TERMINOLOGY ALL HOME HEALTH BILLERS NEED TO KNOW
Certified Nursing Assistant (CNA): A CNA or certified nursing assistant is an individual who studied and passed the licensure exam for nursing assistant. He or she assists the patients in providing health care needs and supervised by a Licensed Practical Nurse or a Registered Nurse.
Skilled Care: Residents in need of skilled care receive skilled nursing care or rehabilitation and 24-hour medical supervision, but do not require hospitalization. A physician order is required for admission.
Custodial Care or Personal Care: Residents depending upon custodial care receive supervision and assistance with personal care and other activities of daily living. This level of care is suitable for people who do not need the care of a practical nurse. Often this level of care is provided for people suffering from illnesses such as Alzheimer’s disease.
Palliative Care: This term is used to describe a type of comprehensive medical care for people with life-ending illnesses. The goal is to ease the patient’s physical, emotional, social and spiritual suffering, as well as to support families. Like hospice, this type of care can be provided in various settings such as hospitals, nursing homes, or the patient’s home. Palliative care can begin after a doctor certifies a patient’s life expectancy is six months or less.
Activities of Daily Living: These are the everyday tasks that individuals do to manage their own personal care. Examples include eating, dressing, using the bathroom and walking.
Instrumental Activities of Daily Living: These are tasks that enable people to live independently in the community. Examples include shopping, cooking and house cleaning.
Adult Day Care: This service provides a protective setting for individuals who are functionally impaired. This care is generally provided during daytime hours and offers a planned program that includes a variety of health, social and support services.
Advance Directive: Also known as a living will, this document states a person’s healthcare decisions in the event that person becomes incapacitated and can no longer make these choices.
Aides for Independent Living: These devices or tools make living easier and safer for older persons. Some examples include long-handled shoehorns, touch fasteners on clothing, bathtub stools, and telephone amplifiers. Senior service and healthcare agencies often provide booklets describing such aids and where to purchase them.
Alternate Family Care: Also known as adult foster care, this community-based health program offers room, board, and personal care services to physically impaired individuals who are seeking an alternative to institutionalization. Participants are placed in the homes of carefully screened caregivers who provide supervision and assistance with activities of daily living. Depending on the individual’s needs, placement is on a short- or long-term basis.
Alzheimer’s Association: This national, non-profit, charitable organization is dedicated to research, support and education for Alzheimer’s patients, families and the community. It offers information, support groups, advocacy, training, newsletters and a safe return wanderer’s alert program.
Area Agency on Aging: Each county in New Jersey has an Area Agency on Aging designed to provide information on local community resources for older adults.
Assisted Living: This senior housing option for older adults combines housing, personal care services, and light medical care in an atmosphere of safety and privacy. Based on a monthly fee, basic services typically include meals, laundry, housekeeping, recreation and transportation. Additional services might include help with dressing, bathing, and medication management. Some facilities offer housing to recently discharged hospitalized patients who need to regain strength in a supportive environment before returning to their own home. Assisted living is primarily an out-of-pocket, private pay option, although some facilities accept Medicaid.
Board and Care Home (also known as a residential care facility): These homes provide older persons with room and board and, if required, personal assistance with activities of daily living such as medication supervision, meal preparation and other supportive services. This type of housing is typically paid for privately by the individual unless the home accepts and the person qualifies for Medicaid.
Chore Services: Employment or home-care agencies supply workers to perform light housekeeping, minor house repairs, and yard maintenance.
Companion Services: Intermittent or round-the-clock personnel provide support, encouragement and companionship to older adults in their own homes or institutional settings. Some services may provide assistance with daily living activities such as meal preparation, dressing and grooming.
Congregate Housing: This housing option offers private living quarters, usually in a multiunit complex, along with supportive services such as communal meals, personal-care services, and social and recreational activities supervised by a professional staff.
Conservatorship: Also known as “guardianship of the estate,” this court process secures an individual’s right to manage another person’s financial affairs after that person has become unable to do so and a power of attorney or trust has not been established.
Continuing Care Retirement Community: This senior housing option offers a comprehensive continuum of care from independent living to skilled care in a nursing home. Typically, the able-bodied person enters an apartment or cottage and, as needs increase, proceeds through increasing levels of care. There are requirements for incoming residents based on age, financial assets, income, as well as physical health and mobility. All require substantial entrance fees in addition to fluctuating monthly rent.
Durable Medical Equipment (DME): Doctors can order this medical equipment for home use. These items are reusable such as walkers, wheelchairs, or hospital beds. The equipment is available for rent or purchase depending upon the user’s financial status and insurance coverage.
Elder Lawyers: These law professionals specialize in the comprehensive planning for the needs of older adults and their families. Examples include estate planning, Medicaid and asset protection planning, power of attorney, living wills and legal housing contracts.
Geriatric Care Manager: This professional is trained to assess a person’s total-care needs and to arrange necessary services. Care managers typically evaluate the older person’s situation, make recommendations, arrange appropriate services and keep family members informed. Since care problems rarely occur one at a time and services may be fragmented, this service can be used by caregivers to coordinate a care plan. There is a fee for this service and each individual care manager determines rates.
Health Care Staffing: Health Care Staffing typically includes the following positions, among others: physicians, nurses, medical technicians, therapists, home health aides, and custodial care workers.
Home Care: Trained personnel from home-health agencies, the Visiting Nurses Association, and public health departments provide in-home health and supportive services including nursing, therapies, and assistance with personal care. Home health aides provide personal care for patients who need assistance for a variety of reasons including illness, advanced age, disability, or cognitive impairment. Home health aides may work with patients as part of a hospice care program also.
