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)
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
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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.
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,
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
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.
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
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.
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.
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
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.
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
Intensive Care: Continuous and closely
monitored healthcare that is provided to critically ill patients.
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.
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
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.
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.
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
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
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.
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.
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.
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
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
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
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.
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.
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
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.
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
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.
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
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
Utilization Review (UR): An evaluation of
the medical necessity, appropriateness, and cost-effectiveness of
healthcare services and treatment plans for a given patient.
Veteran’s Benefit – Aid and Attendance
(VA): The benefit that pays for a portion of
assisted living services.
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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.