Also known as ADLs. Self-care tasks that independently functioning individuals perform on a daily basis. Examples include:
In general, acute rehab is different from sub-acute rehab that is provided at skilled nursing facilities. Acute rehab is appropriate for patients who will benefit from an intensive, multidisciplinary rehabilitation program. Patients receive physical, occupational and speech therapy as needed and are medically managed by specially trained physicians. There is an attending physician onsite 24 hours a day to manage the medical aspects of each patient’s care.
Acute rehab is covered under Medicare and by other insurance providers based on specific criteria for approved diagnoses.
Also known as Living Will or Health Care Directive. It is a legal document that specifies whether you would like to be kept on artificial life support if you become permanently unconscious or are otherwise dying and unable to speak for yourself. It also specifies other aspects of health care you would like under those circumstances.
Special care for individuals with Alzheimer’s disease. This type of care requires special nurses and staff who are knowledgeable about the disease. Specific measures include: promotion of independence, preventing wandering, supporting family, and reducing frustration for the patient.
A healthcare facility for individuals who are able to live independently but may need help with some ADLs. Residents often reside in their own apartments and will have access to facility-provided meals, recreational activities, and light housekeeping services.
The average duration of a single episode of inpatient care at a facility. Length of stay is calculated by subtracting day of admission from day of discharge.
The maximum benefit dollar amount covered by your insurance policy in a calendar year.
Insurance companies use benefit triggers as criteria to determine when you are eligible to receive benefits. The most common benefit triggers for long-term care insurance are:
A type of noninvasive ventilation which uses two alternating pressure settings. One , pressure which generates a constant flow of air and another pressure to assist during inspiration. BiPAP is usually used to treat chronic obstructive pulmonary disease (COPD) or obstructive sleep apnea (OSA).
Health care professionals who assess, plan, and advocate for patients to find resources and facilitates to transition across different levels of health care services. They have registered nursing (R.N.) degrees.
A quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.
Your share of the costs of a covered health care service calculated as a percent (for example, 20%) of the allowed amount for the service. The allowed amount for a certain health care service is the contracted price determined by the health insurance payer and the health care provider.
A CCRC is a facility which houses different levels of aging care needs ranging from independent living through assisted living to skilled nursing. The various levels can be in different floors of one building or located in adjacent buildings. Contract Type(s). There are three types of continuing care contracts: Type A (Extended), Type B (Modified) and Type C (Fee-for-Service). The different types of contracts determine the health care services offered and how much you will pay for these services.
A type of noninvasive ventilation that functions to maintain a continuous level of positive airway pressure both during inspiration and expiration. Usually used to treat obstructive sleep apnea (OSA).
The method in which different insurance policies coordinate benefit payments for a claimant. Consult your insurance carrier for the COB information if applicable.
Your share of the costs of a covered health care service prescribed as a fixed amount (for example, $100).
Non-skilled care to assist with the Activities of Daily Living. It is usually provided by aides, volunteers, family or friends who are not medically trained. Custodial care, not in conjunction with skilled care, are usually not covered by insurance.
The amount of health care expenses that you must pay out of pocket before your insurance begins to pay any expenses. The deductible may not apply to all health care services; please consult your insurance coverage information or evidence of coverage.
For Medicaid eligibility purposes, a disabled person is someone whose physical or mental condition prevents him or her from doing enough work or the type of work needed for self-support. The condition must be expected to last for at least 12 months or be expected to result in death.
The release of an admitted patient from inpatient stay at a care facility.
It is a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR order may be instituted on the basis of an Advanced Directive from a person or from someone entitled to make health care decisions on the person's behalf.
Also known as Deductible Period or Benefit Waiting Period. It is a specified duration at the beginning of a disability during which you receive covered services, but the insurance does not pay benefits.
Formal caregivers are paid for their services and have had training and education in providing care. This may include services from nursing homes, home health agencies and other trained professionals.
A type of medical care or rehabilitation therapy provided at the patient’s home, rather than in a hospital or skilled nursing facility.
Hospice is a program designed to give supportive care and services in the final phase of a terminal illness. Hospice focuses on comfort and quality of life rather than cure. Additionally, the program also provides emotional, spiritual and bereavement support to the terminally ill patient and their family.
Also known as family caregivers. They are are persons who provide care to family or friends usually without payment.
An inpatient rehabilitation facility is a type of transitional hospital facility usually after a traditional hospital designed to provide an intensive rehabilitation program to patients able to participate in >3hrs of occupational, speech and/or physical therapy.
Administering drugs or nutrients through the venous blood vessels due to the individuals inability to take medications by mouth or the formulation of the ingredient is not suitable to be ingested by mouth.
