The terminologies and language we use to describe aging services are complex and confusing. Sometimes, it seems, understanding the language of aging can be the first big barrier to getting the help you need.

For someone looking for care, planning ahead, or managing a health crisis, getting caught up in the jargon should be the least of their concerns. And yet, families and older adults are often expected to be literate in aging and health terms.

There are acronyms to memorize. Word variations that essentially mean the same thing. And terms defined by legislation, insurance coverage, and more.

While there’s no simple way to ensure communication and language results in true understanding, professionals at the very least should explain all the terms they use.

That’s why we’ve collected and defined common words associated with caregiving and aging. We hope that you will find this glossary helpful. As this is a long list, one simple way to search for a specific term is to press “Ctrl+F” for a search bar in the right corner of your screen.

Aging & Caregiving Glossary of Terms

Area Agency on Aging (AAA):

These local (usually government) agencies oversee the delivery of certain federally-funded services (including case management, transportation, and nutrition) authorized by the federal Older Americans Act.

Activities of Daily Living (ADLs):

Basic skills a person must have to remain independent. These skills include walking, eating, dressing, bathing, toileting, and transferring (getting in and out of chair, getting in and out of a bed, or sitting up in bed). Sometimes people use the term “ADL” to collectively include both ADLs and IADLs, or Instrumental Activities of Daily Living.

Adult Protective Services (APS):

This local government agency employs social workers to help older adults who may be victims of abuse, neglect, and exploitation. Adult Protective Service agencies in DC, MD, and VA also help in cases of suspected self-neglect.

Advance Directives:

A term that collectively refers to certain legal documents used to protect self-determination when a person (for whatever reason) is unable to communicate their own desires regarding healthcare decisions. There are two basic types of these legal documents: Living wills (see Living Will) and powers of attorney (see Powers of Attorney).

Aging Life Care Expert:

Alternative term for case manager.

Assisted Living Facility (ALF):

A long-term care housing option, which provides housing and some personal care for older adults. Residents may live in their own apartments or (in group homes) may have their own room and share common space.  Services offered by assisted living facilities typically include: personal care, meal preparation, medication management, housekeeping, transportation, and social activities. Some assisted living facilities offer additional care for adults with memory loss.  In the spectrum of long-term care housing options, assisted living is the middle step between independent living and nursing homes.

Care Manager:

An alternative term for “case manager.”

Case Manager:

Case Managers may help their clients in a variety of ways, including: assessing client needs, preferences, and budget; educating clients about available services; linking or referring clients to those services; helping eligible clients apply for public benefits; and monitoring and tweaking those services over time.  In the DC metro area, almost anyone can call themselves a case manager.  At Iona, all of our case managers are licensed social workers or registered nurses.

Certified Nursing Assistant (CNA):

This is a professional designation. CNA’s typically work as Personal Care Aides (PCAs) or Home Health Aides (HHA’s). The specific assistance that they can provide is legally determined by state jurisdiction.

Certified Residential Facility (CRF):

Group homes, certified by the city, to provide housing and sometimes care to specific populations. In a group home, a resident will have their own room and share common space.  CRFs may offer independent living or assisted living.

Co-insurance payment:

A term used for certain types of health insurance policies. A health insurance provider may require a patient to make a co-insurance payment for certain covered services.  That is, the provider pays for a percentage of the service cost and the patient pays the remaining percentage.  Because co-insurance payments are based on percentages (and not set fees—like co-pays), the actual amount of the co-insurance payment will vary depending on the service cost.

Co-pay:

A term used for certain types of health insurance policies. A health insurance provider may require a patient to make a co-pay for certain covered services. That is, the provider pays for part of the service cost and the patient pays a set fee for the remainder.  Unlike co-insurance (which is based on percentages), co-pays usually are set at an exact fee for certain covered services.

Combined Form:

This DC form is used to apply for Community Medicaid, Medicaid Spend-down, QMB, and SNAP.

Companion:

Similar to a personal care aide, but with less hands-on duties.  A companion, for example, may supervise and cue personal care, but would not physically assist with the care.  Companions usually cost less than a personal care aide.

Conservator:

A court appointed official who manages (and “conserves”) the finances of a person whom the court has deemed incompetent.

