This glossary of terms and definitions is intended to be a resource to help you better understand many commonly used terms in the medical field.

(Some excerpts were taken from Wikipedia, MedicineNet.com, Healthcare Coverage Glossary)

A

Access: In healthcare – the opportunity or right to receive healthcare.

Accreditation: A seal of approval given by a governing body to a senior housing or service provider. To be accredited, the provider must meet requirements set by the accreditation body and must undergo a thorough evaluation to ensure that it meets certain standards of quality.

Activities: Planned activities to emphasize: socialization, physical functioning, personal interest and pursuits, education and more. Intended to promote independence through physical and mental activity. Rules defined Title 22.

Activities of Daily Living (ADLs): Things we normally do in daily living including any daily activity we perform for self-care (such as feeding ourselves, bathing, dressing, grooming), work, homemaking, and leisure. The ability or inability to perform ADLs can be used as a very practical measure of ability/disability in many disorders. 

Acute Care: A short-term medical treatment, usually in a hospital, for patients having an acute illness or injury or recovering from surgery.

Admission: Acceptance by a hospital or other healthcare facility of a patient who is to be provided with room, board, and continuous nursing service in an area of the hospital or facility where patients generally reside at least overnight.

Admission’s Center: The office and personnel involved in the medical review of clinical and financial information facilitating transfers for residents to skilled nursing facilities.

Admitting Physician: The doctor responsible for admitting a patient to a hospital or other inpatient health facility. 

Adult Day Health Care: Daily structured programs in a community setting with activities and health-related and rehabilitation services for seniors who are physically or emotionally disabled and need a protective environment. This care is provided during the day, and the senior receiving the care returns home in the evening. 

Advanced Directives: Two kinds of legal documents, living wills and medical powers of attorney. These documents allow a person to give instructions about future medical care should he or she was unable to participate in medical decisions due to serious illness or incapacity. Each state regulates the use of advance directives differently.

Affordable Housing: Independent, affordable apartment living for older adults with limited incomes. Rental assistance is offered through the U.S. Department of Housing and Urban Development (HUD).

Against Medical Advice (AMA): A term used with a patient who checks himself out of a hospital or a healthcare facility against the advice of his doctor. Sometimes known as DAMA, Discharge Against Medical Advice.

Aging: As the campaign promotes, “aging is an active verb”; used to describe the process everyone experiences, not as a label placed on old and frail individuals. 

Aging Experience: Long-life experience, longevity.

Aging-in-Place: A concept that allows a senior to remain in his or her living environment, despite the physical and/or mental decline that may occur during the aging process. 

Ambulatory: Able to walk about, not bed-ridden or chair-bound. 

Ambulatory Care: Medical care including diagnosis, observation, treatment and rehabilitation that is provided on an outpatient basis.

Ancillary Services: The name given to professional services such as laboratory tests and radiology exams. 

Assessment: An evaluation of the health status of an individual by performing a physical examination after obtaining a health history. Various laboratory tests may also be ordered to confirm a clinical impression or to screen for dysfunction.

Assignment of Benefits: The patient or guardian signs the Assignment of Benefits form so that the physician or medical provider will receive the insurance payment directly.

Assisted Living: A living arrangement which provides older adults with support for everyday living tasks and healthcare needs, as well as dining, medication management, housekeeping, scheduled transportation, exercise and social programs.

Authorization: If a physician wants to perform a surgery, order a medical supply, or refer the patient to a specialist an authorization and approval by the health plan is required.

B

Benefit Penalty: Definition: A method used by the insurance company to reduce payment on a claim when the patient or medical provider does not fulfill the rules of the health plan.

Board Certified: Board certified in medicine means a physician who has passed an examination given by a medical specialty board and has been certified as a specialist in that medical area. 

Board Eligible: A physician has completed the requirements for admission to a medical specialty board examination but has not taken and passed the examination.

Board and Care: A residential setting which offers a lower level of care than a skilled nursing home. Falls under the same licensing requirements as assisted living.

Business Office Manager (BOM): Individual who is responsible for the community administrative support to include: personnel records, admissions, accounts payable, accounts receivable, admissions, etc.

C

California Department of Social Services (DSS): The Department is made up of more than 4,200 employees who are responsible for the oversight and administration of programs serving California’s most vulnerable residents.

California Health and Human Services Agency (CHHSA): A state agency tasked with administration and oversight of California’s significant “state and federal programs for healthcare, social services, public assistance and rehabilitation.” The agency is headed by the Secretary of the California Health and Human Services Agency. It has its headquarters in Sacramento.

