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Glossary of Common & Pertinent Long Term Care Terms

The following is a glossary of common or relevant long term care terms that you may come across while talking with Allwel, and their definitions.

Definitions

Activities of Daily Living (ADLs) – Refers to the basic activities of daily life. Some ADLs include: bathing, dressing, eating, moving around (ambulating), and toileting. In the world of long term care, a person who requires assistance with ADL’s will receive the assistance from family, a home health or personal care aide, or a home health care nurse. Allwel assists persons with ADL’s through the staffing of Personal Care Aides, Living Skills Trainers, and Nurses.

Advance Directive (AD) – Refers to the “advance directive” of a person to have his or her wishes fulfilled if he or she is unable to speak for his or herself. It is also called a living will and provides direction on what they wish for themselves regarding the extent of care to be provided or life-saving procedures in the case of an emergency situation. Allwel’s Case Managers or Service Coordinators can assist individuals with linking to professional services who can work with the family and participant in developing an appropriate set of Advanced Directives.

Adult Day Care – A daily or weekly program that provides a social and protective environment for adults who are at home during the night, but who need supervision, assistance, and social activities during the day, because the person providing the nightly care must go to work or has other responsibilities. Allwel’s Case Managers or Service Coordinators will work with the family and person receiving care to determine if an Adult Day Care, also known as a Structured Day Program or possibly a Medical Day Program will complement the plan of care, and assist in linking to an agency of the participant’s choice.

Ancillary Services – Any services provided by providers other than the one responsible for caregiving (aides, nurses, etc.) These services can be imaging x-ray/CT Scans, laboratory (blood, urine) testing (such as blood or urine testing) or other social/human services (counseling, housing supports). Allwel’s Case Managers, Service Coordinators, and nurses will work with the family and person receiving care to determine what available ancillary services can complement the plan of care or address other needs that will enhance independence in the community.

Asset – Refers to items that are owned and that have value including a home, bank account, or stock. When applying for Medicaid Status, there a qualifications as to how much value in assets an applicant can have, depending on the number of people in a household.

Caregiver – A caregiver is someone who provides necessary care to another person in need. Caregiving can be Medical or Non-Medical. Medical is provided by Doctors, Nurses, etc. Non-Medical is provided by family, companion or personal care aides, or even friends. Allwel’s staff of Personal Care Aides are available to share in as much or as little as needed by a participant and his or her family caregiver(s).

Centers for Medicare and Medicaid Services (CMS) – The federal agency responsible for administering the Medicare and Medicaid Programs.

Certification – The process a nursing home, Licensed Home Care Services Agency, or even a Personal Care Aide must undergo to be allowed to provide services under the Medicaid or Medicare programs.

Certified Nursing Assistant (CNA) – Certified Nursing Assistants are responsible for care work that is more advanced than what is allowable for Personal Care or Home Health Aide.

Chronic Care – Care that addresses a lengthy or incurable illness, such as diabetes, multiple sclerosis. Allwel develops plans of care that address chronic care needs through our nurses working with the participant’s doctor, and training and supervision of our Personal Care Aides in the details of the plans.

Companion/Companion Care – An individual or type care give that provides social outlet and non-medical care. A companion can provide friendship as well as prompting or cues, preparing meals, or the oversight and supervision of a person’s safety. Allwel can provide companion care though the staffing of Personal Care Aides that are guided by companion plans of care.

Continuing Care Retirement Community (CCRC’s) – Refers to a housing setting in the form of a room or apartment setting and can include a range of health care and social services.

Custodial Care – Custodial care is another term for companion care that provides the non-medical social, support, and oversight of the activities of daily living.

Durable Healthcare Power of Attorney – A document where the individual empowers a person he or she trusts to make healthcare decisions on their behalf should he or she be unable to do so on their own due to an emergency situation. Allwel’s Case Managers or Service Coordinators will work with the family and person receiving care to link to a provider that will work with family and participant in developing an appropriate Power of Attorney document.

