Your Internet Guide to the resources devoted to serving older adults on
Cape Cod and the Islands.

Elder Resources: Glossary of Terms

Adult Day Care
- offers participants the opportunity to socialize, enjoy peer support and receive health and social services in a safe, familiar environment. It also provides a break for care givers responsible for a person who can't be left alone but who does not require 24-hour nursing care in a residential facility. Adult day care services may include: care and supervision; small group and individual activities; nutritious meals; transportation; case management; recreation and exercise; nursing care; education; family counseling; assistance with activities of daily living; and occupational, speech and physical therapies. (4)

Adult Day Health/Adult Day Care
-- Medicaid approved community based programs offering nursing care, social and therapeutic recreation, nutrition and transportation services at a site outside the home. (2)

Adult Foster Care
-- A program which watches elders who are experiencing increased difficulty living safely alone with persons in the community who are willing to open their homes and function as care givers. Most care givers provide housing and appropriate care and also receive training and organizational support. Programs provide room and board and personal care services in a residential setting for elders who have sufficient functional impairment to require supervised living. (2)

Area Agencies on Aging (AAAs)
-- Provides funding for a range of long term care services, which are available without regard to income or assets.

Assisted Living
can be provided in a variety of settings, including free-standing facilities, facilities close to or integrated with skilled nursing facilities, components of continuing care retirement or independent housing complexes. Most residences consist of single or semi-private rooms or apartments with a private bathroom. In addition to a group dining area, most facilities provide residents access to cooking facilities. Rooms or suites can usually be furnished with the resident's personal belongings. (1)

Services and activities generally provided in an assisted living setting include the following:
  • up to three meals a day, usually served in a common dining area
  • Supervision, coordination or assistance as needed with activities of daily living, including eating, toileting, bathing, dressing and walking
  • 24-hour security and emergency response
  • Medication management
  • Housekeeping/maintenance
  • Laundry/linen service
  • Transportation
  • Social and recreational activities
  • Health/wellness programs (1)

Care Management
-- Comprehensive client-oriented needs assessment to identify unmet needs or problems inhibiting secure and independent living in a home environment, followed by developing and periodically reviewing a care service plan.

Case Management Services
-- provide assistance in both locating and managing services for your ongoing needs. Professional case managers usually have a background in counseling, social work or related health care field and are trained to assess your individual situation and to implement and monitor a care plan to meet the needs of your loved one. They work with you, the physician, therapist, and patient to identify and arrange services such as transportation, home care, meals and day care. Additionally, case managers can help determine eligibility for entitlement programs, plan for long-term care and intervene in crisis situations. You may find case managers at hospitals, mental health programs, home health agencies, social service agencies. Many private care managers exist in local communities. (4)

Congregate Housing
-- non-institutional residences integrate a shared living environment with supportive services for residents, thereby offering an alternative to nursing home placement for persons who have experienced some functional impairment but do not require constant supervision. (2)

- Court appointed custodian of property belonging to a person determined to be unable to properly manage his or her property. (8)

Durable Power of Attorney
- A Durable Power of Attorney is similar to a Power of Attorney except that it continues notwithstanding the disability of the principal if certain language is included in the document. However, death of the principal still revokes it and the principal may revoke it in writing. (8)

Geriatric Care Manager
-- a professional who helps elders and their families develop and implement long term care plans that maximize independence, providing assessments and locating and arranging services to meet individual needs.

-- One who legally has care and management of the person or estate, or both, of an incompetent person, who can not act for himself or herself, or of a minor. Court appointed to protect the interest of a minor or incompetent person and to provide for their care, welfare, education, maintenance and/or support. (8)

-- an individual appointed by the Probate Court to manage legal, financial and day-to-day affairs of another individual deemed unable to make decisions for her/himself. The guardian has legal custody of the individual, who is termed a "ward."

