Four Seasons Healthcare Resources For Seniors

Glossary of Long Term Care

There is a lot to learn when it comes to aging, disability, long term care and long term care insurance. Use our glossary to help with any terms you may not quite understand. We have tried to relate these definitions directly to Long Term Care and the information you will need to make informed decisions.

Activities Of Daily Living (ADL) - An industry term meaning the physical functions that a person normally performs independently every day. They includes eating, bathing, dressing, continence, transferring and toileting. These activities are used to measure a person’s level of dependence.

Adult Day Care – A program that provides protective care for adults who stay at home at night but who need supervision and assistance during the day, generally because the family caregiver must go to work. A daytime community-based program for functionally impaired or disabled adults that provides a variety of health, social and related services. Adult day care facilities are often used in combination with home and family caregivers in order to give the primary caregiver a break. Find Adult Day Care programs in your area through your county’s Dept of Aging.

Alzheimer’s Disease – A degenerative disease of the brain which attacks nerve cells in the cortex of the brain thereby impairing a person's abilities to think and function. For further information, there is a link to the Alzheimer’s Association on the Resources tab of this site.

Alzheimer’s Care – A treatment center that specializes in providing care for those with Alzheimer's Disease with more of the care geared towards supervision of the patient in a safe and controlled environment.

Assisted Living Facility - Assisted Living Facilities provide personal care and assistance with ADLs in a residential setting for those that aren't able to live independently but do not require the level of round-the-clock care provided in a nursing home. Assisted Living Facilities have seen a tremendous growth in recent years while the number of skilled nursing facilities has remained flat.

Bed Sores – Bed sores are caused by lying or sitting in one position, trapping skin and tissue between the bones and the bed or wheelchair. The blood pools in one spot and cannot flow properly, causing damage to the tissue. Bed sores can happen to anyone with limited mobility, but those with diabetes are especially at risk for developing these pressure sores. Diabetics are not only more prone to bed sores, they also have a more difficult time recovering from them. Although easily prevented and completely treatable if found early, bedsores are often fatal – even under the auspices of medical care – and are one of the leading iatrogenic causes of death reported in developed countries, second only to adverse drug reactions. Prior to the 1950s, treatment was ineffective until Doreen Norton showed that the primary cure and treatment was to remove the pressure by turning the patient every two hours. Source: livestrong.com, Wikipedia

Benefit Triggers – Activities of daily living (and/or cognitive impairment) levels that trigger the need for long-term care. Qualifying events to become eligible to receive benefits under your Long Term Care insurance policy. In a tax qualified policy this will be the requirement to need assistance for at least 90 days with 2 of the 6 activities of daily living or having a severe cognitive impairment.

Case (Care) Management - Case Management is a process of assessing an individual's Long Term Care needs and evaluating viable alternatives. Good case management should be performed by medically qualified individuals who understand the aging process and the resources available in the community. Case managers review medical, financial and legal issues and can offer referrals to various professionals for dealing with your circumstances while evaluating all funding options and best conserving your assets. They can act as liaisons to families and long-distance caregivers and provide crisis intervention when needed. They can offer valuable guidance in identifying your options and facilitating transitions between levels of care when needed. Case management is required for most Partnership-Certified long term care insurance policies.

Certified Nursing Assistant (CNA) – (Also called a Nurse Aide) A staff member who has completed at least 75 hours of classroom and 75 hours of clinical training (in a facility) and has passed a state-administered exam. CNAs are responsible for assisting nursing home patients with their Activities of Daily Living such as bathing, toileting, eating and moving about. Attendants in a nursing facility are required to be CNAs where caregivers in a home care setting generally are not. The State maintains a Nurse Aide Registry. Employers should require employees to provide their original CNA card as proof of their training. They should also verify that the employee is “in good standing” on the registry and that their certification is “free of encumbrances”, ie, that no complaints have been reported about the individual.

