24-hour controlled access

Term indicating that the senior care building requires a pass key or code, or magnetic card to open entrance doors.


Word used to describe the design of products, services, and environments for people with disabilities. Often used to describe the ability for someone in a wheelchair to be able to access services and products or to maneuver an area.


the period of time it takes for an older adult to adjust to living in a new environment.

Actively Dying

The condition of being within two to three weeks of death. This state is during the end stages of a terminal disease or simply reaching the end of one’s life.

Adult Child

This term describes individuals who are typically middle-aged and have aging parents.

Affordable Housing

Housing that is purpose built or retrofitted to be affordable for individuals with limited or low incomes. This is not to be confused with Section 8 housing. People qualifying for affordable housing must earn a certain amount of income without surpassing a maximum threshold.

Age Identification

This term is used to describe the age a person ‘feels’ rather than the age they physically are. Studies have shown that a positive outlook on the effects of aging closely correlate with being healthier both mentally and physically.


Ageism is discrimination against a person based on their age. This is analogous to discrimination based on race and sex.

Aid & Attendance

a benefit paid by Veterans Affairs (the VA) to Veteran, Veteran spouses or surviving spouses of Veterans. Certain requirements for care are needed, and certain parameters regarding financial eligibility exist. Aid & Attendance can provide a significant source of funding for assisted living or adult care home services.


The feeling or state being isolated from a certain group. Often used to describe the feeling of separation that an elderly individual might have towards family or friends.


Term used to describe having mixed feelings or ideas about something or someone.

Anti-anxiety Drugs

Medications used to suppress feelings of worry or depression.


A general lack of interest.


As the result of an infection or foreign body such as bacteria or parasites the body encapsulates the matter. This is the body's defensive reaction to attempt to prevent the spread of infection to other parts of the body.

Accelerated benefits

Cash money that can be accessed from a life insurance policy before death occurs, typically accessed to pay for in-home care, assisted living or nursing home care.

Accessibility (a.k.a. wheelchair accessible)

Defines a space which is free of barriers, inclusive of having hallways and doorways wide enough to traverse safely and easily. Assisted living communities, adult family homes and nursing homes all must follow specific guidelines for making their communal spaces fully accessible to residents.

Acute Care

Typically means care within a hospital setting. The patient may be medically unstable or require monitoring by health care professionals or require therapies or treatments. Term is typically used for short-term illness after which point a person can recuperate and return to wellness.

Acute Illness

A sickness which is chronic, likely debilitating in some manner.


Alzheimer's Disease is a chronic neurodegenerative disease which is progressive and fatal. Research indicates the disease is caused by plaques and tangles in the brain. The most common early symptom is difficulty remembering things that recently occurred (short-term memory loss). As the disease progresses, symptoms typically involve problems with language, disorientation and changes in personality. The disease causes loss of a person’s ability to complete even the most simple tasks. People with Alzheimer’s Diseases frequently withdraw from family and society. Speed and progression of the disease is different for each person. Average life expectancy following diagnosis ranges from three to nine years. In the end stages, muscles impacting basic body functions no longer occur. The National Institute on Aging states that an estimated 5 million Americans have Alzheimer’s.


American with Disabilities Act of 1990 Civil rights law which prohibits discrimination based on disability.


Activities of Daily Living. A means of describing the functional status of a person. ADLs do not include cognitive (thinking/processing) abilities - this is a separate function. All senior living providers offer support or full management of ADLs for their residents.

  • Basic ADLs: Bathing, feeding, going to the toilet, dressing, grooming, taking meds
  • Mobility ADLs: Being able to get out of the house to undertake errands, visit family or friends or to travel, be able to walk and to get up out of and into a chair without assistance.
  • Instrumental ADLs: Cooking, shopping, housework, transportation
  • Cognitive: based on abilities to be aware of time/number, place, person and self (Note - most LTC policies are based on the BASIC ADLs and cognitive abilities)

Adaptive devices

Patented items which make a task easier for someone with a disability, illness or cognitive impairment. In skilled nursing, an Occupational and Physical Therapist are likely to make recommendations as to what types of adaptive devices will help with stability, mobility and maintaining independence.


Checking someone in to a care setting or signing the paperwork to make a move into a senior living or senior care community.

Adult Day Care (a.k.a. Adult Day Services)

Provide social interaction and activities for older adults and perhaps also for disabled individuals during daytime hours.

Adult Day Health

Similar to Adult Day Care only with a health care component such as medication monitoring, social services or perhaps also clinic services.

Advance Directives

The umbrella term for a Will or Trust, DPOA (Durable Power of Attorney) or POA, Living Will, No code (POLST form) and other legal documents.

Advance Directive for Health Care

A written document which states your wishes regarding how you would want medical decisions to be made should you lose the capacity to make the decisions for yourself. A health care advance directive may be comprised of a Living Will, a Durable Power of Attorney for Health Care or both.


A person who looks after the well-being and fair treatment of another individual.


The process of ensuring that another person's rights and preferences are known and followed.


Adult Family Home (also known as Adult Care Home, Residential Care Home, Board & Care or Adult Foster Care Home) – a home licensed typically for two to six individuals who may be frail of body, frail of mind or both.

Aging in place

The concept of remaining in the same physical location when additional services are required or requested.


Behaving in an abnormally forceful or belligerent way either verbally, physically or by simply being physically present when it is not appropriate to be in someone else's physical space.


Assisted Living (becoming a broadly used term, but generally means assistance with ADLs, regardless of where that service is provided. Also called assisted care.

Alcohol related dementia (aka Alcohol induced dementia)

presents much like Alzheimer's Disease in that a person is forgetful and can become quite frail.

Alternate plan of care clause

Within a long-term care policy, an insurance company may consider paying coverage for any other type of care not specifically noted in the policy. For instance, if a person needs help with a specific number of ADLs and the policy only lists skilled nursing and assisted living coverage; if there is an "alternative plan of care clause," the insurance company may be open to paying out the benefit for care in an Adult Care Home.

Alzheimer's Disease

A form of dementia that is both progressive and degenerative, which affects brain functions, causes the loss of short-term memory and reasoning ability, the ability to care for oneself and deterioration of speech and communication skills.


Ability to walk, get around.

Apoplexy (a.k.a. stroke)

Used as a synonym for the word "stroke," because many stroke patients lose consciousness during the acute stage of vascular compromise. This word also is used to describe loss of consciousness.

Ancillary Services (a.k.a. Additional services)

Within senior housing and care communities, these may be therapies, beauty shop, outings or even medical supplies or services. Assisted living typically does not include ancillary services or products in the monthly charge. Some adult family homes may include such items. It is important to request a listing of possible ancillary charges prior to selecting a senior provider.


The most common disorder of the blood. A deficiency of red blood cells and/or hemoglobin.


A blood clot to the brain.


Similar to a savings account or CD at a bank, only this account is held with an insurance company. There are different types of annuities within these broad types:

  • Fixed - a guaranteed interest rate
  • Immediate - paying out a monthly, immediate income
  • Variable - Return may vary as it is tied to stocks, bonds or index funds
  • Medicaid Conforming - follows guidelines to qualify for COPES/Medicaid
  • Life - No remaining value to pass on via will to trust, a guaranteed monthly payment is made as long as the person is alive, based on the contractual agreement (these are becoming scarce)


Medications which help an individual feel better about their life or that may have a calming effect on a person.


Nervousness or anticipation that causes stress and affects behavior.

Area Agency on Aging (AAA)

A nationwide network of programs, State and local, that can assist older people with planning their life-long needs. Some of the services are: adult day care, counseling, information about and referral for in-home services, legal services, nutrition and meals, personal care, respite care, skilled nursing care/therapy, and transportation.


a language disturbance caused by brain atrophy, brain damage, stroke, dementia or Alzheimer’s Disease. Causes impairment in a person's ability to speak, write or even comprehend.


Adult Protective Services agency that may respond to a report of abuse or neglect.


Advanced Registered Nurse Practitionervery similar to a general physician, typically practicing family practice-type medicine, but some specialize in Geriatric Care.


Choking on liquid, phlegm or food.


To review a person's health history and to document that individual's current health & mental status, psychosocial needs and service preference needs.

Assistive devices

Used to describe walkers, canes, even devices that attach to shoes. Something used to help with ambulation.

Atrophy (as it relates to muscles or the brain)

Relaxing or death of cells, or withering of cells, muscles or brain.


Lipid-laden plaques which obstruct the arteries.

Auditory delusions

Hearing things which are not actually present or occurring.

Behavioral Changes

This term describes a change, either rapidly or slowly, over time of a person’s attitude, personality, and mood. This change is often paired with the diagnosis of dementia or Alzheimer’s Disease.

Bridge phrases

a form of redirection. When a person with memory loss asks the same question over and over, to help them feel validated, the question is turned into a redirection question that may or may not be related to the question the older adult is asking.

Bed alert pads, floor mat pads or wheelchair pads

Alarm system that notifies a caregiver that a resident is moving and needs transfer assistance or needs reminding that they should not self-transfer.

Bed hold

Reserving space in a nursing home or assisted living community even though the resident is not yet living there. There may or may not be a fee involved in a bed hold.


Bars which are intended to keep a person from rolling out of bed or to be able to elevate oneself while lying in bed. These are now considered a form of restraint and are not allowed in senior care settings.


