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What is…? Glossary of Terms

Activities of Daily Living (ADL)
Activities of Daily Living (ADL) are activities that are done regularly to meet basic, daily hygiene and household needs.  Some of these activities are related to personal care – dressing, grooming, bathing, toileting (or incontinence care), eating, moving (transferring from a bed or chair).  Other less personal tasks that are important for daily living (sometimes called Instrumental Activities of Daily Living (IADL)) include housework, managing money, taking medication, preparing and cleaning up aftermeals, laundry, shopping for groceries and essentials, using the telephone, caring for pets.

Acute Care
Acute care has recovery as its primary goal. Physicians, nurses, or other skilled professional services are typically required and care is usually provided in a doctor’s office or hospital.  Acute care is usually short term.

Acute Care Hospital
An acute care hospital is a facility that admits patients who have an acute illness with the intention to restore their health to previous function.

Acute Illness
Acute illness is a condition that occurs in a short time and is expected to be cured with proper treatment.  Examples are pneumonia or a broken bone.  An illness or condition, such as diabetes, obesity and asthma that lasts for a long time or reoccurs with frequency, is called a chronic illness. 

Adult Care Care
Adult day care is a facility where adults with some physical or mental limitations, who are in need of social interactions, can be cared for in a supervised environment with other adults.  Westchester County licenses and classifies Adult Day Care as Medical, Psychiatric and Social Programs.  A list of these can be found at the following Westchester County website (http://seniorcitizens.westchestergov.com/caregiving/adult-day-care-services)

Advance Care Planning (ACP)
Advance care planning (ACP) is about making clear your wishes and goals for health care across your life span.  This includes conversations and completing an advance directive.  Advance care planning involves thinking about your preferences for medical care and documening your choices, so that someone can speak for you if you do not have capacity to make decisions for yourself.  In New York State, advance care planning includes appointing a health care agent by completing a New York State Health Care Proxy. ACP also includes communicating your choices in conversations with your family, health care agent, physcians, and others involved in your care.   Advance care planning is not just about old age; at any age, a medical crisis could leave a person too ill to make his or her own health care decisions.

Advance Directive
An advance directive is a legal document that states your choices regarding health care decisions.  In New York State the basic advance directive, for every person age 18 or older, is the New York State Health Care Proxy, in which you appoint someone, a health care agent, to make health care deciisons for you if you do not have capacity to make them yourself.   Additional advance directives in some cases of serious illness (or frailty at an advanced age), include documentation, such a MOLST or DNR.  A Living Will is also a kind of advance directive but is not a legal document in New York State.   Advance directives go into effect only if you do not have capacity to make decisions yourself, due, for example, to being unconsciousness after a severe injury.

Aging-in-Place (AIP)
Aging-in-Place organizations (AIPs) are grassroots, membership organizations, formed by area residents rather than government agencies or social service providers.  They differ based on the needs and resources of each community.  Most Aging-in-Place membership groups provide a mix of social support, health care and home maintenance services, including, referrals to local service providers and agencies for in-home and personal support.   They can often provide volunteer transportation for personal care and medical appointments, as well as cultural and social activities.

Allow Natural Death (AND)
Allow Natural Death (AND) is a medical order that is sometimes used in place of a Do Not Resuscitate (DNR) order.  AND orders focus on what is being done rather than what is not being done.

Assisted Living Facility
Assisted living facilities provide help with some activities of daily living, such as taking medication, bathing and dressing, as well as meals, transportation, housekeeping and social activities.  It is a daily service, but is not a full time service.  Some assisted living facilities have on-site beauty shops and other amenities.

Be Prepared Kit (BPK)
The Be Prepared Kit (BPK) is a tool for keeping documents and information about advance care planning and other long-term planning in one place. If something were to happen to you suddenly, your family can go to your Be Prepared Kit and will know where to find all your important papers and information organized in one place with separate folders for different areas.  Your family can locate important information, such as personal and professional contacts, financial and health care information, wills, insurance policies, final arrangements, and more.   The Be Prepared Kit is a project of the Westchester End-of-Life Coalition. (Further information:  http://westchesterendoflife.org/programs/be-prepared-kit™)

BiPAP/BPAP (Bivalve Positive Air Pressure apparatus) and CPAP (Continuous Positive Air Pressure apparatus)
Bivalve Positive  Air Pressure apparatus (BiPAP/BPAP) and Continuous Positive Air Pressure apparatus (CPAP) are machines that help treat breathing difficulties.  BiPAP/BPAP uses variable levels of air pressure to push air into the lungs.  CPAP is an older version of the same kind of apparatus.  Both devices are used in the treatment of breathing difficulties, such as sleep apnea, a chronic condition of pauses in breathing during sleep that makes it difficult to get restful sleep.  The apparatus looks like an oxygen mask and is placed over mouth and nose.

