Global movement to support continued participation by older adults and population groups in social, economic, spiritual, and cultural opportunities, with the goal of enhancing quality and extending healthy life expectancy.
Accountable care organizations (ACOs)
Accountable Care Organizations, or ACOs, is a payment model that bears similarities to HMOs, however there is more financial incentive for ACOs to improve quality, and outcomes while containing costs, avoiding service duplication and preventing errors.
ACOs are part of the Affordable Care Act’s effort to shift from the current fee-for-service, treatment structure that is best suited to high volume, over testing and over treatment. The “organization” part of ACO encompasses at minimum, at least 50 practitioners, specialists, and a hospital or acute care facility serving at least 5,000 patients annually.. Other members may include skilled nursing, allied health, or home health care companies.
The primary stakeholder in an organization — usually the physician group — is held “accountable” for outcomes and cost containment. They are tasked with collaboratively improving care to reach cost and quality targets set by the payor. ACOs meeting these argets are eligible for bonuses; those that fall short may incur penalties.
According to an analysis by Deloitte, “their innovation lies in the flexibility of their structure, payments and risk assumption.” The Centers for Medicare and Medicaid Services is experimenting with several different ACO models to find the optimal balance of payment, cost, outcomes and participant mix.
Under CMS, common ACO models include pioneer – the early adopter organizations and advance payment model ACOs. Only traditional Medicare fee for service providers can participate in Medicare ACOs and are eligible for shared savings financial incentives.
The Dartmouth Institute has more information about ACOs along with an interactive map. Institute Director and former RWJF clinical scholar Elliot Fischer, MD, MPH explains the workings of ACOs in this video.
Products, technologies and built environments that are accessible to and useable by persons with disabilities, who otherwise would be denied access.
Activities of daily livings (ADLs)
Activities performed by a person in the course of a normal day including bathing, dressing, grooming, eating, walking, taking medications, and other forms of personal care.
Planning and construction that anticipates modification of a built environment in order to accommodate actual or potential changes in ability and mobility due to illness, injury or aging to support independent living; sometimes referred to as flexible, or flex, design.
Administrative services only (ASO)
Administrative services only (ASO) is an arrangement an employer makes with a third party to administer the employer’s health insurance benefits to its workers, family members, and retirees. Employers often use ASO arrangements because they are self-insured, meaning they assume the financial risk of providing health insurance benefits to workers. When they are self-insured, they do not need to contract with a health insurer to provide health insurance to their workers. Many self-insured employers use third-party administrators (TPAs) in ASO arrangements and they also contract with health insurers as ASOs. As ASOs, health insurers process claims and make payments and let the employers’ workers, families, and retirees use the insurers’ physician and hospital networks. TPAs usually don’t have networks of providers and so they just process claims and make payments.
Adult care home (also called Board and Care Home or Group Home)
These homes provide housing, personal care services and supervision for a limited number of elderly residents.
Adult day care
Adult day care centers offer social, recreational and health-related services to seniors who can’t be left alone because they’re confused or disabled or because they have special health or social needs.
Adult foster care
Arrangements that allow a vulnerable adult to live in the home of a host family willing to provide a bedroom, meals, personal care, 24-hour supervision and companionship.
An adjuvant is an ingredient used in some vaccines that helps create a stronger immune response in people receiving the vaccine. In other words, adjuvants help vaccines work better. Some vaccines that are made from weakened or killed germs contain naturally occurring adjuvants and help the body produce a strong protective immune response. However, most vaccines developed today include just small components of germs, such as their proteins, rather than the entire virus or bacteria. Adjuvants help the body to produce an immune response strong enough to protect the person from the disease he or she is being vaccinated against. Adjuvanted vaccines can cause more local reactions (such as redness, swelling, and pain at the injection site) and more systemic reactions (such as fever, chills and body aches) than non-adjuvanted vaccines.
Advance Beneficiary Notice of Noncoverage (ABN)
A notice that a doctor or supplier should give a person with Medicare to sign if it is believed that Medicare does not consider the service medically necessary and Medicare will not pay for it. If the patient does not get an ABN to sign before s/he gets the service from their provider of service (doctor), and Medicare does not pay for that service, then the patient does not have to pay for the service. If a doctor does give the patient an ABN to sign and Medicare does not pay for it, then the patient is responsible to pay for the service. (This form could also be given by a home health agency or hospital.)
A tendency for use of health services in a population group to be higher than average. From an insurance perspective, adverse selection occurs when persons with poorer-than-average health status apply for, or continue, insurance coverage to a greater extent than do persons with average or better health expectations. Many adults over 50 may fall into this group, due to chronic health conditions such as diabetes or high blood pressure.
Age-related macular degeneration
Age-related macular degeneration, known as AMD, is the leading cause of vision loss in older adults, according to the National Eye Institute. The disease destroys the macula — the part of the eye responsible for sharp vision. AMD strikes people 50 and older, and may progress so slowly that vision loss is not noticed for years. It does not cause complete blindness – some peripheral vision remains; however, central vision is blurred, dim, or has what is described by sufferers as a “black spot” in the middle of their vision. It interferes with the ability to drive, recognize faces, read, or perform other tasks requiring close vision and can lead to loss of independence, depression and reduced quality of life for many older adults.