The actions a person takes as a result of their personality or other influence. This term is typically used when a person's actions are outside the norm of society.


A person who is loud, perhaps yelling and not thinking about what they are saying. The person is typically angry and acting in a way that is upsetting to other people in contact with the person.


Two times a day.

Bi-polar (a.k.a. Manic depressive)

A psychiatric condition defined by periods of extreme mood. Moods can be depressive (unhappy/down) or manic (elevated mood, high energy or unusual thought patterns). A significant variant of bipolar disorder is designated as bipolar II. (The usual form of bipolar disorder is referred to as bipolar I.) Bipolar II is a syndrome in which the affected person has repeated depressive episodes punctuated by what is called hypomania (mini-highs). These euphoric states in bipolar II do not fully meet the criteria for the complete manic episodes that occur in bipolar I.

Bond benefit

Some senior communities were constructed based on tax-favored bonds. In order to qualify and to continue qualifying for such tax-favored funding, a community must maintain a certain level of "lower income" residents.

Bowel impaction (a.k.a. constipation)

Condition of the digestive system where a person finds it difficult to have a bowel movement.

Bowel obstruction

A blockage of the intestines and is considered a medical emergency and may require surgery.


Blood pressure.


A diet of only bananas, rice, unsweetened applesauce and toast (or pasta or potatoes).


Bachelor of Science in Nursing.

Care Conference

scheduled meetings in which the older adult and their family or support system participate with social work staff, therapists, nurses and managers who oversee their care. These meetings are intended to discuss progress of recuperation or to discuss current need for treatments or care and to discuss plans for future care and support which may be needed. Care conferences may be held frequently during a skilled nursing stay, or may be held on a regular basis in assisted living or as care needs change. Whenever there is a change in condition (change in care needs or mental alertness), an assessment of needs occurs, a plan of care is written and these plans are discussed with the senior and/or their legally-responsible representative.

Chronic pain

any pain that exists for longer than 12 weeks.

Cognitive impairment

slight memory loss

Consumer protection

a group of laws designed to ensure the rights of consumers and to ensure fair trade, competition and accurate information in the marketplace.


This is the mental action of thinking. The process of cognition involves acquiring information and understanding that information through your memories and experiences. This process is heavily affected by dementia and Alzheimer’s Disease.

Coping Behavior

Coping behavior is the term used to describe the actions of a person under significant stress to minimize, reduce, or tolerate the amount of stress or grief they are feeling. Often times the individual coping with stress will act in a manner uncharacteristic of their typical personality.


The act of sitting down and talking with a licensed therapist/counseling professional.


This term describes the emotional reaction of someone to something the individual they are talking to has said.

Care Manager

A professional who provides consulting services to an older adult to help make decisions, to advocate for them and to ensure proper care and treatments are received. This person also documents current status of a person and attempts to project future needs. This person may also recommend or suggest additional services, care or treatments.

Care Plan

A written document which defines a resident's specific needs; and then outlines a means for meeting those specific needs. The care plan also makes note of any particular, possible concerns which require a higher level of monitoring.

Caregiver Stress

a condition of exhaustion which often presents itself as anger or guilt that results from unrelieved caring for a chronically ill or mentally confused individual.

Case Manager

Synonymous with Care Manager.


A tube placed into the body cavity. This word is used in many ways. Catheters allow drainage of infection. They can also allow fluids or access (central venous catheter - also known as a central line - placed into a large vein in the neck, chest or groin for easier access to give intravenous drugs or fluids) or surgical instruments into the body. Also very common term used to describe a tube for directing out urine or feces from the body

  • Condom catheter - a latex sheath placed over the penis
  • Foley catheter - inserted through the urethra of the penis into the bladder
  • Superpubic - a surgically-created connection between the bladder and the skin


Continuing Care Retirement Community. A complex or campus offering independent living, assisted living and skilled nursing care; and perhaps dementia care as well.


Occupancy rate, number of occupied beds or apartments in relation to the number of total licensed beds or apartments. This number is typically stated numerically by the number of beds or apartments which are occupied; or as a percentage.

Central venous catheter (a.k.a. central line)

A catheter placed into a large vein in the neck, chest or groin when a health care provider needs access for more intensive cardiovascular monitoring, for assessment of fluid status and for increased access for intravenous drugs and fluids.

Certificate of Medical Necessity

Physician's orders stating a person requires care services


Certified Financial Planner

Chore services

Not related to personal care. These are tasks which are considered to be errands or homemaker duties. They do not involve actually touching an individual.

Chronic Care

Medical care which addresses preexisting or long term illness (this is the opposite of acute care, which addresses short term or severe illness of a brief period. The most common chronic medical conditions in the elderly are:

  • Asthma, Emphysema,
  • Chronic Bronchitis
  • Cirrhosis of the Liver
  • Congestive Heart Disease
  • Depression
  • Hypertension


Coronary Heart Failure


A flat, absorbent material placed on top of a chair or mattress to protect against moisture. Similar to an adult diaper which is not attached to a person, but rather lies flat on top of a surface.


Care Manager

C.N.A. (a.k.a. RNA, NAR)

Certified Nursing Assistance, Registered Nursing Assistant or Nursing Assistant Registered

Cochlear implant

An implanted hearing aid device for a person who is severely hard of hearing. Unlike a hearing aid, the implant doesn't amplify sound, but instead stimulates the auditory nerves inside the cochlea with electrical pulses.


A relationship in which two people's personalities are intertwined into one. This is viewed as unhealthy as the two people frequently have different needs and preferences, which causes unnecessary stress or conflict for the other person. This term is not to be confused with "dependence," which is used to describe a single individual's reliance upon something or someone else.

Cognitive impairment

A syndrome causing memory loss or inability to process information or to react in a way that is considered to be socially normal.


Under Medicare, it is the percentage or portion of the Medicare-approved amount that you the consumer have to pay after having met the deductible for Part A and/or Part B. For other types of health insurance, it is usually a percentage of billed charges after you have met the deductible. For example, if you have paid the deductible and the insurance company pays 70 percent of the remaining amount of your claim, your coinsurance is 30 percent.


A surgical procedure which connects part of the colon onto the anterior abdominal wall, leaving the patient with and opening in the abdomen, called a stoma. With a colostomy, feces leave the patient's body through the stoma and collects in a pouch attached to the patient's abdomen.


An amount a person must pay out of their own pocket before insurance begins covering a service or product.


Chronic Obstructive Pulmonary Disease. Characterized by limitation of airflow in the airway. COPD is the umbrella term for chronic bronchitis and emphysema.


Having to do with mental status and abilities.


Anger or frustration in a person with memory loss which causes anxiousness. Typically manifested in speaking angrily, hitting, biting. In many cases a person who is combative can be helped by removing stimulation and approaching them in a caring and nurturing manner.


The presence of two or more conditions or diseases in the same individual

Companionship services

The act of entertaining or simply being with another person, typically for a fee.

Complaint investigation

When the state receives a call from a Mandatory Reporter or a call regarding suspected abuse, neglect, exploitation or violation of resident rights or states codes and laws, a person hired by the state (typically a Registered Nurse or Masters of Social Work) is dispatched to review the circumstances and to write a report, or suggest a plan of action.


Congestive Heart Failure

Conservatorship (a.k.a Guardianship)

A court order that property or a person be subject to the control of another person, entity or agency.

Continuum of Care

Used to describe a senior living situation or a senior service which offers independent living through skilled care. This term is also used to describe the entire senior housing and care industry.


A gradual recovery of health after illness (today we hear the word recuperate more frequently)


A program offered within the Medicaid in the state of Washington (entitlement program) which provides financial assistance within adult care homes and in-home care and possibly assisted living.

Crash bar

A handle of a door which is rectangular and typically spans the width of the door. Used to open a door, and is oftentimes alarmed.

Creutzfeldt-Jakob Disease

Rare and incurable degenerative neurological disorder that is fatal.

Crohn's Disease

A chronic inflammatory disease of the intestines. It primarily causes ulcerations (breaks in the lining) of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus.


Community Services Office. An office assisting and processing Medicaid applications.


Community Services Rep - a Marketer or Admissions person


Directing, prompting or supervising someone with cognitive impairment; demonstrating how to eat, medication reminders, prompting with visual or verbal cues so as to accomplish dressing or toileting

Custodial Care

Term used to describe non-medical care, very light care; synonymous with monitoring.


Cardio Vascular Accident = a stroke

Day and Night confusion

A person with dementia or reaction to medication, disease or infection may be awake during the night and sleep during the day.


Director of Community Relations - a Marketer or Admissions person

DD (Developmentally Disabled)

sometimes also noted as DDD; A person who has not matured in a way that is normal for their age - typically as it relates to mental capacity and ability to process ideas or to retain information or memories; may also involve the inability to complete activities of daily living without guidance or assistance.


Removal of dead, damaged or infected tissue.


Lack of water in the body.


A false belief. In psychiatric terms, the term relates to a mental illness.


The broad term used to describe a lessening of an individual's ability to think, process information or respond to stimulus; a person who is not able to interact with society in a normal fashion due to memory loss, brain damage, illness or health condition.


A person's unwillingness or inability to recognize the reality of a situation or matter.