Durable Medical Equipment (DME) – This is specialized mechanical equipment, tools or prosthetics that assist persons in completing basic tasks, moving around, or being safe in the home and in the community. These include hospital beds, wheelchairs, special pill dispensers, prosthetic leg, one-handed cutting board, or a communication device. Allwel’s Case Managers, Service Coordinators, or nurses will work with the family and person receiving care to determine what DME will assist in promoting the independence of the person receiving care, and link the family and individual the DME provider of their choice to provide the equipment.

Elder Care – Refers to caregiving arrangements for older persons. It can also be termed geriatric care or senior care, and refers to the whole scope of care for an individual.

Geriatric Care – As with Elder Care, Geriatric Care is care for older persons.

Guardian – Refers to an individual or agency appointed by a court to be responsible for manage the affairs of a person receiving care, and who is unable to cognitively be responsible for his actions or safety. Guardianship is very specific in what the individual is able to impose on the person for whom guardianship is required, and the courts are very strict in enforcing that any limitations are not exceeded by the guardian. Allwel’s Case Managers, Service Coordinators, or nurses will work with the family and person receiving care to determine if guardianship is an appropriate part of the plan of care, and will assist in linking to a provider of the family’s choice.

Health Insurance Portability and Accountability Act (HIPAA privacy law) – Any agency involved in the care of an individual or has health-related information about someone in relation to that care is responsible for maintaining that individuals right to privacy under the Health Insurance Portability and Accountability Act. It is a federal law that sets standards for protecting and securing private information.

Home and Community Based Services (HCBS) – Refers to the caregiving services that are provided in a community setting as opposed to a hospital or nursing facility. These services include personal care aides, case management, home modifications such as ramps or stair lifts, a Personal Emergency Response system (PERS), or even home-delivered meals. Allwel provides Medicaid HCBS under two Waivers: Traumatic Brain Injury Waiver and Nursing Home Transition and Diversion Waiver, as well as through Medicaid Managed Care Organizations including Fidelis, Univera, Aetna, Humana, Blue Cross / Blue Shield, and more.

Homebound – A specific term used to refer to an individual who has great difficulty in the home without assistance or is recommended to not leave due to a medical condition. Frequently, homebound persons only leave the home to seek medical treatments or very necessary appointments. Allwel can provide services to homebound individuals who require up to 24 hour per day care, 7 days per week.

Home Energy Assistance Program (HEAP) – Refers to the federally funded program designed to assist eligible low-income persons in paying costs associated with home heating. In most cases, this is a one-time benefit, and the credit is applied to the energy bill by the utility or fuel provider. Allwel’s Case Managers or Service Coordinators will work with the family and person receiving care to determine if HEAP is an appropriate financial assistance, and assist in filling out appropriate paperwork and gathering the needed information for the subsidy.

Home Health Agency – Refers to an agency that provides home health care services to people. In New York State, Home Health Care agencies that work with the Medicaid program must be licensed, and are termed Licensed Home Care Services Agencies (LHCSA’s). Agencies that also work under the Medicare program must be certified, and are referred to as Certified Home Health Agencies (CHHA’s). CHAA’s typically have the ability to provide care beyond what is permitted to LHCSA’s, but generally for not as long, depending on the service. Services provided by a LHCSA must be performed by a licensed professional – such as a registered nurse or physical, respiratory or occupational therapist – and be under the scope of a physician’s prescription (orders). Allwel is a Licensed Home Care Services Agency, with a license for 7 counties in Western New York, as well as the 5 Boroughs of Manhattan and Nassau County.

Home Health Aide – A NYS certified individual who is allowed to provide hands-on personal care. Home Health Aides have more hours of training than a Personal Care Aide, and are able to perform some tasks that Personal Care Aides are not permitted. Allwel has staff who are qualified and who meet the educational currency requirements to provide Home Health Aide services under our license.

