Healthcare Glossary

Activities of Daily Living (ADL) Physical needs — The self-care tasks which are used to measure the Functional Impairment Level of an applicant or a client for home care services include the ability to bathe, dress and undress, eat, toilet, transfer in and out of a bed or chair, get around inside one's own home, and maintain continence.

Activities of Daily Living (IADL) Instrumental — The six daily tasks (light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money) that enable the patient to live independently in the community.)

Administration on Aging (AoA) — The principal federal agency responsible for administering the provisions of the Older Americans Act, except Title V. It advocates at the national level for the needs, concerns and interests of elder persons throughout the nation, and is housed within the Office of Human Development Services (OHDS) of the Department of Health and Human Services (DHHS).

Adult Day Care — A community-based group program designed to meet the needs of functionally impaired elders and other adults who can benefit from participating in group settings. Most programs include an individualized plan of care, group exercise, adult education classes and recreation, nutritious meals, and social work services. In addition, these programs make respite for caregivers possible, and provide support groups for participants and caregivers.

Adult Day Health Care — A community-based program similar to adult day care but designed for elders and persons with disabilities who need a higher level of care, but can still benefit from receiving services in a group setting. In addition to the services of an Adult Day Care program, other services provided include physical, occupational and speech therapies and nursing supervision of health care needs

Advance Directive — A document, such as a health care proxy or living will which allows an individual to convey his or her wishes about end-of-life care ahead of time. In Massachusetts, only the Health Care Proxy is legally binding on medical providers.

Aging Service Access Point (ASAP) — A private, non-profit, state-designated agency under contract with the Massachusetts Executive Office of Elder Affairs to provide a single-entry point for seniors and caregivers to access a variety of programs and services.

Area Agency on Aging (AAA) — Agencies established under federal law, the Older Americans Act (OAA), to respond to the needs of Americans aged 60 and over in every local community with the goal of keeping seniors living independently in their own homes. Like the ASAPs (see above), AAAs work with the MA Executive Office of Elder Affairs to plan and provide social services and nutrition services for elders, and support for caregivers.

Assisted Living Facility (ALF) or Assisted Living Residence (ALR) — A facility that combines housing and supportive services for elders. Services include assistance with personal care, such as medication management, bathing, dressing and ambulating, and may include laundry, housekeeping, transportation, and social activities.

Certified Home Health Agency (CHHA) — A home health agency that meets Medicaid and Medicare requirements and standards for the provision of nursing care, rehabilitation therapies and the service of home health aides. Certification is by the MA Department of Public Health for reimbursement under Medicare, Medicaid and other insurance policies.

CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) — Auxiliary medical services for active military/veterans and their dependents.

Chore Services — A type of home care service to assist frail elders to remain in their home, including vacuuming, washing floors and walls, defrosting freezers, cleaning ovens, cleaning attics and basements, and removing fire and health hazards.

Community Services — Are support services that can include adult day care, meal programs, senior centers, transportation, and other services. These can help people who are cared for at home-and their families. For example, adult day care services provide a variety of health, social, and related support services in a protective setting during the day. This can help adults with impairments—such as Alzheimer's disease—continue to live in the community. And it can give family or friend caregivers a needed "break."

Companions — People provided by home care agencies who regularly visit frail elders providing socialization, medical escort, errand service, light meal preparation, as well as respite or temporary relief to family caregivers.

Congregate Housing — A shared living arrangement that allows elders to maintain their privacy and independence in a home-like setting with supportive services. In Massachusetts, the program is sponsored by the Department of Housing and Community Development (DHCD) and the Executive Office of Elder Affairs.

Congregate Living Facility — A non-institutional, independent group living environment that integrates shelter and service needs of functionally impaired and/or socially isolated elders who do not need institutional supervision and/or intensive health care.

Congregate Meals — A program, funded under Title 111-C of the Older Americans Act, providing one meal a day (usually lunch) at senior centers, churches and other community sites.

Continuing Care Retirement Communities (CCRCs) — An alternative housing option designed to accommodate the needs of elders who can no longer live alone. CCRCs offer a full continuum of care, ranging from fully independent units, to assistance with personal care in assisted living apartments, to long-term care in a skilled nursing facility.

Council on Aging (COA) — A municipally appointed volunteer agency that provides services to elders, families and caregivers. While each COA is unique to its community, most councils offer information and referral, transportation, outreach, meals (congregate and home delivered), health screening, and fitness and recreation programs.

DNR/DNI Order (Do Not Resuscitate/Intubate Order, also known as a "Comfort Care Order") — Instructions in the medical record of an individual who has decided that they not wish cardiopulmonary resuscitation. A DNR informs medical personnel, including EMTs and paramedics, to provide care and transport in the community without artificial means to maintain heart function and breathing.

Durable Power of Attorney — A document that grants a person(s) the legal powers to perform on behalf of the Grantor certain specified acts and functions, related to real estate, banking and financial transactions, personal and family maintenance, and government benefits, among others. This power is effective immediately and continues to be effective even if the Grantor becomes disabled or incompetent.