Chronic Care - Care and services that help achieve functional independence for those with continuing and long-term health problems days as opposed to "acute" care which refers to short term or severe illness of a closed duration. Chronic conditions generally have no specific cure and require care over a protracted period of time. Chronic care is often used interchangeably with Long Term Care in the medical community.

Chronically Ill Individual – A person who has been certified by a licensed health care practitioner as being unable to perform at least two activities of daily living (ADLs) for at least 90 days due to a loss of functional capacity. Also an individual requiring substantial supervision to protect themselves from threats to health and safety due to severe cognitive impairment.

CLASS – The Community Living Assistance Services and Support Act (CLASS Act) establishes the first national, government run Long Term Care insurance program. It will be a consumer financed insurance pool overseen by a government trust. A primary goal of CLASS is to reduce the role of Medicaid which today pays for more than 40% of all personal care for seniors and others with disabilities. CLASS is the latest in a series of measures the government has taken to encourage people to plan for Long Term Care and acquire Long Term Care insurance. In previous years, elements of bills like the Deficit Reduction Act took steps to expand the private Long Term Care insurance through tax incentives, government-funded marketing campaigns, and by tying LTC coverage more closely to Medicaid through State Partnership Programs. CLASS takes these measures a step further by providing a mechanism for working adults to obtain LTC coverage with limited benefits regardless of health. Traditional private LTC insurance requires that applicants meet certain good-health requirements. CLASS insurance will be “guarantee issue” and will not have such health qualification requirements. The effective date of the program is Jan 1, 2011 but it probably will not be operational until 2013 or later. Now that the bill has been signed into law by President Obama, it will go to the Department of Health and Human Services where the terms of the program will be worked through. Although some publications have indicated an effective date as early as 2011, the Secretary has until October 2012 to designate a benefit plan. It will be another 5 years from that point before anyone is eligible for benefits. The CLASS provisions create a government administrative structure under which participants will pay a monthly premium and will be eligible for modest benefits for their long term care needs after 5 years of paying premiums. The premiums have not yet been determined. Under the law, the premiums have to be set that the the program is actuarially sound/solvent for 75 years. Given the fact that there are no health qualifications, those who enroll are more likely to need care and will be more expensive to cover than those who buy private insurance. To cover its costs, the program would therefore have to charge more than private insurers. Current estimates of costs are in the area of $180 to $240/month – significantly higher than currently charged for individual LTC insurance for qualified buyers.

Co-Insurance - In Long Term Care the concept of co-insurance refers to the amount that the insured must pay out-of-pocket to make-up the difference between their actual costs and the amount the policy covers. The greater the amount the insured is willing and able to "co-insure" the lower the policy benefits must be and therefore policy premiums.

Cognitive Impairment - A deterioration and loss of intellectual capability that affects a person's memory, language, personality and ability to reason, communicate and understand. Severe cognitive impairment is a symptom of Alzheimer's and other forms of dementia. In terms of insurance, long-term care insurance policies must pay for services when a deficiency in a person’s short or long-term memory requires substantial supervision to maintain the safety of the policyholder and those around them. A doctor must certify cognitive impairment.

Continence - One of the six Activities of Daily Living. It refers to the ability to control bladder and/or bowel movements.

Compound Inflation - A rider where your benefits increase by a rate compounded every year. For example, if your Maximum Daily Benefit (MDB) was $100 and you had a 5% compound inflation rider, the Maximum Daily Benefit would increase by 5% per year. Therefore in year two it would by $105, but in year three $110.25, in year four $115.76 etc. The difference between a compound and simple inflation rider is not significant in earlier years, but becomes greater as time goes on. It is recommended that you talk to a Long Term Care specialist to determine which inflation rider would be best for your individual circumstances.

Comprehensive Policy - Long Term Care insurance policy that covers care in multiple settings including facility and in-home care.

Custodial Care – Care to help individuals meet personal needs such as bathing, dressing and eating. Professional training is not always required to perform this service. See also Personal Care

Daily Benefit - The maximum amount a Long Term Care policy will pay for covered services in any given day.

