Adult care home: See group home.  

Adult day care: A daytime community-based program for functionally impaired adults that provides a variety of health, social, and related support services in a protective setting.

Advance directive:  A living will, a health care power of attorney, or both in the same document.

AIDS (acquired immune deficiency syndrome): A virus caused by HIV that severely impairs the immune system.

Alzheimer's Disease: A progressive, irreversible disease characterized by degeneration of the brain cells and severe loss of memory, causing the individual to become dysfunctional and dependent upon others for basic living needs. It is the most common form of dementia.

Ambulatory care: All types of health services that are provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services which do not require an overnight stay.

Amyotrophic lateral sclerosis (ALS): A rare fatal progressive degenerative disease that affects nerve cells, usually begins in middle age, and is characterized especially by increasing and spreading muscular weakness.

Anesthesia: A loss of sensation especially to touch usually resulting from a lesion in the nervous system or from some other abnormality.

Antibiotic: A drug that is able to inhibit or kill microorganisms ant that is used to cure or control infection.

Apnea: Transient cessation of breathing.

Artificial nutrition and hydration:  Substances capable of sustaining life fed to an individual through a tube in the stomach, a vein, or both.

Assisted living: Residences that provide services and emphasize privacy and choice. Residents typically have private locking rooms and bathrooms. Personal care services are available on a 24-hour-a-day basis.

Attending physician:  The physician who has primary responsibility for the treatment and care of the patient.  He or she usually is, but need not be, the primary care physician. Where more than physician is performing services at the same time, the primary care physician will usually be considered to have such responsibility.

Autonomy: The ethical principle that independent actions and choices of an individual should not be constrained by others.

Autopsy: An examination of the body after death, usually with such dissection as will expose the vital organs for determining the cause of death or the character and extent of changes produced by disease.

Barbiturates: Any of various derivatives of barbituric acid used especially as sedatives, hypnotics, and antispasmodics.

Battery: Touching another person in an offensive manner without consent.

Beneficence: The ethical principle that requires providers, other things being equal, to do what will further the patient’s interest.

Beneficiary:  Under Medicare, the person who is covered by the program.  Under an insurance policy, the person or persons entitled to receive its proceeds. Under a trust agreement, the person for whose advantage the trust fund is maintained by a trustee.

Best interest standard: A legal standard to guide decisions by a surrogate or guardian. The surrogate or guardian makes the decision from the point of view of a hypothetical “reasonable person” on the basis of objective, socially shared criteria. Compare substituted judgment standard.

Board and care home: See group home.

Bone marrow: The tissue that occupies the cavities of most bones.

Brain death: The irreversible cessation of all functions of the entire brain, including the brain stem.

Brain stem: The part of the brain connecting the spinal cord with the hemispheres of the brain.

Burden of proof: The risk of losing an issue or case unless a party presents facts that amount to a preponderance of the evidence or, in some cases, the higher standard of clear and convincing evidence.

CAT (computerized axial tomography) scan: A device that depicts structural abnormality in an organ or tissue by use of X-ray data to produce a cross-sectional view.

Cancer: A malignant tumor of potentially unlimited growth.

Capacity: The ability to understand and appreciate the nature and consequences of a decision, and the ability to reach an informed decision in the matter. Compare competence.

Capitation: A method of payment for health services in which the provider is paid a fixed amount for each patient without regard to the actual number or nature of services provided.

Cardiac death: Irreversible cessation of breathing and the beating of the heart.

Cardiopulmonary: Of or relating to the heart and lungs.

Cardiopulmonary resuscitation (CPR):  A combination of chest compressions and mouth-to-mouth breathing used when breathing, heartbeat, or both stop.

Cardiovascular: Of, relating to, or involving the heart and blood vessels.

Care plan (also called service plan or treatment plan): A written document that outlines the types and frequency of the long-term care services that a person receives.

Caregiver: A person who provides companionship and non-medical services related to the activities of daily living.

Case management: Offers a single point of entry to the aging services network. Managers assess clients' needs, create care plans, and coordinate and monitor services. They may operate privately or may be employed by social service agencies or public programs. Typically, case managers are nurses or social workers.

Catheter: A tubular medical device for insertion into canals, vessels, passageways, or body cavities, usually to permit injection or withdrawal of fluids or to keep a passage open.

Cause of death: For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate and using international rules for selecting the underlying cause of death from the reported conditions.

Chemotherapy: The use of chemical agents in the treatment or control of disease or mental disorder.

Chronic care: Care and treatment given to individuals whose health problems are of a long-term and continuing nature. Rehabilitation facilities, nursing homes, and mental hospitals may be considered chronic care facilities.

Chronic illness: Long-term or permanent illness that often results in some type of disability and which may require a person to seek help with various activities.

