Are you dealing with issues involving elder law? Maybe you’re trying to figure out the best living situation for your aging parents, or perhaps you need to write a will or establish a trust. When you face issues you haven’t dealt with before, sometimes the legal vocabulary surrounding them can be a bit daunting.
To make wise decisions in any legal matter, you need to understand what documents really mean and what your lawyers are talking about — and that’s especially true when you’re making decisions that affect the people you love the most.
To that end, we’ve put together this handy elder law glossary to explain many of the key terms you’re likely to come across when facing issues that involve aspects of elder law.
We hope this elder law glossary is helpful.
Activities of Daily Living (ADLs)
Basic actions that independently functioning individuals perform on a daily basis:
- Transferring (moving to and from a bed or a chair)
- Caring for incontinence
Many public programs determine eligibility for services according to a person’s need for help with ADLs. Many long-term care insurance policies use the inability to do a certain number of ADLs (such as 2 of 5) as criteria for paying benefits.
Recovery is the primary goal of acute care. Physician, nurse, or other skilled professional services are typically required and usually provided in a doctor’s office or hospital. Acute care is usually short-term.
Adult Day Services
Services provided during the day at a community-based center. Programs address the individual needs of functionally or cognitively impaired adults. These structured, comprehensive programs provide social and support services in a protective setting during any part of a day, but not 24-hour care. Many adult day service programs include health-related services.
(Also called Health Care Directive, Advanced Health Care Directive, Living Will, or Health Care Directive) Legal document that specifies whether you would like to be kept on artificial life support if you become permanently unconscious or are otherwise dying and unable to speak for yourself. It also specifies other aspects of health care you would like under those circumstances.
Progressive, degenerative form of dementia that causes severe intellectual deterioration. The first symptoms are impaired memory, followed by impaired thought and speech, and finally complete helplessness.
A contract in which an individual gives an insurance company money that is later distributed back to the person over time. Annuity contracts traditionally provide a guaranteed distribution of income over time, until the death of the person or persons named in the contract or until a final date, whichever comes first.
Assisted Living Facility
Residential living arrangement that provides individualized personal care, assistance with Activities of Daily Living, help with medications, and services such as laundry and housekeeping. Facilities may also provide health and medical care, but care is not as intensive as care offered at a nursing home. Types and sizes of facilities vary, ranging from small homes to large apartment-style complexes. Levels of care and services also vary. Assisted living facilities allow people to remain relatively independent.
Washing oneself by sponge bath or in the bathtub or shower. One of the five Activities of Daily Living (ADLs)
Benefit Triggers (Triggers)
Insurance companies use benefit triggers as criteria to determine when you are eligible to receive benefits. The most common benefit triggers for long-term care insurance are:
- Needing help with two or more Activities of Daily Living
- Having a Cognitive Impairment such as Alzheimer’s Disease
A caregiver is anyone who helps care for an elderly individual or person with a disability who lives at home. Caregivers usually provide assistance with activities of daily living and other essential activities like shopping, meal preparation, and housework.
Having a long-lasting or recurrent illness or condition that causes you to need help with Activities of Daily Living and often other health and support services. The condition is expected to last for at least 90 consecutive days. The term used in tax-qualified long-term care insurance policies to describe a person who needs long-term care because of an inability to do a certain number of Activities of Daily Living without help, or because of a severe cognitive impairment such as Alzheimer’s Disease.
Deficiency in short or long-term memory, orientation to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness. Alzheimer’s Disease is an example of a cognitive impairment.
Spouse of a nursing home resident applying for or receiving Medicaid long-term care services.
Services and service settings in the community, such as adult day services, home delivered meals, or transportation services. Often referred to as home and community-based services, they are designed to help older people and people with disabilities stay in their homes as independently as possible.
Ability to maintain control of bowel and bladder functions, or when unable to maintain control of these functions, the ability to perform associated personal hygiene such as caring for a catheter or colostomy bag. This is one of the five Activities of Daily Living.
Continuing Care Retirement Communities (CCRC)
Retirement complex that offers a range of services and levels of care. Residents may move first into an independent living unit, a private apartment, or a house on the campus. The CCRC provides social and housing-related services and often also has an assisted living unit and an on-site or affiliated nursing home. If and when residents can no longer live independently in their apartment or home, they move into assisted living or the CCRC’s nursing home.
Countable Assets (Long-Term Care, Medicaid)
Assets whose value is counted in determining financial eligibility for Medicaid. They include:
- Vehicles other than the one used primarily for transportation.
- Life insurance with a face value over $2,500
- Bank accounts, stocks, bonds and trust assets
- Your home provided that your spouse or child does not live there, and its equity value is greater than $688,000 (2023).