Director of Nursing - A nurse who supervises other nurses (RNs), Licensed Practical Nurses (LPNs) and Certified Nurse Assistants (CNAs). Generally the head nurse in a nursing facility.

Durable Power of Attorney for health care (DPA) – A legal document in which a competent person gives another person (called an attorney-in-fact) the power to make health care decisions for him or her if unable to make those decisions themselves. A DPA can include guidelines for the attorney-in-fact to follow in making decisions on behalf of the incompetent person.

Elimination Period - Also known as a deductible or a waiting period. This is the number of days after the insured qualifies for and begins receiving services before the policy begins to pay benefits. An insured must pay out-of-pocket for covered services during this period. While some policies have no deductible periods and pay benefits from the first day, the most common waiting periods are 30 days, 60 days, or 90 days. The longer the elimination period the lower the premium.

Facility Only Policy – An insurance policy where benefits are only covered if the policyholder is receiving care in a licensed Long Term Care facility, e.g. a Nursing Home or Assisted Living Facility.

Franchise – A business in which an individual or group purchases the right to use a company’s name and business model in a defined territory. The franchisee will then pay a percentage of revenue generated in that territory to the franchisor. Franchise fees and royalties contribute substantially to overhead costs. Furthermore, most non-skilled home care franchises do not require the individual’s running the franchise to have any medical experience.

Free Look Period – An insurance policy provision which allows the insured to cancel the policy for a full refund within 30 days of receiving the policy.

Future Purchase Option/Guaranteed Purchase Option – An insurance term where the premium doesn't increase when you increase coverage under this option as compared to automatic compound or simple inflation where the coverage increases each year automatically without a concurrent increase in premium.

Guaranteed Renewable - Guaranteed Renewable means that the insurance company cannot cancel a policy or change any of the benefits, unless a policyholder fails to pay the premiums. Insurance companies are only allowed to increase premiums for a "class" of policies, but not for an individual personally for any reason including a change in health or age. Note, see Lapse Protection.

Hands-On Assistance - The physical assistance of another person without which you would be unable to perform one of the Activities of Daily Living. Some insurance carriers define the inability to perform an ADL without hands-on assistance as a trigger for policy benefits. This is a more stringent measure than merely requiring "stand-by" assistance.

Home and Community Based Services (HCBS) – Services that are provided to people in their homes by various types of providers. HCBS may include services such as case management, minor home modifications, home delivered meals and personal emergency response systems. Many such services may be accessed via your county Dept of Aging.

Home Care - Skilled and unskilled Long Term Care services provided in the home.

Home Care Agency – A business staffed and licensed to provide health services to patients in their own homes. Licensing requirements vary by state with some states being very stringent (eg Delaware) and others being much more lenient. Some states such as Pennsylvania have only recently required Home Care Agencies to be licensed at all. As a general rule of thumb, licensing requirements tends to become more stringent as an industry matures.

Home Care Registry – A business licensed to refer independent caregivers to consumers. The key difference between agencies and registries is that agencies employ their caregivers where registries don’t. By law, registries are not allowed to supervise their caregivers because it would make them “employees”. If a caregiver is a business’s employee, that company is responsible for the caregiver’s employment taxes. See Agencies vs Registries under Resources/Regulation.

Home Health Aide – An individual who provides "hands-on" custodial assistance in the home. Home health aides may be licensed but do not provide medical care. Typically they will help with activities of daily living such as bathing, dressing and transferring.

Home Health Care (HHC) – Services include but are not limited to: skilled nursing care, speech, physical or occupational therapy, homemaker services, home health aide, assistance with activities of daily living (ADLs), personal care, hospice services and respite care.

Homemaker Services – “Hands-off" domestic services that provide assistance with the personal chores or activities that are necessary to live at home. They are meant to assist a person with chronic illness or disability to remain at home and as independent as possible. They would typically include housekeeping, cooking, transportation and running errands or shopping.

Hospice Care - Designed to give supportive and palliative care to people in the final phase of a terminal illness. Hospice care can be provided at home or in a hospice facility and encompasses physical, emotional and spiritual support for the patient and their family. The emphasis is on patient comfort rather than cure.