Home Health Care (Home Care) –Home Care (Homecare) refers to any type of person-centered care that is provided at a person’s the home or while in the community. This is the term that generally refers to the type of care provided by personal care aides, home care nurses, and other specialized services.

Home Health Nurse – Refers to a nurse with significant assessing and addressing the needs of persons who receive caregiving arrangements in home settings. They can be Registered or Licensed Practical Nurses, and typically have problem solving skills developed from the challenges associated with providing care in a home setting.

Hospice Care – Hospice is a type of care specific to when a person is reaching end-of-life due to a prolonged illness. Hospice provides very special physical and emotional support specific to making both the individual who is receiving care and the families feel as comfortable and as supported as possible. Allwel’s Case Managers, Service Coordinators, or nurses will work with the family, the participant receiving care, and the participant’s doctor to determine if Hospice services are becoming necessary. If so, we will assist in linking to the Hospice provider and can also supplement any home care needs that the family wishes to include.

Intermittent Care – Refers to caregiving arrangements that are infrequent in nature such as a couple of hours per day and/or a few days per week. Intermittent care is frequently used when there are family or other supports in place, but have to be absent from the home for any length of time. Allwel’s schedulers will work with the family and the participant to develop a schedule that works for the family providing and the individual receiving care. Scheduling can be as flexible as needed, and at the frequency that makes sense for the plan of care.

Level of Care (Level I or Level II) – Refers to the intensity and/or the type of care that is provided by a Personal or Home Health Care Aide. Generally, Level I is a less intensive type or amount of care whereas Level II care requires a great deal of hands on assistance or use of a mechanical lift, for example. Allwel’s Personal Care Aides will provide Level I or Level II care as determined by the nurse and the participants doctor.

Licensed Practical Nurse (LPN) – Licensed Practical Nurses are licensed nurses that are required to pass a licensing examination and requires less time/education than what is required for a Registered Nurse.

Long-Term Care – Refers to caregiving arrangements that are required for long periods of time. In New York, Long Term Care services are generally termed so if an individual requires more than 120 continuous days of care to remain safe in the community, and is often used in conjunction with home health care. All of the care provided by Allwel falls under the heading of Long Term Care.

Long-term Care Insurance – Refers to a type of private insurance specific to covering home health care or nursing facility types of care. There are a number of different levels of insurance, and generally are able to supplement the total cost of long term care. Allwel’s Case Managers or Service Coordinators will work with the family and person receiving care in working with a Long Term Care Insurance Provider to be as efficient as possible within the available funds of the policy. Allwel strives to be a good steward of any payer’s funds, and works hard to make sure that the right level of care is delivered at the right time.

Managed Care Organization – Refers to private organizations that address the persons who are eligible for Medicare or Medicaid services, and directly pay provider organizations to provide the care that is needed. Allwel works with a number of Managed Care Organizations to provide services to their members.

Managed Care Plan – Refers to the type of providers and benefits/services that a Managed Care Organization’s “plan member” is able to receive. Allwel serves a number of New York State Medicaid Managed Care plans.

Medicaid – Refers to the Federal and State program of partnership that provides a specific set of medical and long term care benefits to low-income individuals and individuals with disabilities. States provide Medicaid Benefits that have been approved by the Federal Government when receiving Federal supporting funds called FMAP (Federal Medical Assistance Percentages). Allwel is a Licensed Home Care Agency with a License and Provider Agreement to serve Medicaid eligible individuals.

Medicaid MCO (MMCO) – Refers to a managed care organization with a plan of comprehensive services specific to Medicaid beneficiaries that are not standard or commercially available.

Medicaid Waiver – Refers to the ability of a state to offer services that over and above what is generally permitted by the Medicaid Program. Waivers are used to provide services to very specific groups of people including children, individuals with developmental or physical disabilities. In New York, there are a number of different Waivers of which long term Home and Community Based Services are provided (1915c). Some services that would not be able to be provided without a waiver are Service Coordination, or the other specialized services that fall under the Traumatic Brain Injury, Nursing Home Transition and Diversion or, Office of People with Developmental Disabilities waivers. Allwel has a provider agreement with New York to provide Waiver services since the year 2000.

