Senior Care Glossary

Reviewed by the AllyKin Editorial TeamCMS data via Medicare.gov Care CompareLast updated: January 2025Methodology: How we research and rank →

Plain-language definitions of the terms you'll encounter when researching assisted living, memory care, Medicaid, and elder law. 68 terms across 20 categories.

A B C D E F G H I L M N O P R S T U V W

A

ADL (Activity of Daily Living): Basic self-care tasks a person performs each day: bathing, dressing, eating, transferring (moving from bed to chair), toileting, and continence. Care assessments count how many ADLs a person needs help with — results determine the appropriate level of care and Medicaid eligibility in most states.
Advance Directive: A legal document that records a person's wishes for medical treatment if they become unable to communicate. Includes a living will (specifying treatments to accept or refuse) and a healthcare proxy or durable power of attorney for healthcare. Facilities are required to ask about advance directives upon admission.
Aid & Attendance (VA Benefit): A Veterans Affairs pension enhancement for veterans and surviving spouses who need help with daily activities. In 2026, pays up to $2,431/month for a veteran with a dependent. Requires wartime service, a medical need determination, and income/asset thresholds. Can be combined with Medicaid waiver services in some states. → See also: VA Benefits
Alzheimer's Disease: The most common cause of dementia, accounting for 60–80% of cases. A progressive neurological disease that damages memory, language, and reasoning over time. Distinguished from other dementias by its characteristic amyloid plaques and tau tangles. Care needs typically escalate from early-stage home care to memory care communities in mid-to-late stages. → See also: Memory Care
Asset Limit (Medicaid): The maximum value of countable assets a person may own to qualify for Medicaid long-term care coverage. In most states, the individual limit is $2,000. Exempt assets typically include a primary residence (up to a value cap), one vehicle, personal belongings, and irrevocable funeral plans. A community spouse may retain significantly more. → See also: Medicaid Spend-Down
Assisted Living Facility (ALF): A residential care setting that provides housing, meals, 24-hour supervision, and help with ADLs. Not a medical facility — for residents who need assistance but not continuous skilled nursing. Licensing and naming vary by state (e.g., 'Personal Care Home' in Georgia, 'Residential Care Facility for the Elderly' in California). National average cost is $4,200–$4,800/month.
Adult Day Services: Community-based programs providing structured activities, meals, health monitoring, and socialization during daytime hours — typically 7 a.m. to 6 p.m. Allow family caregivers to work while their loved one is supervised. Cost averages $80–$120/day nationally. Medicaid often covers adult day services under HCBS waivers.

B

Benefit Period (Medicare): The period during which Medicare covers skilled nursing facility care. Begins the day a beneficiary is admitted to a hospital or SNF and ends after 60 consecutive days with no inpatient care. After a new benefit period begins, Medicare will cover SNF days again — up to 100 days per benefit period. → See also: Skilled Nursing Facility
Board & Care Home: A small residential facility (typically 6–10 residents) providing room, meals, and personal care assistance. Often called a group home, adult foster care, or residential care home. Generally less expensive than larger assisted living communities and may offer a more intimate setting. Regulations vary significantly by state.
Bridge Loan (Senior Care): A short-term loan used to cover care costs while waiting for a larger asset to become available — most commonly a home sale. Senior-specific bridge loans can be obtained from specialty lenders and repaid once the house sells. Useful for families who need to place a parent immediately but rely on home equity to fund ongoing care.

C

Care Plan: A written document developed by a care team (nurses, therapists, social workers) that outlines a resident's goals, medical needs, and specific services to be provided. Federal law requires skilled nursing facilities to create a care plan within 7 days of admission. Assisted living facilities must have a service plan. Families have the right to participate in care planning meetings.
CASPER (CMS Database): Certification and Survey Provider Enhanced Reports — the federal database maintained by CMS that records every nursing home inspection deficiency, complaint investigation, and staffing level. Powers the Five-Star Quality Rating System and is accessible through Medicare's Care Compare tool. → See also: Five-Star Rating
CCRC (Continuing Care Retirement Community): A campus-style retirement community offering a continuum of care — independent living, assisted living, and skilled nursing — under one contract. Residents pay a significant entrance fee ($100K–$1M+) plus monthly fees. Residents can transition between levels of care without moving off-campus. Three contract types exist: Type A (all-inclusive), Type B (modified), and Type C (fee-for-service).
CMS (Centers for Medicare & Medicaid Services): The federal agency within the Department of Health and Human Services that administers Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). CMS sets minimum standards for nursing homes, conducts annual inspections (surveys), and publishes quality data on Care Compare.
Cognitive Impairment: A broad term for any decline in memory, reasoning, or problem-solving ability. Ranges from Mild Cognitive Impairment (MCI — noticeable changes but independent function preserved) to moderate and severe dementia (significant loss of daily function). Cognitive testing tools include the MMSE, MoCA, and CDR scale. → See also: MCI
Community Spouse Resource Allowance (CSRA): The portion of a couple's assets a non-institutionalized spouse (community spouse) can keep when the other spouse applies for Medicaid long-term care. In 2025, the CSRA is between $30,828 and $154,140, depending on the state. The community spouse also retains the primary home, one car, and personal property. → See also: Asset Limit