Chronic obstructive pulmonary disease (COPD): Lung disease (such as emphysema or chronic bronchitis) that is characterized by chronic airway obstruction resulting in a slowed rate of exhalation.

Civil: In legal proceedings, civil are distinguished from criminal.

Clinical: Involving or concerned with the direct observation and treatment of living patients.

Code: Hospital terminology to designate the extent of resuscitation to be taken in the event of sudden cardiac arrest. Also, legal terminology referring to a compilation of laws or regulations.

Codicil: A supplement or amendment to a will.

Cognitive impairment: Deterioration or loss of intellectual capacity that requires continual supervision to protect the individual or others. It is measured by clinical evidence and standardized tests of (1) short or long term memory, (2) orientation as to person, place and time, or (3) deductive or abstract reasoning. It can result from Alzheimer's disease or other form of dementia.

Coma: A state of profound unconsciousness caused by disease, injury, or poison. The eyes are closed. Compare vegetative state.

Comatose: In a coma.

Comfort care: Measures that aim to relieve or alleviate, but not to cure, illness or injury.

Competency: The ability, as determined by a court of law, to make and articulate rational decisions. Compare capacity.

Congestive heart failure: A failure in which the heart is unable to maintain adequate circulation of blood in the tissues of the body or to pump out the blood returned to it.

Coronary: Of, relating to, affecting, or being the arteries or veins of the heart.

Coroner: The person with legal authority to hold an inquest regarding a death that may be accidental or violent. He or she may or may not be a physician. Compare medical examiner.

Critically ill: A patient who is experiencing an acute life-threatening episode or who is believed to be in imminent danger of such an episode. A critically ill patient is medically unstable and, if not treated, likely to decline.

Custodial care: Assistance with activities of daily living as well as with self-administration of medications and preparation of special diets. It does not require specialized training or services.

Death: An irreversible cessation of heartbeat and respiration, or when there is an irreversible cessation of total brain function.

Deductible:  The amount that must be paid by the beneficiary (or the insured) before benefits become payable by Medicare (or an insurance company).

Defibrillator: An electronic device used to restore the rhythm of a heart by applying an electric shock to it.

Dementia: A group of diseases (including Alzheimer's Disease) that are characterized by memory loss and other declines in mental functioning.

Depression: A disorder marked especially by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide.

Diabetes: Any of several conditions involving excessive amounts of urine. One of them, diabetes mellitus, is a disorder usually characterized by inadequate secretion or utilization of insulin, by excessive amounts of sugar in the blood and urine, and by thirst, hunger, and loss of weight.

Diagnosis: The art or act of identifying a disease from its signs and symptoms.

Diagnosis-related group (DRG): A classification system that uses diagnosis information to establish hospital payments under Medicare. It groups patient needs into 467 categories.

Dialysis: The process of removing blood from an artery (as of a kidney patient), purifying it, and returning it to a vein.

Disability: The limitation of normal physical, mental, and social activities of an individual. There are varying types (functional, occupational, learning), degrees (partial, total), and durations (temporary, permanent) of disability.

Do-Not-Intubate Order (DNI Order): A directive by a physician not to intubate a patient for mechanical ventilation. Other life-sustaining efforts short of intubation are not ruled out.

Do-Not-Resuscitate Order (DNR Order):  An order entered by an a physician in the patient’s medical record stating that, in the event the patient suffers cardiac or respiratory arrest, cardiopulmonary resuscitation should not be attempted. More generally, it refers to a doctor’s direction not to administer all techniques for restoring heart and lung functions or, sometimes, other forms of life-prolonging treatment. Also called "no code."

Durable power of attorney: A power of attorney that is legally effective when a person is incapacitated or no longer competent. See related power of attorney and health care power of attorney.

Dyspnea: Difficult or labored breathing.

EEG (electroencephalogram): A device that measures electrical activity in the brain.

Endotracheal tube: A tube designed to be inserted through the natural opening of a patient's windpipe, usually for mechanical ventilation. One type of tube is inserted via the patient's nose and another via the patient's mouth.

Ethics committee: A consultative committee in a hospital or other institution whose role is to analyze ethical dilemmas and to advise and educate health care providers, patients, and families regarding difficult treatment decisions.

Euthanasia: See mercy killing.

Fiduciary: Relating to a relationship of confidence or trust that imposes duties to act for the benefit of another person.

Functionally disabled: A person with a physical or mental impairment that limits the capacity for independent living.

Futile care:  A medical procedure or treatment that cannot achieve its stated goals or produce its expected benefits with an acceptable level of probability regardless of repetition and duration of treatment.

Geriatrics: A medical specialty focusing on treatment of health problems of the elderly.

Group home: A residence that offers housing and personal care services for three to 16 residents. Services such as meals, supervision, and transportation are usually provided by the owner or manager.