AMD occurs twice as often in Caucasians as in African Americans. Other risk factors include smoking and family history. The CDC estimates that 1.8 million adults in the United States have AMD and another 7.3 million are at substantial risk for vision loss. The Macular Degeneration Partnership puts that figure higher – at around 15 million – and predicts a virtual epidemic of AMD as the Baby Boom generation ages. AMD occurs in two forms – wet and dry. Although the disease is irreversible, some treatments are available for the wet form which slows disease progression; the dry form has no known treatment. However, training and special devices can help older adults maintain independence and maximize function.
Aging and Disability Resource Center
The Aging and Disability Resource Center Program (ADRC), a collaborative effort of AoA and the Centers for Medicare & Medicaid Services (CMS), is designed to streamline access to long- term care. The ADRC program provides states with an opportunity to effectively integrate the full range of long-term supports and services into a single, coordinated system. By simplifying access to long-term care systems, ADRCs and other single point of entry (SEP) systems are serving as the cornerstone for long-term care reform in many states.
Federal, state, and local government agencies mandated by the Older Americans Act to channel funds and coordinate programs for older adults and their families. Private, nonprofit, or church groups may sponsor these programs. According to the National Care Planning Council, Area agencies on aging normally contract with local for profit or nonprofit or public providers to deliver benefits. An agency may be allowed to provide directly, supportive services, nutrition services, or in-home services if it can prove a case for providing these services more effectively. An agency may also provide directly, case management services and information and assistance services depending on the methods used for such services in that state. this issue brief from the Leadership Council of Aging Organizations has more information on the history of the aging network, the growth of senior population and how further investments in social, nutrition and other community supports can help bend the health care cost curve on the mandatory side of the budget.
Under the Alignment Initiative, the Centers for Medicare and Medicaid Services intends to identify and address conflicting requirements between Medicaid and Medicare that potentially create barriers to high quality, seamless, and cost-effective care for Medicare-Medicaid enrollees (dual eligibles). The goal is to create and implement solutions in line with the CMS three-part aim, which includes: solutions that advance better care for the individual, better health for populations, and lower costs through improvement.
These drugs decrease activity of an organic brain chemical, acetylcholine (a neurotransmitter involved in the transmission of nerve impulses in the body), to balance out the production of dopamine (which helps control the brain's reward and pleasure centers and also helps regulate movement and emotional responses.
They are used to treat incontinence, depression and sleep disorders. Medications with strong anticholinergic effects, such as antihistamines that cause drowsiness, are well known for causing acute cognitive impairment in individuals with dementia and may cause confusion and hallucinations. With the cholinergic deficit in some forms of dementia, they could increase this deficit and counteract any cholinesterase inhibiting medications. Adverse effects may include blurred vision, dry mouth and urinary retention.
Inability to carry out a complex or skilled movement due to deficiencies in cognition.
Area Agency on Aging
A city or county agency funded under the Older Americans Act that offers various social and health programs to people age 60 and older.
Artificial nutrition and hydration
Refers to the delivery of nutrition and fluids through a feeding tube when a patient is no longer able to eat or drink.
A facility that provides housing and some health services to people who can no longer live independently and who require some assistance but don’t need 24 hour nursing care. Definitions of assisted living facilities vary from state to state.
Assistive technology/adaptive services
Equipment that helps an older person function. This may be something as simple as a walker that helps someone move around or an amplification device that makes it easier to use the telephone.
A promising scientific approach based on using demographic data and methods for getting insights into biological mechanisms of observed processes.
A type of funding in the form of a lump sum payment that confers responsibility for Federal programs to individual states, which then have substantial discretion how to use the Federal grant dollars. Under the Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35), seven block grant programs were established, including a primary care block grant. At the option of each state, the state may apply for a primary care block grant which includes the Community Health Center and the Primary Care Research and Demonstration programs. In 2011, Kaiser Health News analyzed how shifting to block grants might change Medicaid; it seems remarkably prescient today.
Board and care home
Small or mid-sized residential care home that offers meals and includes some assistance with activities of daily living, but not skilled nursing. Rooms may be shared or private and, depending upon licensing, a board and care home might serve only seniors or people with disabilities or chronic psychiatric problems. Some adults find it is a more cost-effective option than assisted living. PBS NewsHour recently looked at the foster home industry in Oregon. This Next Avenue story gives a more general overview of adult foster homes.
Bone mineral density (BMD)
The amount of bone tissue in a segment of bone. Measuring BMD is the best way to evaluate bone strength and predict fracture risk. Results are reported as T-scores and Z-scores.
A person, either paid or voluntary, who helps an older person with the activities of daily living, health care, financial matters, guidance, companionship and social interaction.
Case managers work with family members and older adults to assess and arrange needed services.
Illnesses have one or more of these characteristics: they aren’t subject to permanent cure, leave residual disability, and typically require some type of sustained, ongoing care or treatment. Examples include diabetes and arthritis.