Iatrogenic – Caused by treatment or diagnostic procedures. An iatrogenic disorder is an adverse condition that is caused by medical personnel or procedures or that develops through exposure to the environment of a health care facility. Relating to a disorder caused by the treatment itself. Bed sores are generally considered an iatrogenic condition and facility occurrence statistics are maintained by the State. One should consider bedsore statistics when evaluating nursing homes. See the Does Size Matter presentation in the Resources section of this website for more analysis of nursing home quality.

Indemnity Payment Disbursement – An insurance term meaning the actual dollar amount of the benefit, regardless of the cost of services. For example, if the policy has a $100 Daily Benefit, the policy would pay $100 whether the actual cost of the service rendered was $75 or $125.

Inflation Protection - A rider you can add on to your Long Term Care insurance plan that adjusts the benefits over time to account for inflation. Inflation protection riders can adjust benefits annually based on a simple or compound fixed rate (e.g. 3 or 5%) or based on the consumer price index (CPI). Alternatively some plans have a Future Purchase Option where you have the option to increase benefits in the future.

Informal Care - Care provided by family and friends of a loved one. While, unlicensed and generally unpaid, informal care makes up the majority of in-home care and has been termed the "back-bone" of our national Long Term Care system. In residential settings,formal paid care is often used to supplement the informal care provided by family caregivers.

Instrumental Activities Of Daily Living (iADL) - Skills necessary to live independently but not necessary for fundamental functioning. IADLs for instance would include shopping, preparing meals, taking medications, paying bills etc. Inability to complete Instrumental Activities of Daily Living is not a trigger to start receiving benefits under a Long Term Care insurance policy. However, many policies will cover these services for someone who is eligible for benefits due to inability to perform a specified number of the Activities of Daily Living.

Lapse - Termination of a policy due to the policyholder's failure to pay the premium. Note: see Lapse Protection.

Lapse Protection - Policyholder's can pay past-due premiums and reinstate their policies up to 5 months after they have lapsed if the failure to pay was the result of cognitive or functional impairment.

Levels of Care (Level I and Level II) – Medicaid terms used to designate the amount of care a patient requires. The intensity of care provided to nursing home patients depends on their medical needs. Most patients need a less intensive level of care that the Medicaid program calls Level I (formerly “intermediate care”), while others need a more intensive amount of care called Level II or skilled nursing care. The cost of Level II care is higher than that of Level I, both to private pay patients and to the Medicaid program. The Medicare program does not cover Level I care and covers skilled care only in certain circumstances and in certified facilities.

Licensed Practical Nurse (LPN) – A nurse who graduated from an approved one-year nursing program and passed a state-administered test. LPNs frequently hold supervisory positions in nursing homes. An LPN has had more training than a CNA and less training than an RN.

Lifetime Maximum Benefit - The maximum amount an insurance carrier will pay over the life of a policy. For a policy with a maximum Daily Benefit and set benefit period it is equal to the current Maximum Daily Benefit times the Benefit Period in days.

Living Will – A legal document in which a competent person directs in advance that artificial life-prolonging treatment not be used if he or she has or develops a terminal and irreversible condition and becomes incompetent to make health care decisions.

Long Term Care (LTC) – Health or personal services required on a continuing basis by people who are chronically ill, aged, disabled or developmentally disabled. People have historically thought of long-term care referring to care provided in an institution such as a nursing home, but it may also refer to continuing care provided in the patient’s home.

Long Term Care Insurance – Insurance that will pay all or part of the cost of long-term care. Many private insurance companies have developed comprehensive long-term care policies. LTC insurance policies are sold by private insurance companies or agents, and are increasingly being offered as benefits by employers. Premiums are based on the age of the person at the time of purchase, the benefit amount, the benefit time period, elimination period or deductible, and special options (inflation adjustment, non-forfeiture benefits, spousal discounts, etc). ~ Link to LTC CD?

