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New York State

Glossary of Terms

Activities of Daily Living (ADLs)
Activities that people do independently every day—eating, toileting, transferring, bathing, dressing, and maintaining continence.
Acute Care
Medical care that is required for a short period of time to cure a certain illness and/or condition.
Adult Day Care
Health support and rehabilitation services provided in the community to people who are unable to care for themselves independently during the day, but are able to live at home at night.
Alternate Level of Care
Care received in a hospital inpatient setting for those persons waiting to be placed in a nursing home or while arrangements are being made for home care.
Assisted Living
Services provided to support an individual in the performance of activities of daily living (ADLs) or severe cognitive impairment, usually in a community-based residence. Assisted living facilities are now licensed in New York State and are identified as an Adult Care Facility or an Assisted Living Residence.
Assisted Living Facility
A residential facility providing ongoing care and related services for persons needing assistance in the activities of daily living.
Care Management
The consultative and planning services provided by a professional, typically a licensed nurse or social worker, to assess, coordinate and monitor the overall medical, personal and social services needed by an individual requiring long term care.
Chronically Ill Individual
A person who is unable to perform without substantial assistance from another individual at least 2 ADLs (Activities of Daily Living) for a period of at least 90 days due to a loss of functional capacity, or a person requiring substantial supervision to protect the person from threats to health and safety due to severe cognitive impairment.
Cognitive Impairment
The loss or deterioration of intellectual capacity in people suffering from conditions, such as Alzheimer's disease or similar forms of irreversible dementia, characterized by such symptoms as: short- or long term memory loss; loss of orientation as to people, places or time; and loss of ability for deductive or abstract reasoning.
Combined Home Care Benefit
A New York Partnership insurance option that permits combining of home and community-based care benefit days to pay an amount in excess of the daily benefit amount for home and community-based care benefits set forth in the policy. Where this benefit is stated in the policy, the combination of benefit days shall result in no more than the equivalent of 31 days of home and community based care benefits being paid at the home and community based care daily benefit amount in any one month period.
Community Based Services
Long Term care services that are rendered generally at home, but include services rendered in a group setting, such as an adult day care center, or where human assistance is required to aid in necessary travel, such as to a physician's office.
Consumer
The individual served by the long term care system regardless of age, income or disability.
Copayment or Coinsurance
The amount you must pay for each medical service, outpatient hospital service or hospital stay.
Custodial Care
Non-medical care that addresses personal needs, and is available to a chronically ill individual.
Dementia
Impairment of intellectual faculties due to a disorder of the brain.
Home Care and Home and Community Based Care Benefits
A wide range of long term health care services including skilled nursing care, home health care, personal care services, assisted living, and adult day care.
Home Care Services
A wide range of long term health care services, from skilled care and physical therapy to personal care delivered at home or in a residential setting.
Hospice Care
A program of care and treatment for persons who are terminally ill and have a life expectancy of six months or less.
Informal Supports
Unpaid care and support provided to the consumer by family, friends, neighbors and others in the community.
Long Term Care
Necessary diagnostic, preventative, therapeutic, curing, treating, mitigating, rehabilitative services and maintenance and personal care services, required by a chronically ill individual pursuant to a plan of care prescribed by a licensed health care practitioner. These services are not limited to a facility. This definition is similarly identified as "qualified long term care services" in the Internal Revenue Service code.
Long Term Care Insurance
Insurance available through private insurance companies as a means for individuals to pay for needed care and protect themselves against the high costs of long term care. This is the most comprehensive level of coverage for long term care services under insurance regulations in New York State.
Medicaid
A means-tested program supported by federal, state and local funds, and administered by each state to provide health care for eligible individuals.
Medicare
A federal government insurance program to assist those 65 and older and the disabled with medical and hospital expenses. Medicare covers only skilled care in a skilled nursing facility and limited nursing care at home. It does not usually provide benefits for personal or custodial care, and for this reason provides limited assistance in a program of long term care. Medicare requires co-payments and deductibles.
Medicare Supplement "Medigap"
Private insurance policies that supplement Medicare benefits by covering co-payments and deductibles for medical and hospital expenses. Similar to Medicare, these policies do not provide coverage for personal or custodial care, and for this reason provide limited assistance in long term care situations.
New York City Metropolitan Area
The counties of Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, and Westchester.
