Common Definitions
Glossary of Terms
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Activities of Daily Living (ADLs) – the tasks involved in daily self care including: the ability to bathe; dress/undress; eat, toilet, transfer in and out of bed or chair; get around inside the home; and manage incontinence.
Administration on Aging (AOA) – The principal agency in the federal government having responsibility to administer the provisions of the Older Americans Act (except Title V), and advocate on the federal level for the needs and interests of elder citizens. AOA was established in 1965, and is located within the Department of Health and Human Services (DHSS).
Adult Day Health (ADH) – Provides health care, supervision, restorative services, and socialization for elders who require skilled services or physical assistance with activities of daily living. Nutrition and personal care services are also provided to participants. The Division of Medical Assistance must approve Adult Day Health Centers for operation.
Advocacy – A process whereby the needs of elder persons are brought to the attention of decision-makers at all levels of government and in the private and non-profit sectors. It includes defining problems and possible solutions, analysis of social trends as they are likely to affect elder persons, formulating policy and making recommendations concerning funding.
Aging and Disability Resource Center (ADRC) – A cooperative effort of the Administration on Aging and the Centers for Medicaid and Medicare Services (CMS) developed to assist states in their efforts to create a single, coordinated system of information and access for all persons seeking long term support regardless of age, disability, or income. Massachusetts, through EOEA received a three-year grant to implement ADRC through the Northeast section of Massachusetts, beginning in the Merrimack Valley. ESMV is in partnership with Northeast Independent Living Program (NILP) to implement ADRC locally.
Age Information – You can find information on approximately 40,000 services and programs for elders in Massachusetts by calling 1-800-AGE INFO. (1-800-243-4636.) The TDD/TYY number is 1-800-872-0166. The website is www.ageinfo.com.
Aging Service Access Point (ASAP) – A state designation for private non-profit agencies like ESMV that are under contract with the Executive Office of Elder Affairs to implement the coordination and delivery of Community-Based Long Term care services. Includes information and referral, case management, coordinating and authorizing the delivery of home care services, clinical screening for nursing facilities, protective services, and in nutrition services.
Applicant – An individual who has applied for Home Care Program services by entering into an intake and assessment process by telephone, mail, or person as documented by an ASAP.
Area Agency on Aging (AAA) – A regional body established by federal law charged with the responsibility to plan, support, and fund social services and nutrition services under the Older Americans Act operating within a specific planning and service area. For ESMV, that is the 23 cities and towns of the Merrimack Valley.
Area Plan – A document submitted by an Area Agency on Aging to the Executive Office of Elder Affairs requesting a grant or contract to administer activities and services for elder persons within a planning and service area in accordance with the Older Americans Act. The Area Plan covers a four-year period.
Assessment – The gathering of information to determine a comprehensive picture of an individuals’ health and social service status and their ability to manage daily needs independently. Information gathered includes health status, functional ability, memory and cognition, ADL and IADL needs, transportation, housing, and informal support resources, and emotional and behavioral wellbeing.
Assisted Living (AL) – A type of living arrangement in which supportive services are offered to an elder in a housing setting in order to prevent placement in a nursing facility. Services include: a responsible person available 24 hours a day if requested; assistance with daily living activities; assistance with medications; case management.
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Bill Payer Service – Money management services provided to a person who requires assistance in managing his or her finances due to physical or cognitive difficulties. Client approval is necessary for the appointment of a bill payer.
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Case Management – Activities related to helping an elder maintain their independence including: conducting needs assessments; determining unmet needs and eligibility for services and programs; coordinating and monitoring a service plan; home visits; and helping to resolve health, economic, housing or other issues which inhibit an individuals ability to live independently.
Case Manager (CM) – The professional staff member of an Aging Service Access Point organization who provides case management services to applicants and/or clients.
Certified Home Health Agency (CHHA) – A Home Health agency that has met the Medicaid and Medicare conditions of participation and standards for Home Health Agencies in Massachusetts, and provides nursing care, rehabilitation therapies and Home Health aide service in the community. Certified means approved by the Department of Public Health for reimbursement under Medicare, Medicaid and other insurance policies. A term that includes all Visiting Nurse Association (VNA) but is also inclusive of profit organizations certified to provide home health services.