Medical Day Program – A daily or weekly program that provides a social and protective environment but in conjunction with medical services such as medication prefills, blood sugar testing, and more, for adults who are at home during the night, but who need supervision, medical assistance, and social activities during the day, because the person providing the nightly care must go to work or has other responsibilities. For a Medical Day Program to be appropriate, an individual must require a medical service during the visitation period. Allwel’s Case Managers or Service Coordinators will work with the family and person receiving care to determine if a Medical Day Program will complement the plan of care, and assist in linking to an agency of the participant’s choice.

Medical Social Worker (MSW) – Refers to an individual who provides social work services to individuals who need assistance with case management, coordination of community resources, or counseling regarding coping with the challenges of disability or prolonged illness.

Medicare – Refers to the federal program that provides skilled medical care and medical insurance to people aged 65 and older. Medicare Part A covers hospital expenses, Part B covers physician and outpatient services, and Part D covers prescription drugs. Allwel’s Case Managers or Service Coordinators can work with the family and person receiving care to determine if and when Medicare is an available program for individuals under 65 and with disabilities, generally two years after a long term disability status is received.

Medicare Part A – Specific to Hospital Insurance, and provides for inpatient care in hospitals, and/or skilled nursing facilities where care is required for 120 days or less.

Medicare Part B – Specific to coverage for doctor’s services and outpatient services such as therapies or some home care.

Medicare Part D – Specific to coverage of Prescription Medications. Medicare Part D Participants (Beneficiaries) choose a Medicare Part D provider that is the best “fit” for their prescription needs.

Medigap Insurance Policy – Refers to a private health insurance that pays for items or specific charges not included in Medicare services or reimbursements.

Nursing Home – There are many different terms for this type of institutional care. It can also be called a Skilled Nursing or Long-term Care Facility, and provides the combination of housing and around the clock nursing care and supervision. Typically, individuals will utilize nursing home care when the medical or behavioral needs exceed what is safe to be addressed in the community, or because the individual or family feel this the appropriate setting for the person needing ongoing care. Allwel specializes in providing just the right amount of care at the right time, providing families the option of providing care for their loved one in a community setting if they so choose.

Payer – Refers to the term for an insurance provider that will cover and pay for a specific set of health care benefits for its plan members.

Pediatric Home Health Care – Refers to care services provided to children with illnesses and/or special needs.

Personal Care Aide (PCA) – Refers to a New York State certified agency care giver that assists persons with their activities of daily living. Personal Care Aides assist with prompting, cueing and supervising people who are able to attend to many of these activities on their own. Personal Care Aides will also complete whole tasks if the person is unable to do so on their own due to physical or cognitive challenges. Allwel provides the majority of daily care through the staffing of Personal Care Aides.

Personal Emergency Response System (PERS) – Refers to an electronic system that provides monitoring and emergency communication to an agency that dispatches immediate help when notified of an emergency. Generally, an individual carries a small device which they trigger by button if they fall, or have another type of medical emergency. Allwel’s Case Managers or Service Coordinators will work with the family and person receiving care to determine if a PERS will complement the plan of care, as well as assist in linking to a PERS provider of the family/participant’s choice.

Plan Member – A person who selects a managed care plan through an employer, the Medicare or Medicaid programs, or as an individual enrollee, and receives payment supports in accordance with that organizations offered coverages. Many of Allwel’s participants are members of Medicaid Managed Care Plans.

Plan of Care – A specific term for a written plan developed by a nurse along with a doctor for addressing the medical, social and emotional needs of a person receiving long term/home based care. The plan is adjusted as needed by changes in a person’s needs or the supports available in the community or from family. Allwel’s Director of Patient Services works closely with the participant, the family, and the participant’s doctor to develop an appropriate plan of care, as well as adjust that plan as necessary when needs change.