Relying upon someone else


A mental status which causes a person to feel tired, without energy and perhaps without interest in interacting or completing tasks.


The process of decreasing and then removing a chemical substance (drug or alcohol) from a person. This term is also sometimes used as it relates to nutrition when an individual's diet is being changed with the intent of providing improved nutritional status.

Diabetes mellitus

A metabolic disorder of hyperglycemia (high blood sugar)

  • Type 1 = autoimmune destruction of the pancreatic beta cells with produce insulin
  • Type 2 = Gestational diabetes, which involves insulin resistance Both forms of diabetes are chronic conditions, yet treatments exist to prolong life


To define a disease or condition by its outward signs and symptoms or to analyze the underlying physiological or biochemical causes of a disease or condition.


Renal replacement therapy which acts as a replacement for a lost kidney due to renal failure or missing kidney.

Dietary supplement

Can be a vitamin, mineral, herb, botanical (excluding tobacco), an amino acid or an extract. Intended to give the body something it needs or is lacking. Can cause drug interactions and other problems for other adults.

Directive to Physicians

Umbrella term used to describe the legal documents outlining a person's wishes and intents. Typically describes a Living Will and a DNR (Do not resuscitate). DNRs are now more readily called a POLST form.

Discharge Planner

A social worker or health care professional who helps patients and their families who are leaving a hospital environment to transition to another level of care.

Disease course

  • Chronic course - long lasting and likely deteriorates
  • Recurrent course - long lasting but relapses frequently
  • Relapse - affected again by something which affected the patient in the past
  • Remission - a state of absence of a disease or disappearance of a chronic disease

Discharge (as it relates to leaving an acute or senior care setting)

The point at which an older adult is released from the acute or rehabilitative environment to return home or to a different (lower level) care setting.

Discharge (as it relates to a wound)

The body attempting to eliminate infection from the body by encapsulating it and sending liquids to an open area of the body to flush out infection.

Disorganized Thinking

A thought disorder used to describe a pattern of unusual language that is thought to reflect mental illness.

Death with dignity

referring to physician-assisted dying laws which allow a terminally ill patient to receive medical assistance and aid-in-dying


This is the state of your body not having enough water to carry out basic bodily functions and can lead to very serious complications and illnesses. This results from not drinking enough water or hydrating beverages.


an extremely upset state of mind that occurs


The state of not accepting that something difficult or unwanted has happened or will happen. This creates an inability to see one’s own or someone else’s need for assistance.

Divided Attention

Refers to the ability to focus on more than one task at a time. This is often something that declines over time as people age.


Durable Medical Equipment - Medical equipment required by a doctor's order to be used in the home or in a care setting. These are reusable items, such as hospital beds, walkers, and wheelchairs; paid for under Medicare, subject to a coinsurance of the Medicare-approved amount


Do not resuscitate. This document has been replaced by a POLST form, but the senior housing and health care industries still call the POLST form a "DNR"


Director of Nursing Services


Director of Nursing


Durable Power of Attorney; Document giving someone else the legal right to make decisions on your behalf (as long as they are in line with the decisions you would typically make on your own) and to transact business. There are Powers of Attorney that are also limited to:

  • Health Care
  • Financial
  • Durable Power of Attorney includes both
  • Must have provision for HIPPA to be a useful document

Dressing change

Changing a bandage on a wound or incision. This is considered a skilled task; however, it can be delegated through nurse delegation.

Drug holiday

Removing a person from all medications to remove all traces of the medication from their system. Frequent practice within Geropsych programs.

Drug interactions

A situation where a substance affects how the drug affects the body. Interactions can be due to conflicting drugs, drug and food interactions as well as drugs and herbal interactions.


A term used to describe the way older adults are treated in the senior housing industry. To be treated with dignity is to be respected, listened to, and have your needs attended to in a manner that is acceptable to you.


This term describes an attitude or state of mind where you are not interested in what is happening around you and to you. When a person is disengaged they will seem distant or distracted and might not act the way that they used to.


This term means to have difficult or labored breathing.


This word is the condition of having difficulty or discomfort while swallowing. This is usually a symptom of a disease.

Early onset dementia

This term refers to dementia and Alzheimer's disease that affect people earlier than usual. The thresh hold for early onset is when someone is in their 40s and 50s, and experiences the effects of Alzheimer's disease or dementia.


a prominent, computerized patient charting system used in hospitals, clinics, nursing homes and other health care settings.

Estate planning

Estate planning refers to the preparation of a person's estate before their death. An estate is all of the material goods and cash that a person owns. Estate planning services are offered by financial professionals as well as attorneys.


Executive Director, the General Manager of a senior care community


Emergency Department


Retention of water causing swelling, particularly in the extremities (legs / arms) -causes stress on the heart.


Tested frequently in the elderly via blood or urine sample. Muscles, body functions and neurons are activated by electrolyte activity - for instance, muscle contraction is dependent upon the presence of calcium, sodium and potassium. Without these ions, muscle weakness or severe muscle contractions can occur. Other ions frequently discussed in the elderly are: magnesium, chloride, phosphate and hydrogen carbonate.

Elimination period

A number of days before a benefit begins (a term used primarily in the insurance industry)


A term most frequently seen within dementia care, where a person leaves a building or home without the caregiver's permission or recognition the person is leaving.


Inflammation of the brain caused by viral or bacterial infection. As the brain pushes against the skull, death can result.


Providing positive support and reinforcement to helps a person behave in a certain way or to take a certain action. Frequently used in regards to the act of enticing a person to take part in a social activity or in completing a task such as eating food or drinking liquids.


Liquid supplement to provide a patient with nutrition, glucose, fiber or other food supplements (a common product brand name is Ensure)


The term is an umbrella term to denote that federal or state funds are being used to help pay or offset the cost of care, health care or nutrition services. Financial assistance to financially and medically needy individuals. Term is also used to describe Veteran's benefits when a Veteran requires care services, regardless of financial status.


Emergency room

Estate recovery

The act of the State placing a lien on an individual's assets in order to recover all or some of the money paid out in entitlements.


Person named to be in charge of an estate

Exit seeker

A person who cunningly attempts to elope by looking for opportunities to get outside or to leave a home or building.

Exit seeking

Behavior of feeling compelled to leave a building or house. Some Alzheimer’s Disease patients feel they must be elsewhere - such as at work or they may relive a traumatic experience such as thinking a family member has been injured, and feeling they need to be of help to that person.


The act of using something in an unjust, cruel or selfish manner for one's one benefit.

Failure to thrive

Lacking interest in living, inclusive of eating, drinking and perhaps even responding to stimulus or interaction.

Fair Housing Act (a.k.a. the Civil Rights Act of 1964)

Prohibits discrimination in housing as it relates to race, religion, national origin sex, handicap and family status. Title VIII of the Act is also known as the Fair Housing Act.

Fall precautions

Actions taken to monitor or help a person avoid losing their balance. This term is also used for someone who has fallen quite a bit or is at risk for fall, with the intent to more diligently monitor the person in the event that an additional fall occurs.

Fall risk

A person who is unstable on their feet, has an unsteady gait (means of walking), stutter steps (prevalent in stroke and Parkinson's patients)

Family conflict

Disagreement, discord or acting out of family members who are in disagreement or who are not able to communicate well with each other. Frequently, such disagreements cause a division of family members, and creates stress or poor communication within a family unit.

Family meeting

A time to speak about a person's needs, gather input for the older adult and their support system and for the caregivers or management staff to give feedback and concern regarding a person's care, health, spiritual and mental condition.

Fee for service

A means of charging a person based on time it takes to complete a task or service. Time may be calculated in increments of 5 minutes, 15 minutes, half hour or hour; or with new technology, services may be calculated in exact minutes.

Fee schedule

Also known as "rate schedule." Document which outlines monthly base rates, service fee rates and perhaps ancillary (additional) fees.


The highest standard of care imposed by law. The expectation is to be highly loyal to the person to whom they owe the duty. Also means that a person providing a service cannot place their own, personal interests before the duty at hand.

Food handler's permit

A certificate obtained by attending a classroom or online training regarding food safety and sanitation. A requirement of anyone who serves food.


Not medically stable or lacking in energy and strength. Also used to describe a person who is susceptible to illness or is not functioning well in regards to being independent with activities of daily living.


Used to describe the muscular reaction which occurs in individuals (particularly with Parkinson's disease) where the muscles contract and brain signals are not sent to the muscles to change. Frequently causes a person to become rigid and can lead to falls.

Functional Incontinence

Occurs when a person does not recognize the need to visit the toilet.

Frontotemporal Dementia

This term describes the condition of progressively losing nerve cells in key areas of your brain. This condition can cause a variety of illnesses that usually require special attention to manage. The effects of these conditions include; marked changes in behavior, the effects are most prominent in the regions that control conduct, judgment, empathy, etc. The second common effect is the decline in the ability to speak clearly and fluently as well as understand speech. The third condition causes degeneration in the areas that control muscle movement and motor coordination.

Functional incontinence

When an older adult is typically aware of the need to urinate, but for either physical or mental reasons, they are unable to make it to the bathroom in time.

Funeral pre-planning

This is the process of planning arrangements for one's body after death. The planning of a funeral can be a complicated and expensive affair so funeral pre-planning is one of the best things a person can do for their family.


