California Partnership for Long Term Care

Glossary

Adult Day Care
A licensed day care program that usually provides personal careHelp with bathing, grooming, getting from a chair to a bed and other personal assistance., supervision, protection or assistance in eating, bathing, dressing, toileting, moving about or taking medications.
Adult Day Health Care
Services in an adult day careA licensed day care program that usually provides personal care, supervision, protection or assistance in eating, bathing, dressing, toileting, moving about or taking medications. center and, in addition, include medical, skilled nursing and therapy services.
Alzheimer's Day Care Resource Centers
Individualized day care for people with moderate to late stage Alzheimer's disease or related dementias.
Association Policy
Policies sold through organizations that you may belong to, such as professional or trade organizations.
Care Management
A process to assess, plan, coordinate and monitor long-term careCare given to someone who can no longer perform activities of daily living. needs and services. Care managementA process to assess, plan, coordinate and monitor long-term care needs and services. Care management/care coordination takes an all-inclusive look at a person’s total needs and resources, and links that person to a full range of appropriate services, using all available funding (and informal) sources./care coordination takes an all-inclusive look at a person’s total needs and resources, and links that person to a full range of appropriate services, using all available funding (and informal) sources.
Community Programs and Services
Programs and services include: senior centers, senior nutrition sites, adult day careA licensed day care program that usually provides personal care, supervision, protection or assistance in eating, bathing, dressing, toileting, moving about or taking medications. centers, Alzheimer's resource centers, "Meals on Wheels" programs, transportation, care managementA process to assess, plan, coordinate and monitor long-term care needs and services. Care management/care coordination takes an all-inclusive look at a person’s total needs and resources, and links that person to a full range of appropriate services, using all available funding (and informal) sources. programs, home health agencies, hospice programs, legal services and health insurance counseling
Community-based Care
Adult day careA licensed day care program that usually provides personal care, supervision, protection or assistance in eating, bathing, dressing, toileting, moving about or taking medications. or adult day health careServices in an adult day care center and, in addition, include medical, skilled nursing and therapy services. or Alzheimer's day care
Congregate Housing
A term for housing arrangements with shared common space specially designed for older residents. Residents live in their own unit and housekeeping, meals, laundry, transportation and other non-medical amenities are included in their monthly rental. This type of housing is often provided in retirement communities and through other senior housing arrangements.
Continuing Care Retirement Communities (CCRCs)
Offer independent housing units or apartments with nursing home careFor people with chronic or disabling illnesses who cannot care for themselves but don't need hospital care., with the assurance of guaranteed lifetime long-term careCare given to someone who can no longer perform activities of daily living. services. Residents of a CCRC pay a large one-time entry fee plus a monthly maintenance fee in exchange for their housing and access to multiple levels of long-term care services. Their monthly maintenance fee changes as they move through the different levels of care within the CCRC. Moving into a CCRC requires signing a legally binding contract. Since this contract has serious financial implications, this decision should be discussed with a trusted financial advisor and the contract reviewed by an attorney before you purchase your unit. CCRCs are licensed by the Departments of Social Services and/or Health Care Services.
Daily Benefit
The amount of benefits a policy will pay each day until the total value of the policy is exhausted. The daily benefitThe amount of benefits a policy will pay each day until the total value of the policy is exhausted. The daily benefit is no less than 70 percent of the average daily private pay rate in a nursing home in California at the time of purchase. Currently in California, it is $170 a day. is no less than 70 percent of the average daily private pay rate in a nursing home in California at the time of purchase. Currently in California, it is $170 a day.
Deductible
DeductibleDeductible that must be met only once in your lifetime that must be met only once in your lifetime
Downgrades
Companies must allow the policyholder to reduce coverage in exchange for a lower premium.
Elimination Period
An elimination, deductibleDeductible that must be met only once in your lifetime or waiting period is the number of days one must wait after the company certifies eligibility for benefits but before the policy begins paying for care. Some policies have no elimination periodAn elimination, deductible or waiting period is the number of days one must wait after the company certifies eligibility for benefits but before the policy begins paying for care. Some policies have no elimination period and pay benefits from the first day. The most common waiting periods available are 30, 60 or 90 days. The policyholder is personally responsible for the costs of long-term care expenses during the elimination period. The policy premium will be lower if a longer elimination period is selected, but the policyholder will pay the full cost of care during that time. It is recommend that it be no more than 30 days on policies of less than two years and no more than 90 days on other policies. and pay benefits from the first day. The most common waiting periods available are 30, 60 or 90 days. The policyholder is personally responsible for the costs of long-term careCare given to someone who can no longer perform activities of daily living. expenses during the elimination period. The policy premium will be lower if a longer elimination period is selected, but the policyholder will pay the full cost of care during that time. It is recommend that it be no more than 30 days on policies of less than two years and no more than 90 days on other policies.
Flexible Benefits
Long-term careCare given to someone who can no longer perform activities of daily living. policies must allow the total amount of all the policy benefits to be used interchangeably or in any combination of benefits covered by the policy.
Forgetfulness Feature
Companies are required to allow reinstatement of a policy if it lapses because the policyholder forgot to pay premiums.
