There are lots of new terms associated with Long Term Care Insurance. Schneider & Shulman Associates have put together this handy guide to the most important ones.
Activities of Daily Living (ADLs): Any activity undertaken in a normal day, such as bathing, toileting, continence, dressing, eating and transferring, or when substantial supervision is needed due to cognitive impairment. Long Term Care typically refers to skilled, intermediate and custodial care received at home or in an adult day care center, assisted living facility or nursing home.
Acute Care: Care provided by a doctor or other health care professional designed to treat or cure an illness, wound or condition. Long Term Care is not acute care.
Adult Day Care: A place that provides a program of activities and services to individuals in need of Long Term Care. It is a helpful option for individuals living at home whose family caregivers work during the day and who require someone to be with them throughout the day.
Alzheimer’s Disease: A progressive neurological disease that affects brain functions, including short term memory loss, inability to reason, the deterioration of language and the inability to care for oneself.
Assisted Living Facility: A licensed residential facility that provides room, board and 24-hour personal care to individuals with Long Term Care needs. This is an important care option for individuals who are not able to manage at home but do not need the level of skilled care provided in a nursing home.
Bed Reservations: An optional benefit that pays for reserving a bed in a care facility should a person need to be hospitalized during a covered stay.
Benefit Amount: The maximum amount of Long Term Care Insurance that the policyholder feels is necessary to meet his/her needs.
Benefit Period: The length of time insurance will last if a person receives care every day at a cost equal to or more than the daily maximum benefit amount. If care costs less, the insurance will last longer than the benefit period. The benefit period is used together with the daily maximum benefit amount to calculate a lifetime maximum benefit.
Care Coordination Services: Services such as information, advice and development of a plan of care by a professional care coordinator.
Caregiver: Someone who helps a person accomplish the basic, everyday activities they can no longer manage without assistance due to illness, injury or cognitive impairment.
Certified in Long Term Care (CLTC): The only third-party professional designation in the Long Term Care Insurance industry, the CLTC program trains Long Term Care Insurance professionals how to offer guidance to individuals and families making Long Term Care plans.
Chronic Care: Care provided to help maintain daily function. There is no expectation that the care recipient will improve or recover.
Cognitive Impairment: A deterioration or loss in intellectual capacity that results in partial or total impairment in short and long term memory, orientation to people, place and time, deductive or abstract reasoning and judgment. This is considered an activity of daily living (ADL).
Community-Based Services: Services designed to help people remain independent and in their own homes, such as Meals On Wheels or adult day care facilities.
Continence: The ability of the body to control urination, bowel movements or both. This is considered an activity of daily living (ADL).
Custodial Care: Services aimed at maintaining your health and/or preventing deterioration in your functional status, provided on an extended basis. Long Term Care includes custodial care.
Daily Maximum Benefit: The maximum amount that Long Term Care Insurance will pay in any single day.
Dementia: A deterioration of mental faculties due to a disorder of the brain.
Elimination Period: A deductible in which the covered person pays for services for a specified number of days before the policy begins paying.
Home Health Care: At-home services for occupational, physical, respiratory, speech therapy or nursing care. Medical, social worker, home health aide and homemaker services are typically included.
Home Modification: Physical adaptations to a home that enable a person to live and function within that environment.
Homemaker Services: Services designed to provide household support. Homemaker services include light housekeeping, laundry, shopping, cooking and home management.
Hospice Care: Provides care to alleviate physical, emotional or spiritual discomforts near the end of life. Hospice care is usually provided at home.
Inflation Protection: An optional Long Term Care Insurance policy feature that is available for additional premiums and provides for increases in benefit levels over time to help pay for expected inflation in the costs of Long Term Care services.
Long Term Care: Personal care and other related services provided on an extended basis to people who need help with activities of daily living (ADLs) or who need supervision due to a severe cognitive impairment. It can be provided at home, in a nursing home, in an assisted living facility or in an adult day care center.
Long Term Care Insurance: Insurance that helps defray the costs of assistance with activities of daily living (ADLs) or the costs of supervision due to a severe cognitive impairment.
Medicaid: The joint federal-state program that pays for health care services for individuals who fall below income guidelines set by their states of residence.
Medicare: A federal health care program for most adults age 65 and older and certain disabled individuals. Medicare pays for Long Term Care under limited circumstances and for short periods of time.
Medicare Supplement Insurance: Private insurance to help pay hospital and medical costs Medicare does not cover. It pays for Long Term Care under limited circumstances and for limited periods of time. Medicare Supplement Insurance is not the same as Long Term Care Insurance.
Monthly Benefit: The amount of insurance benefit per month in a Long Term Care Insurance policy a person can choose to cover Long Term Care expenses. A typical monthly benefit ranges between $1,500 and $12,000.
Nonforfeiture: Allows a policyholder to retain benefits at a reduced rate, should he/she stop paying his/her premiums at some point in the future. This option must be offered to all purchasers of Tax Qualified Long Term Care Insurance policies.
Nursing Home: A licensed facility that provides 24-hour-a-day room and board, nursing care and personal care services. Nursing homes also provide medical care, therapy and other health-related services.
Partnership Programs: Cooperative programs bringing together state governments and Long Term Care insurers. Under the programs, people who purchase approved Long Term Care Insurance policies can still qualify for Medicaid once their insurance benefits run out without jeopardizing their assets.
Personal Care: Care to help meet personal needs such as bathing, dressing and eating.
Plan of Care: A plan prescribed by a licensed health care practitioner for meeting a patient’s need for Long Term Care services.
Premium: The money paid to an insurance company for coverage.
Respite Services: Services by a substitute provider to give time off to the regular caregiver. Respite services can be provided from a few hours to a few days.
Return-of-Premium Option: An optional, usually expensive feature of Long Term Care Insurance policies that allows for some or all of the premiums paid to the insurance company to be returned to the family upon the death of the covered person.
Shared Care Policy: A Long Term Care Insurance policy that allows spouses to pool and share benefits and possibly reduce overall costs. In a 10-year Shared Care Policy, a couple has a total of 10 years of care between them. If one spouse uses only 2 years of benefits, the other will have 8 years.
Skilled Nursing Care: Nursing and rehabilitative care that is performed by skilled medical personnel, usually available 24 hours a day and ordered by a physician under a treatment plan. It can be in a facility setting or at home. Medicare and Medicaid have their own definitions of “skilled nursing care,” which do not necessarily match those in Long Term Care Insurance policies.
Skilled Nursing Facility: A state-licensed, institutional setting that provides skilled care by skilled medical personnel. Care is available 24 hours a day and is ordered by a physician under a treatment plan.
Spend Down: The depletion of income and assets to meet eligibility requirements for Medicaid. Recent regulation changes have made spending down more difficult.
Sub-Acute Care: The first level of skilled care beyond the acute hospital setting. Patients receiving sub-acute care usually require skilled nursing and rehabilitation services.
Toileting: Getting to and from the toilet, getting on and off the toilet and performing associated personal hygiene-related tasks. Toileting is considered an activity of daily living (ADL).
Transferring: The ability to move in or out of a bed, chair or wheelchair. Transferring is considered an activity of daily living (ADL).