The manner in which someone walks.

Gait Belt

A belt placed around a patient's waist to allow the caregiver an easier means to be able to assist the person to transfer or to steady them while walking.

Gall stones

Crystalline bodies formed within the body from normal or abnormal bile components.


Gastro Esophageal Reflux Disease - mucosal damage produced by the abnormal intrusion of gastric liquids into the esophagus


A clinician specializing in the elderly, especially those who are frail and have complex medical and social problems.

Geropsych (or Geropsychiatry)

An outpatient or inpatient hospital program which helps define and treat mental disorders and mental illness such as depression, anxiety, delusions, memory loss, episodic outbursts, etc. Having to do with the mental well-being of older adults.


The act of giving money to other individuals or to charity.


A disease of the optic nerve which involves damage to the nerve and as a result, visual impairment. Can cause blindness.


General Manager

Guardian ad litem

A short-term, court appointed person who oversees either the financial and medical or only one aspect of a frail or mentally incapacitated individual before a permanent Guardianship/Conservatorship can be initiated.


A legally appointed person who has authority to care for the personal and property interests of another individual (called a ward). This term is used interchangeably with the word "Conservatorship" Gout – a form of arthritis, primarily impacting men. Gout occurs when urate crystals accumulate in joints, causing inflammation and intense pain. Uric acid occurs in the body from breaking down purines – a naturally occurring substance made by the body and also found in many food items such as red meads, certain vegetables, seafood and shellfish. Purines are found in many foods.

Grief counseling

Grief counseling is meeting with a professional therapist to work through the effects of losing a person, pet or thing.

H & P

History & Physical


It's estimated that 10% of the population have such sensory experiences. Seeing, hearing, smelling, tasting, touching things that aren't in reality present. A hallucination can also affect balance.

Hands on assistance

Care that requires that a person touch another person

Health care directive (a.k.a. Advance Directives)

Term used to describe legal documents of a Living Will and Power of Attorney.


Implies viral infection and likely injury to the liver - can be self-limiting, healing on its own or progressive. Acute hepatitis is when it lasts less than 6 months, chronic hepatitis is when it persists longer.

  • A = infectious jaundice contracted through contaminated food, treatable
  • B = not common in elderly unless they are getting blood transfusions
  • C = contracted through contact with blood, serious precautions taken when caring for someone with Hep C - particularly if receiving insulin. Not yet treatable, but science is close to resolving
  • Drug-induced and alcohol induced hepatitis is becoming more prevalent in the elderly


Health Insurance Portability Act, enacted in 1996. Requires that a person give written approval before private or health care information may be shared with other people or other agencies.

History & Physical

An annual or time-specific check-up of major organ functions, health status and review of wellness, illness or disease. This check-up results in a written document outlining the status of a person's health and noting any specific areas of concern.


The act of collecting items, typically viewed as a mental disorder as a result of mental instability.


Not able to leave the home, except for doctor or medical appointments.

Homemaker Services (a.k.a. Chore Services)

Household services provided by another such as laundry, light cleaning, meal preparation, shopping and transportation assistance.

Home care

Services provided which are typically hands-on services. These services may be offered in a private home setting, or may be offered by an outside agency within a senior living setting.

Home health care

Services which typically include a higher level of care, monitoring and therapies. This license requires a higher level of documentation, procedures and policies and a higher level of regulation. Visits are typically brief and limited and focused on delivering a treatment or therapy and may include social worker assistance.


Care and services for someone (and their family) who is not expected to live for more than six months and who has an illness or disease which is viewed by medical professionals as "untreatable." Hospice services can be offered in any living setting. Hospice services can be deleted at any time or can be extended for another six-month period of time, contingent on the physician's diagnosis and orders.


Referring to the regulatory phone line for Mandatory Reporters to self-report unwitnessed injuries or to report abuse

Hoyer lift

This is a brand name of a type of lift - there are actually many types of lifts. Proper name is mechanical lift. Device that allows one person to transfer another person, even if the resident is quite heavy.


Fearful of water or taking a shower or bath


A situation created by a lower than normal amount of sugar (glucose) in the blood stream. Patient reaction varies from feeling queasy to coma or even permanent brain damage. Seem frequently in people with diabetes. Can be readily treated by ingesting glucose or foods digestible to become glucose.


Low blood pressure. Older adults frequently pass out and can fall if they stand up and experience a sudden drop in blood pressure.

Home modification

This term refers to the adaptation of a home to be more accessible. Common examples of home modification are walk-in bathtubs, stair climber chairs, and wheelchair ramps.

Home maintenance stress

This term is used to describe the increasing effort to maintain a person's home as they grow older. This is what causes most individuals to move out of their homes is that they simply become too difficult to maintain, or the worry about unexpected costs or repairs becomes overwhelming for an older adult.


an excess of glucose in the bloodstream.


abnormally high blood pressure.


Irritable bowel syndrome (affects 22% of the population) - gas, bloating, indigestion, constipation, diarrhea, flatulence, passage of mucous in the stool, cramping-abdominal pain


Intermediate Care Facility


Intensive Care Unit


Independent living; senior housing type that typically denotes that the resident requires no personal care services.


A stoma (opening) constructed by bringing the end of the small intestine (the ileum) out onto the surface of the skin, where waste passes out and in collected in an external bag.


a distorted sensory perception which is an interpretation of the brain. Not considered mental illness, but rather an incorrect assumption.


Stool that is stuck in the bowel as a result of severe constipation.


The incapacity of an individual to participate in legal proceedings.


Lack of control over bladder or bowel, or lack of recognition of the urge or need to urinate or defecate; or unawareness that urine has flowed out of the body or that a bowel movement has occurred.

Information release

A written document stating whether a person or legal entity has given permission for medical or financial information to be shared with other medical or housing & care professionals.


Inability to sleep

Instrumental Activities of Daily Living (IADLs)

Tasks in addition to activities of daily living, that you are required to be able to perform in order to live independently (that is, without assistance or substantial supervision from another person); bill paying, grocery shopping, laundry, light housekeeping, meal preparation, medication management, using the telephone. Most long-term care insurance policies will not pay benefits for the loss of ability to perform IADLs


Dying without a legal will.

Intravenous therapy

Placing liquid substances directly into a vein. Treatments can be intermittent or constant. If constant, then the term intravenous drip applies.

Irrevocable Trust

A legal document that once established will not come to an end until the terms of the trust have been fulfilled.


Inadequate flow of blood to part of the body caused by constriction or blockage of the blood vessels. This word is also used to describe a lack of oxygen to the tissue.

Joining the journey

A belief and strong movement in the senior housing and care industry to not correct someone with memory loss, but instead be supportive of what the person says – even if it is incorrect or far-fetched.

Kidney stones

Aggregations of dissolved calcium oxalate crystals in the urine which form inside the kidneys or ureters.


Refers to a small area which is typically part of another living space, such as a living or dining area. Likely does not have a stove, but may have burners, a microwave, sink and cupboards.


Behavior of some Alzheimer’s Disease patients, placing clothing on top of clothing or placing undergarments on top of regular clothing; or wearing multiple watches or jewelry.

Level of Care

Every community views levels of care differently. Belief that people fit somewhat into categories of care ranging from being independent to full (also called "heavy care" or "full care")

Lewy Body Dementia

This is an overlapping of Alzheimer's & Parkinson's Disease


Term used to define the type of application and approval required to operate a service or business.


A recorded document which gives public notification that an individual or business has placed a "hold" on assets which may currently not be liquid or available to cover the debt or payment due.

Life support

Mechanical and electric devices intended to keep body functions, nutrition and hydration continuing.


Typically relates to an on-site resident manager or care giver who actually lives in the home.

Living Will

Legal document that outlines medical and treatment preferences

Locked facility

Typically a memory care community that has barriers in place to deter people from leaving the building. (There is no such thing as a fully locked facility due to fire codes)

Long distance care giving

The act of being of support to an older adult when living in a different city, state or country. Assistance is most often offered by phone or via the Internet, but may include the help of a hired case or care manager, other family members or friends of the older adult.

Long Term Care

Services rendered over an extended period of time to someone needing assistance with activities of daily living; types of services are rehabilitation, skilled nursing, and palliative care (hands-on care), inclusive of supervision and a wide array of personal care and social services. Long-term care can be provided at home, in a community, or in various types of facilities, including adult care homes, nursing homes and assisted living facilities. Regardless of where it is provided, most long-term care is custodial care, the type of care that is not paid for by Medicare.

Long Term Care Insurance

An insurance policy that helps pay for a portion of long-term medical and non-medical care, like help with activities of daily living. Generally, Medicare will not pay for long-term care.

Long Term Care Ombudsman/Ombudsperson Programs

Federally-funded programs that are nationwide and run independently of care communities, which provide problem resolution between residents and assisted living facilities, nursing homes and other residential care facilities. Many volunteers help extend this service to our community.


Licensed Practical Nurse (in some states = LVN)


Long term care

LTC Insurance

A policy an individual may purchase to cover fully or partially the cost of care in a care setting, or to cover perhaps in-home care, in the event that assistance with a defined number of Activities of Daily Living or mental impairment exists.

Life care community

This is another type of Continuing Care Retirement Community (CCRC), which requires move-in prior to needing care services, and also requires access to certain amounts of income or assets. These communities operate based on a long-term commitment that ensures care is continued until the end of life.

