Carefully Read and Study the LTC Glossary

It is important to become familiar with particular words and when you enter the world of long term care insurance. This long term care review can give you much of the information you will need. Pay attention to the definitions of facility and care provider. All words that are defined on this page are capitalized.

Every policy has their own definitions. I used my personal policy unwritten by John Hancock as a guide when I defined the terms below.

The LTC Glossary will give you some background information when reading a policy or talking with an agent. Before you sign on the dotted line and pay your first month’s premium, carefully read your policy’s LTC glossary of words and phrases.

LTC Glossary of Terms for for Activities of Daily Living includes the following activities…

• Bathing means being able to take a sponge bath by yourself; being able to wash yourself in a tub or shower, including getting in and out of the tub or shower.

• Continence means the ability to maintain control of your bowel or bladder functions. Or when unable to maintain control of your bowel or bladder functions, you are also unable to perform associated personal hygiene (including caring for catheter or colostomy bag).

• Dressing means putting on and taking off all your clothing and any necessary braces, fasteners or artificial limbs.

• Eating means feeding yourself by getting food into your body from a receptacle such as a plate, cup or table; feeding yourself with the aid of a feeding tube or intravenously. Eating does not usually include preparing your meals.

• Toileting means getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

• Transferring means moving into or out of a bed, chair or wheelchair. Transferring does not include getting into or out of the tub or shower.

Adult Day Care means social and health-related services provided during the day in a community or group setting to six (6) or more persons. The purpose of the program is to support frail or impaired elderly or other disabled adults who can benefit from care in a group setting outside the home.

Adult Day Care Center means a place that is licensed to provide Adult Dare Care by jurisdiction in which the services are provided. If licensing is not required, Adult Day Care Center means a place that provides Adult Day Care, has enough full-time staff to maintain no more than an 8 to 1 client-staff ratio and has established procedures for obtaining appropriate aid in the event of a medical emergency. An Adult Day Care Center is a place that provides adult care for only part of a day.

LTC Glossary of Terms for for Assisted Living Facility means a facility that….

• is licensed to provide Custodial Care according to the always of the jurisdiction in which it is located if that state requires such licensing.
  OR

• if licensing is not required, it meets all of the following criteria.
  • Has a 24-hour on-site staff to provide custodial care.
    
  • provides custodial care services for a charge, including room and board.
    
  • provides 3 meals a day and can accommodate special dietary needs.
    
  • provides, at a minimum, assistance with bathing and dressing.
    
  • provides custodial care services to 10 or more people.
    
  • has established procedures for obtaining appropriate aid in the event of a medical emergency.

Some facilities may include Alzheimer facilities or Assisted Living Facilities that are either free standing facilities or part of a life-care community. They may also be met by some personal care and adult congregate care facilities.

An Assisted Living Facility does not mean…

• a hospital or clinic.
  
• your own home.
  
• a facility for the treatment of alcoholism, drug addiction or mental illness.
  
• a rest home (home for the aged or a retirement home) that does not as its primary function provide Custodial Care.

LTC Glossary of Terms for for Care Advisory Services means assessment and care planning by a Home Health Agency, a Care Management Organization or an Independent Care Manager. Care Advisory Services do not determine edibility for benefits under many policies. Care Advisory Services includes….

• assessing your need for long-term care services.
  
• coordinating delivery of long-term care and services.
  
• monitoring the long term care and services delivered.
  
• developing a recommendation for long term care services that is consistent with your care needs based upon their assessment.

LTC Glossary of Terms for for Care Management Organization means an organization that ….

• has a full-time administrator.
  
• maintains records of services provided to each client.
  
• is licensed if required by state or federal law, and operated to provide Care Advisory Services according to the laws, if any, of the jurisdiction in which it is located.
  
• has a staff including at least 1 full-time registered nurse, 1-full-time licensed social worker, 1-full-time individual who holds the designation of a ‘Care Manager’ from the National Association of Professional Care Managers, or a full-time person with a Masters in Gerontology from an accredited school of Gerontology.

Chronically III Individual is a person who has been certified by a Licensed Health Care Practitioner as

1. being unable to perform (without Substantial Assistance from another individual) at least 2-Actiivites of Daily Living for a period of at least 90 days due to a loss of functional capacity.
   OR
   
2. requiring Substantial Supervision to protect such individual from threats to health and safety due to Cognitive Impairment.

Cognitive Impairment is when there is a deficiency in a person’s short-term or long-term memory; orientation as to person, place or time; deductive or abstract reasoning; or judgment as it relates to safety awareness. Your cognitive impairment must be established and reliably measured by clinical evidence and standardized tests. The need for Substantial Supervision due to the presence of cognitive impairment must be established by such clinical evidence and standardized tests.

Custodial Care means non-skilled long-term care in Your Plan of Care and approved by a Licensed Health Care Practitioner. The custodial care is necessary due to Your Cognitive Impairment or to assist you in the Activities of Daily Living.

LTC Glossary of Terms for for Date of Service is the day that you are eligible for benefits under the policy (including dates of service referring the elimination period) on which you…

• are a resident in a nursing home or an assisted living facility
  
• receive Home Heath Care or Hospice Care
  
• receive services covered under your policy that are Medicare eligible (for which benefits are not payable under your policy).

The Elimination Period (waiting period) is the number of Dates of Service that would otherwise be covered by your policy, where you will not receive paid benefits. The Elimination Period is usually shown in the Policy Schedule. Some companies have only one Elimination Period that needs to be satisfied while your policy is enforce while other have more.

Home refers to your primary residence, including your independent living quarters in a continuing care retirement community or similar entity. It usually does not include a Nursing Home, an Assisted Living Facility, an Alzheimer’s facility, an Adult Care Center, a rest home, a hospital or rehabilitation facility / hospital, or a facility for the treatment of alcoholism, drug addition or mental illness.