Cancer
Cancer is the general label for for more than 100 different illness that all begin with abnormal cell growth. Cancer begins in the cells, which are the building blocks of the body. Normally, the body forms new cells as needed, replacing old cells that die.  Sometimes this process goes wrong.  New cells grow even when they aren not needed, and old cells don’t die when they should. These extra cells can form a mass called a tumor.   Tumors can be benign or malignant.  Benign tumors are not cancer tumors while malignant ones are.  Cells from malignant tumors can break away and spread to other parts of the body.  Most cancers are named for where they start (for example, lung cancer starts in the lung, and breast cancer starts in the breast). The spread of cancer from one part of the body to another is called metastasis.  Symptoms and treatment depend on the cancer type and how advanced it is.  Most treatment plans may include surgery, radiation and/or chemotherapy.  Some may involve hormone therapy, biologic therapy, or stem cell transplantation.  All cancers are staged according to their status and location. Cancer is a serious illness.  (Source:  NIH: National Cancer Institute; www.nlm.nih.gov/medlineplus/cancer.htm).  

Capacity
In a health care decision making context, capacity refers to an individual’s ability to make medical decisions for him or herself.  A nurse or doctor may determine that an individual lacks capacity if he or she is unconscious, has had a major stroke, has advanced dementia, or otherwise is not responsive.

Cardiopulmonary Resuscitation (CPR)
Cardiopulmonary Resuscitation (CPR) is an emergency procedure done on a person when their heart has stopped or when they are no longer breathing.  CPR can sometimes restart a stopped heart.  In CPR, chest compressions are provided to engage the heart to beat while, at the same time, air is pushed into the lungs by a device or from the mouth of the the person performing CPR.  Electric shocks (called defibrillation) may also be used to restart the heart, and some medicines might also be given.  CPR is most effective in people who are generally healthy before their heart stops.  It is not indicated for individuals with serious illness who are not expected to recover as it may cause suffering and/or prolong dying rather than improve quality of life.

Case Manager
In a health care context, a case manager is a professionally trained person who coordinates care for a patient.  He or she usually helps research resources for both custodial and skilled medical care, as well as financial aid possibilities.   A case manager can be trained as a social worker, health advocate, psychologist, or have a similar background and training.  In addition to hospitals, many illness specific organizations employ case managers to help their clients and families.

Certified Home Health Agency (CHHA)
Certified Home Health Agencies(CHHA) provide part-time, intermittent health care and support services to individuals who need intermediate and skilled health care. Among the services that may be included are skilled nursing, physical therapy, occupational therapy, speech and language pathology, and personal care. (Source:  NYS Department of Health: http://www.health.ny.gov/health_care/medicaid/program/longterm/chhas.htm).

Chaplain Services
See Pastoral Services

Chart
In a health care context, a chart is the record of your treatments and care. Medical chart, medical record and health record are all terms used for a document that describes a patient’s medical history and treatments in a particular health care setting.  It includes observations and medical orders as well as prescriptions of drugs and therapies. A carefully kept chart is required for institutions that are certified or licensed by the state, such as hospitals, physicians in private practice, hospices and others.  Each institution keeps its own charts. Patients have a right to see their own chart at any time.  With the introduction of electronic medical (health) records (EMRs), it may be possible for medical charts from different institutions to be seen in one file for better coordinated care and easier access by attending physicians and patients themselves.

Chronic Illness
A chronic illness lasts a long time (3 months or more, as defined by the U.S. National Center of Health Statistics) or reoccurs frequently.  It can be controlled but there is no known cure.  Examples include diabetes, obesity, asthma, and heart disease.

Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow and make breathing difficult. Emphysema and chronic bronchitis are the two most common conditions. (MayoClinic.com)  Coughing up mucus is often the first sign of COPD.  The airways branch out inside your lungs like an upside-down tree.  At the end of each branch are small, balloon-like air sacs.  In healthy people, both the airways and air sacs are springy and elastic. When breathing in, each air sac fills with air like a small balloon. The balloon deflates with exhaling. In COPD, the airways and air sacs lose their shape and become floppy, like a stretched-out rubber band.  Cigarette smoking is the most common cause of COPD. Breathing in other kinds of irritants, like pollution, dust or chemicals, may also cause or contribute to COPD. Quitting smoking is the best way to avoid developing COPD.   Treatment can offer comfort, but there is no cure. COPD is a serious illness.  (Source:  NIH; http://www.nlm.nih.gov/medlineplus/copdchronicobstructivepulmonarydisease.html).

