Glossary of Long Term Care Insurance Terminology

 

AARP: The American Association of Retired Persons: A non-profit organization doing education, research,, lobbying, etc. for the benefit of people over age 55.

Activities of Daily Living (ADLs): Activities that folks do independently every day like bathing, eating, dressing, mobility(moving about), transferring (for instance, from a bed to a chair, toileting, and maintaining bowel/bladder continence - used as a measure of the ability to function.

Acute Care: Care for an illness or injury that is finite in length, occurs rapidly and has pronounced symptoms. Medical care that is required for a short period of time to cure a specific illness or condition.

Adult Day Care: Social, rehabilitative or recreational services provided for folks who need daytime supervision. An alternative between care home and institutional care. Health support and rehabilitation services provided in the community to folks who are unable to care for themselves independently during the day yet are able to live at home at night.

Adult Foster Care: Live-in arrangements where one adult lives with and is given care and/or services by an unrelated family or individual. These arrangements may be managed independently or certified by the state.

Ageism: Prejudice against folks due to their age.

Aging In Place: When an older individual continues to live outside of an institutional environment at home or within the community.

Alternate Facility: A licensed residence other than a skilled nursing facility where care services can be delivered (i.e. Alzheimer's or Christian Science, hospice or assisted living setting).

Alternate Plan of Care Benefit: Payment for a unique arrangement of services designed specifically to allow a person to reside in a care setting other than a skilled nursing facility (i.e. services providing assistance and capital improvements such as grab bars, ramps and/or durable medical equipment).

Alzheimer's Disease: An organic dementia resulting in premature mental loss, first described in 1906 by Alois Alzheimer, a German neurologist.

Alzheimer's Units: Special units within skilled nursing facilities or assisted living facilities which specifically provide care and services for folks with Alzheimer's disease.

Aphasia: Loss of ability to understand or use language.

Assessment: A determination of mental or physical status by a health professional based upon established medical guidelines.

Assisted Living Facility (ALF): A non-medical facility providing laundry, some forms of personal care, room, board and usually recreational services. These facilities are licensed by state departments of social services, an they exist under several names including sheltered house, board and care home, domiciliary care facility, community-based care facility, residential care facility, etc.

Bankruptcy: An event we are trying to avoid by utilizing the insurance mechanism.

Bed Reservation Benefit: Pays the cost of reserving you place in a care facility should you need to be hospitalized during a covered stay.

Benefit Period: The maximum time, usually in days, that a particular policy will pay your daily benefit. The average stay in a skilled nursing facility is 2.8 years, so many folks choose either a 3 year plan (1095 days) or 4 year plan (1465 days) in order to cover the average stay plus a little time to spare. Others feel safest with an unlimited benefit period.

Capital Improvements: Permanent physical adaptations to your residence which enables you to remain and function at home.

Care Coordinator: A health care professional who manages and arranges for care services - Can be a nurse, social worker, doctor or other similarly trained and, licensed professional.

Care Management: Services provided by a trained professional, typically a social worker or nurse, to coordinate, monitor and assess the overall personal, social and medical care needed by an individual.

Caregiver - Primary: A key person (usually a relative) providing and overseeing care for a person.

Caregiver(s) - Secondary: Relatives or others who assist in part-time care giving.

Catastrophic Illness: Illness resulting in sudden permanent or temporary change or significant disruption in a person's lifestyle.

Chronic Care: Care for an illness recurring frequently or continuing over a long period of time. Chronic conditions often begin inconspicuously. Symptoms are less pronounced than acute conditions.

Cognitive Impairment: The loss or deterioration of mental capacity in folks suffering from conditions like Alzheimer's disease.

Cognitive Reinstatement: A policy provision to continue a policy which has lapsed (providing that back premiums are paid) when the cause of the lapse was because of cognitive impairment.

Continuing Care Retirement Community: Residential community providing services and living arrangements from independent living apartments to ALF and SNF care.

Custodial Care: Services that can be given reasonably and safely by a non-medical person, mainly to assist with ADLs including eating, dressing, bathing and other routine activities.

Daily Benefit Amount: A specific, daily, maximum dollar amount payable on a covered period of care. Policies can offer a range of choices, usually in ten-dollar increments. Your choice should take into account the local costs of care, how much money or care you can count on from your family and how much you could pay for care out of your own resources without dipping into savings.

