Reference
Understanding Dependency: A Glossary of Terms
The vocabulary of long-term care sits at the intersection of medicine, insurance, and law. These definitions cover the terms most families encounter first — and the ones that most often cause confusion.
- Activities of Daily Living (ADLs)
- The six fundamental self-care tasks — bathing, dressing, toileting, transferring, continence, and eating — used across medicine, insurance, and long-term care to measure a person's functional independence. Most long-term care insurance policies and Medicaid programs use the number of ADLs a person cannot perform without help as the trigger for benefit eligibility.
- Instrumental Activities of Daily Living (IADLs)
- A second tier of more complex tasks required to live independently in a community, including managing finances, preparing meals, managing medications, using the telephone, shopping, housekeeping, and transportation. IADL loss frequently precedes ADL loss and is often the first sign a family notices.
- Custodial Care
- Non-skilled care that helps a person with ADLs and daily needs — bathing, dressing, meal preparation, supervision — that does not require a licensed medical professional to perform. This is the type of care most people eventually need for the longest period of time, and it is generally not covered by Medicare.
- Skilled Care
- Time-limited, medically necessary nursing or therapy care that must be provided or supervised by licensed professionals. Skilled care is what Medicare will cover — typically for a short period after a qualifying hospital stay — and is distinct from the long-term custodial care most families actually need.
- Medicare
- The federal health insurance program for people 65 and older and certain younger people with disabilities. Medicare covers hospitalization (Part A), physician services (Part B), Medicare Advantage plans (Part C), and prescription drugs (Part D). Medicare does not pay for long-term custodial care.
- Medicaid
- A joint federal-and-state program that provides health coverage for people with limited income and resources. Medicaid is the largest single payer for long-stay nursing home care in the U.S., but eligibility requires a significant reduction in assets — the process commonly known as 'spend-down.'
- Medicaid Spend-Down
- The process by which a person reduces their countable assets — through medical bills, allowable expenditures, or other spending — to the level required to qualify for state Medicaid long-term care benefits. Rules vary by state and are governed by federal look-back regulations.
- Long-Term Care Insurance
- A category of private insurance designed to pay for custodial care in a nursing home, assisted living community, or at home. Traditional standalone policies use ADL and cognitive-impairment triggers; hybrid policies combine long-term-care benefits with life insurance or annuities.
- Hybrid Life/LTC Insurance
- A newer generation of insurance product that combines a life insurance or annuity contract with a long-term-care rider. If long-term care is needed, the policy pays those benefits; if not, a death benefit remains for heirs.
- Memory Care
- A specialized subset of assisted living designed for people with Alzheimer's disease and other dementias. Memory care communities feature secured environments to prevent wandering, higher staff-to-resident ratios, and programming specifically designed for cognitive impairment.
- Assisted Living
- A residential setting that provides housing, meals, personal care, and 24-hour supervision for adults who need help with ADLs but do not require the round-the-clock medical care of a skilled nursing facility.
- Skilled Nursing Facility (SNF)
- A licensed medical facility providing 24-hour skilled nursing care, rehabilitation, and long-term custodial care. SNFs are the highest-acuity long-term care setting and also the most expensive.
- Home Health Care
- Skilled medical care — nursing, physical therapy, occupational therapy, speech therapy — provided in a patient's home under a physician's order. Medicare covers time-limited home health care meeting medical-necessity criteria.
- Home Care (Personal Care)
- Non-medical assistance with ADLs, meal preparation, medication reminders, and companionship provided in a person's home. Home care is generally paid out-of-pocket or through long-term-care insurance, not Medicare.
- Respite Care
- Short-term care provided to give a primary family caregiver a break. Respite may be delivered in the home, at an adult day program, or as a short stay in a residential facility.
- Hospice Care
- Comfort-focused care for people with a life expectancy of six months or less. Medicare's hospice benefit is one of the most comprehensive in the program, covering nursing, aide services, medications related to the terminal illness, medical equipment, and family bereavement support.
- Caregiver Burden / Burnout
- The physical, emotional, and financial strain experienced by family members providing sustained care. Caregiver burden is measurable — validated instruments include the Zarit Burden Interview — and is strongly correlated with caregiver depression, chronic disease, and mortality.
- Power of Attorney
- A legal document that gives another person the authority to act on your behalf. A durable financial power of attorney remains valid if you become incapacitated, which is why elder-law attorneys strongly recommend putting one in place before cognitive changes occur.
- Healthcare Proxy
- A legal designation of another person — sometimes called a healthcare power of attorney — to make medical decisions on your behalf if you cannot make them yourself.
- Advance Directive
- A written document describing your wishes for medical treatment in the event you cannot communicate them yourself. Living wills and healthcare proxies are the two most common forms.
- Elimination Period
- In long-term care insurance, the number of days a policyholder must pay for care out-of-pocket before benefits begin. Common elimination periods are 30, 60, 90, or 180 days.
- Benefit Period
- In long-term care insurance, the length of time — typically two to six years or lifetime — a policy will pay benefits once the elimination period is satisfied.
- Cognitive Impairment Trigger
- A benefit-eligibility trigger, common to most long-term care insurance policies, that qualifies a policyholder for benefits when they can no longer safely function due to cognitive impairment — independent of whether they meet the ADL trigger.
- Elder Law Attorney
- An attorney specializing in the legal issues that affect older adults, including estate planning, Medicaid planning, guardianship, elder abuse, and long-term-care contracts.
- PACE Program
- The Program of All-Inclusive Care for the Elderly — a Medicare and Medicaid program that provides comprehensive medical and social services to certain frail older adults who are eligible for nursing home care but can live safely at home with support.
- Adult Day Program
- A community-based daytime program providing supervision, meals, activities, and often health services for older adults who cannot be safely left alone. Adult day programs are frequently used to give working family caregivers a workday's respite.