D

Deficiency (Nursing Home): A violation cited during a state or federal inspection when a nursing home fails to meet regulatory standards. Deficiencies are assigned a scope (isolated, pattern, widespread) and severity (levels A–L). Serious deficiencies — particularly those causing actual harm (Level G+) — trigger penalties, required correction plans, and may affect the facility's Five-Star rating. → See also: F-Tag
Dementia: An umbrella term for a group of symptoms including memory loss, impaired reasoning, and personality changes severe enough to interfere with daily life. Alzheimer's disease is the most common type; others include Lewy body dementia, vascular dementia, and frontotemporal dementia. Not a normal part of aging and not reversible in most forms. → See also: Alzheimer's Disease
DNR (Do Not Resuscitate): A medical order instructing healthcare providers not to perform CPR or advanced cardiac life support if the patient's heart stops or they stop breathing. A DNR must be signed by a physician. It does not mean 'do not treat' — other medical care continues. Different from a POLST, which addresses additional life-sustaining treatments. → See also: POLST
Durable Power of Attorney (DPOA): A legal document authorizing a designated person (the agent) to make financial decisions on behalf of the principal, even if the principal becomes incapacitated. 'Durable' means the authority survives incapacity. A separate document — a durable POA for healthcare or healthcare proxy — covers medical decisions. Both should be established before cognitive decline makes signing impossible.

E

Elder Law Attorney: An attorney specializing in legal issues affecting older adults and their families — including Medicaid planning, estate planning, guardianship, advance directives, and VA benefits. Particularly important when planning for long-term care costs, as proper legal structuring can protect assets and preserve Medicaid eligibility.
Elimination Period (LTC Insurance): The waiting period after a long-term care insurance claim is filed before benefits begin — typically 30 to 90 days. During the elimination period, the policyholder pays care costs out of pocket. A longer elimination period generally means lower premiums. Not all policies count home care days toward satisfying the elimination period.
Elopement Risk: The risk that a resident with dementia or cognitive impairment will leave a facility unsupervised and become lost or endangered. Memory care units are designed to prevent elopement with secured doors, alarmed exits, enclosed outdoor spaces, and GPS tracking. High elopement risk is one of the primary reasons families choose secured memory care over assisted living. → See also: Memory Care

F

F-Tag (Federal Deficiency Code): A three-digit code (F501–F949) used by CMS inspectors to categorize nursing home deficiencies. Examples: F600 (abuse prohibition), F684 (quality of care), F758 (unnecessary antipsychotics). F-tags are published in CASPER and visible on Care Compare. A high number of serious F-tags signals significant quality concerns. → See also: Deficiency
Five-Star Quality Rating System: CMS's 1–5 star rating system for nursing homes, published on Medicare's Care Compare. Composite score combines three sub-ratings: health inspections (2.5-year deficiency history), staffing levels (RN hours per resident day), and quality measures (clinical outcomes like falls, pressure ulcers, and antipsychotic use). A 5-star overall with a 1-star inspection sub-rating is a warning sign. → See also: CASPER

G

GDS (Global Deterioration Scale): A 7-stage clinical scale used to assess the severity of Alzheimer's disease and related dementias. Stages range from 1 (no cognitive decline) to 7 (very severe decline, loss of speech and basic motor function). Used by care teams to match residents to appropriate care settings and predict the care trajectory. → See also: MMSE
Geriatric Care Manager (GCM): A professional (typically a nurse or social worker) who specializes in assessing older adults' needs and coordinating long-term care. Can arrange in-home services, identify appropriate care settings, accompany clients to medical appointments, and serve as a liaison between families and care providers. Now sometimes called an Aging Life Care Professional.
Guardianship: A legal relationship in which a court appoints a guardian to make personal decisions — including healthcare, housing, and daily activities — for a person (the ward) deemed unable to make decisions for themselves. More restrictive than a healthcare proxy or power of attorney; requires court oversight. Should be sought only when less restrictive options (POA, representative payee) are insufficient. → See also: Durable Power of Attorney