Chapter 604 – The Massachusetts law mandating the reporting and investigating of elder abuse and neglect, and the provision of services for elder abuse and neglect.
Chore Services – Activities related to assisting a client to maintain his or her home. Light chore includes vacuuming, dusting, dry mopping, and cleaning bathrooms or kitchens. Heavy Chore includes moving furniture to vacuum, washing floors and walls, defrosting freezers, cleaning ovens, cleaning attics and basements to remove fire and health hazards, woodcutting, changing storm windows, yard work, and snow shoveling. Can also include minor home repairs and weatherization activities.
Client – An individual who is eligible for and receiving Home Care Program services under the provisions of eligibility as defined by the Executive Office of Elder Affairs in Massachusetts.
Community Choice Program – Offers enhanced home care service plans to Mass Health elders at risk of nursing home placement. Services plans are about half the cost of a month’s stay in a nursing home.
Companion Services – Activities related to socialization and recreation, assistance with the preparation of light snacks, help with shopping and errands, escort to medical appointments, nutrition sites, and walks.
Comprehensive Screening and Service Model (CSSM) – these program targets nursing home elders to bring them home to the community with long term care services.
Congregate Housing – A program that offers a shared living environment for elders and disabled adults. Congregate residents can receive home care services.
Congregate Meals – A program authorized under federal funds that provides one meal a day (usually lunch) Monday through Friday at senior centers, churches and other locations. Some programs also offer meals on weekends.
Conservator – A legal term defining an individual or corporation given legal authority to make financial decisions on behalf of an individual and manage their property. A conservator has no authority to make personal or medical decisions.
Consumer Choice Program – Allows elders to hire, train, and supervise their direct care worker. The worker may be a neighbor, friend, or any family member except a spouse. Elder Services provides case management, fiscal services, assistance with documents, and support to help the consumer manage their own care.
Council on Aging (COA) – Are municipal organizations that offer information and direct services to seniors, their caregivers, and other people with aging issues. COA’s are part of a municipal’s government, and work with other service agencies and city/town departments to provide social, recreational, health, safety, and educational programs for seniors in their communities. Where a Senior Center exists, the COA is usually the administrative body providing oversight on programs and services. Senior centers range in size fro small part time centers to large modern facilities with game rooms, exercise equipment, and a full schedule of programs. COA’s rely on volunteers to run their programs, and allow seniors to be actively involved in the planning and operation of senior center activities.
Clustered Services – Services provided to residents in housing by combining like tasks for many residents at the same time. Laundry may be completed on one day of the week, shopping another. This arrangement of service provision allows for better efficiency of service time and is cost effective.
Crisis Intervention Unit (CIU) – Investigates and resolves crisis situations for elders including physical or emotional abuse, neglect, financial exploitation, and self-neglect. There are no eligibility requirements to receive services, and the law defines some professionals as mandated reporters required to report abuse including, health care providers, police officers, COA Directors and other social service professionals.
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Dementia Day Programs – Provide specialized services to address the needs of people with Alzheimer’s disease, dementias, and related disorders. The goal of the program is to enhance cognitive functioning and improve the overall quality of life for individuals and their families. Program services help to maximize the individual’s functional capacity, and reduce agitation, disruptive behavior, and the need for psychoactive medication.
Discharge Planning – A process used to decide what a patient needs for a smooth transition from one level of care to another. This is done involving a social worker or other health care professional, family, the doctor, and the patient. It includes moves from a hospital to a nursing home or home with services. Discharge planning may also include the services of home health agencies to help with the patient’s home care.
Division of Medical Assistance (DMA) – A governmental agency responsible for the administration of the Medicaid program within the Massachusetts Executive office of Health and Human Services. See Medicaid.
Durable Medical Equipment – Also known as DME. Practical equipment that helps a person with their functional daily activities. Example: a tub chair that allows a person to sit while being bathed.
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Enhanced Community Options Program (ECOP) – A program for frail elders who are clinically eligible for a nursing home, and meet certain criteria set forth by EOEA. Provides more intensive services to elders with personal care needs greater than what is offered by the basic Home Care program.
Elder-At-Risk (EAR) – An elder who is unable to provide for himself/herself one or more of the necessities essential for physical and emotional well-being (food, clothing, shelter, personal care and medical care) so that he/she is not able to safely remain in the community without the intervention of the Elder-At-Risk agency. Risk may be due to a variety of factors such as alcoholism, mental health problems, or cultural and linguistic barriers.