Group Policy
Policies sold through your employer.
Home Care
Home health careSkilled nursing or other professional services in the residence, including, but not limited to, part-time and intermittent skilled nursing services, home health aid services, physical therapy, occupational therapy or speech therapy and audiology services, and medical social services by a social worker., personal careHelp with bathing, grooming, getting from a chair to a bed and other personal assistance., homemakers services, hospice careHelps the terminally ill and their families cope with the physical, emotional and spiritual aspects of dying. Care may be provided in a hospice facility or at home. and respite careProvides a break for family members who are the primary caregivers for a person at home. Care can range from a few hours a day to several days..
Home Care Benefit
It should cover at least 50 percent of the minimum daily benefitThe amount of benefits a policy will pay each day until the total value of the policy is exhausted. The daily benefit is no less than 70 percent of the average daily private pay rate in a nursing home in California at the time of purchase. Currently in California, it is $170 a day..
Home Health Care
Skilled nursing or other professional services in the residence, including, but not limited to, part-time and intermittent skilled nursing services, home health aid services, physical therapy, occupational therapy or speech therapy and audiology services, and medical social services by a social worker.
Homemaker Services
Services provided include housekeeping, cooking and grocery shopping.
Hospice Care
Helps the terminally ill and their families cope with the physical, emotional and spiritual aspects of dying. Care may be provided in a hospice facility or at home.
Independent Living
Includes single-family homes, condos, apartments or mobile homes and independent livingIncludes single-family homes, condos, apartments or mobile homes and independent living units in some retirement communities. This type of living does not usually include on-site services such as meals and maid service. units in some retirement communities. This type of living does not usually include on-site services such as meals and maid service.
Individual Policy
Policies sold by private insurance companies to individuals.
Inflation Protection
Protects the policyholder from covering the difference between what the insurance policy will pay, which is based on the costs of services when you purchased the policy, and the actual cost of care when you need it. Every Partnership policy is required to have this protection, and the state highly recommends that you protect yourself by only purchasing a policy with inflation protectionProtects the policyholder from covering the difference between what the insurance policy will pay, which is based on the costs of services when you purchased the policy, and the actual cost of care when you need it. Every Partnership policy is required to have this protection, and the state highly recommends that you protect yourself by only purchasing a policy with inflation protection..
Institutional Care
Skilled nursing facilities and assisted living facilities.
Long-Term Care
Care given to someone who can no longer perform activities of daily living.
Long-Term Care insurance
Specific type of insurance policy designed to offer financial support to pay for necessary long-term careCare given to someone who can no longer perform activities of daily living. services.
New Benefits
Companies must offer any new benefitsCompanies must offer any new benefits they begin selling in California to all existing policyholders. they begin selling in California to all existing policyholders.
Nonforfeiture Benefits
Allow the policyholder to retain some benefits even if the policy is dropped.
Nursing Home Care
For people with chronic or disabling illnesses who cannot care for themselves but don't need hospital care.
Partnership Program
State-approved policies sold through private insurance companies that are designed with specific benefits that protect the consumer's assets and welfare.
Personal Care
Help with bathing, grooming, getting from a chair to a bed and other personal assistance.
Policy Length
The period of time, in years, selected at the time of purchase. For example: You may select a one-year, two-year or a three-year policy.
Residential Care Benefit
It should cover at least 70 percent of the minimum daily benefitThe amount of benefits a policy will pay each day until the total value of the policy is exhausted. The daily benefit is no less than 70 percent of the average daily private pay rate in a nursing home in California at the time of purchase. Currently in California, it is $170 a day..
Residential Care Facilities
Facilities that provide room and board, assistance with personal careHelp with bathing, grooming, getting from a chair to a bed and other personal assistance. and any necessary supervision. They range in size from small, two to six bed "mom and pop" operations to facilities with over 200 living units. They are licensed by the California Department of Social Services.
Respite Care
Provides a break for family members who are the primary caregivers for a person at home. Care can range from a few hours a day to several days.
Return of Premium
The return of premiumThe return of premium benefit refunds a percentage of the total premiums paid, minus any claims. benefit refunds a percentage of the total premiums paid, minus any claims.
Skilled Nursing Facility
Provides 24-hour a day nursing care, has a registered professional nurse on duty or on call at all times and a duly licensed physician available in case of emergency. Those who need to reside in this facility are usually convalescing from serious illness or surgery and require continuous observation and rehabilitative services. Skilled nursing facilities are licensed by the California Department of Health Services.
Substitute or Alternative Benefits of Services
If you are eligible for benefits and want the policy to pay for a benefit or service that is not listed in the policy, you can request that benefit from the insurance company. Although the company has absolute discretion to grant or deny any request, it may agree to it. Some companies offer an alternative care benefit in their contracts, others don't.
Survivorship Benefits
If one spouse passes away, the policy of the surviving spouse will be fully paid.
Waiver of Premiums
While in benefit in a nursing home or residential care facility many policies allow the policyholder to stop paying premiums. A premium waiver may only apply when using the nursing facility benefit or other institutional benefit, although some policies may waive premiums while using the home careHome health care, personal care, homemakers services, hospice care and respite care. or other benefits of the policy.