The deterioration or loss of intellectual capacity. This can include impaired short- or long-term memory, problems with deductive or abstract reasoning, and disorientation with regard to time, place and other people.
Complementary and alternative medicine (CAM)
This is the term for a diverse group of medical practices or products that fall outside the standard realm of Western medicine.
Complementary medicine, such as acupuncture or aromatherapy is used in conjunction with standard care. It can generally be classified into:
whole medical systems such as homeopathy or ayurveda
manipulative and body-based practices, like chiropractic or osteopathic approaches
mind-body medicine such as meditation or relaxation therapy
biologically-based practices such as natural supplements or herbal teas
energy, or "life force" practices including qi gong and reiki
Alternative medicine is used in place of traditional Western medical practices. This might be something like a special diet to fight cancer instead of conventional chemotherapy and radiation. Nearly 40 percent of adults report using complementary and alternative medicine, according to the Mayo Clinic.
A related category, integrative medicine, takes the most promising complementary practices and combines them with mainstream medical care – for example taking omega3 supplements in addition to a statin to reduce cholesterol.
Claims about potential health benefits of CAM are not evaluated by the FDA; manufacturers are permitted to bring products to market without the rigorous scientific testing required for pharmaceuticals. However in 2006, the FDA issued a guidance to clarify what may or may not fall under its purview.
While many clinicians remain cautious about recommending CAM, evidence is mounting about some treatments or approaches. However, few large clinical studies exist to support other alternative approaches and the mainstream medical community remains skeptical of therapies that have not been tested in large-scale controlled medical studies. They also caution that some complementary therapies – including herbal remedies or supplements – can lead to adverse reactions with conventional medications or cause dangerous side effects.
Senior residents live in individual apartments in these buildings but often share meals with other tenants in a common dining room. Other services such as emergency call buttons are often available.
A person appointed by a court to handle someone’s affairs when that person cannot handle them him or herself. A conservator usually handles only financial affairs but in some cases personal affairs as well. This includes issues of day-to-day living such as health care and living arrangements.
(CDPAP) Consumer Directed Personal Assistance Program
This Medicaid program provides services to chronically ill or physically disabled people who have a medical need for help with activities of daily living (ADLs) or skilled nursing services. Services can include any of the services provided by a personal care aide (home attendant), home health aide, or nurse. Recipients have flexibility and freedom in choosing their caregivers. The consumer or the person acting on the consumer’s behalf (such as the parent of a disabled or chronically ill child) assumes full responsibility for hiring, training, supervising, and – if need be – terminating the employment of persons providing the services.
Continuing care retirement community
Residents move between different levels of care on these health care campuses for seniors, as their needs warrant. People can live independently, in assisted living facilities, or move into a nursing home. Residents pay monthly fees and sometimes large entrance fees. Meals, housekeeping laundry, social services, and personal care services are available on site.
Cost of living adjustment (COLA)
An adjustment to a monthly benefit, such as workers compensation or Social Security payments, that reflects higher prices in the economy. Can be a flat percentage increase or tied to inflation.
Critical Access Hospital (CAH)
A rural hospital designation established by the Medicare Rural Hospital Flexibility Program (MRHFP) enacted as part of the 1997 Balanced Budget Act. Rural hospitals meeting criteria established by their state may apply for critical access hospital status. Designated hospitals are reimbursed based on cost (rather than prospective payment), must comply with federal and state regulations for CAHs, and are exempt from certain hospital staffing requirements.
Culture change movement
This grassroots effort seeks to shift the standard model of care within nursing homes to a supportive home environment instead of the traditional, structured-schedule medical facility mindset. The people are put first; residents are able to dictate their own days and their own care, instead of following a forced routine. Nursing homes joining this movement often apply the “Neighborhood Model,” which involves breaking down a nursing home into smaller “households” of 12 to 20 seniors, who share common spaces and make their own life choices. Caregivers are assigned to each household to provide assistance and care and to forge relationships with the seniors. Advocates of the movement believe that Culture Change better respects the rights and dignity of the residents, improves their mental health and increases their enjoyment and life expectancy.
Care that doesn’t require specialized medical training, such as cooking, cleaning or accompanying someone to a doctor’s appointment.
A group of diseases, including Alzheimer’s Disease, characterized by memory loss and other declines in mental functioning.
This is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina in the back of the eye. Although changes may be subtle at first, vision deteriorates over time, and can eventually lead to complete loss of sight. The disease has four stages: mild nonproliferative retinopathy, moderate nonproliferative retinopathy, severe nonproliferative retinopathy and proliferative retinopathy. They correspond to the deterioration of blood supply to the retina, and in the final stage, growth of new, abnormal, fragile blood vessels. If these thin-walled vessels leak blood, severe vision loss or blindness can occur.
Diagnosis related groups (DRGs)
Billing codes used by hospitals when billing Medicare for inpatient services. Medicare reimburses hospitals a fixed amount based on the DRG code assigned to the patient based upon diagnosis. DRG codes are available from the Center for Medicare and Medicaid Services.
