Frequently Used Long-Term Care Terms
To help you understand long-term care and long-term
care insurance, we have provided below a general explanation of
some frequently used terms. Note that the exact definitions of these
terms can vary from company to company, from state to state, and
from policy form to policy form, even between forms of the same
company. Always consult the actual policy for the meaning of the
terms applicable to your situation.
Activities of Daily Living (ADLs)
Everyday functions and activities people
usually are able to do without help. Includes bathing, continence,
dressing, eating, toileting and transferring (moving in or out of
a bed, chair or wheelchair).
Adult Day Care
Care provided during the day for adults,
usually outside of the home in a group setting.
Assisted Living Facility
A residential living arrangement that
can provide individualized care and health services for residents
who need assistance with Activities of Daily Living. May also be
called Custodial Care, Domiciliary Care, Intermediate Care, Personal
Care, Residential Health Care, Sheltered Care or Supported Care
Facilities
At-Home Care
Services and supplies provided when
living in one’s home, such as Home Health Care, Adult Day Care,
Hospice Care and Respite Care.
Caregiver Training
An instructional program for the training
of an informal caregiver (Husband, wife, adult child or other relative
or friend) whose caregiving will allow a patient to remain at home
instead of entering a long-term care facility. This type of training
is typically provided by home health care agencies or other Qualified
Home Health Care Providers, nursing homes, hospitals or other health
care agencies or professionals.
Cognitive Impairment
A deficiency in a person’s memory;
orientation as to person, place or time; deductive or abstract reasoning;
or judgement as it relates to safety awareness.
Custodial Care (Also
called Personal Care)
Care to help people perform Activities
of Daily Living that can be provided by someone without professional
medical training.
Elimination Period
The length of time for which a long-term
care insurance policy will not pay benefits for services covered
by a policy. The longer the elimination period, the lower the premium.
Exclusions
The types of expenses that are not
covered by a policy.
Functional Incapacity
A person’s inability to perform a number
of those Activities of Daily Living specified in a Long-Term Care
insurance policy.
Guaranteed Renewable
Means that an insurance policy cannot
be cancelled, terminated, changed or reduced if all renewal premiums
are paid on time.
Home Health Aide
A licensed or certified home care worker,
other than a doctor, nurse or therapist, who assists patients in
performing the Activities of Daily Living.
Home Health Care
A variety of services and supplies
provided in the home, such as visits by nurses, Home Health Aides
and physical, occupational, speech and inhalation therapists, Homemaker
Services, drugs, medicines, medical supplies and lab services as
well as durable portable therapeutic equipment.
Homemaker Services
Includes domestic, laundry and cleaning
services; food shopping and errands; meal preparation and cleanup
and transportation assistance to and from medical appointments.
Hospice Care
Care provided for pain and symptom
management associated with a terminal illness and any related conditions.
Normally provided by an agency that specializes in providing pain
relief, symptom management and support services to dying persons
and their families.
Intermediate Care
Occasional nursing and rehabilitative
care performed by, or under the supervision of, skilled medical
personnel.
Inflation Protection
An insurance policy option that calls
for regular increases in benefit limits to help offset the future
increases in long-term care expenses.
Married Couple or Married Person Discount
A reduction in the insurance policy
premium when both spouses have Long-Term Care coverage.
Medically Necessary Care
Services and supplies which are provided
in accordance with accepted medical practice; and as are required
by the patient’s condition. It doesn’t include care that exceeds
the scope, duration or intensity needed to provide safe, adequate
and appropriate care; nor does it include treatment provided solely
for someone’s convenience.
Paid-up Survivorship
An insurance policy option that will
waive the surviving spouse’s future premiums upon the death of the
other spouse. A minimum duration of continuous coverage under the
policy by both spouses may be required in order for the benefit
to be applicable.
Home Health Care Provider
A person or organization licensed or
certified to provide Home Health Care services.
Respite Care
Professional care provided on a short-term
basis for the purpose of temporarily relieving unpaid caregivers,
such as family members or friends.
Restoration of Benefits
An insurance policy feature that will
bring a policy’s maximum benefit amounts back to the level that
would apply if policy benefits hadn’t been paid.
Skilled Nursing Care
Daily nursing and rehabilitative care
that can be performed only by, or under the supervision of, skilled
medical personnel.
Tax-Qualified Long-Term Care Insurance
Policy
A policy that conforms to certain standards
in federal law offering federal income tax advantages.
Third Party Notice (Authorized
Designee)
An insurance policy feature that lets
the policyholder name someone who the insurance company would notify
if the policy is about to lapse because the premium hasn’t been
paid on time.
Waiver of Premium
An insurance policy feature that suspends
the premium payment requirement while policy benefits are being
paid.