Elimination Period: The deductible. A specified time period of covered care when no benefits are payable. Should be selected as the longest period that you could sustain care cost using your available assets.

Home Health Care: A wide range of services from physical therapy and skilled care to personal care delivered in a residential setting or at home.

Homemaker Services: Assistance given in maintaining and managing household activities allowing you to remain safely in your home when you cannot manage those activities on your own. Can include laundry, cleaning, meal preparation, chores, etc.

Inflation Protection: Increases your daily benefit amount on an annual basis, if elected. Increases benefits to protect you against the effects of inflation. Most common is the 5% Compound Inflation Rider which increases the daily benefit amount each year by 5% of the previous years daily benefit amount. This compound effect begins to really take off around the 20th year, so if you are younger when you buy, it seems to be the best choice. If you are already in retirement, it's a toss-up between paying for the extra protection or starting out with a higher daily benefit at the beginning.

Intermediate Nursing Care: Assistance for stable conditions that require daily, but not 24-hour, nursing supervision. This care is ordered by a physician and is supervised by registered nurses. It's less specialized than skilled nursing care and often involves more personal care - Generally needed for a long period of time.

Long Term Care (LTC): Sometimes called custodial care. Assistance given over a long period of time to people with physical disabilities or chronic health conditions who cannot care for themselves without help.

Long Term Care Insurance(LTCI): Coverage available through private insurance companies as a means for folks to protect themselves against the rising costs of long-term care.

Medicaid: A means-based program supported by federal, state, and local funds, administered by each state to cover health care for low-income, eligible individuals.

Medicaid Asset Protection: Planning for protection from Medicaid "spend-down" requirements, typically through legal maneuvering provided by irreversible trusts - recently outlawed by Congress except under very specific conditions

Medicare: Federal government insurance assistance with medical and hospital expenses or those age 65+ and the disabled. Medicare covers just skilled care in a skilled nursing facility and very limited skilled nursing care at home and does not provide benefits for custodial or personal care. Medicare requires deductibles and copayments.

Medicare Supplement or "Medigap" Insurance: Private insurance policies that supplement Medicare benefits by covering deductibles and copayments for hospital and medical expenses. These policies do not provide coverage for custodial or personal care.

Nonforfeiture Benefit: Returns some of the premim investment if the coverage is eventually dropped or lapsed. It often takes the form of paid-up coverage with reduced benefits, sometimes offered in the form of a "return of premium" returning some or all of your premium payments upon death or after a period of time. The extra cost can often add from 10 - 100% to the premium cost depending upon your choices.

Nursing Home: A facility providing room and board and continuous, planned, medical treatment programs, including 24-hour-per-day, personal care, skilled nursing care and custodial care.

Personal Care: Assistance given to help with bathing, eating, walking and other routine, daily tasks, provided by trained aides who are not medical professionals but who help with these tasks.

Pre-Existing Conditions: Medical conditions existing prior to the effective date of a policy. Some policies exclude claims stemming from conditions falling under this definition for a specific period of time.

Respite Care: Nursing home or home care temporarily replacing the existing level of support received from a nonpaid, informal caregiver in order to provide supervision and care to a patient while relieving their caregiver.

Skilled Nursing Care: Rehabilitative and nursing care given by or under the direction of skilled medical personnel - 24-hours per day & under a treatment plan ordered by a physician. Can be either at-home or in a facility setting. Note: Medicaid and Medicare both have their own, specific definitions of "skilled nursing care" which do not necessarily match the definitions found in LTCi policies.

Skilled Nursing Facility (SNF): An institutional, state-licensed setting which provides rehabilitative and nursing care under the direction of or given by skilled medical personnel - 24-hours per day & under a treatment plan ordered by a physician.

Spend-down: Depleting nearly all assets in order to meet eligibility requirements for Medicaid.

Third-Party Notification: Gives you an option of having the "premium overdue" notice sent to a third party - Done as a precaution to insure that your policy doesn't unintentionally lapse.

Waiver of Premium: A provision allowing you to stop paying premiums once you are in a period of covered care. This most often applies only to a facility stay, although some policies do waive your premiums for approved home health care as well. The date when the premium stoppage begins will vary with each company.