Disability-adjusted life expectancy
A modification of conventional life expectancy to account for time lived with disability. It is the number of healthy years of life that can be expected on average in a given population. It is generally calculated at birth, but estimates can also be prepared at other ages. It adjusts the expectation of years of life for the loss on account of disability, using explicit weights for different health states.
Disability-adjusted life years (DALYs)
The number of healthy years of life lost due to premature death and disability.
Do not resuscitate order (DNR)
A physician’s order written in a patient’s medical record indicating that medical providers should not attempt cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
The National Institute of Neurological Disorders and Stroke at the National Institutes of Health defines dopamine as an inhibitory neurotransmitter involved in mood and the control of complex movements. The loss of dopamine activity in some portions of the brain leads to movement disorders associated with Parkinson’s disease. Many medications used to treat behavioral disorders work by modifying the action of dopamine in the brain.
Drug Utilization Review (DUR)
A formal program for assessing drug prescription and use patterns. DURs typically examine patterns of drug misuse, monitor current therapies, and intervene when prescribing or utilization patterns fall outside pre-established standards. DUR is usually retrospective, but can also be performed before drugs are dispensed. DURs were established by the Omnibus Budget Reconciliation Act (OBRA) in 1990 and are required for Medicaid programs.
Any intentional or negligent act that causes harm or a serious risk of harm to a vulnerable adult. Abuse may be physical, emotional, sexual, exploitation, neglect, or abandonment.
Elder Economic Security Standard Index
The Elder Economic Security Standard Index (Elder Index) measures income adequacy for older adults, similar to the Federal Poverty Index. Wider Opportunities for Women collaborated with the Gerontology Institute at the University of Massachusetts, Boston to develop benchmarks for basic costs of living for elder households. It illustrates how costs of living vary geographically and are based on the characteristics of elder households: household size, homeownership or renter, mode of transportation, and health status. The costs are for basic needs of elder households; they are based on market costs and do not assume any subsidies.
Focus of health care for older persons from diverse ethnic populations. It is a developing subspecialty in geriatrics with an emphasis on the intersect of knowledge from the fields of aging, health, and ethnicity. It is now generally accepted that cultural beliefs and practices influence an individual's health behavior including choices and use of health care services. For many ethnic older persons, the patient-clinician trust relationship is often influenced by cultural norms. Likewise, the clinical interaction is also impacted by the cultural background of health care providers.
The scaling back or removal of expensive medical treatments for certain medical practices. Recent articles in Medline and the BMJ detail this process more fully.
Adverse effects of eating food contaminated with bacteria, viruses, or parasites.
According to the NIH, about 76 million people in the U.S. become ill from eating contaminated foods annually, resulting in thousands of hospitalizations and some 5,000 deaths each year. Older adults are at increased risk of foodborne illness for several reasons: their bodies produce less stomach acid, making it harder to get rid of harmful bacteria in the digestive system; slower digestion allows bacteria to stay in the system longer, and changes in smell and taste can make it difficult to determine whether food is spoiled.
Seniors also remain sicker longer and have longer hospital stays if required than younger adults who develop foodborne illness. Bacteria from contaminated food can affect a person anywhere from 30 days to three weeks after consumption but within one to three days is average.
Generalized anxiety disorder (GAD)
Generalized anxiety disorder (GAD) is the most common anxiety disorder among older adults, though anxiety disorders in this population are frequently associated with traumatic events such as a fall or acute illness, according to the Anxiety and Depression Association of America. Research on the course and treatment of anxiety in older adults lags behind that of other mental conditions such as depression and Alzheimer's. Experts now recognize that aging and anxiety are not mutually exclusive: Anxiety is as common among the old as among the young. Many older adults with an anxiety disorder also had a disorder when they were younger.
Geriatric care managers
Professionals with special expertise in geriatric care who consult with families and older adults and provide case management services.
A medical specialty focused on treatment the health problems of older people
A family in which grandparents, great-grandparents, other relatives, or close family friends are raising a child because the biological parents are unwilling or unable to do so. Also known as kinship care.
An individual appointed to manage a person’s financial and/or personal affairs when a court determines that person isn’t competent. A conservator is similarly appointed, but only for financial affairs.
Guaranteed issue rights (also called "Medigap protections”)
Rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can't deny you a Medigap policy, or place conditions on a Medigap policy, like exclusions for pre-existing conditions, and can't charge you more for a Medigap policy because of a past or present health problem.
These non-medical services help people with mental or physical disabilities care for themselves and live independently. Examples include case management and help with grocery shopping, personal hygiene, budgeting, communication skills, social skills and vocational skills.
Health Manpower Shortage Area (HMSA)
An area or group designated by the U.S. Department of Health and Human Services as having an inadequate supply of health care providers. HMSAs can include:
(1) an urban or rural geographic area,
(2) a population group for which access barriers can be demonstrated to prevent members of the group from using local providers, or
(3) medium and maximum-security correctional institutions and public or nonprofit private residential facilities.
