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The terms used in long-term care and elder care can be confusing. What is assisted living? How is that different from skilled nursing? How is a home health aid different than a visiting nurse? Below we have compiled definitions of common terms used in long-term care and culture change so you always have a place to go to find out what exactly a term means when you are making decisions about care. Many of these terms are used in the developed world and we are yet to adopt this in our health care system.

Activities of Daily Living (ADLs) –

The activities of daily living (ADLs) is a term used to collectively describe fundamental skills that are required to independently care for oneself such as eating, bathing, and mobility. ADL is used as an indicator of a person’s functional status. The inability to perform ADLs results in the dependence of other individuals and/or mechanical devices. The inability to accomplish essential activities of daily living may lead to unsafe conditions and poor quality of life. Measurement of an individual’s ADL is important as these are predictors of admission to nursing homes, need for alternative living arrangements, hospitalization and use of paid home care.

Adult Day Care –

A day program that provides structured activities for older adults who may require supervision due to limited physical or cognitive abilities and/or who are in need of socialisation in a structured setting. Programs provide meals, transportation, medication monitoring, administration, and social services. Enrolling an older adult in an adult day health program can provide needed respite for care partners.

Advance Directive –

Legal documents that allow you to plan and make your own end-of-life wishes about health care and treatment known in the event that you are unable to communicate. Advance directives consist of (1) a living will and (2) a medical (health care) power of attorney, sometimes called “health care surrogate”, depending on the state. (See Living Will and Medical Power of Attorney). You can create a living will and medical power of attorney form without a lawyer. It is very important that you use advance directive forms specifically created for your state so that they are legal.This document is yet to be introduced in our health care system.

Alzheimer’s Disease –

A progressive disease that destroys cells in the brain and is the leading cause of dementia.Age is the single most significant factor. The likelihood of developing Alzheimer’s disease doubles every 5 years after you reach 65.

Assets –

Money you have or property you own, such as cash, bank accounts, personal property, vehicles, real estate, and the cash surrender value of life insurance.

Assisted Living Facilities –

Assisted living facilities consist of individual apartments, usually studio or one bedroom units, with some two bedroom apartments available. Each apartment has a bathroom equipped with walk in showers and grab bars, emergency call buttons, and often a small kitchenette. The facilities offer three meals a day, personal care (generally 45 minutes to one hour each day), activities, assistance with medications, homemaking, and scheduled transportation. Some have on-site medical services, hair salons, and fitness facilities.

Continuing Care Retirement Community (CCRC) –

A CCRC or Life Care Retirement Community is a retirement community that usually requires an entrance fee, some of which is generally refunded to your estate when the contract is terminated. The communities vary in the array of services that are available. Some have assisted living programs or home health services available to those in independent apartments and all have nursing facilities that can be accessed for short- and long-term care. An older adult needs to be independent without any diagnosis of dementia prior to entering a CCRC.

Dementia –

Severe impairment or loss of intellectual capacity and personality integration, due to the loss of or damage to neuron in the brain. Dementia is not a disease itself but rather a group of symptoms caused by one or several disease processes.

Elder –

Someone who is at least 60 years of age. An elder is also known as older adult senior, senior citizen, aged, or elderly.

Elder Abuse –

Defines elder abuse as acts or omissions resulting in serious physical or emotional injury to an adult age 60 or over. This includes physical abuse, Emotional abuse (harassment, threats, verbal abuse), sexual abuse, financial exploitation, and care partner neglect.

Elder at Risk (EAR) –

These individuals are no longer able to meet essential needs for food, clothing, shelter, personal care, or medical care due to physical and/or mental impairments, substance abuse, or other serious problems, preventing them from remaining safely in the community without intervention.

Elder law attorney –

Elder law attorneys focus on the legal needs of older adults and have a special knowledge of the law as it pertains to estate and Medicaid planning, alternative decision making, and long-term care needs.

PEG Tube –

A PEG-tube is a feeding tube placed in the patient’s stomach to feed the patient liquid food. Often PEG-tubes are put in place when the elder care patient is having difficulty swallowing.

Foley Catheter –

A Foley catheter is a tube placed in urinary bladder and hooked to bag that voids urine.

Geriatrics –

The branch of medicine that focuses on providing health care for older adults and the treatment of diseases associated with the aging process.

Geriatrician –

A physician who specialises in the care of older adults, primarily those who are frail and have complex medical and social problems.

Geriatric Care Manager –

A person with a background in nursing, social work, psychology, gerontology or other human services field, who has knowledge about the needs of and services available for older adults. A geriatric care manager coordinates (plans) and monitors (watches over) a person’s care. He or she also keeps in contact with family members about the person’s needs and how their loved one is doing. Most geriatric care managers are privately paid and usually not covered by private insurance. Some long-term care insurance companies use care managers to assess the individual’s need for services and arrange for the needed services.

Health Care Proxy –

A legal document that allows you to declare someone who can make health care decisions for you in the event that you are not capable of making them yourself.

Home Health Aide (HHA) –

Provides personal care and some household services under the direction of a nurse from a home health agency. HHAs are able to assist with transfers, bathing, and ostomy care. They cannot administer medications or injections.

Home Health Care –

Skilled services in the home including nursing, physical therapy, occupational therapy, speech therapy, and home health aides.

