Accountable Care Organization (ACO) – A network of health care providers that band together to provide the full continuum of health care services for patients.  The network would receive a payment for all care provided to a patient, and would be held accountable for the quality and costs of care.

Activities of Daily Living – Physical (ADL) – The self-care tasks which are used to measure the Functional Impairment Level of an applicant or a client for home care services.  These include the ability to bathe, dress and undress, eat, use toilet, transfer in and out of a bed/chair, get around inside one’s own home, and maintain continence.

Activities of Daily Living -Instrumental (IADL) – The six daily tasks (light housework, preparing meals, taking medication, shopping for groceries/clothing, using the telephone, and managing money) that enable the individual to live independently in the community.

Adaptive Equipment – Accessories that help you manage your daily living more independently.  Examples: commodes, canes, walkers, grab bars, hand rails, raised toilet seats, tub seats and lifts.

Adult Day Health (ADH) – Adult Day Care Centers offer social, recrea­tional, and health-related services in a protective setting. Adult day health serves individuals who cannot be left alone during the day because of health care and social need, confusion, or disability.  In­dividuals may qualify subsidies to cover the cost of services. Call South Shore Elder Services to learn more.

Adult Foster Care (AFC) – A MassHealth program that provides daily assistance with personal care and case management oversight in a caregiver’s home. (See also Group Adult Foster Care)

Advanced Directives – A document, such as a health care proxy or living will which allows an individual to convey his or her wishes about end-of-life care ahead of time.  In Massachusetts, only the Health Care Proxy is legally binding to medical providers.  Click here for more information

Advocacy Resources – Organizations that offer resources, pro­grams, publications and public forums to empower consumers on issues that impact the lives of older adults.

Aging and Disability Resource Consortium (ADRC) – The Aging and Disability Resource Consortium (ADRC) represents an equal partnership between Elder Service Agencies (ASAP/AAAs) and Independent Living Centers. ADRC members collaborate to provide a “No Wrong Door” model to ensure efficient and effective access to community and long-term services and supports. The ADRC serves people age 60 or older and people with disabilities of any age; working together to connect you with services and supports to help you live independently in the community. The core functions of the ADRC are; Information and Referral Services, Options Counseling, and Transitions. These free services support and enhance the role of streamlining access to community and long-term services and supports.

Aging Services Access Points – Non-profit agencies across the state, under contract to the Executive Office of Elder Affairs,  that provide  Information and Referral, Care Management, and Protective Services for elders .

Assisted Living Residences – An option for people who don’t feel comfortable or safe living alone, but do not need the kind of 24-hour nursing and medical care provided by nursing facilities.

Caregiver Support – Programs that support unpaid caregivers such as family members or friends. Support can include information, education, access to services and in-home assessments.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) – An Auxiliary medical services for active military/veterans and their dependents.

Congregate Housing – Shared living arrangement designed to help elders live independently. Typically, elders share a living room, dining room, and a kitchen and have private bedrooms and bath­rooms.

Congregate Meals – Hot meals served at various locations such as housing developments or Councils on Aging. These meals offer an opportunity for socialization, and help strengthen individuals’ ties to the community.

Consumer Directed Care – A service delivery model in which the consumer (or proxy) hires and supervises the people who provide daily assistance to the consumer.

Councils on Aging (COA) – Agencies appointed by local governments that sponsor a wide variety of programs and services for older adults.  Operating through local Senior Centers, these agencies act as advocates for the seniors in their respective communities.  Also known as Senior Services, Elder Services or Elder Affairs.

Do Not Resuscitate/Incubate Order (DNR/DNI) – Instructions in the medical record of an individual who has decided that they do not wish cardiopulmonary resuscitation.  A DNR informs medical personnel, including EMT’s and paramedics, to provide care and transport in the community without artificial means to maintain heart function and breathing.  Click here for more information

Durable Power of Attorney – A document that grants a person(s) the legal powers to perform on behalf of the Grantor certain specified acts and functions related to real estate, banking and financial transactions, personal and family maintenance, and government benefits among others.  This power is effective immediately and continues to be effective even if the Grantor becomes disabled or incompetent.  Click here for more information

Financial Services – Agencies that provide assistance with financial  and estate planning as well as asset preservation and  management with an emphasis on senior citizens.