Health Care Proxy
-- A written instrument which names another person, called the "agent," to make health care decisions for him or her when a doctor certifies in writing that the person can no longer make health care decisions for himself or herself. This document becomes operative only when the person becomes incapacitated in the attending physician's opinion and unable to understand the nature and consequences of health care decisions. A person may revoke a Health Care Proxy verbally or in writing. (8)

Health Care Proxy
-- a legal document recognized under Massachusetts law which enables you to choose a Health Care Agent (a person to speak for you if you ever become incapable of communicating or making decisions about your medical care). It differs from a living will which does not identify an individual with whom your doctor can discuss important medical decisions on your behalf. An "agent" is designated by means of a "proxy," a document which meets certain formalities. The proxy may contain limitations on the agent's authority and specific instructions about medical care. The Health Care Proxy becomes effective only when the patient's attending physician has determined IN WRITING that the patient lacks capacity to make or communicate health care decisions. The patient may revoke the proxy at any time.

The Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions. It is an important document, however, because it concerns not only the choices you make about your health care, but also the relationships you have with your physician, family, and others who may be involved with your care.

Your agent will make decisions about your health care ONLY when you are, for some reason, unable to do that yourself. This means that your agent can act for you if you are temporarily unconscious, in a coma, or have some other condition in which you cannot make or communicate health care decisions. Your agent cannot act for you until your doctor determines, in writing, that you lack the ability to make health care decisions.

Acting with your authority, your agent can make any health care decision that you could, if you were able.

Your agent will make decisions for you only after talking with your doctor or health care provider, and after fully considering all the options regarding diagnosis, prognosis, and treatment of your illness or condition. Your agent has the legal right to get any information, including confidential medical information, necessary to make informed decisions for you.

Your agent will make health care decisions for you according to your wishes or according to his/her assessment of your wishes, including your religious or moral beliefs. You may wish to talk first with your doctor, religious advisor, or other people before giving instructions to your agent.

Health Maintenance Organization (HMO)
-- an entity licensed by the state to provide comprehensive health services to subscribers and their dependents in exchange for enrollment on a capitated basis.

-- trained homemakers provide supervised home based assistance with activities of daily living including light housekeeping, meal preparation, laundry, and errands. (2)

Home Health Aide Services
-- certified home health aides provide home based assistance with instrumental activities of daily living in addition to more advanced procedures including transfers and range of motion exercises under the supervision of a registered nurse. (2)

Home Companion Services
-- Private organizations who specialize in matching individuals employed by the agency with the elder at home. Personal Companions are usually not home health aides or RNs. They provide services such as: driving an elder to a doctors appointment, helping with grocery and clothes shopping, helping with bill paying or doing secretarial work, preparing meals, taking a resident out for lunch or to visit friends, helping with an exercise and staying in constant touch with members of the family. Insurance usually does not cover the cost of companion services. Many home care organizations also provide companion services.

Home Health Services
-- are organizations which may provide a wide range of services at an individuals actual home, services may include certified home health aides, visiting nurses, hospice, companion, housekeeping and licensed physical occupational or speech therapist who are trained in helping a person regain instrumental activities of daily living. It is important to look closely at what a Home Care Organization has to offer, especially in determining the type of supervision the staff providing services are receiving, most should be receiving the supervision from nurse or physician.

Hospice Care
-- hospice care provides special services for terminally ill persons and their families. Nurses, social workers, home health aides, volunteers, therapists and often pastoral counselors who provide dignified, compassionate care for those who are dying. Hospice care is palliative, not curative. Services may be provided at home or in a hospital or nursing home when space is available. Support for family members is a unique aspect of hospice care. (2)

Independent Living Options
- are similar to any apartment, condominium, or single-family development, except that they provide special services. Most are fully secured with staff that may meet and screen visitors around the clock. Many independent living options provide a full range of activities that promote social contact among residents. Shopping trips, outings to cultural events, and organized gatherings are typical activities. Most offer a variety of meal plans, including the option of preparing meals in your own apartment. Some independent living options share affiliations with health care facilities that can provide such care when it is needed. Residents can also purchase home health care services from outside providers.

