Caring for Older Adults in Today’s World

About this Glossary

CaregivingCaring for an older adult can be overwhelming, even more so today than in the past. With all the programs and services out there, where do you start? Just learning all the terminology is mind-boggling and suddenly you have to be an expert in aging issues in order to support your loved ones.

At JF&CS, we want to make it as simple as possible for you to navigate your way and figure out what is best for your family. With this in mind, we have created a glossary of terms to help you understand what’s available. Here are just a few of the common questions we answer:

  • What is the difference between Medicare and Medicaid?
  • What kinds of housing options are available for older adults in Atlanta who need some care but not a nursing home?
  • Is “home health care” the same as “in-home care,” and will Medicare pay for both?
  • How do I know if my mother should go to a senior center versus an adult day center?
  • What is respite care?

Glossary of Terms

Housing Terminology

  • Assisted Living/Personal Care Home
    These terms are used interchangeably. They are residential facilities that are licensed to serve two or more adults who can no longer live alone yet do not require continuous medical attention. These facilities provide 24-hour supervision and assistance with daily activities. Most provide some or all of the following: meals, housekeeping, assistance with bathing and dressing, supervision with medication and incontinence management.

  • Independent Retirement Communities
    These communities are housing complexes for independent older adults. Some offer meals, transportation, housekeeping, laundry services, activities and other amenities. Rental prices vary from community to community and are generally on a monthly basis. Some communities offer home care assistance or will help in referring these services if they are needed. In the Atlanta area, the majority of these communities are high rises.

  • Nursing Home
    These facilities are for patients who may need 24-hour skilled nursing care, personal care and custodial care. The Office of Regulatory Services of the Department of Human Services (DHR) must license Nursing Homes. In addition to licensing, DHR also regulates these facilities. As payment, many Nursing Homes accept Medicaid as well as private pay. Many also offer temporary rehabilitation services that may be covered by Medicare.

  • Subsidized Rental Housing
    These communities are Independent Retirement Communities for older adults who meet the low-income requirements. Each building has their own income guidelines that may differ from another community. If the income requirements are met, the rent is subsidized by the Federal government and the individual pays 30% of their income towards rent. Some of these communities may offer other services, like meal plans and transportation, but most do not.

Types of Care or Levels of Care

  • Long-term care (LTC)
    Long term care generally describes a range of medical, personal and social services designed to meet the needs of people with disabilities, chronic illnesses, or limitations in their ability to function independently. LTC may be delivered at home, in a nursing home, adult day care facility or other facility, and involves both skilled and unskilled care.

  • Skilled care
    Skilled care refers to services provided by or under the supervision of trained medical personnel, such as professional nurses and therapists. A doctor must certify the need for skilled care. Medicare will typically cover short term skilled care.

  • Unskilled care
    Unskilled care refers to services provided by a home care aide or home attendant that help a person perform activities of daily living (ADL). Also known as personal care, these are activities such as getting in and out of bed, dressing, bathing, eating and using the bathroom. Custodial care is assistance with ADLs and also includes homemaking services (such as cooking and cleaning). Medicare never covers custodial care.

In Home Services

  • Counseling
    Counseling services can provide both the older adult and the adult caregiver a safe place to share what they are experiencing, whether it is fear, grief, stress, depression or anxiety. For individuals over 65, many providers are able to bill Medicare, Medicare Advantage and any supplemental insurance. For those under 65, many providers will accept private insurance. Home visits may be available as well.

  • Geriatric Care Management
    Geriatric Care Management (GCM) services can vary but most offer in home evaluations, office consultations and development of care plans for the individual. Other GCM services also offer some of the more time intensive components such as care coordination or ongoing monitoring. The majority of GCM programs are private, fee based and charge by the hour.

  • Home Delivered Meals
    This service provides a home delivered meal that is 1/3 of the recommended daily dietary allowance to a homebound older adult, usually at lunchtime. This service is generally fee based but may offer a sliding scale depending on the provider.