Eldercare Fund – A fund at Elder Services that provides emergency assistance and in-home services for Merrimack Valley elders when there are no other available resources. People do not need to be a client of the agency to receive assistance from the Eldercare Fund. Fund raising activities and events, foundations, and individual donations fund the program.
Elderly Nutrition Program – The Elderly Nutrition Program is a federal and state funded nutrition program, which allows local elderly agencies to provide nutritious meals to senior citizens.
Emergency Shelter Services – Provides temporary overnight shelter for an elder who is without a home due to eviction, fire, flood, other natural disaster, abuse neglect, alcohol dependency, economic incapacity, or unsafe/substandard housing conditions, including lack of fuel or utilities.
Executive Office of Elder Affairs (EOEA) – The state unit on aging in Massachusetts mandated to implement and administer services designed to insure the dignity and independence of elders. Also called the Department of Elder Affairs. Is a cabinet level agency under the Executive Office of Health and Human Services.
Functional Impairment Level (FIL) – The degree of functional impairment experienced by a person, determined by their inability to manage activities of daily living or instrumental activities of daily living. The number of tasks an individual is unable to perform defines each FIL.
Group Adult Foster Care (GAFC) – A Medicaid program for persons who are at imminent risk of needing nursing home placement and who live in a housing unit. Services include: personal care and 24-hour supervision; personal emergency response system; can use adult day health two days per week or eight hours of Home Health Aide services per week.
Guardianship – A relationship whereby an individual or non-profit corporation with trust powers, is given legal authority by a probate court to act on behalf of a person and make personal financial and medical decisions on behalf of a person deemed incompetent to manage their own affairs.
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Health Care Proxy – A person who has been designated to make health care decisions on someone else’s behalf. A health care proxy form must be completed and signed by both the proxy and the patient and secured in medical records for the proxy status to be honored.
Home Care Program – A system of services for elder persons in Massachusetts to assist them in maintaining their independence in a home environment. Home Care Program services are offered to elders over 60 years of age, who meet need and financial eligibility guidelines.
Home Care Services – Services provided by the Home Care Corporation to income and need eligible elders. Home Care services include: case management; chore; companionship; emergency shelter; homemaker; home delivered meals; information and referral; protective services; respite care; social day care; transportation laundry services; and home health services in a limited way.
Home Delivered Meals (HDM) – A program that provides, five or more days per week, at least one home delivered hot or other appropriate meal per day to elder persons who are home bound or for whom congregate meal facilities are not accessible. Home delivered meals can either be a service authorized under the home care program, or under Title III-C of the Older American’s Act. Each meal must comply with nutrition standards, and be religiously and ethnically appropriate to the extent feasible.
Home Health Aide Services (HHA) – The provision of care in the home under the supervision of a registered nurse or, physical, speech, or occupational therapist. Home Health Aide services are performed by trained personnel and include personal care; simple dressing changes that do not require the skills of an RN; assisting the patient with activities of daily living; exercising; taking medications ordered by a physician which are ordinarily self-administered; routine care of prosthetic and orthotic devices; activities that support skilled therapies; and reporting to the professional supervisor any changes in the patient's condition or family situation.
Homemaker (HM) – A trained personnel working under agency supervision. Activities are limited to shopping, menu planning, meal preparation, light housekeeping, and laundry for the client.
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Impairment – (As used in the Home Care Program) Inability to perform certain self-care (See ADLs) tasks or basic tasks around the house (See IADLs) without help from another person.
Information & Referral (I&R) – Includes maintenance of an extensive database of information and resources for elders. Entry point for referrals to services and programs. Information and referral can be conducted by telephone, mail or in person. I&R is one of the basic Home Care services and available without regard to a persons income. May also be referred to as Resource and Referral or Age Info Center.
In-Home Services – A category of services under the federal Older Americans Act that must be provided by all Area Agencies on Aging. In-home services include homemaker, home health aides, visiting and telephone reassurance, chore maintenance, in-home respite care (including adult day care) and minor home modifications.