CPR (Cardiopulmonary Resuscitation)
Combination of rescue breathing (mouth-to-mouth resuscitation) and chest compressions used if someone isn’t breathing or circulating blood adequately. CPR can restore circulation of oxygen-rich blood to the brain.
Non-skilled service or care in the nursing home, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom. Also referred to as long-term care. Generally once Medicare/Rehabilitation ends.
Deterioration of mental faculties due to a disorder of the brain.
Do Not Resuscitate Order (DNR)
Written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR order may be instituted on the basis of an Advance Directive from a person, or from someone entitled to make decisions on the person’s behalf, such as a health care proxy. In Florida this is printed only on yellow paper. Any person who does not wish to undergo lifesaving treatment in the event of cardiac or respiratory arrest can get a DNR order, although DNR orders are more common when a person with a fatal illness wishes to die without painful or invasive medical procedures.
Putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs. This is one of the five Activities of Daily Living.
Durable Power of Attorney
Legal document that gives someone else the authority to act on your behalf on matters that you specify. The power can be specific to a certain task or broad to cover many financial duties. Your signature activates the documents; in Florida you cannot have the durable power of attorney activate on your unemployment. For the document to be valid, you must sign it before you become disabled.
Feeding oneself by getting food into the body from a receptacle or by a feeding tube or intravenously. It is one of the five Activities of Daily Living.
(Also known as a Deductible Period or Benefit Waiting Period) Specified amount of time at the beginning of a disability during which you receive covered services, but the policy does not pay benefits. A Service Day Deductible Period is satisfied by each day of the period on which you receive covered services. A Calendar Day or Disability Day Deductible Period doesn’t require that you receive covered services during the entire deductible period, but only requires that you meet the policy’s benefit triggers during that time period.
Fair market value of property minus any liabilities on the property such as mortgages or loans.
Process by which Medicaid recovers an amount of money from the estate of a person who received Medicaid. The amount Medicaid recovers cannot be greater than the amount it contributed to the person’s medical care. There are many misconceptions about estate recovery in Florida.
(Also called Non-countable Assets) Assets whose value is not counted in determining financial eligibility for Medicaid. They include:
- Personal belongings.
- One vehicle.
- Life insurance with a face value under $2,500.
- Your home provided that its equity value is less than $688,000 (Single person, Florida).
Federal Poverty Level
Income standard that the federal government issues annually reflects increases in prices, measured by the Consumer Price Index.
Assessment of a person’s available income and assets to determine if he or she meets Medicaid eligibility requirements.
Assessment of a person’s care needs to determine if he or she meets Medicaid eligibility requirements for payment of long-term care services. The assessment may include a person’s ability to perform Activities of Daily Living or the need for skilled care.
General Medicaid Eligibility Requirements
You must be:
- A resident of the state in which you are applying.
- Either a United States citizen or a legally admitted alien.
- Age 65 or over.
- Or meet Medicaid’s rules for disability, or blind.
- Meeting certain asset and income guidelines.
Health Care Proxy
The person that makes your health care decisions if you become incapacitated and you did not make a health care surrogate. We have more on the health care proxy on this webpage.
Health Care Surrogate
Legal document in which you name someone to make health care decisions for you if, for any reason and at any time.
Licensed Homemaker Services provides “hands-off” care such as helping with cooking and running errands. Often referred to as “Personal Care Assistants” or “Companions.” This is the rate charged by a non-Medicare certified, licensed agency.
Homemaker or Chore Services
Help with general household activities such as meal preparation, routine household care, and heavy household chores such as washing floors or windows or shoveling snow.
Short-term, supportive care for individuals who are terminally ill (have a life expectancy of six months or less). Hospice care focuses on pain management and emotional, physical, and spiritual support for the patient and family. It can be provided at home or in a hospital, nursing home, or hospice facility. Medicare typically pays for hospice care. Hospice care is not usually considered long-term care.
Inability to maintain control of bowel and bladder functions as well as the inability to perform associated personal hygiene such as caring for a catheter or colostomy bag. Continence is one of the six Activities of Daily Living.
Any person who provides long-term care services without pay.
Instrumental Activities of Daily Living
Activities that are not necessary for basic functioning but are necessary in order to live independently. These activities may include:
- Doing light housework
- Preparing and cleaning up after meals
- Taking medication
- Shopping for groceries or clothes
- Using the telephone
- Managing money
- Taking care of pets
- Using communication devices
- Getting around the community
- Responding to emergency alerts such as fire alarms
(Also called Advance Directive) Legal document that specifies whether you would not want to be kept on artificial life support if you become permanently unconscious or are otherwise dying and unable to speak for yourself. It also specifies other aspects of health care you would like under those circumstances and provides directions to your health care surrogate, family, and medical personnel.
