Glossary of Terms
401K plan – defined pension plan offered by employers as a forced way of saving for retirement by deferring pre-tax dollars into accounts that are invested in various markets on behalf of the beneficiary. Employers often match funds at their discretion. While 401ks reduce the taxable income of the employee that year, disbursements are taxable and applicable to the Adjusted Gross Income (AGI – see below)
Activities of Daily Living (ADL) – refers to common tasks that are required for sustaining a healthy existence. Examples include dressing, bathing, grooming and toileting tasks.
Acuity level – refers to the medical complexity of an individual. The higher the acuity level the more complex the care needs are and therefore the more complicated.
Acute – refers to a disease state or injury that is either new, active or exacerbating. Examples are a fall resulting in a hip fracture, a new stroke or heart attack. Acute conditions are typically actively treated and while they may require a temporary relocation of living arrangements, the hope is that the person can return to their prior environment
Adjusted Gross Income (AGI) – the amount of money earned yearly by an individual or a married couple that is taxable according to IRS tax laws. AGI is used to calculate any additional Medicare premiums
Adult Residential Facilities (ARF) – sometimes known as board and care facilities, these community based residences offer smaller, more intimate settings. These facilities are also called group homes – this term and ARF are more common in young adult group situations such as those with Downs’ Syndrome or other mental challenges.
Advance Directives – legal documentation that provides families of incapacitated patients specific direction and ability to make decisions on behalf of that patient. This includes Durable Power of Attorney (DPOA) for healthcare or financial decisions, Living Will that outlines the patient’s wishes in certain circumstances such as maintaining or removing life support.
Aging in Place – As the industry evolves, there are new terms that become part of the lexicon. Aging in place is one of these terms. The CDC defines aging in place as “The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” As the reader can imagine, most people including Seniors would prefer to stay in their own home as opposed to moving. Moving in general can be distasteful, however it is even more onerous when the move is forced upon a Senior that has lived in their current environment for a generation or so.
Alzheimer’s Disease- condition characterized by plaquing in the brain that impairs memory and higher cognitive functions. The disease state is chronic and progressive over time, robbing the victim of both short and long term memory that necessitates care for everyday functions.
Amyotropic Lateral Sclerosis (ALS) – also known as Lou Gehrig’s disease, ALS is a chronic progressive central nervous system disorder that slowly causes loss of motor control and paralysis over all systems in the body, typically beginning with the musculoskeletal system and progressing eventually to the respiratory system causing death
Aphasia – refers to the lack of ability to communicate. There are two types of aphasia. Expressive aphasia robs the victim of the ability to speak and communicate effectively while receptive aphasia interferes with the ability to understand communication. Aphasia is most commonly the result of brain injury such as stroke.
Aspiration and Aspiration Pneumonia – the accidental inhalation of food into the lungs that festers into bacterial pneumonia that can be life threatening for some Seniors
Assisted Living Facility (ALF) – an emerging segment of the Senior Living paradigm that provides housing and meals plus additional services typically an an a la carte basis
Atrial Fibrillation (A-Fib) – abnormal heart rhythm that predisposes the patient to stroke
Basic Life Support (BLS) – as its name implies, these are emergency services to sustain life when cardiac and/or respiration function has been comprised. Typically BLS is associated with CPR (see below).
Cardiac – anything dealing with the heart
Cardiologist – a physician whose specialty is care of the heart
Cardiomegaly – enlargement of the heart due to increased work load typically associated with Congestive Heart Failure
Cardiopulmonary Resuscitation (CPR) – part of basic life support services (BLS). CPR consists of the external application of respiration through mouth to mouth or artificial means such as an Ambu bag and/or cardiac (heart) pumping such as chest compressions to sustain life on a temporary basis until more permanent measures can be established. CPR is applied in emergent situations when a person has either stopped breathing, has experienced cardiac arrest or both. Common examples include drowning, heart attacks or stroke. Respiratory arrest due to choking also falls under CPR.
Certificate of Deposit (CD) – financial instrument generally considered a safe investment with a fixed rate of return for a finite period of time typically through established financial institutions such as retail banks
Cellulitis – reddening and inflammation of the skin often due to edema, typically of the lower extremities that predisposes the sufferer to infection.