Levels of Care (Nursing Facilities)
-- While the federal government has eliminated all references to and makes no distinction regarding levels of care, the state still utilizes level of care classifications for the sole purpose of licensing long-term care facilities.

Level of care classifications I through IV reflect services provided, /Medicaid participation, and criteria including personnel qualifications and staffing patterns. Multilevel facilities (e.g., II & III) are licensed to provide more than one level of care. All levels are required to provide minimum basic care and services including social services and organized recreational and activities programs.

Levels I, certified nursing facilities, and II, financed by Medicaid or private payment, are now simply defined as nursing facilities. As such, they provide twenty-four hour skilled nursing services as well as restorative and other therapeutic services. Many specialize in areas such as rehabilitation.

Levels III and IV include rest homes and retirement homes. Services range from routine nursing care to assistance with activities of daily living or supervised care for persons who do not require nursing or medical services.

Most retirement homes (Level IV) provide residential rather than nursing care. Multilevel facilities may maintain graduated levels of care up to or including skilled nursing services. (2)

Living Will
- A written statement of a person's intent to refuse or accept extraordinary medical treatment such as artificial life support systems and artificial nutrition or hydration that are designed to prolong life. The statement is written when the person is competent in case it is ever needed to show to a judge in order to disconnect life support systems. This document if not officially recognized in Massachusetts, but it does provide written evidence of a person's wishes. A Living Will is officially recognized in several states. (8)

Long Term Care
-- one or more services provided on an ongoing basis to enable individuals to maximize physical, psychological and social well-being. Recipients can reside anywhere along a continuum from their own homes to any one of many residential facilities.

-- is a federal health insurance program that provides partial payment for up to 100 days of skilled nursing care for disabled persons and those persons aged 65 or over. To be eligible, a person must be admitted to a certified facility or begin receiving approved home based care shortly after discharge from a hospital where he/she has been a patient for at least 3 days, and require skilled nursing or rehabilitative care for the same condition treated in the hospital. Most nursing facilities are required to provide you with the most up-to-date information related to and what is covered under this program. (2)

-- Medicaid, also known as MassHealth, is a state and federal medical assistance program that pays for long term care services for individuals eligible for either home based care or nursing facility or rest home admission based on level of care required or degree of functional impairment. Eligibility is based on medical and specific financial criteria.

Medicaid recipients considering institutional placement and nursing facility residents seeking to convert from private pay to Medicaid status must be screened for medical eligibility according to Division of Medical Assistance regulations prior to admission. Questions regarding Medicaid should still be directed to the local Public Welfare Service Office. (2)

-- private supplemental insurance designed to help cover Medicare deductibles and co-payments.

Nutrition Programs
-- meals may be delivered to the home (meals on wheels) or served at a local group meal site. (2)

Nursing Facility
-- a facility that provides 24-hour nursing care, rehabilitative services and assistance with activities of daily living to the elderly, disabled and chronically ill, as well as to those who have been hospitalized for an illness or operation and require a short period of recuperation and/or rehabilitation before returning home.

-- In December of 1987, Congress passed the Nursing Home Reform Act, a far-reaching bill intended to improve the quality of nursing home care in the United States. The Act, which became known as OBRA '87 because it was contained in the Omnibus Budget Reconciliation Act of that year, included provisions for nurse aide training, pre-screening of residents for mental illness and mental retardation, comprehensive resident assessments, and increased nurse staffing. Both quality of care and quality of life are addressed in OBRA and in related new regulatory requirements for long term care. (2)

Ombudsman Program
-- The mission of the Long Term Care Ombudsman Program is to investigate and work to resolve complaints made by or on behalf of the residents of long term care facilities and to advocate for changes needed to improve the quality of life and care in those facilities. (2)

Paying for Care
- Rates for most facilities vary according to the room, single or multiple occupancy, and level of care required. Basic rates include room and board, and the standard level of nursing care provided by the facility. Additional fees include but are not limited to physician's fees and prescribed medications. Prior to admission, it is essential to determine the specific nature and cost of any additional charges.