Home Health Care means medical and non-medical professional or personal care services provided in your Home to assist you in the Activities of Daily Living or to given supervision needed because of Your Cognitive Impairment. These services must be provided by a Home Health Care Provider.

Home Health Care also includes Incidental Homemaker Services. Incidental Homemaker Services means services incidental to care with the Activities of Daily Living or because of a Cognitive Impairment which are included in a Plan of Care and which provide one of more of the following non-medical support services necessary for you to remain in your home…

meal preparation laundry light housekeeping supervising self-administration of medication shopping for medication medical supplies or food

In some policies Incidental Homemaker Services must be provided during the same visit and by the same individual providing care with the Activities of Daily Living or because of a Cognitive Impairment.

LTC Glossary of Terms for for Home Health Care Provider is either a Home Health Agency or an Independent Home Health Care Provider that provides Home Health Care. A Home Health Care Provided usually cannot be a member of your Immediate Family unless they normally reside in Your Home or there are exceptions stated in your policy.

• A Home Health Agency must meet of the following requirements…
  • It is licensed as a Home Health Agency by the jurisdiction in which the Home Health Care is provided
    OR
    
  • It possesses one of the following certifications in the jurisdiction in which the Home Health Care is provided
    Medicare Certification
    Joint Commission of Accreditation of Health Care Organizations (JCAHO) Certification
    Community of Health Accreditation Program (CHAP) Certification
    OR
    It provides Home Health Care through two or more employees of an organization that is in the business of providing Home Health Care according to the laws of the jurisdiction in which it is located

• An Independent Home Health Care Provider is a care provider not employed by a Home Health Agency who meets one of the following requirements… S/he
  • is a duty licensed registered nurse, licensed vocational nurse, licensed practical nurse, registered physical therapist, registered occupational therapist, registered speech therapist, registered respiratory therapist, licensed social worker, or registered dietitian
    OR
    
  • must be currently qualified as a certified home health aide or certified nurse aide
    OR
    
  • must be currently included in a government sponsored nurse aid registry.

• In the case of a home health aide or nurse aide who does not meet one of the standards set forth above, such aide must present written proof of completion of an established training course which must include training in safely assisting persons with the Activities of Daily Living.

Hospice Care is a program for meeting your care needs if you are Terminally ill. Terminally ill means there is no reasonable prospect of cure and you have a life expectancy, as estimated by a physician, of 6 to 12 months or less, depending upon the benefits written in your policy.

Hospice Care must be provided by an organization that is licensed to provide such care according to the laws of the jurisdiction in which it is located. In most cases you must have satisfied your Elimination Period before receiving benefits for Hospice Services. Hospice Care can usually be provided in your Home, a Nursing Home, an Assisted Living Facility, Adult Day Care Center or in a Hospice Care Facility.

Immediate Family refers to your spouse or partner, or the following relatives of your or your spouse of partner…

parents stepparents grandparents siblings

children stepchildren grandchildren and related spouses of the above

Partner means the unmarried person who is not related to you with whom you have lived in a committed relationship for a specific period of time as stated in your policy, prior to the date you applied for your policy. Some insurance companies do not provide for care by a Partner. This person must have been named in your application or other subsequent document as Your Partner in order to obtain the Partner premium discount as written in the policy.

LTC Glossary of Terms for for Independent Care Manager means

• a registered nurse
  
• a licensed social worker
  
• an individual who holds the designation of a ‘Care Manager’ from the National Association of Professional Care Managers
  
• a person with a Masters degree in Gerontology (or equivalent) from an accredited school of Gerontology.

Licensed Health Care Practitioner is a Physician, registered nurse (R.N.), licensed social worker or any other individual who meets the requirements as prescribed by the Secretary of the Treasury. You can usually select any Licensed Health Care Practitioner of your choosing. However, a Licensed Health Practitioner may not be a member of your Immediate Family.

Medicaid is the reimbursement system under Title XIX of the U.S. Federal Social Act, as amended.

Medicare is the reimbursement system under Title XVIII of the U.S. Federal Social Security Act, as amended.

Nursing Care means skilled or intermediate care provided by one or more of the following health care professionals…

• is licensed and operated to provide Nursing Care for a charge (including room and board), according to the laws of the jurisdiction in which it is located
  AND
  
• has services performed by or under the continual, direct and immediate supervision of a registered nurse, licensed practical nurse or licensed vocational nurse, on-site 24-hours per day.

  A Nursing Home may be a freestanding facility or a distinct part of a facility, including a ward or wing of a hospital or other facility.

  Nursing Home does not refer to…
  a hospital or clinic
  a swing-bed in a hospital
  your home
  a facility for the treatment of alcoholism, drug addition or mental illness
  a rest home (home for the aged or a retirement home) which does not, as its primary function, provide Custodial care.

Your insurance company will most likely as for an update as Your condition and needs change along with a revised Plan of Care each time it is updated. Your insurance company will also ask for periodic updates regarding Your Plan of Care, but usually not more then once every 30 days.

Policy Limit refers to the total amount, as shown on the Policy Schedule, from which You will be paid benefits for all covered care and services. Look and see what benefits will be deducted from the Policy Limit.

Respite Care is the short-term care designed to provide temporary relief to Your primary uncompensated caregiver from his / her care giving duties that is provided in a Nursing Home, Assisted Living Facility, Adult Day Care Center, Your Home or a community-based program. Respite Care usually includes confinement in a Nursing Home or Assisted Living Facility, Home Health Care, Adult Day Care and Hospice Services.

To find out the possibilities for long term care available to you, get a free long term care insurance quote from an impartial expert today!