Look-Back Period For Medicaid - In order to qualify for Long Term Care benefits under Medicaid many people tried to "give away" money to children or transfer assets to a "safe" financial vehicle. In response, Medicaid will now "look-back" to any asset transfers you have made in the 5 years before applying for Medicaid benefits. Any transfers made during this period can be counted as part of your assets for the purposes of determining Medicaid eligibility and can result in an "exclusionary" period before eligibility can be restored. Your best bet is to obtain the advice of an Elder Law Attorney who can guide you to the best means of asset protection for your situation.

Medicaid - Medicaid (Medical in California) is a joint federal and state program that provides health care services for people with low incomes and limited assets. While it was never designed to answer the financial burdens of long-term care for the elderly, it is the only program currently in place to pay for nursing home care for people who cannot afford it and who do not have private insurance or qualify for Medicare or Veterans Administration benefits. Each state sets its own limit on the amount of income/assets a person can have and still qualify for Medicaid. $2000 in “countable” assets is the general rule, and there is a very short list of “non countable” assets (primary home up to $500k, car, furniture, jewelry, and a few others). The bottom line is that you must have extremely limited assets to qualify for Medicaid. If you do qualify, Medicaid will cover qualified Long Term Care expenses but often only in a Medicaid qualified nursing facility.

Medicare - A federal program to provide hospital and medical insurance to people age 65 and older and to certain ill or disabled persons. Benefits for Long Term Care are very limited. The Medicare program has two separate parts: Part A, which covers inpatient hospitalization and skilled nursing care; and Part B, which covers physician services and certain medical equipment and services.

Medigap Insurance – A term commonly used to describe Medicare supplemental insurance policies available from various companies. Medigap is private insurance that may be purchased by Medicare-eligible individuals to help pay the deductibles and co-payments required under Medicare. Medigap policies generally do not pay for services not covered by Medicare, such as Level I long term care.

NonCancelable Policy – A type of insurance contract that cannot be cancelled. Also, the insurance company cannot change the rates. “Non cancelable and guaranteed renewable” means that the policy can't be canceled, the contract provisions can't be changed without your consent, and the premium can't be raised for the life of the policy as long as you continue to pay your premiums. “Guaranteed renewable” means that the policy can't be canceled and the contract provisions can't be changed without your consent as long as you pay your premiums, but the premium can be raised. This information is in the Type of Contract section of your Long Term Care insurance policy.

NonForfeiture Benefits - This is an optional rider on Long Term Care insurance policies that allows the policyholder to retain some limited policy benefit (usually equal to the amount of premiums paid-in) if you lapse your policy.

Non-skilled Care – Also known as custodial care. “Non-skilled” doesn’t mean that the caregiver doesn’t have any training to perform the tasks a custodial patient requires. It means the type of care provided doesn’t require a nursing or doctor’s license. Generally it’s the type of care that can be administered by a family member. For example, a person suffering from brain damage after a recent stroke may have trouble making breakfast and washing himself. These are the types of tasks that could be performed by a family member or a caregiver. Professional caregivers would have training in how to safely, discreetly and professionally perform custodial tasks or Activities of Daily Living (ADLs).

Non Tax-Qualified Policy – Policy holders can only claim tax deductions for long-term care premiums on tax-qualified plans. In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Under this bill there are federal tax advantages for LTC policies that are designated “tax-qualified” (TQ). For instance, on a tax-qualified policy you may be able to deduct part of the policy premium from your taxes as a medical expense if you qualify for a medical expense deduction. Likewise, insurance benefits from a Tax Qualified policy, in general, are not tax taxable as income. To be defined as “tax-qualified” the LTC policy must meet the provisions of the federal guidelines defined in HIPAA. Policies purchased on or after 1/1/97 may or may not be tax-qualified. All LTC insurance policies purchased before 1/1/97 are “grandfathered in” and are considered qualified for tax-favored status. Fewer non-tax qualified policies are available for sale simply because there is greater demand for the favorable tax treatment, but you should be aware of which type of policy you buy.