Home Modifications: Adaptations are made in the home to accommodate changing physical needs. Examples include installing grab bars and handrails by the bathtub and toilet, enlarging doorways and installing ramps for wheelchairs. Many home-health agencies have professionals on staff who can help evaluate a home and recommend modifications.
Hospice: This program provides supportive care with an emphasis on pain relief and comfort for terminally ill persons and their families. Services may be provided at home or in a facility.
Long-Term Care Insurance: These privately sold insurance policies help pay for long-term care services such as home-health care, adult day care, respite care and nursing home care.
Medicaid: This state administered health program is designed to cover the healthcare needs of low-income people. It is financed with federal, state and local tax funds. Medicaid pays an eligible patient’s medical bills, in whole or in part, directly to the provider of healthcare services and suppliers (physicians, hospitals, pharmacists, etc.).
Medicare Managed Care: Also known as Medicare HMO, Medicare managed care is a healthcare option available as part of Medicare benefits. When enrolled in a Medicare managed care plan, the person selects a doctor from the plan’s list of primary care physicians. The chosen primary care physician is responsible for coordinating all of the person’s healthcare needs.
Medicare: This is a federal health insurance program for people 65 years old or over and for certain disabled people under 65. A person is automatically enrolled in Medicare hospital insurance (Part A) when he or she applies for Social Security benefits upon reaching 65. Part A covers inpatient care in a hospital or skilled nursing facility for a limited period of time. Part B covers doctor’s services and outpatient hospital services. This is paid for out of the enrollee’s Social Security. Medicare does not pay full cost of some covered services. For this reason, it is important to have a Medicare Supplement or Medigap insurance (see definition below).
Medicare Supplement: Also known as Medigap insurance, this privately sold insurance policy fills the “gaps” in Medicare coverage. There are 10 standardized policies labeled Plan A through J. Medigap policies only work with the Medicare plan.
Nursing Home: Also known as a long-term care facility or nursing and rehabilitation center, this facility provides continuous nursing care or 24-hour supervision. Most nursing homes provide rehabilitation programs as well as social activities. Care is generally provided on two or three levels including the following.
Intermediate Care: Residents requiring intermediate care receive assistance with activities of daily living, some health services and nursing supervision, but not constant nursing care. Care is ordered by a physician and supervised by a registered nurse.
Skilled Care: Residents in need of skilled care receive skilled nursing care or rehabilitation and 24-hour medical supervision, but do not require hospitalization. A physician order is required for admission.
Custodial Care or Personal Care: Residents depending upon custodial care receive supervision and assistance with personal care and other activities of daily living. This level of care is suitable for people who do not need the care of a practical nurse. Often this level of care is provided for people suffering from illnesses such as Alzheimer’s disease.
Palliative Care: This term is used to describe a type of comprehensive medical care for people with life-ending illnesses. The goal is to ease the patient’s physical, emotional, social and spiritual suffering, as well as to support families. Like hospice, this type of care can be provided in various settings such as hospitals, nursing homes, or the patient’s home. Palliative care can begin after a doctor certifies a patient’s life expectancy is six months or less.
A Personal Care Assistant (PCA): variously known under alternate names such as caregiver, personal care attendant, patient care assistant, personal support worker and home care aide – is a paid, employed person who helps persons who are disabled or chronically ill with their activities of daily living (ADLs) whether within the home, outside the home, or both. They assist clients with personal, physical mobility and therapeutic care needs, usually as per care plans established by a rehabilitation health practitioner, social worker or other health care professional.
Personal Emergency Response System: This is an electronic monitoring system in which a person carries a device that he or she can use to signal a central dispatcher in the event of a fall or the need for help. Emergency assistance is summoned if the person does not answer the telephone (or speakerphone). Help is available 24 hours a day.
Power of Attorney: This is a document by which one person (the principal) authorizes (the agent) to act legally on his or her behalf.
Rehabilitation Services: Trained professionals provide treatment to help disabled individuals attain maximum function, a sense of well being and a personally satisfying level of independence. Any disease or injury that causes mental or physical impairment serious enough to result in disability may require rehabilitation.
Respite Care: This general term is used to describe a variety of services that provide relief and free time to primary caregivers of a functionally disabled person. Respite services are offered through adult day health care, home care, and short term stays in a nursing home or rehabilitation center. Respite care is available for varying lengths of time from a few hours to several days.
Reverse Mortgages: This mortgage tool allows people to live off the equity of their home. Participants receive a monthly payment based on the equity they’ve put into their home. Loans are backed by the federal government and only given to people age 62 and older. The loan is not satisfied until the home is sold.
Senior Center: These community centers provide social, recreational and educational activities.
Transitional Care: Also known as sub-acute care, this comprehensive inpatient rehabilitation program is designed for individuals in need of special care due to illness, injury or disease (ie. a stroke, head trauma or kidney disease). Typically, the patient has a specific course of treatment and does not require intensive diagnostic or invasive procedures. In many cases, patients who participate in sub-acute care are rehabilitated and returned home.
Transportation Services: Senior centers or social service agencies in the community often provide transportation for free or for a minimal charge between an older adult’s home and senior centers, shopping malls and physician appointments.
Trust: This three-party agreement details the transfer of designated assets from one person (the grantor) to another person (the trustee). The trustee holds and manages the assets for the benefit of the third party (the beneficiary).
Wellness Centers/Programs: Healthcare organizations and hospitals often sponsor wellness centers or programs to help people achieve a healthy lifestyle both mentally and physically.
Will: This legal document states how an individual’s estate will be handled after death.