Glossary

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Activities of Daily Living (ADLs) - Everyday functions and activities that people usually do without help. These include dressing, eating, bathing, toileting, transferring and continence.

Acute Rehabilitation Hospital - A facility that provides an aggressive level of rehab, often up to 3 hours a day. Some elders start in acute rehab and then transfer to skilled nursing facilities for continued, slower-paced rehabilitation.

Adult Day Health - A day program that provides structured activities for elders who may require supervision due to limited physical or cognitive abilities and/or who are in need of socialization in a structured setting. Programs provide meals, transportation, medication monitoring, administration, and social services. Enrolling an elder in an adult day health program can provide needed respite for caregivers.

Aging Service Access Points (ASAPs) - The state of Massachusetts is divided into 30 home care regions. The ASAP is often a good point of entry for learning about services and benefits for elders in their community. They provide information and referral services and case management of low income elders. Click on http://www.masshomecare.org/ to learn which ASAP is available in your community.

Alzheimer’s Disease - A progressive disease that destroys cells in the brain and is the leading cause of dementia. See the Alzheimer's Association, Massachusetts Chapter, website, www.alzmass.org, for more information.

Assets - Money you have or property you own, such as cash, bank accounts, personal property, vehicles, real estate, and the cash surrender value of life insurance.

Assisted Living Facilities - Assisted living facilities consist of individual apartments, usually studio or one bedroom units, with some two bedroom apartments available. Each apartment has a bathroom equipped with walk in showers and grab bars, emergency call buttons, and often a small kitchenette. The facilities offer 3 meals a day, personal care (generally 45 minutes to 1 hour each day), activities, assistance with medications, homemaking, and scheduled transportation. Some have on site medical services, hair salons and fitness facilities. Assisted living is paid for with private funds on a monthly basis. There are some facilities that participate in one or both of the subsidy programs available to low income elders. Group Adult Foster Care (GAFC) is a Medicaid program that subsidizes elders below a certain income level who require daily personal care assistance. Low income tax subsidy programs also exist in some facilities for low income elders. The Massachusetts Assisted Living Facilities Association, www.massalfa.org, can be a helpful resource.

Companion - Someone who provides social contact. A companion might just visit at home or go out with an elder. Usually no personal care is rendered.

Conservator - An individual who volunteers or is appointed by the court to manage the estate/finances of another person.

Continuing Care Retirement Community (CCRC) - A CCRC or Life Care Retirement Community is a retirement community that usually requires an entrance fee, some of which is generally refunded to your estate when the contract is terminated. The communities vary in the array of services that are available. Some have assisted living programs or home health services available to those in independent apartments, and all have nursing facilities that can be accessed for short and long term care. An elder needs to be independent, without any diagnosis of dementia, prior to entering a CCRC.

Dementia - Dementia is not a disease itself but rather a group of symptoms caused by one or several disease processes.

Durable Medical Equipment (DME) - Durable Medical Equipment is medically necessary equipment that a physician prescribes for use in the beneficiary’s home such as walkers, wheelchairs, and hospital beds. In order to be considered durable medical equipment, the equipment must be able to with-stand repeated use, serve a medical purpose and be appropriate for use in the home. “Home” is one’s house, apartment, relative’s home, a home for the aged, or some other type of institution that a beneficiary resides (i.e. a hospital or skilled nursing facility). NOTE: This does not include nursing home.
* What DME Does Medicare Pay For? Generally, Medicare helps pay for equipment that meets the following criteria: - Is prescribed by a doctor filling out a certificate of medical necessity. - Is medically necessary. - Fills a medical need; it must be for more than a convenience. - Is appropriate for use in the home. - Can be used over and over again. Medicare pays for durable medical equipment in different ways, depending on the item or service (service includes service calls for repair or routine maintenance) and whether the beneficiary buys or rents the equipment. The Medicare carrier will be able to provide specific guidance on which method would be most beneficial. Medicare pays the same amount whether the supplier accepts assignment or not. Assuming the supplier takes assignment and the yearly Part B deductible is met, Medicare pays 80 percent of the Medicare approved charge. The beneficiary is responsible for the remaining 20 percent either directly or through supplemental insurance.
Not all suppliers accept assignment. If the supplier does not accept Medicare assignment, the beneficiary may pay excess charges for equipment; (the difference between what Medicare pays and what the supplier charges). To keep costs at a minimum the beneficiary should ask if the supplier accepts assignment and compare prices at DME suppliers if they do not. Whether or not the supplier accepts assignment, the supplier is required by law to complete the necessary paperwork and bill Medicare. Beneficiaries have the option of purchasing equipment or renting equipment for 15 months.

Elder - Someone who is at least 60 years of age. An elder is also known as senior, senior citizen, aged, or elderly.

Elder Abuse - Massachusetts law (MGL Ch. 19A, Sec. 14-26) defines elder abuse as acts or omissions resulting in serious physical or emotional injury to an adult age 60 or over. This includes, Physical abuse, Emotional abuse (harassment, threats, verbal abuse), Sexual abuse, Financial exploitation and Caregiver neglect. Protective Services Program investigates and, when appropriate, intervenes in cases where there is evidence that an elder has been neglected, abused or financially exploited by someone in a domestic setting. The protective services system is anchored by a 24 hour, seven day a week emergency hotline. It is empowered by Massachusetts General Law Chapter 19A to take steps that ensure that elder victims of physical and emotional abuse, neglect, and financial exploitation receive protective and supportive services. Elders must consent to services, but in situations where an elder lacks the capacity to provide consent, court ordered services are provided. 1-800-922-2275

Elder at Risk (EAR) - The Executive Office of Elder Affairs contracts with twenty-two (22) non-profit agencies throughout the Commonwealth to provide problem focused and goal oriented casework services to elders who are considered to be seriously at risk. These individuals are no longer able to meet essential needs for food, clothing, shelter, personal care, or medical care due to physical and/or mental impairments, substance abuse, or other serious problems, preventing them from remaining safely in the community without intervention. Unlike the Protective Services Program, the EAR program does not require the presence of an abusive or neglectful caregiver in order for services to be provided. Toll Free: 1-800-AGE-INFO (243-4636 nationwide) TTY Toll Free: 1-800-872-0166 (within Mass. only).