Rates for home based care also vary depending upon level of service (e.g., homemaking, home health aide, or nursing services), individual agency rates, and established rates for specific geographic areas. Prior to contracting for services, it is advisable to make inquiries regarding rates and services. Contacting several agencies allows for both service and rate comparisons.

Because long term care is costly, prolonged care can quickly deplete individual or family savings. While some home based and nursing care costs may be defrayed by private medical and disability insurance policies, long-term care is most often financed through personal funds and/or state and federal medical assistance programs. (2)

Personal Care Homemaker
-- trained personal care homemakers provide home based assistance with instrumental activities of daily living including eating, dressing, bathing, personal hygiene, and ambulation under the supervision of a registered nurse. (2)

Power of Attorney
- An instrument in writing by which a person appoints another as his agent and confers upon him or her the authority to perform certain specific acts or kinds of acts on his behalf. The Power of Attorney is often used to handle an individual's financial matters. A Power of Attorney is revoked upon incapacity of the principal or death of the principal. (8)

Residential Care Facility
-- a facility licensed to provide room and board, supervision and, sometimes, social and other services for individuals who need assistance with activities of daily living (ADLs) but do not routinely require nursing or medical care. Also known as a rest home.

Respite Care
-- this program provides home and/or community based assistance for primary caregivers of severely disabled persons to enable informal caregivers to work or to provide them with relief from the stress of full-time care. Services include homemaker, home health aide, social day care, adult day health, nursing, foster care, and companions. (2)

Rest Homes
- are licensed by the state and may be referred to as offering "level IV" care. They are intended for people who do not require 24-hour skilled nursing services. Rest homes provide supervision, meals, minimum medical services, and social activities.

Retirement Communities
-- Retirement communities provide both shelter and supportive services to elders. The architecture and furnishings are designed to eliminate barriers to freedom of movement (low pile carpeting, no stairs) and to promote independence (lever handles, grab bars in baths) and social interaction (open areas, lounges). Services are provided or coordinated that will lessen the burden of home upkeep, maintain optimal health and encourage social and recreational activities. In the private sector, services such as meals, housekeeping, transportation and sometimes health care are coordinated for the residents, using existing health and home care services. (2)

Skilled Nursing Facility
- provides 24 hour nursing care, rehabilitative services, and assistance with activities of daily living to the chronically ill as well as those who have been hospitalized for an illness or operation and require a short period of rehabilitation before returning home.

Social Day Care
-- community based programs offer social activities for persons requiring day-time supervision due to physical disability or social/emotional problems affecting capacity for self-care. (2)

Subsidized Housing
-- Eligibility requirements vary but are primarily based on income. Rent is generally 30% of monthly income and usually includes utilities. Dwellings are apartment style and many are specially designed for older persons. Handicapped accessible units are often available. Contact housing authorities or private subsidized housing providers for more information.

Supplemental Security Income (S.S.I.)
-- S.S.I. is a state and federal assistance program that pays for residential care provided by rest homes for persons eligible according to financial need. S.S.I. recipients are automatically eligible for Medicaid coverage of home based services and medical expenses as established by the Department of Public Welfare.

Since coverage is subject to change, persons interested in entering rest homes should contact the local Department of Public Welfare for information regarding Medicaid eligibility standards. Questions regarding S.S.I. should be directed to the local Social Security Office. (2)

Visiting Nurse Association (VNA)
-- a certified home health care agency with a community board of directors that provides nursing care, rehabilitation therapies and home health aide services in the community. "Certified" means approved by the Department of Public Health for reimbursement under Medicare, MassHealth (Medicaid) and other insurance policies. A VNA is always a non-profit corporation.


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