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A
Accredited VA claims agent. A VA-recognized representative (like a Veterans Service Organization) who can help file a claim, at no cost for an initial claim.
Activity baseline deviation. A monitoring system’s flag that a person’s behavior has departed from their learned normal daily pattern.
ADA (Americans with Disabilities Act). A federal law that sets accessibility standards for public buildings; its dimensions serve as the reference standard good contractors build to for home modifications.
Adult day program. Daytime care at a center, in a social model (supervision and engagement) or a medical model (nursing and therapy on site).
Adult Protective Services (APS). The public agency that investigates abuse, neglect, and exploitation of vulnerable adults and connects victims to services.
Aging in place. Staying safely in one’s own home while growing older, instead of moving to a care facility.
Aging Life Care Professional (ALCP). A trained professional (often a nurse or social worker) you hire to assess needs and coordinate care; also called a geriatric care manager.
Aid and Attendance pension. An enhanced VA pension for qualifying wartime veterans and surviving spouses who need help with daily activities or are housebound.
Anti-scald valve. A plumbing device that caps hot-water temperature, commonly near 120 degrees Fahrenheit, to prevent burns.
Area Agency on Aging. A local public agency that coordinates services for older adults, including home safety assessments and, in many areas, home modification grants.
C
CARE Act. The Caregiver Advise, Record, Enable Act; a state law requiring hospitals to record a designated caregiver and give discharge instructions. Adoption varies by state.
Care plan. A working document stating a person’s needs, the services to meet them, who is responsible, and how progress is checked; revised as things change.
Caregiver burnout. A serious, measurable state of physical and emotional exhaustion from sustained caregiving stress; also a patient-safety issue.
Caregiver Child Exemption. A rule letting a parent transfer the home without penalty to an adult child who lived there and provided care that delayed nursing home placement.
CCRC contract type (A/B/C). The three continuing care retirement community models: A (life care), B (modified), and C (fee-for-service), differing in entry fee and included care.
Certified Aging-in-Place Specialist (CAPS). A contractor or designer trained specifically in home modifications that support aging and disability.
Community Spouse Resource Allowance (CSRA). The share of a couple’s countable assets the at-home spouse may keep under spousal impoverishment rules.
Countable asset. A resource Medicaid expects a person to use for their own care before it pays; cash, most accounts, and investments.
D
Data retention policy. A vendor’s stated rules for how long it keeps monitoring data and whether it shares or sells it.
DCOF (Dynamic Coefficient of Friction). A lab-measured number for how slip-resistant a floor is when wet; 0.42 or higher is the target for interior wet floors.
Detailed Notice of Discharge. The written explanation of the reasons for a discharge that a patient is entitled to when appealing a Medicare coverage-ending decision.
Durable Medical Equipment (DME) fraud. Schemes that bill Medicare for medical equipment that was unneeded, never delivered, or obtained by soliciting a Medicare number.
Durable power of attorney. A legal document naming an agent to act on someone’s behalf that stays valid if the person becomes incapacitated; this book covers using it, not drafting it.
E
Elder Justice Act. A federal law supporting elder-abuse prevention and the state programs, including Adult Protective Services, that carry it out.
Exempt asset. A resource a Medicaid applicant may keep and still qualify, such as the primary home up to an equity limit, one vehicle, and personal belongings.
Expedited appeal. A faster-than-usual review used when the stakes are immediate, such as an observation classification or a discharge decision.
Expedited discharge appeal. A fast appeal through the Quality Improvement Organization that can keep Medicare coverage in place while a discharge decision is reviewed.
F
Face-to-face requirement. A Medicare home health rule requiring a physician encounter related to the reason for care before services are certified.
Fiduciary duty. The legal and ethical obligation of anyone handling another’s money to act in that person’s interest, keep funds separate, and keep records.
Five-year look-back. Medicaid’s review of roughly the previous 60 months of finances for gifts or below-value transfers made to qualify.
Foot-candle. A unit of light level used to judge whether a room is bright enough; older eyes need considerably more light than younger ones.
G
Grab-bar load rating. The weight a grab bar is built and mounted to hold; a safe bar is rated to at least 250 pounds and anchored into structure.
Guardianship. A court process that appoints someone to make decisions for a person found legally incapacitated; a costly last resort that removes rights.
H
HCBS waiver. A Medicaid Home and Community-Based Services program that can fund home modifications and in-home care; this book covers it in Chapter 5.
Healthcare proxy. A document naming an agent to make medical decisions when the person cannot; also called a healthcare power of attorney.
HHS OIG (Office of Inspector General). The federal watchdog whose hotline receives reports of suspected Medicare and health-care fraud.
HIPAA authorization. A form a patient signs allowing providers to share medical information with a named caregiver or care manager.
Homebound status. A Medicare home health condition: leaving home requires a considerable and taxing effort, though occasional trips are allowed.
Household employer. A person who pays a caregiver directly to work in their home and so takes on payroll-tax and related responsibilities.