Light Therapy

This is a method used to treat Seasonal Affective Disorder (SAD). SAD is a type of depression that occurs during winter months or during prolonged periods where the sun isn’t out very much. Light therapy usually involves being exposed to a therapy light that provides the same type of vitamins and benefits the sun provides you.

Look back period

a phrase often related to Medicaid planning or application. Transfers of assets or gifting (giving away) of assets, or certain activities such as adding an adult child’s name to an account is reviewed during a certain period of past months or years. Within the look back period, actions taken could create a period of ineligibility and create a longer waiting period before a new application can be submitted.


Loneliness is the state of not being with or not having access to interactions with other human beings. Also a feeling that you are excluded and distant from the people you care about.

Macular Degeneration

where the inner lining (the macula area of the retina) begins thinning and in some cases, it bleeds.

Managed care

For seniors, there are specific insurance programs which are alternatives to standard Medicare. In lieu of standard Medicare, the participant pays a lower or zero premium to the HMO to receive health care benefits. In return for paying a lower premium, the senior is then enrolled in a specific care program and must see only certain providers. The Insurance Company then makes the decision as to which treatments, procedures and therapies are offered.

Mandatory Reporter

A person working with older adults is considered to be fully responsible for reporting any suspected abuse, neglect, exploitation, violation of resident rights or violation of state codes and laws.


A severe medical condition characterized by extremely elevated mood, energy and unusual thought patterns.

Manic depressive (now called Bi-Polar Disease)

A person who experiences periods of elation and periods of depression.

MCI (Mild cognitive impairment)

Used to describe early stages of any memory impairment. Researchers believe that this is likely an early manifestation of Alzheimer's Disease

Mechanical soft

Food which has been blended or processed to aid in chewing and/or swallowing

Mechanical transfer devise

An electric or non-electric tool used to lift or to move a person who is unable to assist in getting up out of bed or cannot move from one place to another.


Like an insurance program for older adults or for individuals who have end stage renal failure. The person must pay a monthly premium for this benefit.

Medicare Part A

Hospital insurance and insurance for a certain number of days within skilled nursing.

Medicare Part B

Medical insurance which helps pay for some services and products not covered by Medicare Park A. Part B services are generally covered on an outpatient basis.

Medicare Part C

Also called Medicare Advantage Plans. An option given to consumers to purchase health insurance plans in lieu of standard Medicare Part A & B coverage. Some plans may even include Medicare Part D. These are HMO-type plans and are Managed Care plans.

Medicare Part D

Prescription drug plans.

Medicare Replacement

Also known as an "HMO" or Managed Care. A provider who accepts zero premium or a lower premium and then receives a monthly fee from the purveyor managing the Medicare program to provide all care-related and acute care to an individual.

Medicare Supplement

An insurance policy which covers the co-pays or items which may not be covered by standard Medicare. There are numerous types of policies (Plans A through J) which offer varying levels of coverage.


An entitlement program intended for people who require care services and who meet certain financial criteria.

Medically fragile

A person who can become very quickly medically unstable and require frequent trip to the Emergency Room. An individual who is medically fragile typically requires a high level of monitoring.

Medically necessary

that which is reasonable and appropriate based on clinical evidence and testing. Medicare uses this term to define goods and services they will cover for diagnosis or treatment of illness, injury or to cover the improvement of functionality of a body part.


a private health insurance plan available to purchase to cover the "gaps" between what Medicare will and won't cover.

Memory loss

A person may not be able to retain short-term memories such not remember what they said or did a short while ago, even within minutes.

Mental status

May be used to describe either the mental stability (level of calmness versus anxiety) or it may be used to describe an individual's outlook on life. This term is also used to define an individual's mental well-being as it relates to mental disorders or diseases which cause memory loss, delusions, confusion, etc.

MRSA (pronounced "Mersa")

Methicillin-resistant staphylococcus aureus. A bacterium that has developed a resistance to penicillin. Known as a "hospital-associated infection," as it is contracted most frequently while in the hospital or in a nursing home.


Mental Health Professionals. Professionals called in when someone is at risk of harming themselves or other people.

Mini Mental Exam

A series of short questions which allows a health care professional to measure the current mental status of an individual. This exam may be used to compare improvements or decline in a person's cognitive abilities. This is a specific name for a specific type of exam. There are other questionnaire tools that are also utilized to define memory loss.


Masters of Social Work

Multi-infarct dementia (a.k.a. Mini-strokes or TIAs)

Causes approx. 20% of dementia cases - small, almost imperceptible strokes

Multiple loss

A situation where a person has gone through several personal losses; whether they be loss of own mental or physical abilities or losses of friends or family or losses of physical possessions. The current belief is that these losses accrue and have a multiplying effect on an individual, which may lead to depression.


medication administration records – a manual or computerized tracking system for the dispensing and documenting of medications taken or refused by a resident.

Medicaid planning

Medicaid planning is the process of planning for an individual to make use of the Medicaid program. The planning involved usually centers around legal and financial steps that must be taken, or a spend down of assets or gifting to qualify for an entitlement with Medicaid.

Medicare or Medicaid Fraud

the intentional collection of money from government programs illegitimately or in a deceptive manner.


Death of cells and living tissue typically caused from lack of proper care of a wound site


Avoidance of person or avoiding meeting a person's physical or care needs.


A physician specializing in the kidneys.


A physician specializing in the nervous system


Tingling sensation in limbs, thought to be caused by nerve damage. Frequently seen in individuals with Diabetes.

No Code

A legal document stating that a person does not want certain resuscitation methods performed. This form has been replaced by a new form called a POLST form; however, many health care providers still call this a "No code" or "DNR," which stands for Do Not Resuscitate.

Normal Pressure Hydrocephalus

Spinal fluid build-up in the brain


A business or agency which operates with less emphasis on profit. Not-for-profits still may be seeking to build a "reserve," which is really the very same thing as "profit," only the intent is to place this reserve back into the agency or service at a later date in time. (not to be confused with "free" or "government provided entitlement")

Nurse delegation

Act of training and monitoring a paraprofessional to complete a task which has, historically, only been completed by a nurse. Example = inserting eye drops into the eyes of an elderly person.

Nursing Home

A residential facility licensed by the state that provides room, meals, help with ADLs, recreation, and nursing care to the chronically ill or those unable to take care of their own needs; may also be called a Long Term Care Facility. If certified by Medicare, it is also called a Skilled Nursing Facility



Occupational Therapist (a.k.a. OT)

A rehabilitation professional who instructs people on how to compensate and overcome functional limitations that are a result of injury, illness or disability. OT's teach skills and techniques needed to perform activities of daily living and help maximize the person's independence.


A state-paid or volunteer that seeks to protect the rights of residents.


Cancer specialist or surgeon

One step directions

A means for allowing a person with memory loss to be as independent as possible. The caregiver gives one direction at a time to help the patient work through a process such as brushing one's own teeth.

Oriented x3, x2, x1 =

  • X3 = can still do pretty well with time/numbers, knows where they are and other people
  • X2 = not doing well with time and numbers
  • X1 = not doing well with time and number and frequently doesn't know where they are or think they are somewhere else People can also become disassociated with their own selves, which is the final disorientation which occurs in may occur in someone with memory loss.


(a.k.a. Degenerative Arthritis). Low grade inflammation resulting in point in the joints. This pain is caused by wearing of the cartilage which typically acts as a cushion inside joints.


a disease of the bone which reduces the bone mineral density. Bones become more susceptible to fracture.


A stoma, which is an opening which has been surgically created to connect part of the body cavity to the outside environment.


Over the counter, medications not requiring a prescription

Out of Pocket

Amount of money a person must pay before insurance or another provider begins paying all or a portion of an expense.

Obsessive Compulsive Disorder (OCD)

an anxiety disorder that causes people to have unwanted and repeated thoughts, feelings, ideas or sensations (which is the obsessive portion), which create behaviors that cause them to feel driven to do something (compulsion). People often carry out the behavior in order to remove the obsessive thought, yet this may not resolve the anxiety or eliminate the repetitive through, idea or sensation. OCD may be mild to severe and should be discussed with your physician.


a drug derived from opium with morphine-like effects. Used as a sedative or medication to relieve pain.


Osteoporosis is a disease that affects the strength of a person's bones. Osteoporosis affects the way that bones store calcium and other chemicals that promote bone strength.

PACE Program

Program of All-Inclusive Care for the Elderly - provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits


Primarily caused by gallstones or alcohol consumption; although it can also be a side effect of medication. Severe upper abdominal pain radiating through the back. Causes nausea and vomiting.


A fear or anxiety concerning one's own well-being or safety, which is viewed by society as irrational or excessive. (see psychosis)


A person who is non-licensed


an alternative mode of transportation that doesn't follow a fixed route.


a progressive disorder of the nervous system that affect movement.

Participation (as it relates to COPES)

That portion of the applicant's income that must be paid to the housing/care facility from their personal income.

Payer source

defining the person, entity, business or agency responsible for paying an invoice or bill


A stream of money paid out by a company after a person retires

Per Diem

Term used in two ways in our industry. This can mean "daily rate," for instance, a per diem can denote the amount of money an employee can spend on a daily basis for expenses. This term is also used to explain temporary or occasional work a health care worker offers to a provider. For instance, a Social Worker may work "per diem work," which means that he/she is asked to work only when there are patients to serve, and he/she only receives pay based on the exact amount of hours worked.