H

HCBS Waiver (Home and Community Based Services): A Medicaid mechanism allowing states to provide long-term care services in home and community settings — including assisted living — rather than only in nursing homes. Each state's waiver has unique eligibility rules, covered services, and enrollment caps. Most waivers have waitlists. Room and board costs are not covered; only care services. → See also: Medicaid Waiver
Healthcare Proxy: A person designated in a healthcare power of attorney to make medical decisions on someone's behalf if they become incapacitated. Also called a healthcare agent or surrogate decision-maker. Unlike a living will, a healthcare proxy can respond to unanticipated situations. Selecting a trusted, capable proxy is considered more important than an exhaustive living will.
Home Health Aide (HHA): A trained worker who provides personal care services (bathing, dressing, grooming, light housekeeping) at home. Distinguished from a home health nurse: HHAs provide custodial care, not skilled nursing care. Medicare pays for home health aide services only when a beneficiary also requires skilled nursing or therapy.
Hospice Care: A Medicare-covered benefit providing comfort-focused care for people with a terminal illness and a life expectancy of 6 months or less. Focuses on pain management, symptom control, and emotional/spiritual support rather than curative treatment. Can be provided at home, in an assisted living community, or in a dedicated hospice facility. Covered 100% by Medicare Part A when enrolled. → See also: Palliative Care

I

IADL (Instrumental Activity of Daily Living): Higher-order daily tasks that support independent living: managing finances, using the telephone, grocery shopping, preparing meals, doing laundry, taking medications, and using transportation. IADL difficulties often appear before ADL impairment and signal early-stage cognitive or physical decline. IADL deficits can qualify a person for assisted living services or home care. → See also: ADL
Immediate Jeopardy (IJ): The most serious deficiency level in nursing home surveys — scope/severity level J, K, or L. Indicates a situation in which a nursing home's noncompliance has caused, or is likely to cause, serious injury, harm, impairment, or death. Immediate Jeopardy findings trigger mandatory federal penalties and can result in facility termination from Medicare/Medicaid.
Income Cap State: A state where Medicaid long-term care eligibility requires an applicant's monthly income to be below a set threshold ($2,901/month in 2025). If income exceeds the cap, a Miller Trust must be established to channel the excess income and maintain eligibility. Income cap states include Florida, Texas, Arizona, Georgia, Ohio, and 23 others. → See also: Miller Trust
Independent Living (IL): A housing option for active seniors who can live independently but want a maintenance-free lifestyle with social programming. Also called senior apartments, retirement communities, or 55+ communities. Independent living does not include medical services or personal care assistance — residents in need of those services should consider assisted living.

L

Level of Care (LOC): A care classification that determines the intensity of services required and, in many facilities, the monthly fee tier. Most assisted living communities assess Level of Care at move-in using an ADL/IADL checklist and a nursing evaluation. Common levels are 1 (minimal assistance) through 3 or 5 (extensive care needs). Upgrades trigger higher monthly costs.
Life Settlement: The sale of a life insurance policy to a third party (the purchaser) for a lump-sum cash payment greater than the surrender value but less than the face value. The purchaser becomes the beneficiary and pays future premiums. Life settlements can fund immediate care costs but permanently transfer the death benefit away from named beneficiaries.
Long-Term Care Insurance (LTCI): Private insurance purchased in advance to cover future long-term care costs. Benefits are triggered by the policyholder's inability to perform a specified number of ADLs (typically 2 of 6) or a cognitive impairment. Policies specify daily or monthly benefit amounts, benefit periods (2–5 years or lifetime), and an elimination period. Most policies require applying while still in good health.
Long-Term Care Ombudsman: A state-mandated advocate for residents of nursing homes, assisted living, and other long-term care facilities. Ombudsmen are authorized to investigate complaints, visit facilities unannounced, and represent residents' rights — without cost to families. Every state has a Long-Term Care Ombudsman program under the Older Americans Act.