Continuing Care Retirement Facility (CCRC):

A long-term care housing option that provides multiple levels of care, from independent living through nursing home care, under one umbrella organization.  Depending on the facility, residents may reside in their own apartment through all stages of care.  CCRC’s often require residents to pay an expensive entry fee in addition to monthly fees.

Custodial Care:

Refers to services including personal care, housekeeping, meal preparation, medication reminders, and sometimes transportation.  The term is often used when making a distinction between these services (typically provided by family or an aide) and “skilled nursing care,” which would be provided by a nurse or a physical- or occupational therapist.  Skilled nursing care is often covered by health insurance, whereas custodial care rarely is covered.

DC Office on Aging (DCOA):

This office is DC’s Area Agency on Aging.

Delirium:

An umbrella term that describes a set of symptoms, including confusion and disorientation. Deliriums are caused by a variety of medical conditions, including infections, vitamin deficiencies, and medication interactions. In certain situations, delirium can require emergency medical care. It is sometimes confused with dementia.

Dementia:

An umbrella term that refers to any of several permanent and progressive diseases that cause memory loss, including Alzheimer’s, Huntington’s, Parkinson’s, and stroke.  It is sometimes confused with delirium.

Discharge Plan (D/C):

This is provided following a hospital or nursing home stay. A discharge plan specifies medical instructions and prescriptions with which a patient is advised to follow-up after they leave the facility. The plan also could include medical equipment, and referrals to services (like in-home skilled care or custodial care) intended to help the patient be safe after discharge.

Do Not Resuscitate Order (DNR):

A legal document informing medical personnel that a patient does not wish to be resuscitated under certain circumstances (usually life threatening).

Durable Medical Equipment:

Generally speaking, includes medical equipment that cannot easily be used up—like wheelchairs, walkers, crutches, etc.

Extra Help:

In terms of Medicare, this is extra financial assistance to help lower-income Medicare recipients afford premiums and co-insurance associated with Medicare Part D.

Formulary:

The list of medications covered by a particular health insurance plan.

Geriatrician:

A physician specialized in treating older adults.

Group Home:

Another name for Certified Residential Facility.

Guardian:

A court appointed official responsible for making healthcare and day-to-day decisions of a person whom the court has deemed incompetent.

Home Care Provider:

An agency (or person) that provides in-home custodial care, and sometimes in-home skilled care.

Home Health Agency:

In its strictest definition, a home health agency accepts Medicare to provide skilled and custodial care. Some Home Health Agencies also offer private pay services or Medicaid services.

Home Health Aide (HHA’s):

Home Health Aide is a Medicare-defined type of assistance. It refers to Aides who are paid by Medicare.  Medicare HHA’s only help with personal care (i.e. bathing, dressing, and grooming).

Hospice:

A type of care that provides comprehensive services at the end-of-life. Hospice care focuses on comfort care towards easing one’s dying process.  It may include personal care, skilled nursing care, and pastoral/counseling. Hospice is similar, but not the same as palliative care. To receive hospice care, patients must agree to stop seeking a cure for their diagnosis. Patients receiving palliative care may still seek a cure.

Housekeeping (heavy):

Heavy housekeeping (as opposed to light housekeeping) refers to labor intensive housekeeping tasks including laundry, scrubbing, mopping, and vacuuming.  Many home care providers will not do heavy housekeeping.

Housekeeping (light):

Light housekeeping (as opposed to heavy housekeeping) refers to housekeeping tasks that are not very labor intensive including washing dishes, dusting, and straightening.

Instrumental Activities of Daily Living (IADLs):

Refers to a set of skills that often are needed for a person to function independently. IADLs should not be confused with ADLs, which are more basic skills a person must have to remain independent. IADLs include: meal preparation, shopping, medication management, money management, use of telephone, heavy housekeeping, light housekeeping, and transportation ability.

Independent Living Facility:

A long-term care housing option that provides apartment housing for older adults (who do not need personal care), and may also provide services like meal preparation, transportation, and social activities. Some independent living facilities receive Department of Housing and Urban Development money, so that residents pay around one-third of their income in rent.  Other independent living facilities are not subsidized.  In the spectrum of long-term care housing options, independent living is the first level of care, followed by assisted living and nursing homes.