Elder law attorney - Elder law attorneys focus on the legal needs of the elderly and have a special knowledge of the law as it pertains to estate and Medicaid planning, alternative decision making and long-term care needs. The website for the National Academy of Elder Law Attorneys, www.naela.com, can provide more information and lists of attorneys in your area.

Escort - Someone who accompanies an elder to appointments (medical or social).

Federal Poverty Guidelines (FPG) - Income limits set by the U.S. government each year as a measure of poverty, used to decide eligibility for some assistance programs. For current dollar amounts, see Poverty Guidelines from the U.S. Dept. of Health and Human Services.

Friendly Visitor - A volunteer who visits an elder weekly for socializing.

Geriatric Care Manager - A human services professional who specializes in assisting elders and their families to meet their short and long term needs. Visit www.caremanager.org, the website for the National Association of Professional Geriatric Care Managers, for more information.

Geriatrician - A physician who specializes in the care of the elderly, primarily those who are frail and have complex medical and social problems.

Health Care Proxy - A legal document that allows you to declare someone who can make health care decisions for you in the event that you are not capable of making them yourself.

Home Health Aide (HHA) - Provides personal care and some household services under the direction of a nurse from a home health agency. HHA’s are able to assist with transfers, bathing, and ostomy care. They can not administer medications or injections.

Home Health Care - Skilled services in the home including nursing, physical therapy, occupational therapy, speech therapy, and home health aids.

Homemaker - A person who can do light house cleaning, shopping, laundry, meal preparation, and errands (no heavy chores).

Hospice - Care that addresses the physical, spiritual, emotional, psychological, social, financial and legal needs of the dying patient and his/her family. A concept that refers to enhancing the dying person's quality of life. Hospice care can be given in the home, a special hospice facility or a combination of both.

Independent elderly housing - Apartments that have been allocated for elders and disabled people. They can, but don’t necessarily, have organized services such as meal sites and activities. They often include some social work coverage, emergency call buttons inside the apartment, and bathrooms that include equipment such as grab bars.

Legal Guardian - A court appointed individual responsible for the financial and physical well being of a person deemed incompetent.

Living Will - A document (not legally binding in Massachusetts) that spells out one’s wishes for end of life care.

Long Term Care Insurance - Insurance that can cover the expenses of home care, assisted living facilities, and long term care. Every policy is different and not all policies provide benefits for all services.

Meals on Wheels - Meals on Wheels programs were developed to provide nutritious hot meals to seniors who are largely homebound. The meals are delivered for a nominal fee.

Medicaid - A joint federal/state program that pays for health care for individuals and families with low incomes and low assets. Coverage and eligibility requirements vary from state-to-state. Medicaid is the primary payer of nursing home care. Some states also offer some home and community-based long-term care services for eligible individuals through their Medicaid programs. These additional services are at the option of the state and are not mandated by federal law. (www.cms.hhs.gov)

Medicare - The federal program that provides hospital and medical care to people age 65 or older, and to some younger people who are very ill or disabled. Benefits for nursing home and short-term home health services are limited and are generally available only to people while they are recovering from an acute illness. Coverage is restricted to medical care, and does not include custodial care at home or in nursing homes.

Nursing Home - A residential facility in which a full range of medical, housing, food, and social services are provided 24 hours a day. To enter a nursing home in many states an assessment of need must be completed to establish medical eligibility.

Occupational Therapist - A rehabilitation professional who teaches people to compensate for functional limitations as a result of an injury, illness or disability by learning skills and techniques needed to perform activities of daily living and optimize independence.

Personal Emergency Response System - In case of a fall or other medical emergency, this electronic device enables the user to contact help 24-hours-a-day simply by pressing a button. A number of private companies offer these systems.

Physical Therapist - A rehabilitation professional who utilizes various therapies to help people maximize mobility, and restore strength and body movement after an illness or injury such as a stroke, fall, back injury, etc.

Power of Attorney - The legal designation of someone to be responsible for your financial decisions at the point that you are no longer able to manage your own affairs.

Rest Home - Usually basic accommodations including private bedrooms and baths although some have shared baths, three meals a day, shared living room and dinning room, activities, emergency pull cords, and assistance with medication. Some Rest Homes accept Medicaid for payment and some have endowments for low income elders not on Medicaid.

Retirement Community - Apartment units for elders in a community of independent but often aging-in-place elders. These communities are generally available for monthly rental and do no require an entrance fee. The apartments usually have full kitchens and emergency pull cords and provide housecleaning and 1 or 2 meals each day. There are activities in the building and outside trips. While the communities do not have assisted living programs, often people can access services through private organizations to allow them to remain in their apartments.

Senior Center - A community facility for the elderly. Senior centers provide a variety of activities for their members including any combination of recreational, educational, cultural or social events. Also, some centers offer nutritious meals and limited health care services.

Skilled Nursing Facility - Also known as a nursing home. These facilities provide 24 hour nursing coverage and total care of a person’s needs. They also provide short term rehabilitation services for people returning to the community.

Visiting Nurse/Home Health Agency - Medicare certified agencies that are working under the orders of one’s doctor to provide nursing care and, potentially, physical, occupational, and speech therapy as well as home health aid services.

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