Caregivers: All persons who are not employees of an organization, are not paid, and provide or assist in providing healthcare to a patient (e.g., family member, friend) and acquire technical training, as needed, based on the tasks that must be performed.

Care Manager: A professional case manager, usually a licensed social worker, who assesses a person’s ability to live independently in a home environment, develops an appropriate care plan for services and equipment, and organizes needed home services.

Centers for Disease Control and Prevention (CDC): A federal agency under the U.S. Department of Health and Human Services, based in Atlanta, Georgia. CDC works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health departments and other organizations. 

Centers for Medicare and Medicaid Services (CMS): A federal agency within the U. S. Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer Medicaid (known as Medi-Cal in California), the State Children’s Health Insurance Program (SCHIP), and health insurance portability standards.

Certified Nursing Assistant (CNA): A person who assists individuals with healthcare needs with activities of daily living (ADLs) and provide bedside care—including basic nursing procedures—all under the supervision of a Registered Nurse (RN) or Licensed Vocational Nurse (LVN).

Co-Insurance: Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. In some healthcare plans, co-insurance is called “co-payment.” Co-insurance is often specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the employer or insurance company pays 80 percent.

Cognitive Fitness: Keep your mind sharp with “the process of thought”, games and exercises.

Community: Eskaton uses the word “Community” to describe each of its full spectrum of living environments — including independent living, assisted living, memory care, rehabilitation and skilled nursing, and affordable housing (Villages, Lodges, Manors and Care Centers); preferred over facility, institution or home.

Companionship Plus: Personal activity assistants that provide social support needed by older adults to participate in activities they may no longer enjoy alone. Whether it’s getting needed transportation, writing letters, e-mail, pursuing hobby interests or watching a Video. Visits can be scheduled as needed, or on a regular weekly basis. 

Continuing Care Retirement Community (CCRC): Senior housing community planned and operated to provide a continuum of accommodations and services for seniors, including but not limited to independent living, congregate housing, assisted living, and skilled nursing care, all in one location.

Co-Payment: Co-payment is a predetermined (flat) fee that an individual pays for healthcare services, in addition to what the insurance covers. For example, some HMOs require a $10 “co-payment” for each office visit, regardless of the type or level of services provided during the visit. Co-payments are not usually specified by percentages. 

D

Deductible: A flat amount a group member must pay before the insurer will make any benefit payments.

Discharge: The release of a patient from a course of care.

Discharge Planner: A healthcare professional who facilitates a patient’s movement from one healthcare setting to another, or to home. It is a multidisciplinary process involving physicians, nurses, social workers, and possibly other health professionals.

Do Not Resuscitate (DNR): A physician’s written order instructing healthcare providers not to attempt cardiopulmonary resuscitation (CPR) in case of cardiac or respiratory arrest. A person with a valid DNR order will not be given CPR under these circumstances. Although the DNR order is written at the request of a person or his or her family, it must be signed by a physician to be valid.

Durable Medical Equipment (DME): Medical equipment used in the course of treatment or home care, including such items as crutches, knee braces, wheelchairs, hospital beds, prostheses, etc.

Durable Power of Attorney: A legal document that designates another person, usually a family member, to make medical decisions if the individual is unable to do so for themselves.

E

Emergency Medical Services (EMS): A group of governmental and private agencies that provide emergency care, usually to persons outside of healthcare facilities; EMS personnel generally include paramedics, first responders and other ambulance crew.

Emergency Medical Technician (EMT): A person trained in and expert in the performance of the procedures required in emergency medical care.

F

Fee Schedule: The fee determined by a managed care organization (MCO) to be acceptable for a procedure or service, which the physician agrees to accept as payment in full. Also known as a fee allowance, fee maximum, or capped fee.

Foundation: The Foundation raises funds to subsidize the organization’s community living and home-based services.

Fully Funded Plan: A health plan under which an insurer or managed care organization bears the financial responsibility of guaranteeing claim payments and paying for all incurred covered benefits and administration costs.

G

Geriatrician: A physician who specializes in the diagnosis and treatment of diseases of older persons.

Geriatrics: The branch of medicine concerned with the diagnosis, treatment and prevention of disease in older adults and the problems specific to aging.

Gerontology: The study of the social, psychological and biological aspects of aging.

H

Health Care Directive: A legal document that specifies whether you would like to be kept on artificial life support if you become permanently unconscious or are unable to speak for yourself.

Health Insurance Portability and Accountability Act (HIPAA): A U.S. law designed to provide privacy and security standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other healthcare providers. Developed by the Department of Health and Human Services, these new standards provide patients with access to their medical records and more control over how their personal health information is used and disclosed.