Centers for Disease Control and Prevention (CDCP) – federally funded agency that is the front line of defense for global health threats as well as serving as the authority on health research. The organization is government funded and serves to progress the collective body of healthcare knowledge for the advancement of healthcare delivery.
Certified Nurses Assistant (CNA)- these individuals are often the ones that work most closely with residents in skilled nursing and long term care settings. While they are not licensed nurses, most states require a certification that is indicative of a certain level of training. The work associated with patient care is perhaps the most demanding type of work and is the least paying within these settings.
Chronic – refers to a disease state that may or may not be active but is affecting or can affect a person’s clinical needs. Chronic conditions can disrupt a person’s ability to stay in their environment temporarily or permanently. Examples include diabetes, Parkinsons’ disease and dementia.
Chronic Obstructive Pulmonary Disease (COPD) – a decrease in an individual’s respiratory ability that often leads to loss of functional ability, loss of endurance and other impairments
Cognitive loss or impairment – commonly referred to dementia and often assumed to be Alzheimer’s disease, cognitive impairment refers to a loss of the ability to recall memories, perform specific tasks that require sequential thought and analysis in response to stimuli. There are many origins of cognitive impairment, ranging from organic diseases to trauma to infectious disease.
Co-morbidities – having multiple diagnoses at the same time, often associated with higher acuity level
Congestive Heart Failure (CHF) – a chronic condition whereby excessive fluid in the sac around the heart that restricts the ability of the heart to expand and contract. The result is that the efficiency of each beat decreases forcing the heart to work harder that results in a condition called cardiomegaly where the heart enlarges, just like any muscle that is working very hard. The enlarged heart takes up even more space, creating a vicious cycle. Edema of the lower extremity is very common as is shortness of breath, particularly upon exertion.
Crohn’s Disease – a disease of the gastrointestinal system that causes chronic symptoms of indigestion and irregularity
Daily Bed Rate – the price charged for a resident to occupy a bed in a facility on a daily basis. This is more common in short term stay rehabilitation facilities or long term care. The rate is calculated daily due to the large fluctuation when dealing with residents whose health may be somewhat tenuous.
Diabetes – there are two types of diabetes. Type I is typically referred to as juvenile diabetes because it is a condition that is diagnosed in childhood. Type II is adult onset diabetes and refers to the inability of the pancreas to create insulin that helps regulate the amount of sugar in the blood. Too much sugar in the blood causes the blood to be viscous, creating problems wherever there are small blood vessels such as in the eyes or the kidneys. Viscous blood also delays healing because blood does not circulate fast enough. Mild diabetes can be treated with diet and exercise, moderate cases with oral medications and severe cases with insulin injections.
Diuretics – a classification of pharmaceuticals that typically is prescribed when a patient has a fluid overload situation, such as CHF. The drug forces frequent urination (typically over a 6 hour period) that decreases the amount of fluid retained by the body assisting with managing heart rate and blood pressure. The pill itself is also commonly referred to as a “water pill” and its most common trade name is Lasix.
Do Not Resuscitate (DNR) – part of a medical chart that expresses an individual’s desire to not receive cardiopulmonary resuscitation in the event their heart stops or they stop breathing. The status is typically assessed upon hospital admission but can also be outlined in advanced directives (Defined above).
Durable Medical Equipment (DME) – devices such as walkers, wheelchairs, hospital beds, oxygen concentrators and any other equipment that is used daily by patients to assist their function and safety. Typically, DME can help extend the amount of time a patient can remain at home
Durable Power of Attorney (DPOA) – healthcare and financial instrument that allows an appointed person (the DPOA) to act on behalf of a patient when the patient is incapable of making their wishes known. This is a legal document that requires specific measures to make it enforceable. It also designates one individual as the contact point and decision maker. Ideally, the DPOA has been made aware of the patient’s wishes ahead of time and uses the Living Will as their guide in making decisions on behalf of the patient.
Dyspnea – also known as shortness of breath, dyspnea is commonly used when a patient is exerting themselves. This leads to the frequently used acronym DOE or dyspnic on exertion.