Instrumental Activities of Daily Living (IADL) – Daily tasks, including the ability to prepare meals, do housework, do laundry, go shopping, take medicine, get around outside the home, use transportation, manage money, and use the telephone. A case manager assesses these tasks in determining a person’s functional impairment level (FIL) and need for Home Care services. If an elder needs help with one of these tasks, he or she is considered to have an IADL impairment in that area.
Intermediate Care Facility (ICF) – A nursing home that provides assistance with activities of daily living and routine nursing care, and occasionally provides the services of skilled therapists such as physical therapist or occupational therapist. Nursing supervision by an R.N. or an L.P.N. is required during the day and evening shifts. Residents need for care is not as intense or as specialized as that in a Skilled Care Facility (SCF). ICFs are known as Level III Facilities.
Interdisciplinary Case Management – A client centered approach that includes Home Care nurses and case managers working cooperatively to coordinate service plans, and maintain ongoing communication with the elder, family members, and informal and formal supports.
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L.A.C.E. Program – a volunteer run computer education program that teaches elders to use and access computer technology. Volunteers handle all administrative responsibilities, class registration duties, and teaching and coaching students. Classes are offered at a small fee at a computer learning center housed at Elder Services.
Level of Care – See Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), and Level IV Facility.
Level IV Facility – A rest home and/or retirement home that provides custodial care. The services provided in these facilities are more residential than medically oriented. They provide protective supervision for the residents, as well as room, board, social activities and limited social services.
Long Term Care (LTC) – One or more services provided on an ongoing basis to enable chronically impaired individuals to be maintained at their maximum levels of psychological, physical and social well-being. The recipients of services can reside anywhere along a continuum from their own homes to any type of institutional facility.
Long Term Care Assessment – The procedure specified in Massachusetts to determine eligibility for Home Care program services, community based long-term care services, and nursing facility services. The LTC Assessment Tool is the form used when conducting an assessment.
Long Term Care Facility (LTCF) – Means any skilled nursing home (See SNF) or intermediate care facility (See ICF). LTC facilities are ranked into different levels based on the extent of skilled care that they provide.
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Mass Health – (referred to also as Medicaid) a health insurance program financed by the federal and state governments. It pays medical bills for low income Americans including close to 13% of the personal health care expenditures for the elderly. It is the primary means of payment for nursing home services in the United States.
Meals on Wheels (MOW) – Home-delivered meals provided to elders, regardless of their income, under Title III-C of the federal Older Americans Act and with state funding.
Medicaid – see Mass Health.
Medicare – A two-part health insurance program for Americans aged 65 and older and certain disabled people who have benefits under the Social Security system. Part A of Medicare covers hospital costs while part B includes benefits for doctor's fees both in and out of hospitals. Participation in part A of Medicare is guaranteed to all citizens who are eligible for Social Security. Part B is optional and an additional fee is required to participate.
Medicare Part A (Hospital Insurance) – Hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (medical Insurance) – Helps pay for doctor visits and services, outpatient hospital care, durable medical equipment, and some medical services that aren’t covered by Part A.
Medicare Part D (Prescription Drugs) – A new addition to Medicare beginning in January 2006, which helps pay for prescription drugs.
Medigap Policy – A Medicare supplemental health insurance policy sold by private insurance companies to fill “gals” in Medicare coverage. Medicare policies work only with the original Medicare Plan.
Money Management Program – Matches trained and bonded volunteers to assist elders having difficulty writing checks, paying bills, and budgeting. Provides both bill paying and representative payee services.
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Nursing Home Ombudsman Program – A program authorized under the federal Older Americans Act. The nursing home or long term care ombudsman is a trained and certified volunteer who investigates and resolves complaints made by or on behalf of nursing home residents which may affect the health, safety, welfare or rights of such residents.
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Older Americans Act – The 1965 federal legislation authorizing services for older Americans. The OAA is the basis for funding support services (known as Title III-B), nutritional services (known as Title III-C) and the Senior Aide employment program (Title V).
Ombudsman – Generally speaking, refers to a person who helps investigate and resolve conflicts between parties (See Nursing Home Ombudsman).
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Personal Care (PC) – Services can be provided by a personal care homemaker or home health aide and include assistance with bathing, dressing, shampoo/hair combing, foot care (excluding nail cutting), denture care, shaving, bedpan routines, ambulating, and transfers.