Guardian (also called conservator): A court-appointed representative of an incompetent person who manages health care or property but often not both.

Handicapped: Physically or mentally impaired.

Health Care Financing Administration (HCFA):  A branch of the U.S. Department of Health and Human Services charged with management of health care programs such as Medicare and Medicaid.

Health care power of attorney:  A durable power of attorney that authorizes a family member or friend to make medical and other health care decisions for an individual when he or she is unable to do so.

Health care representative (also called health care agent):  The person selected in a health care power of attorney to make decisions about medical treatment and other health care matters for the individual who signs the document.

Health maintenance organization (HMO): A health plan whose members receive services only from personnel employed by or under contract to the organization.  HMOs generally require patients to select a primary care physician who coordinates the patient’s care.  The member usually needs a referral from the primary care physician before going to a specialist or a hospital. Members must be in a plan for a specified period of time, usually one year.

Heart attack: An acute episode of heart disease due to insufficient blood supply to the heart muscle itself.

HIV (human immunodeficiency virus): Any of a group of viruses that infect and destroy cells of the immune system causing the marked reduction in their numbers that leads to a diagnosis of AIDS.

Home care: Paid or unpaid assistance provided to a person with a chronic disability or illness, living in the community.

Home health aide: A person who assists elderly, ill or disabled persons with household chores, bathing, personal care, and other daily living needs. The aide may or may not be under the supervision of a home health or social service agency.

Home health care: Care provided to individuals and families in their place of residence for promoting, maintaining, or restoring health; or for minimizing the effects of disability and illness, including terminal illness. In the Medicare Current Beneficiary Survey and Medicare claims and enrollment data, home health care refers to home visits by professionals including nurses, doctors, social workers, therapists, and home health aides.

Hospice: A program which provides comfort and supportive care for terminally ill patients and their families. The whole family is considered the unit of care, and care extends through their period of mourning.

Hospice care: Services for the terminally ill provided in the home, a hospital, or a long-term care facility. Includes home health services, volunteer support, grief counseling, and pain management.

Hospital: An institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical.

Hydration: The addition of water, for example by intravenous fluids, to the body.

Incidence: The number of cases of disease having their onset during a prescribed period of time. It is often expressed as a rate. Incidence is a measure of morbidity or other events that occur within a specified period.

Incompetent: A person who has been determined by a court of law to be unable to make and articulate rational decisions. Compare capacity.

Independent living facility: Rental units in which health services are not included as part of the rent, though they may be available on site and may be purchased by residents for an additional fee.

Infarct: An area of a tissue or organ that dies because of obstruction of its supply of blood.

Informed consent: A person's consent to a proposed medical procedure or treatment after being provided information relevant to that decision. The information that is required includes: diagnosis, nature and purpose of proposed intervention, risks and consequences of it, the probability that it will be successful, feasible alternatives, and prognosis if the treatment or procedure is not given.

Inpatient: A person who has been admitted at least overnight to a hospital or other health facility for the purpose of receiving diagnostic treatment or other health services.

Insurance: A plan from a private insurance company for health services.  The insurer receives a premium from an individual or an employer, pays the hospital, doctor or other provider of health services, and assumes the risk that premiums will not meet expenses.

Inquest: A legal hearing held by a coroner concerning the manner of death.

Instrumental activities of daily living: Indicators of functional well-being that measure the ability to perform more complex tasks. In the National Long Term Care Survey, they include: heavy housework, light housework, laundry, preparing meals, shopping for groceries, getting around outside, traveling, managing money, and using a telephone. A person is considered disabled in such an activity (with the exception of “getting around outside”) if he or she does not do the activity because of a disability or health problem. A person is considered disabled on the “getting around outside” activity if he or she requires active help, uses equipment, or cannot get around outside at all because of a health or disability problem. See activities of daily living.

Intermediate care: Occasional nursing and rehabilitative care ordered by a doctor and performed or supervised by skilled medical personnel.

Intravenous: Situated within, performed within, occurring within, or administered by entering a vein.

Intubation: Insertion of a tube into a body canal or hollow organ, for example, insertion of an endotracheal tube into the trachea for use by a ventilator.

Joint Commission on Accreditation of Health Care Organizations (JCAHO): An independent, not-for-profit organization that accredits hospitals, health care networks, home care organizations, nursing homes and other long term care facilities, assisted living residencies, behavioral health care organizations, ambulatory care providers, and clinical laboratories.

Law: A statute or judicial decision prohibiting, encouraging, or regulating actions and behavior. Also, the profession of attorneys.

Life expectancy: The average number of years of life remaining to a person at a particular age.

Life-prolonging treatment:  Any medical treatment that is used to keep a person from dying.  Ventilation, cardiopulmonary resuscitation, dialysis, and artificial nutrition and hydration are examples.