Geriatric Care Management (GCM) – Private elder care specialists. Their services include: Consultation, Assessment, Care Planning, Benefits Eligibility, Home Adaptations, Arrangement for In-Home Services, Nursing Home Planning, Crisis Intervention, Home Health Services, Respite Care, and Advocacy. Many GCMs are privately paid and some accept insurance.

Group Adult Foster Care (GAFC) – A Medicaid program which pays for some services delivered to eligible residents of participating assisted living facilities.  GAFC can provide things like daily personal care and oversight of services.  (Room and board expenses of assisted living GAFC residents may be covered under the Massachusetts  SSI-G program.)

Guardianship – A probate court appoints one or more individuals to handle the personal and financial affairs of a minor or person of any age the court determines to be mentally incompetent.

Health Care Proxy – A document legally recognized in Massachusetts that is authorized by a competent person designating another person to act as his/her health care agent with the authority to make all health care decisions for the Grantor should he/she become unable to make or communicate those decisions.  Click here for more information

Home Health Agencies – Companies that provide workers to assist people in their homes.  It is important to know who you are doing business with before you hire anyone to come into your home.

A Certified Home Health Agency has been licensed and approved to provide home health services under Medicare and Medicaid.  Certified agencies provide the services of such professionals as registered nurses, occupational therapists, physical therapists, respiratory therapists, speech therapists, social workers and home health aides.  A physician’s order is generally needed to receive services under Medicare or Medicaid.

A Non-certified Home Health Agencies cannot bill Medicare or Medicaid.  Many non-certified agencies offer the same medical care as certified agencies (but for private pay) and also offer a range of non-medical care such as homemakers and companions. There is no need for a physician’s order to hire such an agency.  Placement Agencies differ from certified and non-certified agencies in that workers are considered contractors and not employees of the agency.  Such agencies generally provide less supervision and oversight of the workers.  Many do not cover workmen’s compensation or payroll taxes; these become the responsibility of the consumer.

Home Health Aide (HHA) – HHAs provide hands-on assistance with personal care tasks such as bathing and dressing. They may also assist with non-medical tasks such as laundry and light housework. Home Health Aides have some level of training and may be certified. Many work under the supervision of a nurse and are trained to monitor vital signs, watch for skin breakdown, and observe the healing of wounds.

Home Maker – Workers who provide non-medical assistance with such tasks as grocery shopping, meal preparation, light housekeeping and laundry.

Hospice – Programs that offer a special way of caring for people who are terminally ill.  Hospice care involves a team-oriented ap­proach that addresses the medical, physical, social, emotional and spiritual needs of the patient.  Hospice also provides support to the patient’s family or caregiver as well.  Hospice care is covered under Medicare Part A.

Independent Living Centers – Private, non-profit, consumer con­trolled, community-based organizations that provide information, services and advocacy by and for persons with all types of disabili­ties.  They help individuals with disabilities achieve their maximum potential within their families and communities.  Independent Living Centers provide a strong advocacy voice on national, state and local issues.  They work to assure access to housing, employment, transportation, communities, recreational facilities, and health and social services.

Living Will – A set of instructions documenting a person’s wishes about medical care intended to sustain life.  It is used if an individual becomes terminally ill, incapacitated, or unable to communicate or make decisions.  Massachusetts  law does not recognize a Living Will as legally binding on medical personnel.  Click here for more information

Long-Term Care Insurance (LTCI) – An insurance policy designed to alleviate some of the costs associated with nursing home and home health care for persons who become unable to care for themselves independently.  Most policies provide coverage for a specified number of years or may offer lifetime coverage.  The cost of policies vary in relation to the age of the individual at purchase, the conditions and services covered, and the amount and length of coverage.

Long-Term Care Ombudsman Program – Trained volunteers advocate for the rights and quality of care of residents of Long-Term Care Facilities such as nursing and rest homes.  Ombudsman volunteers work to resolve residents’ complaints, provide information to residents and the public, and educate consumers about life in a Long Term Care Facility.

Medicaid – See MassHealth.

Meals on Wheels (MOW) – A service that provides home-delivered meals to elderly and disabled citizens without regard to income.  MOW is funded through a combination of federal funds through Title IIIC of the Older Americans Act and State funds.

