Independent judgment by the A.M. Best Company, a private organization that evaluates and monitors the financial strength of life insurance companies. The company assigns letter grades from A++ (the highest) through C.
Basic actions performed by an independently functioning person on a daily basis: (a) bathing; (b) dressing; (c) toileting; (d) transferring (moving to and from a bed or a chair); (e) eating; and (f) caring for incontinence. The need for assistance with ADLs or inability to perform ADLs is used to determine eligibility for many public programs such as Medicaid reimbursed long-term care services. Also, many long-term care insurance policies use the inability to do a certain number of ADLs (such as 2 of 6) as criteria for paying benefits.
Care that has recovery as its primary goal; typically requires the services of a physician, nurse, or other skilled professional and usually provided in a doctor's office or hospital; usually short term.
(also called Third Party Designation or Third Party Notice) Long-term care insurance benefit that lets you name someone who the insurance company would notify if your coverage is about to end because of lack of premium payment. This can be a relative, friend, or professional, such as your lawyer.
Services provided during the day at a community-based center. Programs are designed to meet the needs of functionally and/or cognitively impaired adults through an individual plan of care. These structured, comprehensive programs provide a variety of social and support services in a protective setting during any part of a day, but less than 24-hour care. Many adult day service programs include health-related services.
(also called Health Care Directive, Advanced Health Care Directive, Living Will, or Health Care Directive) Legal document used to specify whether you would like to be kept on artificial life support if you become permanently unconscious or are otherwise dying and unable to speak for yourself. It also specifies other aspects of health care you would like under those circumstances.
Progressive, degenerative form of dementia that causes severe intellectual deterioration; first symptoms are impaired memory, which is followed by impaired thought and speech and finally complete helplessness.
Residential living arrangement that provides individualized personal care, assistance with Activities of Daily Living, help with medications, and services such as laundry and housekeeping. Facilities may also provide health and medical care, but care is not as intensive as care offered at a nursing home. Types and sizes of facilities vary, ranging small homes to large apartment-style complexes. Levels of care and services also vary. Assisted living facilities allow people to remain relatively independent.
Criteria insurance companies use to determine when you are eligible to receive benefits. The most common Benefit Triggers for long-term care insurance are: (1) needing help with two or more ADLs, or (2) having a Cognitive Impairment.
Specified amount of time at the beginning of a disability during which covered services are received, but for which the policy will not pay benefits (also known as a Deductible Period or Elimination Period). A Service Day Deductible Period is satisfied by each day of the period on which you receive covered services. A Calendar Day or Disability Day Deductible Period doesn't require that you receive covered services during the entire deductible period, but only requires that you meet the policy's benefit triggers during that time period.
(also called Group Home) Residential private homes that are designed to provide housing, meals, housekeeping, personal care services, and supports to frail or disabled residents. At least one caregiver is on the premises at all times. In many states, Board and Care Homes are licensed or certified and must meet criteria for facility safety, types of services provided, and the number and type of residents they can care for. Board and Care Homes are often owned and managed by an individual or family that is involved in the every day operation of the home.
(also called care coordination services) Service in which a professional, typically a nurse or social worker, arranges, monitors, or coordinates long-term care services.
Person providing care to someone with chronic illness or disability; may be unpaid (family, friend, or volunteer) or paid; provides care in the home or community. Unpaid caregivers are also called Informal Caregivers. Paid caregivers are trained and possibly licensed or certified, if required by the state. They are sometimes called Formal Caregivers.
Amount of money you may be entitled to receive from the insurance company when you terminate a life insurance or annuity policy. The amount of cash value is determined as stated in the policy.
Special tax-exempt irrevocable trust written to comply with Federal tax laws and regulations. With this kind of trust, you transfer cash or assets into the trust and may receive some income from it for life or a specified number of years (not to exceed 20). The minimum payout rate is 5 percent and the maximum is 50 percent. At your death, the remaining amount in the trust goes to the charity that was designated to receive it as part of the trust arrangement.
Having a long lasting or recurrent illness or condition that causes a person to need help with Activities of Daily Living and often other health and support services, for example Parkinson's Disease or Alzheimer's disease. At a minimum, the condition is expected to last for at least 90 consecutive days. Term used in a tax-qualified long-term care insurance policy to describe a person who needs long-term care because of an inability to do a certain number of everyday Activities of Daily Living without help or because of a severe cognitive impairment.
Deficiency in short or long-term memory; orientation to person, place and time; deductive or abstract reasoning; or judgment as it relates to safety awareness. (An example of a cognitive impairment is Alzheimer's disease.)
Services and service settings in the community, such as adult day services, home delivered meals, or transportation services. Often referred to as home and community-based services, they are designed to help older people and people with disabilities stay in their homes as independently as possible.
Ability to maintain control of bowel and bladder functions; or when unable to maintain control these functions, the ability to perform associated personal hygiene (including caring for a catheter or colostomy bag). One of the six Activities of Daily Living.