Nursing Home
A facility that provides room and board and a planned, continuous medical treatment program, including 24-hour-per-day skilled nursing, personal and custodial care. All nursing homes that are licensed or certified and legally operating within the appropriate jurisdiction are deemed to be eligible for benefit payments.
NY Connects: Choices for Long Term Care
A consumer-centered entry point for information about and linkages to services that assist individuals of all ages with long term care needs. In New York State NY Connects: Choices for Long Term Care serves individuals who need long term care support, their family caregivers, and those planning for future long term support needs, regardless of how they will pay. It also serves as a resource for long term care professionals and others who provide long term care services to older adults and to people with physical disabilities of all ages.
NY Connects Information and Assistance
Comprehensive and objective information and support (as necessary) for individuals and their caregivers/families about all medical, non-medical (e.g. housing) and other community services; institutional services; eligibility criteria, etc. to link them with the opportunities, services and resources available to help meet their particular needs.
Olmstead Decision
1999 Supreme Court Decision that requires states to administer services, programs, and activities "in the most integrated setting appropriate to the needs of qualified individuals with disabilities." It challenged states to review intake and admissions processes to ensure the most integrated setting of care.
Partnership for Long Term Care
A public-private partnership which provides that if a long term care policy qualifying under the partnership program is purchased, the insured will qualify for Medicaid coverage without "spending down their assets" once the benefits under the policy are exhausted.
Period of Care
A specified number of days of care either in a nursing home or while receiving home care services without a break in the services for a specified number of days.
Personal Care
Assistance provided by another person to help with walking, bathing, eating and other routine activities of daily living. It is provided by individuals qualified to help with these tasks.
Pre-existing Condition
A condition for which medical advice was given or treatment was recommended by, or received from, a licensed health care provider within six months before the effective date of coverage. If the insurer uses a pre-existing condition limitation, then the pre-existing condition limitation cannot be excluded from coverage for more that six months after the effective date of coverage.
Provider
Individual, organization or group rendering long term care services for a fee.
Residential Care Facility
A facility that provides 24-hour care and services sufficient to assist a minimum of three residents with personal needs that result from the inability to perform ADLs (Activities of Daily Living) or from severe cognitive impairment, provides at least two meals per day, has formal arrangements for emergency medical care, and has appropriate procedures in place for the administration of prescribed drugs where allowed by law. All residential care facilities (also known as assisted living facilities, adult care facilities, assisted living residences) that are licensed or certified and legally operating within the appropriate jurisdiction are deemed to be eligible for benefit payments.
Resources
The ability and means available through personal, governmental and community sources to meet an identified need.
Respite Care
Nursing home or home care that temporarily replaces the existing level of support received from an informal, non-paid caregiver for the purpose of providing care and supervision to the patient while relieving the caregiver.
Service Coordination
Coordinating services and benefits appropriately and prudently in a manner sensitive to consumer preference, enabling consumers to make informed choices about their long term care needs that balance cost, access and quality by involving them in the planning, evaluation and decision making for such care.
Severe Cognitive Impairment
The loss or deterioration of intellectual capacity in people suffering from conditions, such as Alzheimer's disease or similar forms of irreversible dementia. Severe cognitive impairment must be measured by clinical evidence and standardized tests that reliably measure impairment in the individual's short-term or long term memory, orientation as to people, places or time, and deductive or abstract reasoning.
Skilled Nursing Care
Nursing and rehabilitative care provided by, or under the direction of skilled medical personnel.
Social Adult Day Services
Social adult day services are structured, comprehensive programs that provide older people with personal care, nutrition, socialization, supervision and monitoring in a protective setting during part of a day, but for less than a 24-hour period.
Spending-down
Depleting almost all income/assets to meet usual eligibility requirements for Medicaid.
Stakeholders
Those served by the long term care system, as well as the individuals, groups, organizations and government agencies that provide services, funding, advocacy or hold a shared interest in the long term care system.
Technology Dependent Children
Children who require medical devices and technology to sustain life and/or to interact and have an effect on their environment.
Traumatic Brain Injury (TBI)
Damage to living brain tissue caused by an external, mechanical force. The term does not include brain injuries that are caused by insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congenital disorders, birth trauma or degenerative processes.
Waiting Period
The number of days you must be in a nursing facility or the number of days of home health care you must receive before long term care benefits will be paid under the policy. During the waiting period, you must privately pay for the nursing facility stay or home health care services.