Health-related quality of life (HRQL)
In public health and in medicine, the concept of HRQL refers to a person or group's perceived physical and mental health over time. Physicians have often used HRQL indicators to measure the effects of chronic illness in their patients in order to better understand how an illness interferes with a person's day-to-day life. Similarly, public health professionals use HRQL indicators to measure theeffects of numerous disorders, short and long-term disabilities, and diseases in different populations. Tracking HRQL in different populations can identify subgroups with poor physical or mental health and can help guide policies or interventions to improve their health.
Home health care
Various health services provided in a patient’s home, under the direction of a physician.
Home- and community-based services
Support services delivered in community settings or in an older person’s home designed to help that person remain independent and avoid institutionalization. These can include home-delivered meals, transportation, adult day care, homemaker services, transportation services, and various services delivered at senior centers.
Home and Community-Based Waivers
These give states the option to bypass Medicaid rules governing institutional care and instead provide that care in the community. These Home and Community Based services (HCBS) became a formal Medicaid State plan option in 2005. Within broad federal guidelines, states can develop home and community-based services waivers (HCBS Waivers) to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting. Currently, more than 300 HCBS Waiver programs are active nationwide. While specifics vary by state, all must show that costs are the same or lower than comparable institutional care, protect recipients’ health and welfare, provide adequate and reasonable provider standards to meet the needs of the target population and ensure services follow an individualized and person-centered plan of care.
Non-medical services for people who need assistance performing household duties. These can include light housekeeping, laundry, limited personal care, grocery shopping, meal preparation, and shopping.
Care of people with terminal illnesses that emphasizes pain control, symptom management and emotional and social support rather than life-sustaining treatments. Can be provided at home or in an institutional setting.
Human Development Index (HDI)
A composite index that measures the overall achievements in a country in three basic dimensions of human development — longevity, knowledge and a decent standard of living. It is measured by life expectancy, educational attainment and adjusted income per capita in purchasing power parity (PPP) US dollars. The HDI is a summary, not a comprehensive measure of human development.
Deterioration of the immune system associated with aging.
The low-grade pro-inflammatory status of the immune system that appears to contribute to the aging process.
Interventions to Reduce Acute Care Transfers is a quality improvement program designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities. It includes clinical and educational tools and strategies for use in every day practice. The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. Such transfers can result in numerous complications of hospitalization, and billions of dollars in unnecessary health care expenditures.
International Classification of Functioning, Disability and Health (ICF)
Describes body functions and structures, activities and participation. These domains are classified from body, individual and societal perspectives. Since an individual's functioning and disability occurs in a context, this classification includes a list of environmental factors.
International Classification of Primary Care (ICPC)
ICPC is the official classification of the World Organization of Family Doctors. It is the most widely use international means to capture and order primary care related information. ICPC is mapped to the International Classification of Diseases (ICD). This allows communication between the two classification systems and complementary usage. ICPC classifies patient data and clinical activity for General/Family Practice and primary care, taking into account the frequency distribution of problems seen in these domains. It allows classification of the patient’s reason for encounter (RFE), the problems/diagnosis managed, interventions, and the ordering of these data in an episode of care structure.
LATE is an acronym for limbic-predominant age-related TDP-43 encephalopathy. This brain disorder mimics Alzheimer’s and can develop in tandem with it. Researchers found LATE affects different brain proteins than those thought to impact Alzheimer’s and perhaps other forms of dementia. It possible that as many as one-quarter of adults over 85 may have this form of dementia, according to Peter T. Nelson, MD Sanders-Brown Center on Aging, University of Kentucky, lead author of this study which describes the disease and its impact.
Life course framework
An approach to the study of aging that combines the study of the changing age structure with the aging experiences of individuals. Several fundamental principles characterize the life course approach. They include
Products, technologies and built environments that accommodate, or can be adapted to accommodate, changes in ability and mobility throughout the life stage and age continuum.
A document indicating a person’s desire for treatment (or not) in the event he or she becomes incapacitated and unable to make health care decisions.
A range of medical, nursing, social, and community services designed to help people with chronic health impairments over an extended period of time.
Long-term care insurance
An insurance policy that covers long term care expenses in a facility or at home. Terms of policies differ widely.
Long-term care insurance partnership
A public-private partnership which provides that if a long-term care policy qualifying under the partnership program is purchased, the insured will qualify for Medicaid services without "spending down their assets" once the benefits under the policy are exhausted.
Long-term care ombudsman
Ombudsmen work with nursing homes and board and care facilities to improve the quality of life for residents. They serve as patient's rights advocates, investigating and negotiating resolutions to concerns voiced by residents.
A joint state/federal health program for people with very low incomes, severe disabilities, and impoverished seniors. The states administer Medicaid.
A national health program for seniors (age 65 and older), people with serious disabilities and patients with end-stage kidney disease.