Long-term care insurance policy provision automatically included in many newer policies, which provides a limited amount of continuing coverage even if the policy lapses due to non-payment of premium, if the non-payment is due to a significant increase in premium rates. The policy defines what is considered a significant increase in premiums based on your age at the time you bought the policy.
Retirement complex that offers a range of services and levels of care. Residents may move first into an independent living unit, a private apartment or house, on the campus. The CCRC provides social and housing-related services and often also has an assisted living unit and an on-site or affiliated nursing home. If and when residents can no longer live independently in their apartment or home, they move into assisted living or the CCRC's nursing home.
Premium payment option that requires a person to pay premiums for the life of the policy or until they begin to receive benefits. Premiums are usually paid on a monthly, quarterly, semi-annually or annual basis. The policy is not cancelable, except in the event of nonpayment of premiums.
(also called Nursing Home or Long-Term Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs.
Assets whose value is counted in determining financial eligibility for Medicaid. They include vehicles other than the one used primarily for transportation, life insurance with a face value over $1,500, bank accounts, trusts, and your home, if your spouse or child does not live there and its equity value is greater than $500,000 (in some states up to $750,000).
Combination of rescue breathing (mouth-to-mouth resuscitation) and chest compressions used if someone isn't breathing or circulating blood adequately. CPR can restore circulation of oxygen-rich blood to the brain.
(also called personal care) Non-skilled service or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom. May also include care that most people do themselves, such as using eye drops.
Specified dollar amount that is the maximum amount paid per day for covered services. Policies may pay the full daily maximum regardless of the cost of care or may pay a percent of actual expenses up to the specified daily maximum amount. Some policies specify a single Daily Maximum for all covered services (for example, nursing home care, assisted living facility, home care) and other policies have one Daily Maximum for nursing home care and a lower amount for other covered services.
Specified amount of time at the beginning of a disability during which covered services are received, but for which the policy will not pay benefits (also known as an Elimination Period or Benefit Waiting Period). A Service Day Deductible Period is satisfied by each day of the period on which you receive covered services. A Calendar Day or Disability Day Deductible Period doesn't require that you receive covered services during the entire deductible period, but only requires that you meet the policy's benefit triggers during that time period.
Legislation passed by the U.S. Congress and signed into law in December 2005 that is designed to trim the Federal deficit. It includes major changes in the Federal Medicaid policy.
Method of paying long-term care insurance benefits that only requires you to meet the benefit eligibility criteria. Once you do, you receive your full daily benefit.
For Medicaid eligibility purposes, a disabled person is someone whose physical or mental condition prevents him or her from doing enough work or the type of work needed for self-support. The condition must be expected to last for at least a year or be expected to result in death. Persons receiving disability benefits through Supplemental Security Income (SSI), Social Security, or Medicare automatically meet this criterion.
(also called Outline of Coverage) Description of benefits, exclusions, and provisions of a long-term care insurance policy. Most state laws specify the format and content of the Outline of Coverage. The Outline of Coverage must be provided to a prospective applicant for insurance before the application is taken.
Written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR order may be instituted on the basis of an Advance Directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy. In some jurisdictions, such orders can also be instituted on the basis of a physician's own initiative, usually when resuscitation would not alter the ultimate outcome of a disease. Any person who does not wish to undergo lifesaving treatment in the event of cardiac or respiratory arrest can get a DNR order, although DNR is more commonly done when a person with a fatal illness wishes to die without painful or invasive medical procedures.
Legal document that gives someone else the authority to act on your behalf on matters that you specify. The power can be specific to a certain task or broad to cover many financial duties. The power can be given to start immediately or upon mental incapacity. To be valid the document must be signed by you before you become disabled.
Feeding oneself by getting food into the body from a receptacle, such as a plate, cup or table, or by a feeding tube or intravenously. It is one of the six Activities of Daily Living.
Specified amount of time at the beginning of a disability during which covered services are received, but for which the policy will not pay benefits (also known as a Deductible Period or Benefit Waiting Period). A Service Day Deductible Period is satisfied by each day of the period on which you receive covered services. A Calendar Day or Disability Day Deductible Period doesn't require that you receive covered services during the entire deductible period, but only requires that you meet the policy's benefit triggers during that time period.
The process by which Medicaid recovers an amount of money from the estate of a person who received Medicaid. The amount Medicaid recovers cannot be greater than the amount it spent on the person's medical care.
(also called Non-countable Assets) Assets whose value is not counted in determining financial eligibility for Medicaid. They include personal belongings, one vehicle, life insurance with a face value under $1500, and your home, if your spouse or child lives there or its equity value is less than $500,000 ($750,000 in some states).
(also called Reimbursement Method) Most common method of paying long-term care insurance benefits. Your policy or certificate will pay benefits when you receive eligible services. Once you have incurred an expense for an eligible service, benefits are paid either to you or your provider. The coverage pays for the lesser of the expense you incurred or the dollar limit of your policy.
Article provided by Administration on Aging website National Clearinghouse for Long-Term Care