Constipation
Constipation occurs when bowel movements become difficult or less frequent.   The normal length of time between bowel movements ranges widely from person to person.  Some people have bowel movements three times a day; others, only one or two times a week.  Going longer than three days without a bowel movement is too long.   

Continuing-Care Retirement Community
Continuing-care retirement communities offer several levels of care in one setting, such as senior housing with independent living for those who are healthy, assisted living for those who need help with daily activities, and round-the-clock nursing care for those who are no longer independent.  Residents can move among the various levels of care depending on their needs.

Cough
Coughing is a reflex that keeps the throat and airways clear.  Although it can be annoying, coughing helps the body heal or protect itself.  Coughs can be either acute or chronic.  Acute coughs begin suddenly and usually last no more than 2 to 3 weeks.   Acute coughs are the kind most often associated with a cold or flu.  Chronic coughs last longer than 2 to 3 weeks.  Causes of chronic cough include asthma, allergies, chronic obstructive pulmonary disease (CPOD), gastroesophageal reflux disease (GERD), smoking, throat disorders, such as croup in young children and some medicines.  Coughing can be associated with serveral conditions and can also be a side effect of medication. (Soure:  NIH; http://www.nlm.nih.gov/medlineplus/cough.html). 

Custodial Care
Custodial care is non-skilled care delivered by a home health aide or attendant. Custodial care involves assistance with Activities of Daily Living (ADL): walking, bathing, dressing, using the bathroom, moving from seated to standing, getting in and out of bed.  Custodial care can also involve tasks, such as cooking, cleaning, and food shopping.

Death Certificate
A death certificate is a legal document, certifying the date, time and cause of death.  In New York State a death certificate is signed by a physician or nurse practitioner.  It is the only legal proof that someone has died.  It is used by families to settle their affairs and by New York State to stop social security payments and other benefits.

Dementia
Dementia is the name for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change.  They may become agitated or see things that are not there. Memory loss is a common symptom of dementia.  However, memory loss by itself is not the same as dementia. People with dementia have serious problems with two or more brain functions, such as memory and language. Although dementia is common in very elderly people, it is not part of normal aging. Many different diseases can cause dementia, including Alzheimer’s disease and stroke.  Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve symptoms or slow down the disease.  (Source:  NIH; http://www.nlm.nih.gov/medlineplus/dementia.html)

Depression
Depression is a serious medical illness. Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer. It is more than just a feeling of being “down in the dumps” or “blue” for a few days. If you are one of the more than 20 million people in the United States who have depression, the feelings do not go away. They persist and interfere with your everyday life. Symptoms can include: sadness, loss of interest or pleasure in activities you used to enjoy, change in weight, difficulty sleeping or oversleeping, energy loss,feelings of worthlessness, thoughts of death or suicide. There are a variety of causes, including genetic, environmental, psychological, and biochemical factors. There are effective treatments for depression, including antidepressants and talk therapy. Most people do best by using both. Depression or symptoms of depression may occur with serious illness and should be addressed as a priority similar to management of pain.  (Sources:  (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/); http://www.nlm.nih.gov/medlineplus/magazine/issues/fall09/articles/fall09pg16-17.html).

Do Not Resuscitate (DNR)
In a health care context, a Do Not Resuscitate (DNR) order is a legal, medical order not to give a person CPR or advanced life support to restore breathing if the heart stops beating or the person stops breathing.  Hospital staff sometimes refers to a DNR as “no code,” in contrast to “blue code” which calls for the resuscitation team, or “full code” which calls for using all possible means, including inserting breathing machines (ventilators) to restore breathing and heart beat, and maintain vital functions mechanically.

Durable Medical Equipment (DME)
Durable medical equipment (DME) is medical equipment that can be used more than one time,  such as crutches, knee braces, wheelchairs, hospital beds, and prostheses  In order for DME to be paid for (at least in part) by Medicare or other insurance, it must be ordered by a physician or nurse practioner.

Durable Power of Attorney
A durable power of attorney is a legal document in which a person (the “principal”) appoints another person(s) (the “agent” or “attorney in fact”) to make decisions about the principal’s personal financial and legal affairs. “Durable” means that the powers will continue to exist even after/if the principal becomes incompetent and unable to make his or her own decisions. Among items incuded in a durable power of attorney may be matters related to the management of property, financial assets, personal relationships and affairs, taxes, and insurance including health insurance, but in New York State, not health care decisions. For health care decisons a health care agent is appointed in a Health Care Proxy.