A long term acute care facility is a transitional hospital facility usually after a traditional hospital stay designed for patients with serious medical problems that require physician driven treatment for an extended period of time—usually 20 to 30 days.
Services and supports necessary to meet health or personal care needs over an extended period of time.
A type of insurance to help assist in nursing home expenses. Long-term care insurances include retiree and government-funded insurance, such as Medigap. Other types of insurance help pay for 24-hour care. The benefits and costs of these plans vary.
The maximum number of days covered by your insurance policy for skilled nursing facility stay in a calendar year.
Medicaid is a means-tested health and medical services program for certain individuals and families with low incomes and few resources. It is the largest public payer of long-term care services in the U.S.
Medi-Cal is California’s Medicaid program.
Medicare is a Federal health insurance program that pays for hospital and medical care for people over age 65 and those meeting specific disability standards. Benefits for nursing home and home health services are limited.
A Medicare insurance plan offered by a private insurer that contracts with Medicare to provide you with all your Part A (hospital insurance) and Part B (medical insurance) benefits.
Medicare covers skilled nursing care in a skilled nursing facility under certain conditions for a limited time. In 2014, Medicare beneficiary pays:
Days 1–20: $0 for each benefit period
Days 21–100*: $152 copay per day of each benefit period
Days 101+: all costs
*The copay for days 21-100 are updated each year.
The center for medicare and medicaid services created a comprehensive 180 point rating system for nursing facilities. The rating system is based on a combination of on-site and self report of health inspection results, staffing data, and quality measure data.
Also known as Medigap coverage. It is private insurance policy that covers gaps in Medicare coverage. Medicare Supplement policies cannot work with Medicare Advantage plans.
Sometimes the term nursing home is interchanged with a skilled nursing facility (SNF), intermediate care facility, or convalescent home. However, the formal definition is that it is a post-acute care facility that provides non-skilled care to those who are chronically ill or unable to take care of daily living needs. The non-skilled care needs are usually higher than what an assisted living facility can handle. Typically skilled nursing facilities will have beds designated for nursing home residents which they name "long-term beds," whereas, the "short-term beds" are for residents with skilled-needs.
A healthcare field that aims to promote independence by restoring function to individuals so that they can maintain or reach meaningful and purposeful activities. (E.g. brushing teeth, combing hair, going to the bathroom, and other ADLs etc)
Therapy types that include Physical therapy, occupational therapy and speech therapy that can be offered on an outpatient basis. The therapy will be tailored to the individual's own schedule in order to maintain their customary daily activities.
A PICC or PIC line is a form of intravenous access that can be used for a prolonged period of time (e.g. for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition).
A field of healthcare focused on restoring and/or promoting mobility, functional ability, quality of life and movement potential. (E.g. stand up, walk, and get in and out of bed etc.)
The POLST is a relatively new document that states a person’s end-of-life wishes. With the use of a POLST paradigm, emergency and medical personnel have clear orders on which actions to take in the event of an emergency based on the patient’s wishes. It includes the patient’s desire to have or refuse CPR, to be taken to a hospital, and whether to receive artificial nutrition. The paradigm can follow a person wherever he goes; it’s valid at home, in a nursing home, a long-term care facility, and in the hospital.
A letter of attorney that gives someone else the authority to act on your behalf on matters that you specify.
Taken from Medicare.gov.
Time that you spend in a hospital as an outpatient before you're admitted doesn't count toward the 3 inpatient days you need to have a qualifying hospital stay for SNF benefit purposes.
Observation services aren't covered as part of the inpatient stay.
You must enter the SNF within a short time (generally 30 days) of leaving the hospital and require skilled services related to your hospital stay.
After you leave the SNF, if you re-enter the same or another SNF within 30 days, you don't need another 3-day qualifying hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days.
A short-term arrangement that affords a caregiver some time off to refresh and relax.
Skilled care is the provision of services and supplies that can be given only by or under the supervision of skilled or licensed medical personnel such as a nurse, doctor, or therapist. Examples include help with administering intravenous medications, caring for wounds, and providing physical therapy.
A healthcare facility certified by Medicare that provides skilled care to individuals. Medicare covers skilled care services that are needed daily for up to 100 days. Medicare certifies these facilities to ensure they have the staff and equipment to give skilled nursing care, rehabilitation services and other related health services. SNFs are designed for patients that are unable to participate in more than 3 hours of therapy but have needs requiring credentialed healthcare providers such as nurses and therapists to provide care such as intravenous medication administration or physical therapy.
A type of medical therapy performed by speech therapists focused on assessing and treating issues in speech, language, and swallowing. Usual conditions they evaluate and manage include individuals who have suffered from a stroke and elderly with swallowing difficulties.