ED or ER – acronyms that refer to emergency department or emergency room that are used interchangeably to refer to the part of the hospital where those who brought in typically by ambulance due to health crisis that requires immediate attention. This is typically the beginning of the acute disease phase though also can be due to exacerbations of chronic conditions.
Edema – a term for swelling, typically of the extremities
Glucometer- device used by diabetics to measure blood glucose levels
HIPAA – the acronym stands for the Health Insurance Portability and Accountability Act which is the law that protects Personal Health Information (PHI) by creating a standard of managing PHI to which all healthcare providers and service providers must agree to uphold. Violation of HIPAA laws are sanctions and fines
Hypertension – also known as high blood pressure according to guidelines established by the American Heart Association. High blood pressure is a significant risk factor for heart disease and stroke.
ICD -10 code – refers to the system by which illnesses, injuries and diseases are classified by assigning them numerical codes. The codes allow for billing and reimbursement based upon the codes.
Independent Physician Association (IPA) – a grouping of physicians that organize together for the purpose of contracting with insurance companies as well as hospitals and other provider centers. The IPA is, as the name implies, independent meaning that they are free to enter into whatever business arrangements are in their best interest. However, recently IPAs began sharing risk with insurance companies, meaning that they are both the payer and the provider
Individual Retirement Account (IRA) – an investment vehicle that allows an investor to take pretax monies and invest them in market based investments that will grow tax free as long as the money stays in the IRA account. Seniors must take disbursements starting at age 70 1/2 .
Instrumental Activities of Daily Living (IADL) – refers to activities such as cooking, shopping, housekeeping, management of finances and advocacy of one’s health needs.
Lewy Body Dementia – a diagnosis that was first discovered by Dr. Lewy that is noted for significant build up of protein bodies in the brain that interferes with cognitive function. Lewy body dementia is the second most common form of diagnosed dementia after Alzheimer’s.
Licensed Vocational (or Professional) Nurse (LVN/LPN) – a type of licensure for nursing that allows the practitioner to provide certain nursing services as specified by each state’s practice act. LVN or LPN also depends on the state. This licensure typically has restrictions on the types of services and usually requires supervision by registered nurses (RN). For this reason, the use of LVN/LPNs is prevalent in Senior Living environments such as ALFs and CCRCs because the facility’s restrictions on the types of services is often consistent
Living Will – a legal document that allows an individual to outline their wishes in the event that they are not able to express those desires. Part of the Advanced Directives, the Living Will serves as a guide for the Durable Power of Attorney (DPOA) for making critical decisions on behalf of the incapacitated patient.
LOA (Letter of Agreement) – a document that establishes a temporary relationship that outlines the parameters of accepting a patient into a facility when the payer organization and the facility do not already have a formalized contractual relationship
Maximum Medical Improvement (MMI) – term commonly used when a patient has reached their potential for recovery from an injury or illness. This is often the point that may serve as a trigger for changing living environments
Means testing – refers to the determination of certain premiums, commonly Medicare Parts B and D, according to the taxable income of a individual tax or joint tax filer.
Medicare – the federally funded insurance program that Seniors who have paid into the program can begin accessing at age 65, or if they meet a certain set of criteria related to illness, such as kidney disease. There are 4 different Medicare programs – A, B , C and D
Medi-Gap insurance – an insurance product sold by private insurance companies that bridges the gap between what Medicare Parts A & B will cover. Typically this is co-pays and deductibles. Medi-Gap policies have no networks and must pay to any healthcare provider that is receiving Medicare A and/or B funds.
Multiple Sclerosis (MS) – a chronic, progressive disease that attacks the sheaths around nerves causing the afflicted individual to gradually lose voluntary control over their muscles. People with MS can plan for needing progressive levels of care as the disease process progresses.
Naturally Occurring Retirement Community (NORC) – a phenomenon whereby Seniors have naturally gravitated to a geographic location forming a community that has similar needs as it pertains to healthcare and other services that foster continued independence.
Occupational Therapist (OT) – a trained rehabilitation professional who focuses largely on helping a patient recover their Activities of Daily Living (ADL) functions
Orthopedics – the study of the musculoskeletal system and how it functions. Orthopedic conditions typically involve bones and joints and the structures that support them. Treatment can vary from conservative measures including medicine and physical therapy to the aggressive such as surgery. Orthopedic conditions are common in the Senior population ranging from chronic conditions such as arthritis to fractures and injuries caused by falls.