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
The bipartisan and widely supported Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law by President Obama on April 16, 2015. The MACRA permanently repeals the Sustainable Growth Rate formula for determining Medicare payments for clinicians’ services, establishes a new framework for rewarding clinicians for value over volume, and streamlines other existing quality reporting programs into one new system. According to the Centers for Medicare and Medicaid, The MACRA will help accelerate paying for and rewarding value. CMS calls it “a major opportunity to put a broad range of health care providers on the path to value” through the new Merit-Based Incentive Payment System (MIPS) and incentive payments for participation in certain Alternative Payment Models (APMs).
Sometimes called "Part C" or "MA Plans”, they are a type of Medicare health plan offered by private companies approved by Medicare. MA Plans provide all Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Most MA plans offer prescription drug coverage.
Medigap/Medicare Supplemental Insurance
Medigap insurance pays for items that Medicare doesn’t cover, such as deductibles, co-insurance and copayments owed by Medicare members.
Minimum data set
The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing facilities. The entire process, called the Resident Assessment Instrument (RAI), provides a comprehensive assessment of each resident's functional capabilities and helps nursing facility staff identify health problems.
Resident Assessment Protocols (RAPs) are part of this process and provide the foundation upon which a resident's individual care plan is formulated. MDS assessment forms are completed for all residents in certified nursing facilities, regardless of source of payment for the individual resident. MDS assessments are required for residents on admission to the nursing facility and then periodically, within specific guidelines and time frames. MDS information is transmitted electronically by nursing facilities to the MDS database in their respective states. MDS information from the state databases is captured into the national MDS database at the Centers for Medicare and Medicaid (CMS).
The information filled out on the MDS determines the Resource Utilization Group (RUG) category, which ultimately determines the per diem rate paid to the facility for a resident whose stay is covered under Medicare Part A.
Money Follows the Person (MFP)
The Money Follows the Person (MFP) Rebalancing Demonstration Grant helps states rebalance their Medicaid long-term care systems and transition individuals with chronic conditions and disabilities back into the community from institutional care. Its emphasis is on home and community based care and eliminating restrictions in many states on how Medicaid funds for long term care can be used. The goal is to allow people to receive long-term care in their choice of setting. This chart shows which states are currently participating in the program.
Multidimensional functional assessment
An examination of an older adult’s physical, mental and social condition, including the ability to perform activities of daily living. It was developed by the Duke Center for the Study of Aging and Human Development, to assess the impact of services and programs on older adults’ functional status.
National Health Service Corps
The National Health Service Corps is a federal government program administered by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Bureau of Health Workforce. It offers financial and other support to primary care providers and sites in underserved communities considered Health Professional Shortage Areas (HSPAs). Medical and dental students in their final year of school can get up to $120,000 tax-free loan repayment for a three-year service commitment at an NHSC site. Qualified health care providers provide culturally competent care to more than 11 million people at 5,000 NHSC-approved health care sites in urban, rural, and frontier areas. Currently some 10,400 care providers participate in the program; more than 50,000 have been involved since its inception in 1972.
After a long-term care insurance policy has been in force for a sufficient period of time, you will be entitled to a nonforfeiture benefit if you let the policy lapse. Instead of cancelling the policy, the nonforfeiture benefit allows you to keep it in force as a paid-up policy. Nonforfeiture benefits vary from policy-to-policy; they usually include (1) keeping the same benefit amounts, but making the benefit period shorter, or (2) keeping the same benefit period, but with reduced benefit amounts.
Outcome and Assessment Information Set (OASIS)
The Outcome and Assessment Information Set (OASIS) is the data collection tool used by the Centers for Medicare & Medicaid Services to ensure that home health agencies provide quality care for all patients who are receiving skilled care that is reimbursed by Medicare or Medicaid. These data form the basis for patient case mix profile reports and patient outcome reports that home health agencies and state survey staff in the certification process use for quality improvement and quality monitoring purposes. CMS requires HHAs to complete an OASIS survey any time they open a new case, when significant changes in condition occur, upon transfer to or discharge from a hospital, and when a patient dies or is discharged from home care services. The questions include various aspects of the patient’s diagnosis, clinical condition, living arrangements and ability to manage his or her own care.
This medical discipline focuses on the physical, psychological and spiritual needs of a patient. The goal is to achieve the best quality of life by relieving suffering and controlling pain and symptoms
Patient Self-Determination Act (PSDA)
Requires most United States hospitals, nursing homes, hospice programs, home health agenices, and health maintenance organizations (HMOs) to provide to adult individuals, at the time of inpatient admission or enrollment, informaiton about their rights under state laws governing advance directives (ADs), including:
the right to participate in and direct their own health care decisions;
the right to accept or refuse medical or surgical treatment;
the right to prepare an AD; and
information on the provider's policies that govern the use of these rights.
The act prohibits institutions from discriminating against a patient who does not have an AD. The PSDA also requires institutions to document patient information and provide ongoing community education on ADs.
PSDA was an amendment to the Omnibus Budget Reconciliation Act of 1990. The law became effective December 1991.