Services and supports necessary to meet health or personal care needs over an extended period of time. Generally, the same thing as custodial care.
Long-Term Care Facility
(Also called Long Nursing Home or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs.
Long-Term Care Insurance
Insurance policy is designed to offer financial support to pay for long-term care services.
Long-Term Care Services
Services that include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assists people with Activities of Daily Living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility. For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility.
“Look Back” Period
Five-year period prior to a person’s application for Medicaid payment of long-term care services. The Medicaid agency determines if any transfers of assets have taken place during that period that would disqualify the applicant from receiving Medicaid benefits for a period of time called the penalty period.
Joint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services.
Federal program that provides hospital and medical expense benefits for people over age 65, or those meeting specific disability standards. Benefits for nursing home and home health services are limited.
Medicare Supplement Insurance
(Also called Medigap coverage) Private insurance policy that covers gaps in Medicare coverage.
(Also called Medicare Supplement Insurance) Private insurance policy that covers gaps in Medicare coverage.
(Also called exempt assets) Assets whose value is not counted in determining financial eligibility for Medicaid. They include:
- Personal belongings
- One vehicle
- Life insurance with a face value under $2,500
- Your home provided that your spouse or child lives there, and its equity value is less than $688,000 (2023)
(Also called Skilled Nursing Facility, Rehabilitation or Long-Term Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs. Generally reserved for the patients needing the most care.
Partnership Long-term Care Insurance Policy
Private long-term care insurance policy that allows you to keep some or all of your assets if you apply for Medicaid after using up your policy’s benefits. The Deficit Reduction Act of 2005 allows any state to establish a Partnership Program. Under a Partnership policy, the amount of Medicaid spend-down protection you receive is generally equal to the amount of benefits you received under your private Partnership policy. (State-specific program designs vary.)
(Also called custodial care) non-skilled service or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom.
Personal Services Contract
Legal payment to caregiver for services that does not interfere with the Medicaid transfer penalty. You can learn more about personal services contracts here.
Revocable Living Trust
Temporary care which is intended to provide time off for those who care for someone on a regular basis. Respite care is typically 14 to 21 days of care per year and can be provided in a nursing home, adult day service center, or at home by a private party.
A type of loan based on home equity that enables older homeowners (age 62 or older) to convert part of their equity in their homes into tax-free income without having to sell the home, give up title, or take on a new monthly mortgage payment. Instead of making monthly payments to a lender, as you do with a regular mortgage, a lender makes payments to you. The loan, along with financing costs and interest on the loan, does not need to be repaid until the homeowner dies or no longer lives in the home.
Nursing care such as help with medications and caring for wounds, and therapies such as occupational, speech, respiratory, and physical therapy. Skilled care usually requires the services of a licensed professional such as a nurse, doctor, or therapist.
Skilled Care Needs
Services requiring the supervision and care of a nurse or physician, such as assistance with oxygen, maintenance of a feeding tube, or frequent injections.
Social Security Disability Insurance (SSDI)
Government insurance program that pays disability to those who qualify through work experience. Unlike SSI (below), SSDI is not "needs based," meaning the government does not look at your assets in determining benefits.
Special Needs Trust (a/k/a Supplemental Needs Trust)
Type of trust where assets held for beneficiary does not interfere with government benefits such as SSI and/or Medicaid. We have more information on special needs trusts here.
Requirement that an individual spend most of his or her income and assets to pay for care before he or she can satisfy Medicaid’s financial eligibility criteria. As part of spend down, you can consult with an elder law attorney to help you protect assets. We have more on spend down planning here.
The amount of income the community spouse may divert away from the Medicaid applicant's income. This is done to make sure the community spouse has enough income to live on. This amount can be increased if the community spouse has high costs to live at home or in the assisted living facility. We have more on spousal diversion here.
Supplemental Security Income (SSI)
Program administered by the Social Security Administration that provides financial assistance to needy persons who are disabled or aged 65 or older. Many states, such as Florida, provide Medicaid without further application to persons who are eligible for SSI. This is a "needs based" government program as well, meaning that the government looks at your income and assets as part of qualification.
Transfer of Assets
Giving away property for less than it is worth or for the sole purpose of becoming eligible for Medicaid. Transferring assets during the look back period results in disqualification for Medicaid payment of long-term care services for a penalty period.
Moving into and out of a bed, chair, or wheelchair. Transferring is one of the five Activities of Daily Living.