Osteoarthritis (OA) – a condition characterized by the degradation of cartilage leading to painful and swollen joints. OA typically affects one or more joints but is not a systemic disease, rather more commonly due to significant injury or so-called “wear and tear” over a lifetime. OA is typically the driving force behind elective total hip and total knee replacements.
Patient Protection and Affordable Care Act (PPACA or ACA) – more commonly known as ObamaCare, this legislation mandates that all Americans purchase healthcare insurance or face penalties for not doing so. The PPACA also established insurance exchanges to facilitate the purchase of insurance. The law further punishes hospitals and healthcare systems for re-hospitalization within 30 days of discharge. More information can be found at http://www.dol.gov/ebsa/healthreform/
Parkinson’s Disease – a neurologic condition that is related to overstimulation of motor nerves in the brain. The overstimulation causes muscles to be likewise stimulated and is often synonymous with uncontrollable tremors or hand shaking. There are several different forms of Parkinson’s with slightly varying presentations.
Personal Health Information (PHI) – any information that is relevant to an individual’s health is considered protected information by the HIPAA regulations for the purpose of keeping the information private except to those who are allowed under HIPAA to access the PHI. Typically, this is healthcare providers, insurance companies and family members.
Physical Therapist (PT) – a rehabilitation professional who helps patients recover gross motor function such as walking, balancing, transferring
Physician extender – a healthcare practitioner with a license that allows that individual to proxy for a physician. In most states, this is either a nurse practitioner or a physician assistant that can prescribe medications, write orders and provide diagnostic education – all under the indirect supervision of a licensed physician.
Prior level of Function (PLOF) – refers to a person’s functional abilities prior to the onset of an acute condition or exacerbation of a chronic condition. PLOF is typically expressed in terms of an individual’s ability to walk, transfer, perform ADLs (see definition above) and generally take care of themselves
Prior Living Environment (PLE) – the previous place the Senior lived. The importance of PLE is often when recovery from an illness, injury or surgery is necessary. The ability to return to the PLE is often determined by the characteristics of the environment itself. Examples include stairs to access the living space, safety concerns, inadequate facilities or lack of space to use specialized equipment.
Post acute – any needs for care provided to a patient once they have left the hospital. This could include outpatient care, clinic visits, inpatient rehab or skilled nursing stay, home health or other ways patients receive care after a hospital admission
Registered Nurse (RN) – a healthcare practitionerllicensed by a state who operates under the direction of a physician to provide healthcare services that can range from the doctor’s office to the hospital to the patients’ homes
Residential Care Facility for the Elderly (RCFE) – the broad term for regulated Senior Living environments that are licensed by the state in which they reside. Licensure requires compliance with state rules and regular inspection/surveying. The rules, includes inspection vary by state.
Roth IRA – a type of individual retirement account in which after tax dollars are deposited into an account that grows tax free. The account owner can withdraw funds after the age of 65 tax free as well.
Senior Apartment Complex – an apartment complex that has a minimum age of 55 in order to be a resident. Note that these are typically simple leases, are not highly regulated and vary widely in amenities.
Sepsis – a systemic blood infection that often is a result of a local infection that was not addressed sufficiently and has spread via the bloodstream.
Skilled Nursing Facility (SNF) – a facility that provides services such as nursing services or rehabilitation services like physical therapy on an inpatient basis. Prior to the evolution in Senior Living and even in the current lexicon, these facilities are commonly referred to nursing homes. The connotation of the old age home is not really applicable to these facilities as they are highly regulated and have been vital to the evolution in Senior Living.
Skilled services – healthcare services that require a specific skill set to deliver and that could not be administered by someone without that specific skill set, training, background and experience. Examples of skilled services include nursing services for high risk intravenous antibiotics or wound care, or physical therapy to teach specific activities such as gait training and/or balance re-education. Skilled services are important when it comes to activation and qualification of insurance reimbursement.
SOB – medical acronym for shortness of breath