Persistent Vegetative State (PVS)
According to a consensus statement by the Multi-Society Task Force on PVS (comprised of representatives of the American Academy of Neurology, the Child Neurology Society, the American Neurological Association, the American Association of Neurological Surgeons and the American Academy of Pediatrics) a vegetative state is a clinical condition of complete unawareness of the self and the environment accompanied by sleep-wake cycles with either complete or partial preservation of hypothalamic and brainstem autonomic functions. The persistent vegetative state is a vegetative state present at one month after acute traumatic or non-traumatic brain injury, and present for at least one month in degenerative/metabolic disorders or developmental malformations.
A PVS can be diagnosed on clinical grounds with a high degree of medical certainty in most adult and pediatric patients after careful, repeated neurologic examinations by a physician competent in neurologic function assessment and diagnosis. A PVS patient becomes permanently vegetative when the diagnosis of irreversibility can be established with a high degree of clinical certainty (i.e., when the chance of regaining consciousness is exceedingly rare). However, some experts disagree with this conclusion.
Suggests that all aspects of human behavior and performance are the result of the interaction or transactions between individuals and their environment. Thus, successful adaptation and adjustment during adulthood require persons to be selective in their choice of stimuli, responses and behavior, and to compensate for changes in ability or health that result from the aging process in order to optimize their behavior and performance.
Physician order for life sustaining treatment (POLST)
This is a standardized form that specifies which medical treatments a seriously ill patient wants or doesn't want. Because it is signed by a physician, as well as a patient, it has the force of a physician's medical order and therefore must be honored in all medical settings. Typically, POLST forms become part of the patient's medical record.
A rare form of behavioral variant frontotemporal dementia (bvFTD), also known as frontotemporal dementia (FTD). People with Pick disease have abnormal proteins inside nerve cells in the damaged areas of the brain. Pick disease is rare. It can occur in people as young as 20. But it usually begins between ages 40 and 60. The average age at which it begins is 54. Over time, tissues in parts of the brain shrink. Symptoms include behavior changes, speech difficulty, and problems thinking, which occur slowly and worsen. There is no specific treatment for Pick disease. Medicines may help manage mood swings.
Plasmapheresis or plasma exchange
A procedure that involves the removal, treatment, and return of blood to the body to remove antibodies, thereby preventing them from attacking their targets. This blood purification procedure is used to treat several autoimmune diseases.
Post-acute care (Sub-acute care)
Short-term care provided to patients who aren’t acutely ill and don’t belong in an inpatient hospital ward but who aren’t well enough to go home. Services can include rehabilitation and specialized care for conditions such as stroke. Can be provided at a long-term care facility or a special hospital unit.
According to the Dartmouth Atlas of Health Care, preference-sensitive care consists of legitimate treatments options for conditions which involve often significant tradeoffs among different possible outcomes of each treatment (i.e., small risk of death in exchange for functional improvement). Intervention decisions — whether to have the, and which to have — should reflect a patient’s personal ethics and priorities, and made only after patients have enough information to make an informed choice, in partnership with the physician.
One of the first steps in undertaking a major organizational change is the evaluation of the preparedness of the organization for that implementation. A readiness assessment addresses the organizational, structural, and human factors that impact change implementation. It analyzes an organization’s infrastructure, culture, leadership styles, performance, processes and resources. Readiness assessments identify organizational needs and help administrators develop a plan – whether upgrading IT or introducing QI goals to staff. It also looks at the people within the organization and how adaptable they are to change.
This type of care falls between nursing homes and home health care. It’s broadly defined as 24-hour supervision of people who need some assistance because of old age or impairments. Room, board and personal care are included. Residential care is provided in groups homes and other settings.
The provision of short-term relief (respite) to families caring for frail elders. Respite services can be provided at home or at adult day care or skilled nursing centers.
A form of arthritis in which the immune system attacks the tissues of the joints, leading to pain, inflammation, and eventually joint damage and malformation. It typically begins at a younger age than osteoarthritis does, causes swelling and redness in joints, and may make people feel sick, tired, and feverish. Rheumatoid arthritis may also affect skin tissue, the lungs, the eyes, or the blood vessels.
Section 202 and Section 811 housing programs
Section 202 and Section 811 housing programs provide subsidies for housing older adults. According to the National Housing Law Project these HUD programs are provide vital affordable housing for the elderly and people with disabilities. Depending on the property, low-income elderly tenants pay rent based on property operating costs; in newer housing, they pay no more than 30% of their adjusted income.
Self-Directed Personal Assistant Services
Self-directed personal assistance services (PAS) are home and community-based personal care and related services provided under the Medicaid State plan and/or section 1915(c) waivers the state already has in place. It provides assistance with activities of daily living for those who need help with basic tasks like bathing, dressing, or feeding, all the way up to skilled nursing services.
Participants (or their designee) set their own provider qualifications and train their PAS providers. Participants determine how much they pay for a service, support or item. participation in the program is voluntary.
The Centers for Medicare and Medicaid Services, permits states to target people already getting section 1915(c) waiver services; limit the number of people who will self-direct their personal care, and/or determine whether this option is available statewide or limited to certain areas.
Participants may hire legally liable relatives (such as parents or spouses), manage a cash disbursement, purchase goods, supports, services or supplies that increase their independence or substitute for human help (to the extent they'd otherwise have to pay for human help) and use a discretionary amount of their budget to purchase items not otherwise listed. The program goes by different names in different states; your state department of health, aging or Medicaid can point you in the right direction.