Lead Agency:

The DC Office on Aging funds five nonprofits, called “lead agencies,” to provide comprehensive services to older adults living in Washington, DC. Iona is one lead agency.

Level of Care:

Generally refers to how much care a person needs.  In terms of facility admissions, “level of care” may refer to the minimum amount of service a person needs to be eligible for admission into a facility.

Living Will:

A type of advance directive that specifies what kinds of end-of-life treatments a person wants or does not want.  The document is used when a person (for whatever reason) can no longer communicate their end-of-life preferences directly to medical staff.

Long Term Care (LTC) Facility:

A term that collectively refers to independent living facilities, assisted living facilities, continuing care retirement communities, and nursing homes.

Long Term Care (LTC) Insurance:

A type of insurance that covers long-term custodial care sometimes at home, and sometimes in a facility, depending on how the policy is written.  Some Medicaid sub-programs act as LTC insurance for low-income/asset older adults.  Medicare does not cover long-term custodial care.

Medicaid:

A federally- and state-funded health insurance (and long-term care) program for low-income/asset adults and children.  The program is administered on the state level. Eligibility requirements, and coverage, vary from one state to another. Medicaid includes several sub-programs.  Some of these sub-programs will also pay for long-term custodial care.

Medicaid Waiver:

Also called “Waiver” or “EPD Waiver,” this sub-program of Medicaid provides health insurance and long-term custodial care for low-income/asset older adults who also have certain level of care needs. Like other Medicaid programs, the Waiver is administered at the state level, meaning that eligibility requirements and coverage vary from one state to another. While offered in DC, MD, and VA, this program is not offered by all 50 states. Some states have “waived” out of providing this program.

Medicare:

A federally- funded health insurance program for older retirees and people with long-term disabilities. Medicare has four parts: Part A covers inpatient medical treatment; Part B covers outpatient medical treatment; Part C (also called Medicare Advantage) is an HMO option that combines Parts A, B, and D under a single provider; and Part D covers prescriptions.  To be eligible for Medicare, one must be an older adult (age 65+) or have a long-term disability. Parts B, C, and D also require that one has paid into the system — meaning that they had payroll taxes deducted from their paychecks for a number of quarters. The required number of quarters varies depending on the age of the applicant. Medicare does not cover long-term custodial care needs.

Medicare Savings Program (MSP):

Comprised of four sub-programs (QMB, QI, QDWI, and SLMB), this Medicaid-funded program helps low- and moderate-income Medicare beneficiaries pay for associated premiums and co-insurance associated with Medicare. NOTE: the four sub-programs provide different levels of financial assistance.

QDWI– stands for “Qualified Disabled and Working Individuals.”

QI – stands for “Qualifying Individual.”   See also Medicare Savings Program.

QMB – stands for “Qualified Medicare Beneficiary.”  See also Medicare Savings Program.

SLMB – Pronounced “slimbee.”  This acronym stands for “Specified Low-Income Medicare Beneficiary.”

Medication Administration:

Refers to the physical act of taking one’s own medication or physically helping another person to take his/her medication. For example, taking a pill from a bottle and handing it to a patient is medication administration.  Likewise injecting a patient with insulin is medication administration. The only professions which can legally administer medications are nurses, physicians, and physician assistants.

Medication Management:

An instrumental activity of daily living skill, which refers to a person’s ability to safely manage his/her own medications. Medication management includes such separate tasks as remembering to take one’s medications, physically administering medications, remembering to refill prescriptions, and picking up medication from the pharmacy.

Medication Reminders:

When a person reminds another person to take their medications, they are making a “medication reminder.” Medication reminders are considered custodial care and therefore may be performed by a Home Health Aide.  Home Health Aides cannot administer medication (see Medication Administration).

Money Management:

An instrumental activity of daily living skill, which refers to a person’s ability to appropriately use and handle their own money. Money management includes such separate skills as the ability to count and make change, knowing when and how to use money, paying bills on time and appropriately managing one’s bank accounts, etc.

Occupational Therapy:

An allied health therapy sometimes ordered at rehabilitation facilities or at home, which treats fine motor skills (e.g. movement of the hands, grasping, etc.).