Medicaid (MassHealth) – A comprehensive health insurance pro­gram for children, families, elders, and those with disabilities.

Many elders who live in Long-Term Care Facilities receive Mass­Health when they can no longer pay privately for their care.  Many other elders receive MassHealth coverage while remaining in the community, living in their own home or with family.

MassHealth covers almost all expenses associated with in-patient and out-patient medical care not covered by other insurance.

To learn more about MassHealth eligibility, elders and caregivers may to speak with a SHINE counselor, or to call South Shore Elder Services at 781-848-3910.

Medicare – is health insurance for eligible U.S. residents over 65 years of age, and some younger individuals with disabilities.  Medi­care is divided into four main parts.

   Part A is usually free. It covers many (but not all) costs associated with hospitalization.

   Part B has a monthly premium and covers many (but not all) costs associated with outpatient medical care such as visits to a doctor, some outpatient therapies, and certain preventa­tive services.  Together, Part A and Part B are referred to as Traditional Medicare.

Medicare recipients with only traditional Medicare must pay various deductibles and co-payments. These can be costly. Many recipients choose additional insurance coverage to protect themselves from those costs.

For those with traditional Medicare coverage, Medicare Supplement (Medigap) plans provide protection from high out-of-pocket medi­cal expenses – but charge premiums. They are accepted by all phy­sicians and hospitals who accept Medicare.  Medigap policies do not cover prescriptions, so you’ll need a separate (Part D) drug plan.

   Part C (Medicare Advantage) combines Part A, Part B, and, some­times, Part D (prescription drug) coverage. Medicare Advantage plans are offered by private companies approved by Medicare. Plans must cover medically-necessary services; but plans can charge different copayments, coinsurance, or deductibles for these services. They also may cover a few services not covered by Medicare. Medicare Advantage Plans, such as HMOs, PPOs, and Private Fee for Service Plans, often have monthly premiums. (You also pay the Part B premium.)   Part C plans may restrict where you get care, and which physicians you see.

   Part D, aka the Medicare Prescription Drug Program, is offered through private insurance companies. Part D plans help pay the cost of prescription medications.  Part D plans may charge monthly premiums, co-pays, and deductibles.  SHINE counselors can help people choose the right coverage. (See SHINE on page 11.)

Occupational Therapy – A form of therapy that helps people improve basic motor functions and reasoning, and their ability to preform tasks in their daily living and working environments.

OneCare – Health plan or provider based organizations that are contracted with Massachusetts and Centers for Medicare/Medicaid Services to provide integrated care including primary care provider, care coordinator, independent long-term services, and other care providers selected by the enrollee.

Options Counseling – A consumer centered program to provide options, referrals, resources and linkages to services through individual counseling sessions.  Counseling sessions can be completed at nursing homes, rehabilitation facilities, hospitals, community agencies, in the home, through email, and over the phone.  The Options counselor works with elders aged 60 and older and younger disabled individuals aged 22-59 to provide information and resources in regards to long term care.  The Options counseling Program works under the ADRC, in conjunction with local independent living centers, to meet the goals of the consumer.

Palliative Care – Any form of medical care or treatment that concentrates on reducing pain and/or the severity of the symptoms of a disease, or slowing the disease’s progress, rather than providing a cure.

Personal Care Attendant (PCA) Program – A consumer-directed pro­gram for MassHealth members who are chronically disabled and re­quire physical assistance with activities of daily living (ADLs) such as bathing and dressing, and instrumental activities of daily living (IADLs) such as meal preparation, laundry and shopping.

Personal Emergency Response System (P.E.R.S. ) –  includes an electronic device worn by an individual. When activated, the device alerts emergency monitoring staff that help is needed. Emergency staff inform local responders, such as a family member, friend or lo­cal Police or Fire Department, to investigate the cause of the alert.

Physical Therapy – A form of therapy that helps restore function, improve mobility, relieve pain and prevent or limit permanent physical disabilities of patients suffering from injuries or disease.

Prescription Advantage – The State’s Prescription Assistance Pro­gram. It “wraps around” other prescription coverage such as a Medicare Part D Plan.  Benefits vary with income. Eligible consum­ers can join at any time. There is no premium for Prescription Ad­vantage, but some moderate income members pay a small annual fee. Call 1-800-243-4636 (800-AGE-INFO) and pick option 2 for more information or to request an application.