I
Institutional refusal documentation. A dated, written statement from an institution refusing to honor a legal document, naming who refused and why; key evidence for escalation.
IRF (Inpatient Rehabilitation Facility). A post-acute setting providing intensive daily therapy for a person who can tolerate and benefit from it.
L
Lidar spatial mapping. Monitoring that builds a 3D map of a room and flags a fall posture, without a recognizable image.
Long-term care insurance elimination period. A waiting period, measured in days like a deductible, during which the family pays before policy benefits begin.
Long-Term Care Ombudsman. A public advocate for residents of nursing homes and assisted living facilities who helps resolve disputes; also central to Chapter 7.
LTC Partnership Program. A state-insurer program under which a qualifying long-term care policy protects an equal amount of assets from Medicaid, in participating states.
M
Mandatory reporter. A person whom state law requires to report suspected abuse of a vulnerable adult; other people may report voluntarily.
MAPR (Maximum Annual Pension Rate). The VA’s maximum yearly pension figure, adjusted annually; its monthly value is the divisor used to figure a VA transfer penalty.
Medicare Summary Notice (MSN). The periodic statement of claims billed to Medicare in your name; not a bill, but a receipt to check line by line for fraud.
Medication reconciliation. Comparing what a person took before, in the hospital, and after, and resolving every difference to prevent medication errors at a care transition.
Millimeter-wave radar (mmWave). A wall-mounted radar (often 60 GHz) that senses movement, and even breathing, without producing an image.
MOON (Medicare Outpatient Observation Notice). A written notice, generally due within 36 hours, telling a patient they are an outpatient under observation and what it means for coverage.
N
NAELA (National Academy of Elder Law Attorneys). A professional association whose directory helps you find attorneys who focus on elder law.
Nursing Home Reform Act (OBRA 1987). The federal law guaranteeing nursing home residents rights, including care-plan participation and freedom from abuse and improper discharge.
O
Observation status. A hospital billing category in which a patient is treated as an outpatient; observation days do not count toward Medicare’s three-midnight rule.
OCC (Office of the Comptroller of the Currency). The federal regulator of national banks, whose guidance discourages the reflexive rejection of valid powers of attorney.
P
Passive infrared sensor (PIR). A motion sensor that detects body heat moving through a space; an older, simpler basis for monitoring. PCAFC (Program of Comprehensive Assistance for Family Caregivers). A VA program providing support, and in some cases a stipend, to eligible family caregivers of veterans.
Penalty period (divisor method). A stretch of Medicaid ineligibility from a disqualifying transfer, figured by dividing the amount by the state’s monthly cost-of-care divisor.
PERS (Personal Emergency Response System). A wearable help button (pendant or wristband) that summons help when pressed; effective only if actually worn.
Phantom billing. Charging Medicare for a service or item that was never actually provided.
Q
QIO (Quality Improvement Organization). An independent body that conducts expedited reviews of Medicare disputes such as observation status and discharge decisions.
Qualified Income Trust. A Miller Trust; a trust that receives income above a state’s cap so an applicant can qualify while the income still goes to care.
R
Reach-range mapping. Arranging a room so everyday items sit in the band a seated or unsteady person can reach without bending low or reaching high, roughly 15 to 48 inches above the floor.
Remote patient monitoring (RPM). Clinical-grade monitoring directed by a physician and connected to a care team, a step beyond consumer devices.
Respite care. Temporary care that gives a family caregiver relief; covered in depth in Chapter 10.
S
Senior Medicare Patrol (SMP). A program that helps Medicare beneficiaries prevent, detect, and report fraud.
SHIP (State Health Insurance Assistance Program). A program offering free, unbiased Medicare counseling, including help understanding statements and spotting fraud.
SNF (Skilled Nursing Facility). A post-acute setting providing nursing and daily therapy at a moderate pace for recovery needing skilled but not hospital-level care.
Spend-down. Legally reducing countable assets to the limit by using money on the person’s own behalf, never by gifting it to family.
Staffing hours per resident day. The hands-on nursing and aide time each resident receives daily; the single most predictive measure of nursing home quality.
Stairlift. A powered seat that carries a person up and down a staircase along a fixed track.
T
Three-midnight rule. Medicare’s general requirement of a hospital inpatient stay across at least three midnights before it covers skilled nursing rehab.
Threshold. The raised strip where two floor surfaces meet in a doorway; even a small lip can catch a foot or a wheel.
Transfer bench. A bench that spans a tub wall with legs inside and outside, so a person sits on the dry side and slides across instead of stepping over the wall.
U
Universal design. Designing a home so it works for a body across a wide range of ability, without special adaptation.
Upcoding. Billing Medicare for a more complex or expensive service than the one actually provided.
V
VA look-back penalty period. Months during which the Aid and Attendance pension is withheld because assets were transferred within the 36 months before applying.
Z
Zero-threshold entry. A doorway or entrance with no raised lip or step, so a walker or wheelchair rolls straight through.
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