Nursing Home:

A long-term care housing option that provides housing, skilled nursing care, and personal care. Nursing homes (sometimes called skilled nursing facilities or rehabilitation facilities) also provide short-term physical rehabilitation care. In the spectrum of long-term care housing options, nursing home is the final step following independent living and assisted living.

Palliative care (sometimes called comfort care):

Medical and psychosocial comfort care for patients who have certain types of disease-related, uncontrolled discomfort (including pain, fatigue, appetite loss, and insomnia).  Palliative care is similar, but distinct from hospice.  Unlike hospice, palliative care works in conjunction with curative treatments.

Pastoral counseling:

Faith-based counseling.  Pastoral counselors generally are trained in both counseling and theology.

Personal Care:

A term that collectively refers to bathing and grooming. It should not be confused with custodial care, which is a broader term (see also Custodial Care).

Personal Care Assistant/Aide (PCA’s):

Personal care aides primarily provide personal care (bathing, dressing, and grooming). Depending on how they’re paid (e.g. private pay or Medicaid), they also may provide assistance with other ADLs and IADLs. Sometimes just referred to as Aide.

Physical Therapy:

An allied health therapy sometimes ordered at rehabilitation facilities or at home that focuses on the functioning of large muscle groups (e.g. ambulation, transferring, etc.)

Powers of Attorney (POA):

A legal document that allows a person to appoint another person to act on their behalf.

Recertification:

Certain concrete benefits (e.g. Medicaid, Food Stamps, Supplemental Security Income, etc.) require recipients to periodically prove again (or “recertify”) that they are still eligible to receive those benefits.

Rehabilitation (physical):

Typically refers to skilled nursing care intended to improve a patient’s functioning so the patient can return to the community.  The term also is used in substance abuse treatment, but with a different meaning.

Rehabilitation facility:

Another name for Nursing Home.

Self-determination:

Refers to a person’s will, ability, or right to make their own choices regarding their life.

Self-neglect:

A term used to describe intentional actions that a person is taking, or is not taking, that results in the person failing to meet their own basic needs.

Skilled Care:

Refers to care that by law must be administered by a nurse, physical therapist, or occupational therapist.

Skilled Nursing Facility (SNF, pronounced “sniff”):

Another name for Nursing Home.

Social Security (SSA):

This federally-funded public benefit acts like a pension and provides life-time income for retirees. To be eligible, older retirees must be at least age 62, and have paid into the system—meaning that they had payroll taxes deducted from their paychecks for at least 40 quarters (or 10 years of full-time employment). Social Security payments are based on how much money a beneficiary paid into the system. Thus retirees who held higher income jobs receive higher Social Security payments.

Social Security Disability Income (SSDI):

This federally-funded public benefit provides long-term income for adults whose disability prevents them from maintaining long-term employment. To be eligible, an adult with a qualifying disability also must have paid into the system—meaning that they had payroll taxes deducted from their paychecks for a number of quarters. The required number of quarters varies with the age of the applicant. SSDI payments are based on how much money a beneficiary paid into the system. Thus, beneficiaries who held higher income jobs receive payments. When an SSDI beneficiary turns age 62, their SSDI payments automatically convert to Social Security payments.

Social Worker:

Social Workers are university-trained professionals who provide a variety of services to clients including discharge planning, psychotherapy or counseling, case management, linking clients to community resources, facilitating support groups, and educating clients about long-term care services.  Social workers are employed at hospitals, nursing homes, and at Iona. Some common accreditations include:

BSW – Bachelor degree in social work.

LGSW – “Licensed Graduate Social Worker.”  To be eligible for this license, a social worker must have an a master degree in social work.

LICSW – “Licensed Clinical Social Worker.”  Among social workers, only LICSW’s can practice psychotherapy. To be eligible for this DC or Virginia license, a social worker must have a master degree in social work or a PhD, and have completed at least two years of practice under the supervision of another LICSW.  Maryland’s equivalent of this licensure level is LCSW-C.

LSWA – “Licensed Social Work Associate.”  To be eligible for this license, a social worker must have a a bachelor degree in social work.