Health Maintenance Organization (HMO): A healthcare system in which an organization hires medical professionals and operates medical facilities to provide a wide range of specified services to prepaid subscribers.

Health Plan Management System (HPMS): A database of information on Medicare Part A and Part B recipients who are enrolled in coordinated care plans. 

Home-Based Support: Describes all Eskaton programs, other than community living, which supports the independence of older adults in the place they call home.

Home Health Care: A health service provided in the person’s place of residence for the purpose of promoting, maintaining, or restoring health or minimizing the effects of illness and disability. Service may include medical, speech and physical therapy. Requires a prescription from physician.

Hospice Care: A service designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure. The goal is to enable terminal individuals to be comfortable and free of pain, so that they live each day as fully as possible.

HUD Housing: Housing and Urban Development, United States Department of (HUD), established to coordinate and administer programs that provide assistance for housing and community development. The department assists in finding solutions to the problems of housing and urban development through state, local, or private action. It makes direct loans, insures mortgages, and provides housing subsidies, and it promotes and enforces equal housing opportunity.

I

Independent Living: A multi-unit senior housing development that may provide supportive services such as meals, housekeeping, social activities, and transportation.

Independent Practice Association (IPA): An organization comprised of individual physicians or physicians in small group practices that contracts with managed care organizations on behalf of its member physicians to provide healthcare services.

Intensive Care: Continuous and closely monitored healthcare that is provided to critically ill patients.

J

Journal of the American Medical Association (JAMA): The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world.

K

L

Length of Stay (LOS): The number of days, counted from the day of admission to the day of discharge, that a plan member is confined to a hospital or other facility for each admission.

Level of Care: The intensity of medical care being provided by the physician or healthcare facility.

Licensed Vocational Nurse (LVN): A nurse who has completed a one- or two-year training program in healthcare and earned a state license. LVNs provide direct patient care for people with chronic illness, in nursing homes, hospitals, and home settings. They assist RNs in caring for acutely ill patients.

Life Plan Community (aka: CCRC): A senior living community that offers a variety of lifestyle and healthcare options on a single campus, including independent living, assisted living, and skilled nursing. They provide older adults with active lifestyle options through a variety of services and amenities.

Livable Design: Forward thinking concept in home building beautifully integrates long lasting functionality for a family’s ever-changing lifestyle. It provides an innovative model of home design that is a better way to live and a better way to build for all ages.

Longevity: The condition of having a long life, or having lived a long life; the average life expectancy of adults continues to spiral upward; the upper limit of average human life expectancy may range from 85 to 100.

Long-Term Care: A variety of services that helps meet medical and non-medical care to people with a chronic illness or disability who cannot care for themselves. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. 

M

Managed Care Organization (MCO): A healthcare delivery system consisting of affiliated and/or owned hospitals, physicians and others which provide a wide range of coordinated health services; utilizes certain concepts or techniques to manage the accessibility, cost, and quality of healthcare.

Medicaid: A joint federal and state program that provides hospital expense and medical expense coverage to the low-income population and certain aged and disabled individuals. In California, this is called Medi-Cal.

Medical Alert System: A bracelet or pendent that a person could wear to warn medical professionals in an emergency about a serious health problem.

Medicare: A federal government program established to provide hospital expense and medical expense insurance to qualifying people aged 65 years and older, and disabled persons.

Medicare Advantage: An alternative to Medicare Parts A and B, in which a private company provides your healthcare coverage.

Medicare Part A: Medicare insurance that pays for stays in the hospital and skilled nursing facilities, along with hospice care, and some home healthcare.

Medicare Part B: Medicare insurance that pays for doctor’s visits, laboratory tests, medical equipment, and some other medical services.

Medicare Prescription Drug Plan (Medicare Part D:. The newest part of Medicare, which provides you with some coverage for prescription brand name and generic drugs.

Medicare Supplement: A private medical expense insurance policy that provides reimbursement for out-of-pocket expenses, such as deductibles and coinsurance payments, or benefits for some medical expenses specifically excluded from Medicare coverage.

Medication Management: Assistance with ordering and taking your medications.

Memory Care: An environment dedicated to meet the special needs of older adults experiencing memory loss, or a significant cognitive impairment.

N

Nonprofit: A corporation organizational structure in which no part of the income is distributable to its members, directors or officers.

Nurse Assistant: A person who has completed a brief health-care training program, and who provides support services for RNs and LVN’s. Also known as an orderly or, when certified by a state agency, a certified nurse aide (CNA).