Living will: A document that allows an individual to choose or refuse medical treatment in case he or she is dying and not able to communicate his or her wishes.

Long-term care: Medical, nursing or custodial care designed to help people who have disabilities or chronic care needs. Services may be short- or long-term and may be provided in a person's home, in the community, or in nursing homes or assisted living facilities.

Lou Gehrig's disease: See amyotrophic lateral sclerosis (ALS).

Managed care: The furnishing of health care services under plans such as HMOs that usually entail fixed and lower payments to hospitals and health professionals in exchange for a larger volume of patients.

Medicaid: Federal- and state-funded program of medical assistance to low-income individuals of all ages.

Medical examiner: A physician who performs an autopsy when death may be accidental or violent. He or she may also serve in some jurisdictions as the coroner.

Medical record: Histories, reports, diagnoses, prognoses, interpretations, and other data or records, written or electronic, that pertain to a patient’s medical condition and which are maintained by a physician, hospital, or other provider of services or facilities for medical treatment.

Medical savings account plans: One of the Medicare+Choice plans. It provides benefits after a single high deductible is met. Medicare makes an annual deposit to an account of the beneficiary, who then is expected to use the money in it to pay for medical expenses below the annual deductible.

Medicare: A federal program providing health insurance to people age 65 or older, to people entitled to Social Security disability payments for two years or more, and to people with end-stage kidney disease, regardless of income. It consists of three separate but coordinated programs: hospital insurance (Part A), supplementary medical insurance (Part B), and Medicare+Choice (Part C). The traditional form of Medicare is a plan (in contrast to a Medicare HMO) that permits payments to any provider that accepts reimbursement from Medicare.

Medicare HMO:  An HMO that receives a stipulated sum for each Medicare beneficiary who has elected to receive benefits from the HMO rather than Medicare itself.  In exchange, the Medicare HMO bears the risk that payments from Medicare will be insufficient to meet the costs of hospital and other medical care for the beneficiary.

Medigap (also called Medicare supplement insurance): An insurance supplement to Medicare that is designed to fill the gaps left by Medicare.

Mental retardation: An impairment of intellectual functions present at birth with no further neurologic deterioration during life. Compare dementia.

Mercy killing: Killing by one person of another who has an incurable illness or injury in its final and most painful stages. When mercy killing occurs with the consent of the patient, it is called voluntary.  When performed upon an incapacitated person or against a person’s wishes, it is called involuntary.

Morbidity: The extent of illness, injury, or disability in a defined population.

Mortality: Death. The term is used to describe the relation of deaths to the population in which they occur.

Multi-infarct dementia: Multiple losses of tissue, usually in both hemispheres of the brain, due to a decrease or loss of oxygen or blood.

Narcotics: Drugs that in moderate doses dull the senses, relieve pain, and induce profound sleep but in excessive doses cause stupor, coma, or convulsions. 
 

Negligence: An unintentional failure to observe the degree of diligence and care that a reasonable and ordinarily prudent person would under the same or similar circumstances. The results of negligence are a breach of a legal duty and an injury for which the law gives relief.

Neurology: The study of the nervous system and its diseases.

Nurse practitioner: A registered nurse working in an expanded nursing role, usually with a focus on meeting primary health care needs. They conduct physical examinations, interpret laboratory results, select plans of treatment, identify medication requirements, and perform certain medical management activities for selected health conditions.

Nursing home: As defined in the National Nursing Home Survey, a nursing home is an establishment with three or more beds that provides nursing or custodial care services to the older population, infirm, or chronically ill. In most other contexts, the number of beds is larger than 16. Compare group home.

Ombudsman: A representative of a public agency or a private nonprofit organization who investigates, mediates, and resolves complaints by residents against long-term care facilities.

Oncology: The study of tumors.

Opioids: Natural and synthetic substances, such as morphine, codeine, and methadone, to control pain.

Organ Procurement Organization (OPO): OPOs are the link between potential donors and recipients and are responsible for the retrieval, preservation, and transportation of organs.

Outpatient services: Services provided outside a hospital by physicians, laboratories, clinics, emergency rooms, hospital outpatient departments, and providers of medical equipment and supplies.

Palliative care: See comfort care.

Paralysis: Complete or partial loss of function especially when involving the power of motion or of sensation in any part of the body.

Paraplegia: Paralysis of the lower half of the body with involvement of both legs usually due to disease of or injury to the spinal cord.

Pathology: The study of the essential nature of diseases and especially of the structural and functional changes produced by them.

Personal care: See custodial care.

Physical dependence: With opioids, it is characterized by a withdrawal effect following discontinuation of a drug. Such dependence is a common effect in chronic pain management, but it is not restricted to opioids.