PACE (Program of All-Inclusive Care for the Elderly) - PACE is unique. It is an optional benefit under both Medicare and Medicaid that focuses entirely on older people who are frail enough to meet their State's standards for nursing home care. It features comprehensive medical and social services that can be provided at an adult day health center, home, and/or inpatient facilities. For most patients, the comprehensive service package permits them to continue living at home while receiving services, rather than be institutionalized. A team of doctors, nurses and other health professionals assess participant needs, develop care plans, and deliver all services which are integrated into a complete health care plan. PACE is available only in States which have chosen to offer PACE under Medicaid. (Currently available in Pennsylvania but not Delaware. Chester County implements the PACE program under their Life at Home Program, Montgomery County calls it their Options Program, ) If a participant is not eligible for Medicaid, he or she may be required to cost share for services.

Palliative Care - Any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. Palliative care strives to relieve the pain, symptoms and stress of illness, and can be used at any point in an illness, including in conjunction with treatments meant to cure. In the US, palliative care is viewed as separate from hospice care and is not limited to those approaching the last stages of life.

Partnership-Certified Policy - A Long-Term Care insurance policy approved by your state for participation in the partnership program. This program allows you to receive benefits from Medicaid for Long Term Care services without spending-down all of your assets if you have previously purchased and depleted the benefits in a partnership-certified policy. This program is not currently available in every state but it is available in Pennsylvania and Delaware. Be sure to seek a LTC insurance policy that is partnership-certified! The premium is the same, the underwriting is the same, and the benefit structure is the same. What makes a partnership-certified policy different is the dollar for dollar match by the State of Medicaid spend-down requirements. It allows policyholders to go on Medicaid with a higher level of assets and/or income than would otherwise be allowed.

Case Study:

The following is an example of how a Partnership qualified policy works. Let's say John, a single man, purchases a Partnership policy with a value of $100,000. Some years later, he receives benefits under that policy up to the policy's lifetime maximum coverage (adjusted for inflation) equaling $150,000. John eventually requires more long term care services and applies for Medicaid. If John's policy was not a Partnership policy, he would be entitled to keep only $2,000 in assets in order to be eligible for Medicaid. He would have to spend down any assets over and above this amount. However, because John bought a Partnership policy, he can keep $152,000 in assets and the state will not recover those funds after his death. However, any assets John has over and above the $152,000 would have to be spent in order for him to be eligible for Medicaid. He would also have to satisfy the income, general eligibility and functional eligibility requirements for Medicaid before he can qualify.

Personal Care - Non-medical care and assistance needed to help a person perform activities of daily living, and/or supervision and assistance for someone suffering from a severe cognitive impairment. Bathing, dressing, toileting, grooming, mobility assistance, incontinence care, feeding and medication reminding (as allowed by State regulation) are all examples of personal care. Most health insurance plans do not cover custodial or personal care but are limited to acute or rehabilitative skilled-care. Long Term Care insurance plans were therefore designed to cover these services

Plan Of Care - A documented, individualized plan of Long Term Care services prepared by a Licensed Health Care Practitioner (LHCP). Typically a Plan of Care would include the types and frequency of care needed and whether the care was to be provided by family care-givers or through formal paid care providers. At Four Seasons Healthcare, the Care Plan is a written proposal developed by the Registered Nurse conducting a general needs assessment in conjunction with the patient/patient’s representative. It details the needs/problems/goals identified and determines what services are required of a home health aide to meet these needs in the patient’s residence.

Pre-Existing Conditions - Medical conditions that existed, were diagnosed, or were under treatment before a LTC insurance policy was issued. If the application is approved by underwriting, most Long Term Care insurance policies will cover pre-existing conditions as long as they were revealed at the time of application.

Registered Nurse (RN) - A nurse who has graduated from a college's nursing program or from a school of nursing and has passed a national licensing exam. RNs care for the sick and injured in hospitals and other health care facilities, physicians' offices, private homes, public health agencies, schools, camps, and industry. A registered nurse's scope of practice is determined by each state's Nurse Practice Act. It outlines what is legal practice for registered nurses and what tasks they may or may not perform.