Senior health insurance counseling program
These programs, found in every states, provide advice and counseling to seniors about Medicare, Medicare drug plans, Medicare supplemental insurance policies, and other types of medical coverage, including state healthcare programs for seniors. They can be an invaluable source of aid for older people confused about how the health care system works. State programs can be located at this site.
A new therapeutic approach that targets so-called “zombie cells” (damaged or senescent cells that tend to accumulate as we age and destroy other cells around them), A combination of the leukemia drug dasatinib and the supplement quercetin, which extended lifespan and health span in mice, has moved into human trials, according to the American Federation for Aging Research (AFAR).
SHIP (State Health Insurance Assistance Program)
The State Health Insurance Assistance Program, is a national program offering one-on-one counseling and assistance to people and their families who have or are about to get Medicare to help them make the right choice. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions; public education presentations and programs; and media activities.
Social Health Maintenance Organization (SHMO)
A managed system of health and long-term care services geared toward an elderly client population. Under this model, a single provider entity assumes responsibility for a full range of acute inpatient, ambulatory, rehabilitative, extended home health and personal care services under a fixed, prospective budget. Elderly people who reside in the target service area are voluntarily enrolled. Once enrolled, individuals are obligated to receive all SHMO covered services through SHMO providers, similar to the operation of a medical model health maintenance organization (HMO).
Special Focus Facility (SFF)
A special focus facility is a nursing home with a recent history of persistent poor quality of care, as indicated by the findings of state or federal inspection teams. Based on inspection findings for the most recent three-year period, CMS selects a group of nursing homes with the worst repeated inspections as SFFs. CMS records indicate that approximately 50 percent of SFFs significantly improve their quality of care within the subsequent 30 months.
A coverage rule used by some Medicare prescription drug plans that requires you to try one or more similar, lower cost drugs to treat your condition before the plan will cover the prescribed drug.
Sundown syndrome or sundowning
A state of confusion that occurs later in the afternoon and into the night. It is most often found in patients who have dementia or Alzheimer's disease and includes a range of behaviors such as increased confusion, anxiety, agitation and sleeplessness.
Supplemental Security Income (SSI)
A federal program that pays monthly checks to people in need who are 65 years or older and to people in need at any age who are blind or disabled. The purpose of the program is to provide sufficient resources so that anyone who is 65, blind, or disabled can have a basic monthly income. Eligibility is based on income and assets. SSI is administered nationally and locally by the Social Security Administration.
Synapses are a physical gap between two neurons that functions as the site of information transfer from one neuron to another, according to the National Library of Medicine. They are essential for learning and memory formation. In response to increased or decreased activity, synapses have the ability to strengthen or weaken, a process known as synaptic plasticity. This plasticity plays a key role in learning and memory, according to the
The human brain consists of approximately 90 billion neurons, nerve cells that receive and send electrical signals. Each neuron has approximately 10,000 synapses. All these neurons communicate together using their synapses to pass electrical or chemical signals to another neuron.
Total Parenteral Nutrition (TPN)
TPN is given to those who are unable to eat normally due to illness, surgery or stomach or bowel disorders, stroke, or some cancers. It is typically administered through a large vein in the body because of its high concentration of ingredients. Individuals who are unable to eat or who do not receive enough calories, essential vitamins, and minerals from eating can receive enough nutrients from TPN to maintain their weight. This type of nutrition requires a doctor's order.
A technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in a painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception.
Health teams which comprise multiple providers from a single background like geriatricians or home care nurses. All team members share the same professional skills and training, speak the same “language” of health, and have the same function within the group.
Products, technologies and built environments that are accessible to and useable by everyone; sometimes referred to as "design-for-all."
This is a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients. In vascular dementia, changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels. Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage. Many experts prefer the term "vascular cognitive impairment (VCI)" to "vascular dementia" because they feel it better expresses the concept that vascular thinking changes can range from mild to severe. Vascular dementia is considered the second most common cause of dementia after Alzheimer's disease, accounting for 10 percent of cases. According to the Alzheimer’s Association, experts believe that vascular dementia remains underdiagnosed.
Wellderly = well elderly
Scientists at Scripps Research Institute are using this term to describe remarkably healthy adults age 85 and older. They are sequencing genomes of wellderlies and comparing them to the genomes of the general public, They hope the genomes of wellderlies may reveal the secret of their celebrated long and healthy lives. Watch a video about it here.
The Western Ontario and McMaster Universities Arthritis Index (WOMAC) is widely used in the evaluation of Hip and Knee Osteoarthritis. It is a self-administered questionnaire consisting of 24 items divided into three subscales. The test questions and subscales scores correspond to pain level, physical function and stiffness, ranging from none to extreme.
SOURCES: This list draws from similar lists compiled by the 2005 White House Conference on Aging, the U.S. Department of Health and Human Services, and the New York Academy of Medicine. Entries have been edited for length and clarity.