Elder Abuse Prevention Programs — Programs designed to alleviate situations of abuse, neglect or self-neglect; includes programs such as adult protection and guardianship/conservatorship. The state Executive Office of Elder Affairs contracts with seven agencies to provide Guardianship services to elders who have been abused and/or who a court has determined to be at risk or harm, and to lack decision-making capacity.

Executive Office of Elder Affairs (Elder Affairs) - The lead state-wide agency in Massachusetts on aging and elder care issues. Among services offered are the Home Care Program, the Family Caregiver Support Program, a toll-free telephone help line (1-800-AGE-INFO) and website with elder care information. (See Section 1 for more information.)

Family Caregiver Support Program, Massachusetts – was established under Title III-E of the Older Americans Act to assist caregivers with information and access to services and supports. The program is administered by the Massachusetts Executive Office of Elder Affairs, in coordination with the Area Agencies on Aging/Aging Services Access Points throughout the Commonwealth of Massachusetts. It provides information and referrals, training, counseling, support groups, respite care options, and other services to family caregivers.

Family Medical Leave Act (FMLA) – A federal law that provides caregivers up to 12 weeks of job-protected leave to care for a seriously ill parent, child or spouse (also covers leave for one's own serious illness, a birth, or an adoption). Workers are eligible who work for firms with 50 or more employees, have at least one year of continuous employment, and worked at least 1250 hours in the 12 months prior to leave. There is no wage replacement available with this leave.

Geriatric Care Manager — A professional case manager, usually a registered nurse or licensed social worker, who assesses an elder's ability to live independently in a home environment, develops an appropriate care plan for services.

Group Adult Foster Care (GAFC) — A Mass Health program that pays for personal care services for eligible seniors and adults with disabilities who live in GAFC-approved housing. Housing may be an assisted living residence or specially designated public or subsidized housing.

Guardianship — A probate court appoints one or more individuals to handle the personal and financial affairs of a minor or person of any age the court determines to be mentally incompetent.

Health Care Proxy — A document legally recognized in Massachusetts that is authorized by a competent person designating another person to act as his/her health care agent with the authority to make all health care decisions for the grantor should he/she become unable to make or communicate those decisions.

Home Care Program, Massachusetts — The state program that provides home-based services to elders so they can maintain their independence and live at home. It is administered through contracts with 27 private non-profit corporations called Aging Service Access Points (ASAPs).

Home Health Agency (HHA) — A public or private agency that specializes in providing skilled nursing services, home health aides, and other therapeutic services, such as physical therapy, in the home.

Home Health Care (Certified) — Health care services provided in the home on a part-time basis for the treatment of an illness or injury, and covered by Medicare only if skilled care is needed and required on an intermittent or part-time basis.

Homemaker Services — Assistance in home management, including light housekeeping, laundry, grocery shopping and meal preparation provided by trained personnel working under home care agency supervision.

Hospice — A public or private organization that provides pain relief, symptom management, and supportive services to terminally ill people and their families in the home or in a separate hospice facility.

Hospitalist — Physicians trained and board certified in internal medicine who specialize in the care of hospitalized patients. They serve as the physicians-of-record for patients. The hospitalist returns the patient to the care of their primary care physician at the time of hospital discharge.

Independent Living Units — Housing units that include some basic services such as meals and housekeeping, usually for a fee. These units may exist in a Continuous Care Retirement Community (CCRC) that also has assisted living units and a skilled nursing facility.

Living Will – A set of instructions documenting a person's wishes about medical care intended to sustain life. It is used if a patient becomes terminally ill, incapacitated, or unable to communicate or make decisions. Massachusetts law does not recognize a Living Will as binding on medical personnel.

Long-Term Care Insurance (LTCI) — An insurance policy designed to alleviate some of the costs associated with nursing home and home health care for persons who become unable to care for themselves independently. Most policies provide coverage for a specified number of years or may offer lifetime coverage. The cost of policies varies in relation to the age of the individuals at purchase, the conditions and services covered, and, the amount and length of coverage.

Long-Term Care Ombudsman Program (LTCOP) — A program designed to investigate actions or decisions by nursing homes and other agencies which may adversely affect the health, safety, welfare, or rights of elders living in long term care facilities. The program is operated through local ASAP agencies to facilitate access to all nursing and rest home residents.

MassHealth — The Massachusetts Medicaid program that offers health care coverage for some low-income and moderate-income families, disabled individuals and persons over age 65 who meet eligibility requirements. The program covers most needed services provided by physicians, dentists, hospitals, clinics, medical equipment suppliers and therapists.

Meals on Wheels (MOW) – A service that provides home-delivered meals to elderly and disabled citizens without regard to income. It is funded through a combination of federal funds through Title IIIC of the Older Americans Act and state funds.

