care, assisted living, and home health care. Premiums are based on age, health, length of deductible period, amount paid, and duration of benefits. Currently pays only two percent of national nursing home costs.

m

Managed Care - There is currently no standard definition of managed care, but it can best be described as a combination of insurance and a health care delivery system. The basic goal of managed care is to coordinate all health care services received to maximize benefits and minimize costs. Managed care plans use their own network of health care providers and a system of prior approval from a primary care doctor in order to achieve this goal. Providers include: specialists, hospitals, skilled nursing facilities, therapists, and home health care agencies.

Medicaid - Medicaid is a State program that provides medical services to clients of the State public assistance program and, at the State's option, other needy individuals. When services are furnished through institutions that must be certified for Medicare, the institutional standards must be met for Medicaid as well. In general, the only types of institutions participating solely in Medicaid are Nursing Facilities, Psychiatric Residential Treatment Facilities, and Intermediate Care Facilities for the Mentally Retarded. Medicaid requires Nursing Facilities to meet virtually the same requirements that Skilled Nursing Facilities participating in Medicare must meet. Intermediate Care Facilities for the Mentally Retarded must comply with special Medicaid standards.

Medical Director - A staff medical director assumes overall responsibility for the formulation and implementation of all policies related to medical care. The medical director also coordinates with an individual's personal physician to ensure that the facility delivers the care that is prescribed. In some instances, the medical director may be a resident's primary physician.

Medicare - Nationwide medical insurance program administered by the Social Security Administration for individuals 65 and over and certain disabled people, regardless of income. Provides for hospital and nursing facility care (Part A) and physician services, therapies, and home health care (Part B). Medicare is a Federal insurance program providing a wide range of benefits for specific periods of time through providers and suppliers participating in the program. The Act designates those providers and suppliers that are subject to Federal health care quality standards. The Federal Government makes payment for services through designated fiscal intermediaries and carriers to the providers and suppliers.

Medicare Certified - A Medicare-certified agency is one that has met the federal minimum requirements for patient care and management and therefore can provide Medicare and Medicaid home health services. www.cms.gov/certificationandcomplianc/downloads/CertandComplianceProcess.pdf

Medications Management / Medication Administration - Formalized procedure with a written set of rules for the management of self-administered medicine, as in an assisted living setting. A program may include management of the timing and dosage for residents, and could include coordination with a resident's personal physician. The resident must take the medication him or herself. For instance, the facility can remind the resident that she needs to give herself the medicine injection, but the facility cannot perform the actual injection itself.

Medi-gap Insurance - Private health insurance policies that supplement Medicare coverage, covering health care costs above those covered by Medicare Part A or Part B. Does not provide benefits for long term care, covering primarily hospital and doctor bills.

n

Non-Ambulatory - Inability to ambulate, walk around, and usually bedridden or hospitalized.

Not-for-Profit - Status of ownership and/or operation characterized by government by community-based boards of trustees who are all volunteers. Board members donate their time and talents to ensure that a not-for-profit organization's approach to caring for older people responds to local needs. Not-for-profit homes and services turn any surplus income back into improving or expanding services for their clients or residents. Many not-for-profit organizations are often associated with religious denominations and fraternal groups. Not-for-profits may also interact with Congress and federal agencies to further causes that serve the elderly.

Nurse Assistant - A Nurse Assistant provides the most personal care to residents, including bathing, dressing, and toileting. Must be trained, tested, and certified to provide care in nursing facilities that participate in the Medicare and Medicaid programs. Nurse assistants work under the supervision of an Registered Nurse or Licensed Practical Nurse.

Nursing Home - Facility licensed by the state that provides 24-hour nursing care, room and board, and activities for convalescent residents and those with chronic and/or long-term care illnesses. One step below hospital acute care. Regular medical supervision and rehabilitation therapy are mandated to be available, and nursing homes are eligible to participate in the Medicaid program. May be referred to as Nursing Facility or Convalescent Home. See also Skilled Nursing Facility.

o

Occupational Therapy - Process to help individuals relearn activities of daily living, generally administered by a licensed therapist.

p

Payer - An organization that pays for health care expense coverage.

Physical Therapy - Process that includes individualized programs of exercise to improve physical mobility, often administered following a stroke, fall, or accident. Physical therapists plan and administer prescribed physical therapy treatment programs for residents to help restore their function and strength.

r

Registered Nurse (RN) - Graduate trained nurse who has both passed a state board examination and is licensed by a state agency to practice nursing. The RN plans for resident care by assessing resident needs, developing and monitoring care plans in conjunction with physicians, as well as executing highly technical, skilled nursing treatments. A minimum of two years of college is required in addition to passage of the state exams.

Rehabilitation - Therapeutic care for persons requiring intensive physical, occupational, or speech therapy.

Residential Care - See Assisted Living.

Respite Care - Temporary relief from duties for caregivers, ranging from several hours to days. May be provided in-home or in a residential care setting such as an assisted living facility or nursing home.

s

Senior Apartment - Age-restricted multiunit housing with self-contained living units for older adults who are able to care for themselves. Usually no additional services such as meals or transportation are provided.

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