Period of Ineligibility

A number of days that a person must wait before benefits or an entitlement begins


Common among both Alzheimer’s Disease patients, people with memory loss, as well as stroke victims - the act of repeating words or concepts over and over, retelling the same story

Personal Emergency Response System

Can be either a pendant or a bracelet worn to press to alert others or to initiate two-way communication with a response team; or a computerized system that can monitor movement or falls that is installed on a wall or placed in a room.

Phobias (at least the ones you'll likely hear about as they're prevalent):

  • Fear of going outdoors
  • Fear of elevators
  • Fear of people
  • Fear of dying
  • Fear of choking
  • Fear of heights
  • Fear of cats or dogs
  • Fear of medications
  • Fear of not being close enough to a bathroom
  • Fear of dying
  • Fear of falling
  • Social phobias - the belief that other people are watching them and judging them constantly. In milder cases, people don't want to be seen eating or drinking in front of other people - causes humiliation

Pick's Disease

Progressive, degenerative neurological disease similar to Alzheimer’s Disease.


The act of shredding paper and rolling it into small balls or rubbing or twisting clothing to create small balls. People with memory loss can also practice this behavior by rubbing their skin repeatedly or by rubbing the carpet.


Liquid has entered the lungs


The act of holding food or medications in the cheeks - primarily a behavior from someone who has loss of cognitive abilities - forgetting how to swallow, but can also be a behavior of someone who has failure to thrive; or is paranoid and does not want to swallow medications.


A system used by senior care providers to assess fees for services.


A document available only through a Health Care Professional. This document outlines what revival or hydration methods a person prefers in the end stages of life, or due to an accident, illness or disease.

Presenting illness

What a medical professional views as the primary or most obvious issue(s)

Pressure sores

(aka bed sores) are an injury to the skin and underlying tissue. They can range from mild reddening of the skin to severe tissue damage – and sometimes infection – that extends into muscle and bone. (See Stage 1, 2, 3 or Wounds)

Primary care physician

A doctor who has been asked to oversee the care of an individual

Private duty

Typically means one-on-one care or care in a private home setting or more personalized care from a caregiver to a single person or couple within a retirement or assisted living setting. The term is used for both professionals (Nurses) as well as paraprofessionals (non-licensed individuals)

Private Pay

Capable of paying for services or goods from personal funds


Pharmacological term meaning "as needed"


The process by which an executor (if there is a legal will), or a court-appointed administrator (if the deceased was intestate), manages and distributes property to heirs or beneficiaries


Delaying or putting something off until a later date in time

Protective undergarments

(a.k.a. Depends, which is brand name) Pads or full briefs to catch urine and feces and to draw moisture away from the skin.


Someone who offers lodging and/or care

Provider tax (a.k.a. "bed tax")

An annual state tax which applies to licensed facilities and communities


A short-term memory loss issue that may be easily misdiagnosed and treated as dementia such as: dehydration, UTI, drug interaction


Word used to describe a mental state in which a person loses contact with reality and may not be able to function socially.

  • Hallucinations - sensory perception - can be visual, auditory, olfactory, gustatory, tactile or proprioceptive (sense of balance and position in space)
  • Delusions - a false belief
  • Personality disorders - a form of mental disorder, long-lasting rigid patterns of thought and actions which causes significant distress or impairment to personal, social and occupational situations


Development in and interaction within a social environment. Can also be used to describe the internal processes that occur within an individual.

Psychosocial dysfunction

Lack of development or decline in one's personal belief in oneself, which can present in physical, emotional or cognitive ways

Psychotropic medications (or drug)

A chemical substance which acts primarily upon the central nervous system and alters brain function. Can temporarily change perception, mood, consciousness and even behavior.


Physical Therapy - service intended to develop, maintain or restore maximum movement and functional ability of a person. An additional goal is to minimize or eliminate pain.


Post-traumatic stress disorder – a mental health condition that is triggered by experiencing a stressful event or witnessing an event. People can suffer from PTSD after falling or after having surgery.


Relating to the lungs or breathing.

Pulmonary Hypertension

The human body has two major areas of blood vessels that distribute from, and return blood to, the left and right heart. The portion of the circulation that distributes the blood from the left side of the heart, throughout the body, is referred to as the systemic circulation. The portion of the circulation that distributes the blood from the right side of the heart, to the lungs, is referred to as the pulmonary (lung) circulation. The left ventricle of the heart pumps oxygenated blood from the lungs into the systemic circulation. When a doctor or a nurse measures the blood pressure on a person's arm, he/she is measuring the pressures in the systemic circulation. When these pressures are abnormally high, the person is diagnosed as having high blood pressure (hypertension). The right ventricle pumps venous blood returning from the body into the arteries of the lungs to receive oxygen. The pressures in the lung arteries (pulmonary arteries) are normally significantly lower than the pressures in the systemic circulation. When pressure in the pulmonary circulation becomes abnormally elevated, it is referred to as pulmonary hypertension.

Palliative care

an approach intended to improve the quality of life to patients and their families who are faced with a life-threatening illness

Period of ineligibility

a phrase often heard in Medicaid planning or in the process of applying for Medicaid. Medicaid laws are complex, and many financial and legal professionals in our community give incorrect or misleading information. Certain look-back dates (reviewing past actions taken with personal finances) can create a period of ineligibility, which means that the older adult does not qualify for state assistance because of an action that was taken that disqualifies them for a period of time from receiving an entitlement. Contact an Elder Law Attorney or speak directly with state representatives who help with Medicaid application and qualifications.

Purpose in life

belief that older adults are more content if they have an impact on other people or if they are creating something.

Quality of Life

Belief that a person should enjoy their surrounding and should find joy or peace in life, free of pain and anxiety. Many people believe that this quality of life also includes having a connection to other people.


Residential Care Facility


Revised Code of Washington

Reasonable accommodation

Modifications to a living unit which allow someone with disabilities to function independently or as independently as possible

Refused or Refusal

A belief protected by law that an older adult may opt to not take medication, accept a treatment, eat food, take water, or refuse services such as bathing, getting dressed, etc. (Highly protected by the Residents Rights but is in direct conflict with the regulations of senior care communities.


Regulations - meaning federal, state and city laws as well as employment law, building and fire codes.


Word used to describe someone recuperating and likely getting some type of therapy to become more independent. This term is also used to describe the process of stopping the misuse or abuse of prescription or recreational drugs or alcohol.

Reimbursement rate

Amount covered or repaid to someone or to an agency or business based on a specific formula


Taking time to talk about the past or to talk about things that have happened in a person's life

Renal failure

Condition in which the kidneys fail to function properly.


Having and holding something against somebody

Residential Care Facility

A generic term for a housing facility that provides care services to its residents; examples are group homes, specialized apartment complexes or other institutions. The term can be used to refer to a wide range of residential care options including assisted living facilities and skilled nursing facilities.

Resident Rights

A document intended to give protection to older or vulnerable adults

Respiratory therapy

Assistance with breathing or relearning to breathe, or expanding the capacity of a person to take in oxygen

Respite (a.k.a. Respite Care)

Short-term stay, ranging from a couple of days to likely no more than thirty days.

Restaurant style dining

Food service where a wait person comes to the table and takes an order and brings the food to the table. The server also picks up the dishes when a person is finished eating.


Items place around or on a person to decrease the ability of the person to move or to stand up

Reverse Mortgage

A loan available to people age 62+ used to access equity in a home. Can be taken in a lump sum or in multiple payments. The obligation to repay the loan is deferred until the owner dies or the property is sold.

Revocable Living Trust

Creation of a fictitious entity which then owns assets.

Rheumatoid Arthritis

Considered to be chronic, this is an inflammatory autoimmune disorder which causes the body to attack the joints. Disabling and painful due to joint destruction.


Registered Investment Advisor, a type of licensure that allows an individual to charge a fee to give financial advice.


An additional statement placed within or at the end of an insurance document which either gives clarity or perhaps an additional benefit to the insured person


Registered Nurse

Role Reversal

The act of an adult child becoming the parent's support system.


Sequential inpatient stays in a hospital or nursing home during a specified time that is separated by a period of moving elsewhere and then needing to return to the hospital or nursing home for the same issue.

Redirecting or redirection

the act of engaging a senior in a subject that is different than what they are focusing upon. The action is intended to reduce agitation or worry present within an older adult. Redirecting may include asking a non-related question or making a suggestion to do something else.

Residency agreement

a rental agreement / lease for move-in to a senior living or senior care community such as an assisted living community or adult family home.

Right to die

the right to refuse extraordinary measures to prolong someone’s life when they are terminally ill or comatose.

Sandwich generation

A person who is in a situation where they are providing help or support to one or more parents and is also caring for one or more children


A psychiatric diagnosis describing a mental disorder. Characterized by impairment of perception or reality with significant social dysfunction.


A motorized wheelchair that looks more like a motorcycle than a chair

Septic (or Sepsis)

Extremely common cause of death in the elderly. Symptoms of sepsis are often related to an infection. The immunological response that causes sepsis is a systemic inflammatory response in the body, causing coagulation of pathways. This causes dysfunction of the circulatory system, organ dysfunction and eventually death.