Personal Care Attendant Program (PCA) – A Medicaid program for chronically disabled persons. A self-directed approach to care. The elder manages his/her own care and hires and fires their worker. Services can include homemaker, personal care, overnight attendant and assistant with activities of daily living.
Personal Emergency Response System (PERS) – an electronic device connected to a person’s telephone line that can be activated in an emergency to get help. When the device is activated, a person from a central monitoring system answers the call, assesses the need for help, and takes appropriate action using pre-established emergency protocols and personal, medical, and emergency information listed for each client. This service operates 24 hours a day, 7 days a week.
Protective Services – Services defined under Chapter 604 of state law that is necessary to prevent, eliminate or remedy the effects of abuse to an elderly person.
Provider Agency – An agency with which a Home Care Corporation or AAA contracts to provide services to elders once the Home Care/AAA has authorized those services. Homemaker agencies in the Home Care program are an example of provider agencies.
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Representative Payee Services – Money management services provided to a person who has been determined incapable of managing his/her benefits by the Social Security Administration or other appointing entity. Client approval is NOT required for the appointment of a representation payee.
Respite Care – Provides safe, temporary relief to caregivers of frail elders and victims of Alzheimer’s disease. Offers home care and health care services. Elder must need help of a primary caregiver, and caregiver must be a relative or an individual who resides with an elder.
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Senior Care Organizations – (SCO’s) For profit or not-for profit- organizations that contract with physician groups, hospitals, and service providers to deliver medically necessary health services as well as social support services for enrollees who are 65 or older, and currently eligible for both Mass Health and Medicare. Enrollment is voluntary.
Senior Companions – Companions are assigned to provide company and supervision to lonely, handicapped or socially isolated elder people and to provide relief to family members with dependent elderly relatives.
SHINE Program – SHINE (Serving the Health Information Needs of Elders) is a program of the Executive Office of Elder Affairs which trains health benefits counselors to provide information to elder persons about Medicare, Medex, Health Maintenance Organizations, long term care insurance, assignment and other health insurance issues.
Skilled Nursing Facility (SNF) – A nursing home in which the residents’ general condition tends to be unstable and requires close observation and care given by professional staff over a 24-hour period. Medicare finances some skilled care; however, private funds or Medicaid must cover the majority. Some SNFs have rehabilitation programs that help people maintain their ability to function (as with arthritis) or to readjust to limitations (as with stroke).
Sliding Fee – A fee charged to elder clients for services. This fee is based on the income of the person receiving the service and utilization of certain Home Care services.
Social Day Care Service – Provides an individualized program of social activity for elders who require daytime supervision because of physical impairment or social or emotional problems that impair their capacity for self-care. Social Day Care provides recreational activities assistance with grooming needs, and nutritional services including a minimum of one meal per day. This differs from Adult Day Care in that it does not focus on health-related services.
Social Security Administration (SSA) – The federal agency responsible for administering the Social Security program.
Supplemental Security Income (SSI) – Monthly payments made by the Social Security Administration to an aged, blind or disabled individual who meets the requirements for such aid under Title XVI of the Social Security Act. Includes state supplementary payments made by the Commonwealth on a regular basis to an individual receiving SSI.
Supportive Housing sites – ESMV has 40 subsidized housing sites in the Merrimack Valley that are clustered by a case manager/nurse team and one vendor. Homemakers work as a team to complete household tasks and personal care is individualized. Multidisciplinary meetings are held monthly. Clients have 24/7 on-call access for non-medical emergencies.
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Transitional Assistance – The provision of services to assist elders in returning to a community setting following discharge from a nursing facility. Often involves temporary housing as well as other services. ESMV has transitional housing available to use in Chelmsford in partnership with the Chelmsford Housing Authority.
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Visiting Nurse Association (VNA) – A certified Home Health agency with a community Board of Directors providing nursing care, rehabilitation therapies and Home Health Aide service in the community. Certified means approved by the Department of Public Health for reimbursement under Medicare, Medicaid and other insurance policies. A VNA is always a non-profit corporation.
Vendor Agency – An independent organization which contracts with a Home Care Corporation or AAA for the provision of a service(s) specified within the contract.
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Waiting List – also known as Managed Intake System. Based on criteria defined by the Executive Office of Elder Affairs, applicants may be put on a waiting list to receive home care services.