Respite Care - Respite care refers to temporary or short-term care provided to the patient so that the primary informal care-giver can take a break or rest. Respite care can be provided at home or in a facility and allows the primary care-giver a temporary relief from care-giving. Respite care can become essential for preventing Caregiver Burnout.

Silvertech – Adaptive and assistive technology products for the aging and their caregivers. Technology companies are taking notice of the unmistakable demographic trends and a surge of new gizmos for older consumers are hitting the market.

Skilled Nursing Facility/Nursing Home - The highest intensity level of Long Term Care. A skilled nursing facility is defined as a health facility or a distinct part of a hospital that provides 24 hour a day nursing care on an inpatient basis. Skilled nursing facilities will have an RN or LPN on duty at all times and a licensed physician on call at all times. Skilled care refers to the technical skills that nurses and doctors need to get you better.

Skilled Care – Refers to the technical skills required to get you better. Generally meaning those tasks provided by doctors, nurses, licensed practical nurses, and physical or occupational therapists. Skilled care is usually received in hospitals or skilled nursing homes, but can also be received in your home. For example, if you’ve had a fall a nurse or physical therapist might come to your home for short visits, X number of times.

Stand-By Assistance - The presence of another person within arm's reach required to prevent injury during the performance of an ADL. For example, if you need somebody standing by to catch you in case you fall getting in and out of the bath. This is a lesser requirement for triggering of policy benefits than the requirement for hands-on assistance.

State Health Insurance Assistance Program (SHIP) -- There are State Health Insurance Assistance Programs in every state with counselors that provide free one-on-one help with your Medicare questions or problems, including Medicaid, Medigap, long-term care insurance and other types of health insurance. In Pennsylvania the program is called Apprise Health Insurance Counciling Program 1-800-783-7067. In Delaware the program is called ELDERinfo 1-800-336-9500.

Step-Down - A policy feature which allows a policyholder to reduce coverage in exchange for a lower premium. For instance, a policyholder can reduce the Daily Benefit, or the total number of years the policy will pay or increase the elimination period. A policyholder has the right to step down policy benefits anytime after the first year and should always be considered before lapsing coverage.

Substantial Supervision - Continual monitoring of a cognitively impaired person by another person (which may include cueing by verbal prompting, gesture, or other demonstrations) to protect you from threats to your health and safety, for instance, while wandering. Often used as a Level of Assistance required for various ADLs.

Tax Qualified - In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Under this bill there are federal tax advantages for LTC policies that are designated "tax-qualified" (TQ). For instance, on a tax-qualified policy you may be able to deduct part of the policy premium from your taxes as a medical expense if you qualify for a medical expense deduction. Likewise, insurance benefits from a Tax Qualified policy, in general, are not taxable as income. To be defined as "tax-qualified" the Long Term Care policy must meet the provisions of the federal guidelines defined in HIPAA. Policies purchased on or after January 1, 1997 may or may not be tax-qualified. All Long Term Care insurance policies purchased before January 1, 1997 are "grandfathered in" and are considered qualified for tax-favored status.

Toileting - One of the six defined Activities of Daily Living. Refers to the ability to get on and off the toilet and perform hygiene related tasks.

Transferring - One of the six defined Activities of Daily living. Refers to the ability to move in or out of a bed, chair or wheelchair.

Underwriting (for LTC Insurance) - The process whereby the insurance carrier reviews an individual's health status prior to issuance of a policy in order to determine if they are eligible for coverage. Underwriting for Long Term Care generally involves one or more of the following: completion by applicant of medical questionnaire, review of applicants medical records, a telephone interview by a nurse or health aid including a cognitive test, an in-home physical and cognitive assessment by a nurse or health aide.

Waiver Of Premium - A common provision in Long Term Care insurance policies that waives the requirement to pay premiums while the insured is receiving benefits.