Senior Center

Community-based programs providing an array of services like social activities, nutrition, and educational and recreational opportunities for older adults.

Sensory Loss (a.k.a. Dissociated Sensory Loss)

A pattern of neurological damage caused by a lesion to a tract of the spinal cord which causes loss of touching sensations, such as feeling heat and cold or sensing pain. It can also lead to vision or hearing loss or loss or inability to sense odors or taste foods.

Sexually inappropriate

A person who touches himself/herself in public, exposes him/herself or says things which are considered to be something a person should not say to someone they don't know intimately. May also denote actions a person takes outwardly, attempting to touch or make sexual advances towards another person


Herpes zoster (which also causes chicken pox). Painful blisters prevalent in people age 50+. Early symptoms include headache, sensitivity to light and flu-like symptoms without fever; may involve itching, tingling or extreme pain in the area of the rash. Not contagious, except when in the blister-phase. Once the rash develops crusting, the disease is no longer contagious. A vaccine exists to reduce the likelihood of an outbreak of shingles.

Sibling rivalry

Two or more children (likely adult children) act in a way that is unsupportive and competitive in nature. When two people disagree strongly and have a history of not getting along, decisions and actions are typically not made in a favorable light, or decisions are delayed - possibly at a cost to the older adult.

Skilled Care

Daily nursing and rehabilitative care that can only be performed by skilled medical personnel or under the supervision of skilled medical personnel. This type of care is typically needed 24 hours a day, requires a physician’s order, and must follow a specified care plan. This type of care is usually rendered in a skilled nursing facility but may also be received in other types of facilities.

Skin integrity

Term used to describe the condition of the skin - is it dry, is skin hanging from the muscle, are there sores or wounds?

Sleep Apnea

Pauses in breathing during sleep. The phrase means "without breath." Can cause blood oxygen desaturation as well as neurological arousal (waking up abruptly).


Skilled Nursing Facility (a.k.a. Nursing Home, Transitional Care, Rehab, Nursing Care)

Social Security

A program for individuals age 62+ (or disabled) to draw money from funds they have placed in the Government's care during their working years

Social Worker

A profession devoted to helping people function the best they can in their environment.


Interacting with other individuals

Speech therapy

profession of assisting with diagnosis and rehabilitation of communication, swallowing.

Spend down

A period of time that a person is using their money to pay for services or goods before they qualify for entitlement through Medicaid


To bring to a point where there is little or no change

Stage 1, 2 or 3 wounds

Describing pressure sores (See Pressure Sores)

  • Stage 1 – Sores are not open wounds; skin may be painful but there are no breaks or tears. There may be redness, or impacted area may be hot to the touch.
  • Stage 2 – Skin breaks open, wears away or forms an ulcer, which is usually tender and painful. The sore expands into deeper layers of the skin. It can look like an abrasion, blister or shallow crater
  • Stage 3 – Sore extends into the tissue beneath the skin, forming a small crater. Fat may show in the sore but not muscle, tendon or bone
  • Stage 4 – The pressure sore is very deep, reaching into muscle and bone and causing extensive damage. Could be causing damage to deeper tissues, tendons and joints.

Stages of cancer

The term ‘stage of cancer’ means the stage the cancer was at when it was first diagnosed. The stage is very important as it is a critical factor in deciding the best way to treat the cancer.

  • Stage 0: ‘in situ’ – Cancer in the position where it started
  • Stage 1: localized cancer – Cancer cells pass through the boundary to the tissue in which it started. This invasion is a serious step because in indicates that the growing cancer cells may threaten life
  • Stages 2 and 3: regional spread – Commonly, at this point, a daughter cell invades through the lymph system which in turn gives the cancer the ability to spread in the local region
  • Stage 4: distant spread – Once in the lymph system, the cancer may spread further to other more distant lymph nodes or into the blood stream thus spreading to other areas of the body.

Stand-by assist

A person is present to monitor when a resident is standing up or transferring, but likely does not touch the person unless they become unsteady.

Stasis dermatitis

Persons who have poor circulation can have fluids which accumulate in the limbs, which causes swelling.

Stasis Ulcer

(a.k.a. bedsores)


medical term meaning "immediately."

Stress incontinence

because of a weakening of pelvic floor muscle, small amounts of urine can be released from coughing, laughing, sneezing, exercising or moving.


rapid loss of part of the brain function due to interruption in the blood supply to the brain

Stutter steps

a symptom of a neurological disorder which causes shuffling or poor balance due to varied and random size of steps.

Sun downing

Agitation which occurs in people with dementia in the evening or early evening.

Survey (as it relates to quality assurance or obtaining opinions)

A written instrument to collect feedback from participants or customers, or to solicit feedback from potential customers; Most frequently used when a business or agency wishes to understand consumer preferences or to determine satisfaction with a product or service.

Survey (as it relates to a senior care community)

An annual or recurring visit from regulatory agencies to determine if a community is following state laws, their own procedures and policies and is also supporting residents' rights. Survey also includes safety measurements such as review of evacuation plans, drills, food handler permits, etc.

Supplement (as it relates to Medicaid)

A fee paid privately above and beyond what the resident (participation) and the state (Medicaid) pay the provider for care. Such a fee must be for something which is not covered already by Medicaid, or it is considered then Medicaid Fraud.

Support group

Three or more people who meet together to talk or give mutual support to one another. There may be a group leader, who is most often referred to as the Facilitator or Support Group Leader.

Swallowing difficulties

An effect some diseases or a stroke can have on a person in regards to being able to ingest liquids or solid foods.

Systemic disease

One that affects a number of organs in the body as a whole

Tax deduction

(not to be confused with a tax credit) - an expense incurred by a taxpayer that is subtracted from gross income and results in a lowering of taxable income

Tax deferred

Tax has to be paid at a later date

Tax exempt

Free of tax

Tax favored

A financial instrument which gives a financial tax benefit to the issuer or the holder of the instrument. For instance, in retirement living, some communities are built with tax-favored bonds. The community must offer back something specific to the community in order to receive this tax-favored benefit - for instance, a community may be required to offer a certain number of living units to individuals who fall within lower income brackets.

Tax qualified

A term used to describe retirement-type investments which grow tax free, until such time that the funds are accessed.

Tax sheltered

A financial term which indicates that tax is not being assessed on an annual basis; however, when funds are taken out, they are taxed


Traumatic brain injury; may be from a work-related, auto accident or other unfortunate event which causes injury to the brain. Individuals with TBI may appear to have memory loss, may behave in the way a child would, and may be uninhibited by other people or themselves, thereby causing themselves to be at risk.

TCU (Transitional Care Unit)

Intended to be a short-term transition location for a patient within an acute care setting (hospital). An area of the hospital which is focused on therapy and treatments rather than emergency care.

TDD (a.k.a. TDDY)

Assistive phone device for people who are deaf or are hard of hearing. The device transfers speech into written words. The device also allows the person to type on a keyboard and an electronic voice sends out a reply from the person using the device

Ted hose

Supportive foot coverings which are extremely tight, intended to reduce edema (collection of water in the limbs) and to assist in reducing pain experienced in the legs

Telephone reassurance

A telephone call to check in on someone to be certain that they are doing well, and to offer a form of socialization for people who are homebound or have difficult with mobility.


A disease or illness which cannot be treated to return a person to wellness


Dying with a legally valid will or trust document in place.


Substance placed into liquids to help individuals who easily aspirate (choke) on thin liquids


frequently called simply an "embolism" or blood clot




Ringing in the ears

Toileting program

A schedule intended to be of help to an individual who is incontinent. By taking an individual or by reminding an individual to visit the bathroom every two hours or on a specific routine, it is possible to manage incontinence more effectively


Nutrition given through the nose

Transfer assist

Help getting from one place to another; whether it be from a bed to a chair, from one chair to another chair; from a wheelchair to a commode, etc. Transfer assistance is provided to people who have difficulty standing on their own, or who may easily pass out when standing up on their own. It is also provided to people who have compromised circulation or diseases which affect the muscles.

Transfer pole

A beam from floor to ceiling placed next to a bed or chair. This is an assistive device which allows a person to self-transfer (for instance, get out of bed on their own by using their arms rather than their legs)

Transition Period

The time it takes for a person to become accustomed to their new living environment and begin to develop new routines of familiarity

Transitional Care

This phrase is typically used for skilled nursing care which is intended to be short-term and rehabilitative in nature. This care may be offered in a section of an acute setting (hospital); or within a skilled nursing facility. The patient is most often recuperating from surgery, illness or episode of a disease. The intent is to be discharged from this care setting within a few days or possibly up to several months


An assistive device used by a person who needs to hold on to something in order to sit up in bed or to be able to elevate oneself

Trial period

A testing time to determine if something is going to work out


A legal document which places real, and perhaps personal, property in the name of a "non-existing" entity. For instance: The Trust of Mrs. James Smith. All property is still controlled by the person named in the trust document; however, the real and personal property are not owned in the actual name of Mrs. James Smith, but rather in the name of "The Trust of Mrs. James Smith."


a process by which some human beings redirect the feelings or emotions they had for someone to another person such as to a therapist or caregiver.


an involuntary quivering movement of muscles, ligaments and nerves

Urge Incontinence

involuntary loss of urine without feeling the need to urinate


A physician specializing in the bladder


A stoma, which is an artificial opening into the urinary system.