M

MCI (Mild Cognitive Impairment): A stage between normal cognitive aging and dementia in which memory or thinking problems are noticeable to the person and family but don't severely impair daily life. Not all MCI progresses to dementia. People with MCI should establish advance directives and financial power of attorney while they still have legal decision-making capacity. → See also: Cognitive Impairment
Medicaid: A joint federal-state health insurance program for people with limited income and assets. The largest single payer of long-term care in the United States, funding approximately 51% of all nursing home costs. Eligibility rules vary by state — income limits, asset limits, and available waiver programs differ significantly. Medicaid does not pay for room and board in assisted living in most states. → See also: HCBS Waiver
Medicaid Spend-Down: The process of reducing countable assets to fall within Medicaid's eligibility threshold. Allowable spend-down strategies include paying off debt, home modifications, prepaying funeral costs, and transferring assets to a spouse (within limits). Improper asset transfers within a 5-year look-back period create penalty periods that delay Medicaid eligibility. → See also: Asset Limit
Medicaid Waiver: Federal approval allowing a state to expand Medicaid benefits beyond what standard rules require — typically to cover home and community-based care. HCBS waivers cover services like personal care, adult day programs, home health, and assisted living care (not room and board). Each state's waiver programs have unique names, eligibility criteria, and enrollment caps. → See also: HCBS Waiver
Medicare: Federal health insurance for people 65+ and certain younger people with disabilities. Part A covers hospital stays and short-term skilled nursing facility care (not long-term custodial care). Part B covers outpatient medical services. Part D covers prescription drugs. Medicare does NOT cover long-term assisted living or memory care room and board. → See also: Skilled Nursing Facility
Memory Care: A specialized type of residential care designed for people with Alzheimer's, dementia, and related cognitive conditions. Features secured environments to prevent elopement, dementia-trained staff, structured routines, and programming adapted for cognitive impairment. Can exist as a stand-alone community or as a dedicated wing within assisted living. Typically costs 20–40% more than standard assisted living. → See also: Alzheimer's Disease
Miller Trust (Qualified Income Trust): A legal trust required in income-cap Medicaid states when an applicant's monthly income exceeds the state threshold ($2,901/month in 2025). Each month, the excess income is deposited into the trust and applied toward the cost of care, allowing Medicaid to pay the remainder. Must be established by an attorney before the Medicaid application is approved. → See also: Income Cap State
MMSE (Mini-Mental State Examination): A 30-point standardized cognitive assessment measuring orientation, registration, recall, attention, language, and visual construction. Scores of 24–30 suggest normal cognition; 18–23 suggest mild impairment; 10–17 moderate; below 10 severe. Used at admission assessments and to track cognitive change over time. Has been partially replaced by the more sensitive MoCA in clinical settings.
MDS (Minimum Data Set): A standardized assessment tool required for all nursing home residents under Medicare and Medicaid. Collects clinical, functional, and psychosocial information used to plan care, determine Medicare reimbursement (through the PDPM system), and report quality measures to CMS. Completed at admission and quarterly thereafter, or when a significant change in condition occurs.

N

Nursing Home (Skilled Nursing Facility): A 24-hour care facility providing skilled nursing services, rehabilitation therapy, and custodial care for individuals who cannot be safely cared for in a less intensive setting. Federally regulated under OBRA 1987. Different from assisted living: nursing homes provide medical services; assisted living provides housing and personal care assistance. Median cost: approximately $8,900/month (semi-private room). → See also: Skilled Nursing Facility

O

OSCAR (Online Survey, Certification and Reporting): The legacy CMS database containing nursing home certification and survey information, now largely superseded by CASPER/iQIES. OSCAR data historically tracked ownership, bed counts, payer mix, and deficiency history. The current Care Compare website integrates data from CASPER and other CMS databases.

P

PACE (Program of All-Inclusive Care for the Elderly): A Medicare and Medicaid program providing comprehensive health care for people 55+ who are nursing-home eligible but wish to remain in the community. PACE participants receive all medical, social, and personal care services coordinated through an interdisciplinary team. Available in about 30 states. Covers all medical care, prescriptions, adult day services, and home care — no copays or deductibles for dual-eligible participants.
Palliative Care: Specialized medical care focused on relieving the symptoms and stress of serious illness — at any stage, not just end of life. Unlike hospice, palliative care can be provided alongside curative treatment. Goals include pain management, emotional support, and improving quality of life for both patient and family. → See also: Hospice Care
POLST (Physician Orders for Life-Sustaining Treatment): A medical order (not just a preference document) specifying resuscitation preferences, the level of medical intervention, and artificial nutrition wishes. Travels with the patient across care settings and must be honored by emergency responders. Called different names in different states (MOLST, MOST, DNAR). More detailed and portable than a DNR. → See also: DNR
Private Pay: Paying for care directly from personal resources — savings, retirement accounts, Social Security, pension income, home sale proceeds, or family contributions. The most common initial funding source for assisted living. When private-pay resources are exhausted, families often transition to Medicaid (if eligible), requiring a Medicaid-certified community.
PRN (Pro Re Nata): A Latin medication instruction meaning 'as needed.' PRN medications are administered only when a resident displays a specific symptom or behavior, rather than on a fixed schedule. Common PRN medications in assisted living include pain relievers, sleep aids, and anti-anxiety agents. High rates of PRN psychotropic use can signal inadequate behavioral care planning.