Hospice –

Care that addresses the physical, spiritual, emotional, psychological, social, financial, and legal needs of the dying patient and his/her family. A concept that refers to enhancing the dying person’s quality of life. Hospice care can be given in the home, a special hospice facility, or a combination of both.

Independent Elderly Housing –

Apartments that have been allocated for older adults and people with disabilities. They can, but don’t necessarily, have organised services such as meal sites and activities. They often include some social work coverage, emergency call buttons inside the apartment, and bathrooms that include equipment such as grab bars.

Incontinence –

Loss of bladder (urine) or bowel movement control. This condition can be transient, intermittent or permanent. Incontinence nurse specialists and physicians can diagnose the kind of incontinence that is present and suggest ways to effectively manage the situation through exercises and timed toileting programs.

Legal Guardian –

A court appointed individual responsible for the financial and physical well-being of a person deemed incompetent.

Living Will –

A document (not legally binding in India) that spells out one’s wishes for end of life care.

Long-Term Care Insurance –

Insurance that can cover the expenses of home care, assisted living facilities, and long-term care. Every policy is different and not all policies provide benefits for all services.


Licensed Practical Nurses or Licensed Vocational Nurses have one to two years of technical training. They assist RNs (see definition of Registered Nurses) with data collection, care planning and monitoring residents’ conditions. They are licensed to administer medications and treatments, transcribe physician orders, etc. Most of the licensed nurses working in nursing homes are LPNs or LVNs, especially on the evening and night shifts.

Meals on Wheels –

Provide nutritious hot meals to older adults who are homebound. The meals are delivered for a nominal fee.

Medicaid –

A joint federal/state program that pays for health care for individuals and families with low incomes and low assets. Coverage and eligibility requirements vary from state to state. Medicaid is the primary payer of nursing home care. Some states also offer some home and community-based long-term care services for eligible individuals through their Medicaid programs. These additional services are at the option of the state and are not mandated by federal law. (Pertaining to US and Not applicable to India)

Medicare –

The federal program that provides hospital and medical care to people age 65 or older and to some younger people who are very ill or have a disability. Benefits for nursing home and short-term home health services are limited and are generally available only to people while they are recovering from an acute illness. Coverage is restricted to medical care and does not include custodial care at home or in nursing homes (Pertaining to US and Not applicable to India)

Nursing Home –

A residential facility in which a full range of medical, housing, food, and social services are provided 24 hours a day. To enter a nursing home in many states, an assessment of need must be completed to establish medical eligibility. (In India, Nursing homes are hospitals with few number of beds)

Nurse Practitioner –

A registered nurse with advanced education and training. NPs can diagnose and manage most common, and many chronic, illnesses. They do so alone or in collaboration with the health care team. NPs can prescribe medications and provide some services that were formerly permitted only to doctors. There are a number of types of nurse practitioners (geriatric, adult, psychiatric-mental health) that work with older adults.

Occupational Therapist –

A rehabilitation professional who teaches people to compensate for functional limitations as a result of an injury, illness, or disability by learning skills and techniques needed to perform activities of daily living and optimise independence.

Personal Emergency Response System –

In case of a fall or other medical emergency, this electronic device enables the user to contact help 24 hours a day simply by pressing a button. A number of private companies offer these systems.

Physical Therapist –

A rehabilitation professional who utilises various therapies to help people maximise mobility and restore strength and body movement after an illness or injury such as a stroke, fall, or back injury.

Power of Attorney –

The legal designation of someone to be responsible for your financial decisions at the point that you are no longer able to manage your own affairs.

Parkinson’s disease (PD) –

This is a neurodegenerative disorder that affects predominately dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra. Parkinson’s disease (PD) is known as an older person’s disease since it is most often diagnosed in people over age 60. Only 4 percent of all cases are diagnosed before age 50. PD is the second most common age-related nerve degenerating disease after Alzheimer’s.

Retirement Community –

Apartment units for older adults in a community of independent but often aging-in-place older adults. These communities are generally available for monthly rental and do not require an entrance fee. The apartments usually have full kitchens and emergency pull cords and provide housecleaning and one or two meals each day. There are activities in the building and outside trips. While the communities do not have assisted living programs, often people can access services through private organizations to allow them to remain in their apartments.

Registered Nurses (RN) –

A graduate from a formal nursing education program (three to four years) who has passed a national examination and is licensed to practice (by the state board). RNs assess, plan, implement, teach and evaluate a person’s nursing care needs, along with the rest of the healthcare team. In addition, they may do data analysis, quality assurance, research implementation and research. They work in all types of health care settings and educational programs. In addition to providing care to individuals, RNs also works with groups of people or populations to determine how to promote health and prevent problems on a larger scale.

Senior Center –

A community facility for older adults that provides a variety of activities for their members including any combination of recreational, educational, cultural, or social events. Some centers also offer nutritious meals and limited health care services.

Skilled Nursing Facility –

Also known as a nursing home. These facilities provide 24-hour nursing coverage and total care of a person’s needs. They also provide short-term rehabilitation services for people returning to the community.

Sundowning –

This is a symptom of Alzheimer’s patients – behaviour can dramatically change during a certain period of the day (usually the later afternoon). Symptoms of the Alzheimer’s are usually more severe during this time of day and can range from mild to combative.

Visiting Nurse/Home Health Agency –

Agencies that are working under the orders of one’s doctor to provide nursing care and, potentially, physical, occupational, and speech therapy as well as home health aide services.