Primary Care Physician (PCP) – A doctor who provides continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis.  They provide referrals to specialized care and services as required by Health Maintenance Organizations (HMOs).

Program of All-inclusive Care for the Elderly (P.A.C.E.) – was de­veloped to address the needs of individuals requiring long-term care.  Often, the comprehensive services offered through this pro­gram permit them to live at home rather than in a nursing facility.  Participants must be at least 55 years old, live in the PACE service area, and be certified as eligible for nursing home care.

Protective Services – Services mandated by the State to investi­gate all reported cases of elder abuse, neglect, self-neglect, and fi­nancial exploitation.  Abuse can be physical, sexual, or emotional.

Anyone with concerns for an elder’s well-being or safety is encour­aged to call and discuss his/or her concerns.  All calls are confiden­tial, and a caller’s identity is fully protected. During business hours call South Shore Elder Services at 781-848-3910. After 5:00pm and on weekends and holidays call the Elder Abuse Hotline at 800-922-2275. For concerns regarding Nursing Facility or Rest Home resi­dents call the Department of Public Health at 800-462-5540

Rehabilitation –  Services and therapies needed by people who have sustained sever injury, often due to trauma, a stroke, an infection, a tumor, surgery or a progressive disease.

Respite Care – Temporary services or assistance designed to relieve unpaid caregiv­ers of some or all of the responsibilities and/or stress of caring for an elder. The care recipient may go to a care facility for a period of time, or care providers may come into the home to give the care­giver a break.  Caregiving can be a very stressful and time consum­ing. Please use this guide or call South Shore Elder Services to find resources to assist you in caring for a loved one.

Rest Home – A facility licensed by the Massachusetts Department of Public Health to provide 24-hour supervision and supportive ser­vices for individuals who do not routinely need nursing or medical care.

Senior Care Options (S.C.O.) – program combines health-care services with social support services.  With SCO, a team of medical professionals works together to provide care that is tailored to an individual’s needs. Plus, SCO doctors provide coverage 24 hours a day.  To be eligible to join a SCO, you must be 1) age 65 and older 2) have coverage under MassHealth Standard and 3) live in an area served by a SCO agency.

SHINE (Serving the Health Information Needs of Elders) –  SHINE counselors are volunteers trained by a state-funded program. They provide unbiased and accurate information to seniors and Medicare recipients about health insurance options and benefits.  Call 1-800-243-4636 (800-AGE-INFO) and pick option 3 to contact a counselor in your area.

Skilled Nursing Facilities – A nursing home providing services for residents whose general condition tends to be unstable, and requires close observation and care given by professional staff over a 24-hour period.  some skilled care is financed by Medicare;

Social Day Care – Centers that provide individualized programs of social activity for elders requiring daytime supervision.  Activities include recreation and social activities. Some social day centers offer limited health services.

Social Security Disability Income/ Supplemental Security Income (SSDI / SSI) – A monetary benefit paid through Social Security to persons under age 65 with disabilities.  SSI-G provides funds for eligible residents who pay for certified assisted living.  It can be combined with GAFC (Group Adult Foster Care ) subsidy for those financially and clinically eligible.

Support Groups – Groups may be facilitated by professionals or may be peer led self-help groups. Support Groups held around the South Shore address many issues and disorders.  South Shore Elder Services can help you find an appropriate group for your needs.

Supportive Housing – An “assisted living-like” environment in state-funded, public elderly/disabled housing.  Services are provided on an as needed basis 24 hours a day.  This type of housing is available through the supportive Housing Initiative Program un by the Executive Office of Elder Affairs and the Department of Housing and Community Development in Massachusetts.

TDD/TTY (Telecommunications Device for the Deaf/Tele-Typewriter) – Used by the hearing and speech impaired, TDDs have a keyboard and some kind of text display and use a standard phone line. Relay services act as links between TDD users and users of standard phones.  Relay operators receive the typed messages from TDD users, speak the messages to the person on the standard phone and then type the responses back to the TDD user. Dial 711 (nationwide) to reach a relay operator.