A GLOSSARY FOR LONG-TERM CARE AND LTC INSURANCE
Navigating the in's and out's of long-term care can be overwhelming. Here is a list of key terms you might come across and will need to understand before you sit down with a professional to discuss the policy that best fits your needs.
A
activities of daily living - activities of daily living consist of bathing, toileting, continence, dressing, eating, and transferring.
adult day care - a place that provides a program of activities and services to individuals in need of long-term care. It is a helpful option for individuals living at home whose family caregivers work during the day and who require someone to be with them throughout the day.
Alzheimer's disease - a progressive neurological disease that affects brain functions, including short-term memory loss, inability to reason, and the deterioration of language and the ability to care for oneself.
assisted living facility (licensed as residential care facility in CA) - a licensed residential facility that provides room, board and 24-hour personal care to individuals with long-term care needs. It is an important care option for individuals who are not able to manage at home, but do not need the level of skilled care provided in a nursing home.
B
bed hold - a benefit that may or may not be included in a long-term care insurance plan that pays for reserving your bed in a care facility should you need to be hospitalized during a covered stay.
benefit amount - The amount that your policy will provide to cover your needs on a daily or monthly basis.
benefit period - The minimum period of time (years) you can expect your coverage to last.
C
care coordination services - services such as information, advice, and development of a plan of care by a professional care coordinator.
caregiver - a caregiver is the person who helps you accomplish basic everyday activities you can no longer manage without assistance, due to illness, injury, or cognitive impairment.
chronic care - care provided to help maintain daily function. There is no expectation that the care recipient will improve or recover.
cognitive impairment - a deterioration or loss in intellectual capacity that results in impairment in some or all of the following: short and long-term memory, orientation to people, place, and time, deductive or abstract reasoning, including judgment.
community-based services - includes services and programs such as meals on wheels and adult day care, that are designed to help people remain independent and/or in their own homes.
continence -the ability of the body to control urination or bowel movements or both, this is an activity of daily living.
custodial care - services aimed at maintaining your health and/or preventing deterioration in your functional status, provided on an extended basis.
D
daily benefit - the amount of insurance benefit per day in a long-term care insurance policy a person can choose to cover long-term care expenses.
daily maximum benefit - this is the maximum amount your long-term care insurance will pay in any single day.
dementia - deterioration of mental faculties due to a disorder of the brain.
E
elimination period -This works like a deductible, in that the policyholders pays for the cost of care for a limited time before the insurer beings to pay benefits for an eligible claim.
H
home health care - at home services for occupational, physical, respiratory, speech therapy, or nursing care. Typically included are 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, cooking, home management, and similar services.
hospice care - is usually provided at home or in a hospice facility and provides care to alleviate physical, emotional, or spiritual discomforts near the end of life.
I
inflation protection - this feature, helps long-term care insurance benefits grow on a regular basis to keep up with the rising cost of care.
L
long-term care - personal care and other related services provided on an extended basis to people who need help with activities of daily living or who need supervision due to a severe cognitive impairment. It can be provided at home, in a nursing home, assisted living facility, or an adult day care center.
long-term care insurance - insurance that helps defray the costs of long-term care services, when a person needs assistance with the activities of daily living or supervision due to a severe cognitive impairment.
M
Medicaid - the joint Federal-state program that pays for health care services for individuals who meet their state's poverty guidelines. It generally covers only those with very little income and assets.
Medi-Cal - California's Medicaid health care program. This program pays for a variety of medical services for people with limited income and resources and/or disabled individuals regardless of any preexisting health condition. If you are eligible, you can receive Medi-Cal benefits as long as you continue to meet the eligibility requirements. Medi-Cal is managed through the local county welfare/social services of California.
Medicare - a Federal health care program for most adults age 65 and older and certain disabled individuals. It pays only for short periods of care, typically up to 100 days.
Medicare Supplement Insurance - private insurance to help pay hospital and medical costs Medicare does not cover. It pays for long-term care under limited circumstances and for limited periods of time. This is not long-term care insurance.
monthly benefit - the amount of insurance benefit per month in a long-term care insurance policy a person can choose to cover long-term care expenses.
N
nursing home - a licensed facility that provides 24-hour a day room and board, nursing care and personal care services. Nursing homes also provide medical care, therapy, and other health related services.
P
personal care - care to help you meet personal needs such as bathing, dressing and eating.
plan of care - a plan prescribed by a licensed health care practitioner that identifies ways of meeting your need for long-term care services.
premium - the money paid to an insurance company for coverage.
R
respite services - services by a substitute provider, from a few hours to a few days, to give time off to the regular caregiver.
S
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 have their own definitions of "skilled nursing care" which do not necessarily match those in long-term care insurance policies.)
skilled nursing facility - generally 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 limit - the depletion of income and assets to meet eligibility requirements for Medicaid (Medi-Cal in CA).
sub-acute care - the first level of skilled care beyond the acute hospital setting. Patients appropriate for sub-acute care typically require skilled nursing as well as rehabilitation services.
T
toileting - getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene related tasks. This is considered an activity of daily living.
transferring - the ability to move in or out of a bed, chair or wheelchair. This is considered an activity of daily living.
Source: John Hancock www.johnhancockLTC.com.