Nursing Home: A community or facility licensed by the state that provides 24-hour nursing care, room and board, and activities for convalescent residents and those with chronic and/or long-term illnesses. Also called a skilled nursing facility or long-term care facility or care center.

O

Occupational Therapist (OT): A licensed health professional who is trained to evaluate patients with joint conditions, such as arthritis, to determine the impact the disease has on their activities of daily living.

Ombudsmen – “Long-Term Care”: A government official who hears and investigates complaints by private citizens against nursing homes, residential care facilities for the elderly, board and care facilities and other government agencies to improve the quality of life for residents.

Out-of-Pocket Maximums: Dollar amounts set by managed care organizations that limit the amount a member has to pay out of his/her own pocket for particular healthcare services during a particular time period.

P

Palliative Care: Medical care or treatment to relieve pain and to improve quality of life for patients with serious or life-threatening diseases. Also known as comfort care.
Personal Emergency Response Systems: An electronic alert bracelet or pendant that automatically calls a 24-hour emergency response call center.

Physical Therapy (PT): A healthcare profession that provides treatment to individuals to develop, maintain and restore maximum movement and function throughout life. This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors.

Power of Attorney: A legal document allowing one person to act in a legal matter on another’s behalf regarding financial or real estate transactions.

Private Duty Nursing Services: Medically necessary services provided to consumers who require continuous in-home nursing care that is not available from a home health agency.

Private Pay: Out-of pocket payment involves using personal income and assets to pay for services and supports, either at-home or in residential care.

Q

Quality Assurance (QA): Programs of regular assessment of medical and nursing activities to evaluate the quality of care.

Quality Management (QM): An organization-wide process of measuring and improving the quality of the healthcare provided by a managed care organization.

R

Registered Nurse (RN): A nurse who has completed a two- to four-year degree program in nursing, and provides direct patient care for acutely or chronically ill patients.

Rehabilitation: Therapy or training specially designed by a health professional to assist an individual recover physical skills lost or compromised as the result of illness or injury.

Resident Care Coordinator (RCC): In conjunction with the Administrator, the resident care coordination is responsible for coordinating the day-to-day operations, and to ensure residents receive quality care.

Residential Care Facility for the Elderly (RCFE): A licensed community which provides care, supervision and assistance with activities of daily living, such as bathing and grooming. They may also provide incidental medical services under special care plans.

Respiratory Therapy: The treatment or management of acute and chronic breathing disorders that help patients recover lung function.

Respite Care: Temporary relief for caregivers, ranging from several hours to days. This may be provided in-home or in a residential care setting such as an assisted living facility or nursing home.

S

Standard of Care: Diagnostic and treatment process that a physician or other healthcare provider should follow for a certain type of patient, illness, or clinical circumstance.

Senior Apartment: Age-restricted multiunit housing with self-contained living units for older adults who are able to care for themselves. Usually no additional services such as meals or transportation are provided.

Skilled Nursing Facilities: Facility for care of patients who are not sick enough to need hospital care but are not able to remain at home. Medicare will pay for skilled nursing facility services if a physician has deemed that a patient requires skilled nursing care. Also referred to as nursing homes and care centers.

Speech Therapy: Treatment of speech disorders. Treatment includes specific exercises designed to improve speech skills, language skills, and oral motor skills.

Social Accountability: Public-service (or public-interest) programs, services or activities that distinguish Eskaton as a nonprofit, tax-exempt organization.

T

Third-Party Payer: Any organization, public or private, that pays or insures health or medical expenses on behalf of beneficiaries or recipients. An individual pays a premium for such coverage in all private and in some public programs; the payer organization then pays bills on the individual’s behalf.

U

Urgent Care Center: A medical facility where ambulatory patients can be treated on a walk-in basis, without an appointment, and receive immediate, non-emergency care. Not equipped to deal with major medical traumas or conditions.

Utilization Review (UR): An evaluation of the medical necessity, appropriateness, and cost-effectiveness of healthcare services and treatment plans for a given patient.

V

Veteran’s Benefit – Aid and Attendance (VA): The benefit that pays for a portion of assisted living services.

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W

World Health Organization (WHO): An agency of the United Nations to further international cooperation in improving health conditions. Although the World Health Organization inherited specific tasks relating to epidemic control, quarantine measures, and drug standardization from the Health Organization of the League of Nations, the World Health Organization was given a broad mandate under its constitution to promote the attainment of “the highest possible level of health” by all people.

X

Y

Z