  • Home Health Care
    Health care services provided in the home are covered by Medicare only if skilled care is needed and required on an intermittent or part-time basis. Home health care is defined as rendering predominantly medically-related services to patients in a home setting rather than in a medical facility. The home care practitioner will help patients increase their ability to tend to their everyday needs at home. Home health care may include skilled nursing in addition to speech, occupational and physical therapy. It may also include assistance with bathing a few times a week if requested by the physician and approved by Medicare.

  • Hospice Care
    This service provides care to those who have terminal illnesses with a life expectancy of six months or less. Hospice places an emphasis on comfort care and pain management. The care includes medical as well as counseling and grief support. Some programs may offer a palliative care component as well if you are still interested in seeking treatment for your illness. Most programs work with patients in their homes and inpatient facilities may be available as well.

  • In-Home Care
    These services provide in home non-medical assistance for those older adults who do not wish to move from their home to receive assistance. Services offered may include housekeeping, personal care, meal preparation, transportation, companionship, bill paying and many others. Live-in assistance may also be available. Most agencies charge by the hour and there is generally a four-hour daily minimum.

Community Services

  • Adult Day Care
    Supervised care for older adults who may have physical limitations or who may have memory problems. These programs are generally held during the day in a group setting to promote an older adult’s social, physical, and mental well being.

  • Advanced Directives for Health Care
    Written ahead of time, a health care advance directive is a written document that says how you want medical decisions to be made if you lose the ability to make decisions for yourself. A health care advance directive may include a Living Will and a Durable Power of Attorney for health care.

  • Area Agency on Aging (AAA)
    The Area Agency on Aging plans, implements, coordinates, monitors, and evaluates home and community-based services such as transportation, legal aid, nutrition programs, homemaker service, senior center activities, shopping activities, employment counseling, pre-retirement advising, and information and referral programs for the 10 county Atlanta region. The AAA also coordinates a statewide aging and long term care database and the regional Aging and Disability Resource Connection.

  • Case Management
    This service assists older adults in gaining access to, arranging, and coordinating services. It is often offered in conjunction with county programs and Medicaid programs.

  • Elder Law
    Attorneys that specialize in elder law issues such as Living Wills, Power of Attorney, Guardianship, Estates, Wills, Medicaid eligibility, or any other legal issues regarding older adults.

  • Respite Care
    This service provides temporary relief to a caregiver of an older adult that requires constant supervision or assistance. It can be provided in the home or at a temporary placement outside the home. A facility, an individual, a volunteer, or an Adult Day Care may provide this service.

  • Senior Centers
    This service provides a way for older adults to remain active and participate in programs with peers. Most offer classes, day trips, social activities, and transportation.

State and Federal Benefits

  • Medicaid
    This program provides aid to individuals who meet the low-income requirements and is funded by the state and federal government. All assets and income are considered for eligibility requirements. It can be used to provide financial assistance for services such as nursing care and home health care.

  • Medicare
    This program is for those 65 and older, or those that are under 65 and have certain disabilities. The Social Security Administration enrolls applicants for this federal health insurance program. Medicare Part A primarily covers inpatient hospital visits and rehabilitation at skilled nursing facilities. Medicare Part B covers most doctors’ bills, preventative care, home health care and some medical supplies but also requires monthly premiums. Medicare Part D is the prescription drug coverage. Medicare does not cover Assisted Living, in home care, or long term care.

  • Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI)
    The Supplemental Security Income (SSI) program pays benefits to disabled adults and children who have limited income and resources. SSI benefits also are payable to people 65 and older without disabilities who meet the financial limits. People who have worked long enough may also be able to receive Social Security disability or retirement benefits as well as SSI. Social Security Disability Insurance (SSDI) pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes. Only individuals who have a disability and meet medical criteria may qualify for SSDI benefits.
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