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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 coverages 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.
Caregiver(s),
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 judgement 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.
Couples
Discount:
A discount applicable if both couples are eligible and apply
for coverage.
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.
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. |