R

Respite Care: Temporary care providing relief to family caregivers. Can be provided at home (in-home respite aide), in an adult day center, or as a short-term residential stay in an assisted living or nursing facility. Medicare Hospice covers up to 5 consecutive days of inpatient respite care per occurrence. Some states fund respite through Medicaid waiver programs.
Reverse Mortgage (HECM): A loan available to homeowners 62+ that converts home equity into cash while allowing the homeowner to remain in the home. The loan balance grows over time and is repaid when the home is sold or the borrower moves out. A Home Equity Conversion Mortgage (HECM) is the FHA-insured version. Proceeds can fund care costs, but the home cannot be used as a Medicaid-exempt asset once the borrower permanently moves to a care facility.

S

Scope and Severity (Deficiency Rating): CMS's two-dimensional system for rating nursing home deficiencies. Severity runs from A (potential for minimal harm) to L (immediate jeopardy with actual harm). Scope ranges from isolated (one resident/incident) to widespread (multiple residents or systemic). The combination determines the deficiency level A–L, which drives civil money penalties and Five-Star score impact. → See also: F-Tag
SNF (Skilled Nursing Facility): A facility meeting federal standards for skilled nursing and rehabilitation services. Medicare Part A covers up to 100 days in a certified SNF following a qualifying 3-day hospital stay: days 1–20 at full cost; days 21–100 with a daily copay ($204/day in 2025); day 101+ not covered. Often used after surgery or hospitalization as a step-down before returning home. → See also: Nursing Home
SSI (Supplemental Security Income): A federal income supplement for low-income adults 65+ and people with disabilities who have limited income and resources. SSI recipients are typically automatically eligible for Medicaid in most states. The 2025 federal SSI benefit rate is $967/month for an individual. States may supplement the federal SSI payment.
Spend-Down: See Medicaid Spend-Down. → See also: Medicaid Spend-Down
Sundowning: A pattern of increased confusion, agitation, or behavioral disturbance in dementia patients during the late afternoon and evening hours. Believed to result from disruption of the circadian rhythm in the brain. Management strategies include consistent routines, increased light exposure during the day, reducing noise and stimulation at night, and medication adjustments. → See also: Dementia

T

Transition of Care: A move between care settings — from hospital to SNF, SNF to assisted living, or assisted living to memory care. Transitions are high-risk periods for medication errors, falls, and re-hospitalization. Best practice includes a care transition coach, medication reconciliation, a 24–72 hour follow-up call, and written care summaries shared across providers.

U

UPDRS (Unified Parkinson's Disease Rating Scale): The standard tool for assessing Parkinson's disease severity and progression. Part I assesses non-motor experiences; Part II evaluates motor experiences of daily living; Part III is the motor examination; Part IV covers motor complications. Scores inform care planning, medication adjustments, and placement decisions for people with Parkinson's disease.

V

VA Benefits (Veterans Affairs): A range of federal programs available to eligible veterans and surviving spouses for long-term care funding. Key programs include Aid & Attendance (pension enhancement for those needing daily care), Community Living Centers (VA-operated nursing facilities), and the Program of Comprehensive Assistance for Family Caregivers (PCAFC). Veterans with service-connected disabilities may qualify for additional benefits. → See also: Aid & Attendance

W

Waiver (Medicaid HCBS Waiver): See HCBS Waiver. → See also: HCBS Waiver
Wandering Behavior: Aimless or purposeful movement by a person with dementia that may result in getting lost, entering dangerous areas, or leaving a safe environment. One of the most common and dangerous dementia behaviors. Memory care communities are specifically designed to allow safe ambulation while preventing elopement through enclosed gardens and secured exit points. → See also: Elopement Risk

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Definitions are educational only and do not constitute legal or financial advice. Medicaid rules vary by state and change frequently — consult an elder law attorney for guidance specific to your situation. Last reviewed July 2026.