Urinary tract infection (many people misspell this as "track") A bacterial infection that affects any part of the urinary tract. Most common type of bladder infection is called cystitis (an inflammation of the urinary bladder)

Utilization review

A process of looking at how certain medical services are requested and performed. This term is used to define how medical professionals are effectively using resources to resolve problems or to take preventative measures.

Universal design

Refers to the design of an object, service, or environment to be usuable by everyone. This term is usually used to describe things designed for those with disabilites to be able to use them.

VA Benefit (a.k.a. Aid & Attendance)

An entitlement program provided to individuals (and/or to their spous) who have served in the US military at least one day during active duty time. This program is intended for individuals who require care services in a care setting.

Vascular Dementia (a.k.a. Multi-infarct dementia)

written as VD; refers to a group of syndromes caused by different mechanisms all resulting in lesions on the brain.


The act of confirming. When speaking with someone with memory loss, it is often more helpful to agree with the person that something did or did not occur, or that whatever they’re speaking about is acknowledged by you. This is the opposite of trying to convince someone they are wrong, which can create increased agitation in someone with memory loss.


An electrical device which assists a person to breathe

Viatical Settlement

A cash payout on a life insurance policy before a person dies


Blood pressure and pulse


To urinate


This is a brand name of an alarm system designed to alert care givers when a person has crossed a path or opened a door or window


People who are confused walk about, not knowing what they are doing or what they are seeking

Well spouse

The person who does not require care, and is likely remaining in the home

Weight change

A weight change is a change in a person's body weight. This change can be gaining or losing weight and whether the loss or gain is positive depends on a person's unique conditions. Weight is monitored frequently to determine if the body may be retaining water or if there is weight gain or loss from too high of or too little food intake.

Word salad

an unintelligible mixture of seemingly random words and phrases. This is a form of speech pattern is seen in patients with dementia or occurs within many older adults who suffer from strokes or other neurological issues.

Adult Care Homes (a.k.a. AFH, Board & Care, Adult Foster Care)

The owner of an Adult Care Home chooses what level of care s/he provides: assisted-living type services, dementia care or even skilled-type care. The State issues licenses to such homes that provide care for two or more individuals in a private home setting.

There are thousands of Adult Care Homes located in neighborhoods throughout the west coast. Each home varies in the types of care offered, the physical layout of the home and the services extended to residents. Some homes are operated by nurses or medical professionals. Such homes often serve as an alternative to skilled nursing care. Other homes are operated by caregivers who can support an older adult with their activities of daily living.

Adult Care Homes offer an individualized approach to meeting a person's unique needs. These homes care for the physically frail and for people with cognitive impairments such as dementia and Alzheimer's Disease.

Adult Care Home providers establish their own policies for admitting residents who pay privately for services, are receiving benefits from long-term care insurance or that are receiving funding from the state through Medicaid/COPES.

Adult Communities

Adult Communities are age-restricted housing developments. They may consist of single-family dwellings, condominiums, mobile homes or apartments.

Adult Communities are characterized as active environments, often offering some type of community activities or interaction with neighbors.

Quite often Adult Communities do not provide care services. Individuals may arrange to obtain in-home or other types of care to continue living independently within such communities. A requirement of an Adult Community may be that a resident be capable of managing his/her own affairs.

All Adult Communities require that you pay privately for services.

Affordable and Low or Lower Income Senior Housing

The CHOICE web site has limited information about Subsidized housing for older adults.

The best source of information for low-income senior housing, section 8 housing, HUD Housing. Contact the Housing Authority in your area by calling Senior Information and Assistance in the county where you wish to reside.

Alzheimer's & Dementia Care

Care for individuals with memory impairments and memory loss is provided by specific Assisted Living communities, many Adult Care Homes, and within some specialty areas of skilled nursing facilities. In-home care, Home health, Chore and Companion services also support people with memory loss to remain in their own homes by providing care for a certain number of hours or by providing 24-hour live-in care.

The factors one must consider when choosing a memory care community or care option are complex.

You can call upon CHOICE Advisory Services, Inc. to assist you free-of-charge in determining the options that best meets your needs.

Call us at: 1-800-361-0138

Assisted Living

These communities vary widely, and it is important to determine, in writing, what services are provided by a specific community. The term "Assisted Living" is not a well-defined term and it may change, based on the regulations and interpretations of the management and/or nursing staff providing care to an individual.

Consumers should not equate Assisted Living with "one-on-one care." Assisted Living subscribes to the concept that one or more care givers can provide support services to multiple residents. Frequently you will find that there are levels of supervision and management to ensure that care is being delivered in a consistent and safe manner.

Communities offering "Assisted Living" have acquired a Boarding Home license with the State of Washington. The care community may license only certain apartments or rooms, or they may choose to license their entire building as a Boarding Home. This license allows certain staff members to provide certain personal care services for an individual. These tasks are typically non-medical in nature such as assisting residents with activities of daily living (bathing, dressing toileting, medication reminders or management, and assistance to meals and activities.

Some Assisted Living communities offer much higher levels of care and provide support regarding transfer assistance (getting up out of a chair), or assistance with walking, using the bathroom, and incontinence care. Some communities have nurses supervising the care, overseeing the resident care or actually providing nursing services. Many Assisted Living communities have contracted with outside health care professionals to provide more extensive, nursing-type services and health care related support such as therapies and treatments.

Assisted Living is also a term used to define a special type of Assisted Living for individuals with memory loss, dementia or Alzheimer's Disease. You may find that such a community specializes in care for people by offering a more secure environment as well as activities and services that are designed for people with cognitive impairments.

The majority of Assisted Living services are provided to individuals who either pay privately for care or that have long-term care insurance with specific provisions for Assisted Living. A limited number of apartments are available for individuals receiving state assistance through Medicaid / Medical or COPES.


There are hundreds of apartment homes available in most every part of the west coast. Very few communities are age-restrictive. Those apartments that cater to older adults are listed on our web site. You may also consider picking up a For Rent magazine at the entry way of your local supermarket. This annual publication lists most all apartment rental homes. Local newspapers and websites also list rental options of apartments and condominium homes.

Continuing Care Retirement Communities (CCRC)

These communities offer levels of independence and care within one building or campus. The advantage is that as your needs change, you can still live within the same community. Some CCRCs require an entrance fee. Some may also offer a month-to-month payment plan. In our area, continuing care communities mirror your living choices, from large buildings in the heart of the downtown area, to suburban campuses.

Some CCRC's only allow admission to retirement living apartments and reserve their Assisted Living and/or Skilled Nursing services for their current apartment residents. Other communities may open their services for direct admission to their higher levels of care for short term or even long term stays.

Almost all CCRC's require that you pay privately for services. Various skilled services may be covered by Medicare. The community may have specific guidelines for the acceptance of Medicaid / Medical.

Skilled Nursing Facilities

(Also known as Nursing Homes, sometimes as Transitional Care Units or Rehabilitation Facilities)

These communities offer the highest level of care in a non-acute care setting. Skilled nurses are available to provide health care to physically or cognitively impaired individuals. Care in a nursing home may be for a short-term recovery basis or for long-term care.

Transitional Care Units and Rehabilitation Facilities focus on therapies and treatments to allow an individual to return home or to a more independent lifestyle. The professional support team may include nurses, doctors, physical-, occupational- or speech-therapists and social services staff.

Nursing Homes accept private payment as well as payment from long-term care insurance. It is likely that these facilities have also contracted with Medicare or the state to provide housing and care under certain guidelines and for specific purposes. Additionally, many Nursing Homes accept state funding through Medicaid.

Medicaid & COPES

The Federal Government has developed programs for older adults who require care services and who qualify financially for services.

The processes of applying for state assistance requires knowledge of the laws regarding Medicaid / Medical, an understanding of the application process and an awareness of the assessment process. You are best served by consulting our Articles of Interest section to educate yourself regarding the options available to you.

Retirement Living or Independent Living

Many communities offer arrangements that allow for living on one's own but within the framework of a senior community. The actual, physical housing might be an apartment, condo, cottage or town home. These communities may offer support services. They often include one or more meals, housekeeping services and other support such as activities and transportation.

Some Retirement Living communities require either a deposit or a move-in fee. Most options are offered on a monthly-rental basis; however, various types of Retirement Living are becoming available in our area.

Some Retirement Communities have licensed part of their community for Assisted Living services (this requires a license). Yet others have contracted with in-home care agencies, nurses, therapists and physicians to provide on-site services.

Retirement Living communities allow the option of hiring private-duty caregivers to provide support services. Retirement Communities must comply with certain state laws to ensure the safety and well being of their residents and to also ensure that they are not providing care services that would otherwise require specific licensure.

The benefit of this living arrangement is that it negates maintenance of a home, and eliminates many chores that residents may no longer care to do, such as cooking or driving. Management staff generally keeps a watchful eye over residents. There may be 24-hour staffing or building security.

Opportunities for social interaction with peers and staff abound. You may still live on your own, but you are not living alone as you may be if you were living in a single family dwelling.

Retirement Living requires that you pay privately for services. A few communities offer reduced rates based on income level.