MSW – Master degree in social work

Speech Language Therapy (SLP – Pronounced “slip”):

An allied health therapy sometimes ordered at rehabilitation facilities or at home. Speech Language Therapists treat patients with speech, swallowing, and cognitive issues.

Supplemental Security Income (SSI):

A federally- and state-funded public benefit that pays income to low-income/asset retirees and/or certain younger adults with long-term disabilities. The purpose of SSI is to raise an individual’s monthly income up to the SSI payment level.  This payment level is determined on an annual basis. As of 2017, the SSI payment level is $735/month. Beneficiaries only receive the amount of money that will bring their current income up to the payment level.  In other words,  if  “Person A” receives $100/month income from any source, Person A will receive $635/month from SSI. Likewise if “Person B” receives $700/month from any source, Person B will only receive $35/month from SSI. If “Person C” receives $735/month or more from any source, then Person C will not receive any income from SSI.

Transfer (in terms of ADLs):

An activity of daily living that refers to a person’s ability to get in and out of chair, to get in and out of a bed, or to sit up in bed.

Do you have an aging or caregiving term that you need defined? Let us know in the comments. Additionally, if you need further explanation for any of these terms, call (202) 895-9448, and ask to speak with Iona’s Helpline. 

Imagine this scenario: Your dad is having a difficult time doing basic household activities and errands. You’ve offered to drive him to appointments, pick up a few groceries, or help organize his bills. And yet, every time you make an offer, he refuses to accept your help.

You’re worried and maybe even a little frustrated that you can’t convince him otherwise. What should you do?

First, you should know that this situation is not uncommon! We often hear from adult children concerned that their older relative just won’t listen or accept their help.

Understanding the reasons why they might reject your offer, and finding ways to empathize with how they are feeling, is a good first step to overcoming your loved one’s resistance.

Five Common Reasons Why Your Parents Won’t Accept Your Help

1. They want to remain independent.

While from your perspective, offering to do a load of laundry doesn’t seem like that big of deal, your parent may see this as the first step to dependence. And dependence can bring up a lot of fears. Am I losing control? Do I still have authority? First laundry, then what? Additionally, while it’s one thing to think, “I’m getting older,” it’s very different to experience the reality that getting older can mean needing extra care.

2. They are afraid to admit they need help.

This fear often relates to wanting to remain independent. The thought is, “If I admit to needing help with this small task, will it lead to losing control over everything else?” Additionally, your relative may be in denial about an illness or denial about a change in their abilities. Admitting they need help requires acceptance first.

3. They don’t want to be a burden to others.

Your family member knows you have your own busy life and schedule, whether that’s work, childcare, or running your own errands. They don’t want to add to your already heavy load.

4. They are private, or don’t trust others.

This reason can be true if you’ve suggested some kind of in-home assistance. While your parents may be comfortable around you, the idea of a stranger in their home can be off-putting. They may also question why you can’t simply provide the care they need or why they have to hire and pay someone to do something you are “capable of doing.”

5. They are uncomfortable with the role reversal.

If their familial role has traditionally been the one in charge and the decision-maker, it can be extremely difficult to accept a change in dynamic. They may resist your help because they are “still the parent and in charge.”

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Keep in mind that the reasons why your family member is rejecting or refusing help are not always apparent. In fact, often the reasons can be intrinsic parts of the person’s value system or personal/psychological identity. In that sense, accepting help may even make them feel like they are losing themselves, and that is frightening.

That’s why establishing the “why” behind their resistance is so important. You cannot begin the work of calming any fears until you know the reasons behind them.

If you’re unsure of how to determine the “why” behind their resistance, start by asking! One way to ease into a conversation is to avoid starting with “you” statements, for example, “You need X and I’m going to do Y.” Instead, you might ask, “What kind of help would you want if you weren’t able to do everything yourself and wanted to remain safely in your home?”

Helping a Family Member Who Doesn’t Want Your Help

Iona is offering a special workshop on October 25, 2017 on strategies for caregivers to help a family member who doesn’t want their help. Offered in partnership with Brighton Gardens of Friendship Heights, the class will be led by Donna Tanner, MSW, LICSW, and cover practical tips for getting your family member’s cooperation, as well as expert advice if they continue to say no.

Learn more and register here.