Lost in Translation?
Medical terminology can be confusing and lead to misunderstanding and lack of access to correct resources. Here are some common terms you may encounter in your caregiver journey, with definitions for clarity.
Durable Medical Equipment (DME): Equipment and supplies ordered by a health care provider for everyday or extended use. DME may include oxygen equipment, wheelchairs, and crutches.
Emergency Medical Condition: An illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to your health if you didn’t get medical attention right away. You could reasonably expect that your health would be put in serious danger; or you would have serious damage to any part or organ of your body.
Emergency Medical Transportation: Ambulance services for an emergency medical condition. Types of emergency medical transportation may include transportation by air, land, or sea. Your insurance may not cover all types of emergency medical transportation or may pay less for certain types.
Home Health Care: Health care services and supplies you get in your home under your doctor’s orders. Services may be provided by nurses, therapists, social workers, or other licensed health care providers. Home health care usually doesn't include help with non-medical tasks, such as cooking, cleaning, or driving.
Hospice Services: Services to provide comfort and support for persons and their families with a life altering illness or in the last stages of a terminal illness. Hospice care can be started and stopped, and more aggressive treatment resumed. Hospice care can be provided in the home or in a facility setting.
Hospitalization: Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. Some insurers may consider an overnight stay for observation as outpatient care instead of inpatient care.
Hospital Outpatient Care: Care in a hospital that usually doesn’t require an overnight stay.
Preventive Care (Preventive Service): Routine health care, including screenings, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems.
Primary Care Physician: Also known as a General Practitioner (GP) or by the acronym PCP, A physician, including an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine), who provides or coordinates a range of health care services for you.
Primary Care Provider: This could be a physician or other trained medical staff, including a nurse practitioner, clinical nurse specialist, or physician assistant, who provides or coordinates care services.
Provider: An individual or facility that provides health care services. Some examples of a provider include a doctor, nurse, chiropractor, physician assistant, hospital, surgical center, skilled nursing facility, and rehabilitation center.
Referral: A written order from your primary care provider for you to see a specialist or get certain health care services. In many health maintenance organizations (HMOs), you need to get a referral before you can get health care services from anyone except your primary care provider. If you don’t get a referral first, the insurance may not pay for the services.
Rehabilitation Services: Health care services that help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt, or disabled. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.
Acute Inpatient Rehabilitation: Inpatient rehabilitation facilities (IRFs) are hospitals, or part of a hospital, that provide intensive rehabilitation services using an interdisciplinary team approach. Admission to an IRF is appropriate for patients with complex nursing, medical management, and rehabilitative needs. Acute rehab is intense rehab for patients who have experienced a major medical trauma and need serious efforts to aid in recovery. Some patients may have had a stroke, just come out of major surgery, had an amputation, or may still be dealing with a serious illness.
Skilled Nursing Care: Services performed or supervised by licensed nurses in your home or in a nursing home. Skilled nursing care is not the same as “skilled care services”, which are services performed by therapists or technicians (rather than licensed nurses) in your home or in a nursing home.
Urgent Care: Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
Terminology related to care provided in facility or other settings
Sometimes an older person can no longer live safely or comfortably in their own home. Some may need more help than a family member or friend can provide. They might move to a residential (live-in) facility, such as a nursing home, an assisted living facility, or a continuing care retirement community.
Residential facility: can provide some or all the long-term care services an older person needs. Some facilities offer only housing and housekeeping, but many also provide personal care, social and recreational activities, meals, and medical services. Some facilities offer special programs for people with Alzheimer’s disease and other types of dementia.
Nursing Home/Skilled Nursing Facility: Nursing homes, also called skilled nursing facilities, provide a wide range of health and personal care services. Their services focus more on medical care than most assisted living facilities.
Skilled nursing care is provided by trained registered nurses in a medical setting under a doctor’s supervision. It’s basically the same level of nursing care you get in the hospital. Patients may go from the hospital to a skilled nursing facility to continue recovering after an illness, injury or surgery. In addition to skilled nursing, care may include rehabilitative services from licensed physical, occupational or speech therapists. A skilled nursing facility provides transitional care. The goal is to get well enough to go home.
A nursing home may also provide long-term residential care. The goal is to provide a safe, comfortable and caring environment for people who are unable to live independently. Long term residential care is not considered a medical service and is typically not covered by insurance. It is considered the person’s residence.
Medicare Part A covers up to 100 days in a skilled nursing facility after a qualifying hospital stay. The Part A deductible covers the first 20 days per benefit period. After that, you pay a share of the cost for each additional day of your stay. You would start paying the full cost after 100 days.
Medicare generally doesn’t cover long-term (residential) stays in a nursing home, but it may pay for some related costs, such as doctor services and medical supplies. Medicaid may also cover some of the costs of nursing homes for people who are eligible based on income and personal resources. If the older person has long-term care insurance, the policy may include some coverage for nursing home care.
Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Typically, several levels of care are offered, and residents pay more if they need extra services or special care.
Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Some assisted living facilities are part of a larger organization that also offers other levels of care. For example, continuing care retirement communities may also offer independent living and skilled nursing care. Exact arrangements vary by facility and by state.
Most people pay the full costs of assisted living themselves. This option tends to be more expensive than living independently but less expensive than a nursing home. Medicare does not pay for assisted living. Medicaid may provide coverage for some aspects of assisted living, depending on the state and whether the person is eligible. This care option is partially covered by some long-term care insurance policies.
Continuing care retirement communities (CCRCs): These facilities, also called life care communities, offer different levels of service in one location. Many of them offer independent housing (in houses or apartments), assisted living, and skilled nursing care, all on one campus. Health care services and recreation programs are also provided.
In a CCRC, where you live depends on the level of service you need. People who can no longer live independently move to the assisted living facility or sometimes receive home care in their independent living unit. If necessary, they can enter the CCRC’s nursing home.
Most CCRCs charge a one-time entrance fee, which may be relatively expensive, and a monthly fee after that. People must pay most of these costs themselves. Medicare, Medicaid, and long-term care insurance may cover some services, depending on the level of care provided.
Navigating the Healthcare System
Determining the best type of care, location of services and placement assistance and options can be overwhelming. Luckily there are resources available to assist you. Azimuth Healthcare can help to clarify options you may qualify for and benefit from, as well as providers and facilities that are available to help you.
Sources: NIH, Healthcare.gov, Wikipedia, United Healthcare.