Medicare — Title XVIII of the Social Security Act is a two-part (A and B) federal health insurance program for Americans aged 65 and older and certain disabled people who have benefits under the social security system or who have ESRD (End Stage Renal Disease).

Medicare Part A — Hospital insurance for those 65 and older, primarily provides coverage for in-patient hospital care, skilled nursing home, home health, and hospice care.

Medicare Part B — Medical insurance for those 65 and older, provides limited coverage for out-patient physician services, ambulance use, durable medical equipment, and home health care services.

Medicare HMO — A Health Maintenance Organization for individuals 65 years and older covered by Medicare. (see HMO).

Medigap — A type of health insurance elders can purchase to supplement their health benefits under Medicare and bridge the gap between what Medicare pays and what clinical care and prescription drugs actually cost.

Nursing Home — A term used to cover a wide range of institutions providing 24/7 personal care and skilled nursing care, also called Skilled Nursing Facilities, Intermediate Care Facilities and Custodial Care Facilities. Not all nursing homes are Medicare approved/certified facilities.

Occupational Therapy – A form of therapy that helps people improve basic motor functions and reasoning, and their ability to perform tasks in their daily living and working environments.

PACE (Program of All-inclusive Care for the Elderly) — A program that provides low-income frail elders with all of their health, medical, rehabilitation, social, and support services and health insurance for one monthly fee. It enables them to remain independent in their community and in their own homes.

Palliative Care — Any form of medical care or treatment that concentrates on reducing pain and /or the severity of the symptoms of a disease, or slowing the disease's progress, rather than providing a cure.

Primary Care Physician (PCP) — A doctor who provides continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is often used by Health Maintenance Organizations (HMOs) to describe the physician who manages treatment for HMO members and provides referrals to specialized care and services.

Personal Care Attendant (PCA) — The PCA Program is a consumer-directed service, funded through MassHealth, where a person with a disability hires, trains and supervises an individual who will provide assistance with the personal care activities of daily living, such as bathing, shampooing, personal hygiene, and medication reminders.

Personal Care Services — Services that provide assistance with one or more activities of daily living either through physical support or supervision. These services are not routinely paid for by either Medicare or Medicaid.
Personal Emergency Response Systems (PERS) – A medical communications alerting system that allows an elder experiencing a medical emergency at home to access medical service via an electronic transmitter to a central monitoring station.

Physical Therapy – A form of therapy that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease.

Rehabilitation — Services and therapies needed by people who have sustained severe injury, often due to trauma, a stroke, an infection, a tumor, surgery, or a progressive disease.

Respite Care — Temporary care service to relieve an in-home caregiver of responsibility for an individual with long-term care needs. Relief care can be provided in the home, in day programs, nursing facilities, rest homes or an Adult Foster Care program.

Rest Home — A facility providing custodial care. Services provided in these facilities are more residential than medically oriented. They include protective supervision for the residents, as well as room, board, social activities and limited social services.

Senior Care Options (SCO) – A managed care program offered to eligible MassHealth (Medicaid) members age 65 and older that provides comprehensive multi-specialty care from physician visits, lab tests, and hospital treatment to dental care, prescription drugs and eyeglasses.

SHINE (Serving the Health Information Needs of Elders Program) — A program of the Executive Office of Elder Affairs providing free, confidential and unbiased counseling services to elderly and disabled adults. This is provided through a volunteer network of health benefits counselors. Examples of Information provided to elders include insurance sources, public benefits, retiree health plans, and prescription drug charge coverage. State wide telephone number is 800-243- 4636 or call your local ASAP.

Skilled Nursing Facility (SNF) — A nursing home providing services for residents whose general condition tends to be unstable, and requires close observation and care given by professional staff over a 24-hour period. Some skilled care is financed by Medicare; however, the majority must be covered by private funds or Medicaid. Some SNFs have rehabilitation programs that help people maintain their ability to function or to readjust to limitations.

Social Security Disability Income (SSDI or SSI, Supplemental Security Income) — A monetary benefit paid through Social Security to persons under age 65 with disabilities. SSI-G provides funds for eligible residents to pay for certified assisted living. It can be combined with GAFC (Group Adult Foster Care) subsidy for those financially and clinically eligible.

Speech Therapy — A therapy that treats speech impairment from stroke, dementia, Parkinson's disease or Multiple Sclerosis; cognitive and memory problems with speaking and listening, voice disorders, speech disorders, and swallowing disorders (dysphasia.)

Supportive Housing — An "assisted living like" environment in state-funded, public elderly/disabled housing. Services are provided on an as needed basis 24 hours a day. This type of housing is available through the Supportive Housing Initiative Program run by the Executive Office of Elder Affairs and the Department of Housing and Community Development in Massachusetts.

Veteran's Benefits — Medical services and other benefits provided by the Veteran's Administration to honorably discharged ex-service members and sometimes to their dependents. For those without service-connected disabilities, income and asset restrictions may apply.