Preauthorization – Refers to the necessary prior approval required by a managed care plan for its plan members to receive any form of medical treatment, test, or service in general. Allwel’s nurses work with the managed care organizations to obtain the preauthorization for services, as well as with the participant’s doctor to ensure there will be no lapse in any coverage.

Private Pay Patients – Refers to persons who pay for their care, “out of pocket”, as opposed to from Medicaid or other insurance provider. Allwel works with family and participants to develop an efficient plan of care that keeps care expenses as low as possible for as long as possible.

Provider – Refers to the qualified, licensed professional, agency or organization that delivers the actual health care service to the person receiving the care.

Provider Network – Refers to a group of health care providers including doctors, hospitals, home care agencies, or specialists that belong to particular insurance provider or health care system. Members of one network are often members of a number of other networks in order to be able to provide services to the persons who are referred to them for care.

Quality Assurance – Refers to the program that organizations use to oversee, evaluate and improve the care provided to its participants/members. Organizations use Quality Assurance programs to identify and rectify problems in care, customer service, or other breakdowns in the systems used. Allwel has a robust Quality Assurance program that incorporates regular meetings of department supervisors, participant satisfaction surveys, and regular reviews of agency policies and procedures.

Referral – The term used to describe the authorization by a managed care plan for an organization to provide services under the member’s plan.

Registered Nurse (RN) – Refers to Nurses who have received the requisite number of years’ training, ranging from 2 year associate’s degree to a 4 year bachelor’s degree. RN’s also pass a state-administered examination, and often must meet certain experience requirements in order to perform home care. Allwel’s Directors of Patient Services (each area served) are Registered Nurses with great experience in addressing the care needs of individuals in home and community settings.

Respite Care – Provides a short-term pause for family who provide ongoing care to someone. The Respite Care is frequently provided by a facility that specializes or has as part of their regular long term care services. Respite Care services can also be provided in the home. Allwel can provide respite care in a home setting by working with the family and the individual’s doctor, and providing the staffing comprised personal care aides.

Reverse Mortgage – Refers to a financial means where homeowners age 62 years or older can use the equity in their home for long term care or other selected expenses. A reverse mortgage is just one option that an individual may use when seeking means to pay for long term care needs.

Special Needs Trust (SNT) – Also known as a Supplemental Needs Trust and are a legal arrangement to retain funds (cash assets) to be used for a person’s care, but that will not be counted against the person’s ability to become a participant of the Medicaid program. There are generally two types of trusts, Private and Pooled, and depending upon the needs of the individual, both will address the care and financial needs. SNT’s need to be developed with the assistance of an attorney who specializes in the area, as the terms of the trust are very important and can make a great difference in what needs the funds will be available to address.

Structured Day Program – A daily or weekly program that provides a social and protective environment for adults who are at home during the night, but who need supervision, assistance, and social activities during the day, because the person providing the nightly care must go to work or has other responsibilities. Allwel’s Case Managers or Service Coordinators will work with the family and person receiving care to determine if a Structured Day Program will complement the plan of care, and assist in linking to an agency of the participant’s choice.

Supplemental Nutrition Assistance Program (SNAP) SNAP – The federal program that provides food and nutrition assistance to low-income individuals and families. This program was formerly known as the “food stamps” program. Allwel’s Case Managers or Service Coordinators can work with the family and person receiving care to determine if SNAP criteria is met, assist in completing the appropriate paperwork, and ensuring that all documentation is gathered. Additionally, any recertification processes or issues that may arise can be quickly addressed.

Utilization Review – Refers to the ongoing assessment and adjustment of the number of hours and type of care being received by a person in relation to changes in their health or support status. Allwel combines the team of schedulers, nurses, family, and participant to review on a weekly basis our participant’s utilization and any changes is scheduling and or health needs. Any necessary adjustments to the plan of care can be made immediately, and the nurse will follow up with the doctor and the insurance provider to inform them of the changes