Elder Law Attorney
An elder law attorney is an attorney who specializes in providing legal services for the elderly, especially in the areas of estate planning and Medicaid planning.  Elder law attorneys specialize in general estate planning issues and counsel clients about planning for the management of assets and health care with alternative decision-making documents to prepare for the possibility of becoming incapacitated.  Elder law is a specialized area of legal practice, covering estate planning, wills, trusts, arrangements for care, social security and retirement benefits, protection against elder abuse (physical, emotional and financial), and other issues involving older people.  (Source:  http://definitions.uslegal.com/e/elder-law-attorney/)

Executor
An executor is a person appointed and named in a last will & testament. The responsibility of the executor is to carry out the wishes stated in the will. This includes, among other things, locating and protecting the assets of the estate, contacting all beneficiaries and heirs, continuing the affairs of the deceased person, such as paying debts and bills, dealing with creditors, and making sure taxes are properly calculated and paid.

Family Health Care Decisions Act (FHCDA)
The Family Health Care Decisions Act (FHCDA) is Publc Health Law in New York State which establishes the authority of a patient’s family member or close friend (in a priority listing) to make health care decisions for the patient in cases where he or she lacks decisional capacity and did not leave prior instructions or appoint a health care agent.  The family member or close friend’s decision-making authority would include the authority to direct the withdrawal or withholding of life-sustaining treatment when standards set forth in the statute are satisfied.  (Source:  NYS Bar Association; http://www.nysba.org/Content/NavigationMenu/PublicResources/FamilyHealthCareDecisionsActInformationCenter/SwidlerHealthJournSpr10.pdf)

Health Advocate
See Patient Advocate

Health Care Agent
In New York State, a Health Care Agent(HCA) is the person named and appointed in a health care proxy to carry out the wishes and choices of the person who has signed the health care proxy.

Health Care Proxy (HCP)
In New York State, a Health Care Proxy (HCP) is a legal document that allows a person to appoint someone they trust (for example, a family member or close friend) to make health care decisions for him or herself if they lose the ability to make decisions.  A Health Care Proxy in some other states is known as a Medical Power of Attorney or a Durable Power of Attorney for Health Care. In some states, a Durable Power of Attorney can include health care decisions, but not in New York State, where a separate health care proxy needs to be completed.

Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects the privacy of an individual’s health information.  (Further details:   www.hhs.gov/ocr/hipaa/understanding/consumers/index.html)

Home Health Aide (HHA)
A Home Health Aide (HHA) helps a patient at home with activities of daily living. Home health aides may do light housekeeping related to personal care during the visit. Medicare will not pay for home health aide services unless they are accompanied by a need for skilled care.

Home Health Attendant (HHA)
A Home Health Attendant (HHA) and a Personal Care Aide (PCA) have some – variable – training to assist individuals with custodial care services.  HHAs and PCAs usually are not licensed by New York State.

Hospice
Hospice is a system of compassionate quality care for individuals with a limited life expectancy due to terminal illness. It involves a team approach with expert medical care, pain management, and emotional and spiritual support tailored to the needs and wishes of the patient and his or her family. Hospices services are usually delivered at home, but are also available in other settings.

Hospitalist
A hospitalist is a physician who specializes in caring for patients in a hospital and is employed by the hospital.  Most hospitalists are certified internists.  They are usually more available in the hospital than a doctor with an outside practice.  They can offer frequent communication with the patient and family, and they have expertise in coordinating the care for hospitalized patients. 

Hospitalization
Hospitalization is the admission as a patient to a hospital. Admission to the hospital is usually an indication that there is medical instability and the level of care needed is greater than what can be managed in an outpatient facility or doctor’s office. Hospitalization is considered acute care management and may include IV medications, breathing treatments, surgery, and drainage tubes, or advance testing. Hospitalization can be a choice for someone who has serious illness; hospice care may be a preferred choice in some circumstances.

Informed Consent
Informed consent means that a patient agrees to a procedure or course of treatment after receiving a clear understanding of what the procedure or course of treatment involves and the effects it is likely to have on his or her illness and quality of life.

Inpatient
See Outpatient

Insomnia
Insomnia refers to challenges with falling asleep, staying asleep or waking too early.  A person with insomnia may be getting too little sleep or have poor-quality sleep. They may not feel refreshed when they wake up. Symptoms of insomnia include:  lying awake for a long time before falling asleep, sleeping for only short periods, being awake for much of the night, and waking up too early. A doctor will diagnose insomnia based on a person’s medical and sleep histories and a physical exam. He or she also may recommend a sleep study. A sleep study measures how well a person sleeps and how their body responds to sleep problems. Treatments include lifestyle changes, counseling, and medicines.  (Adapted from http://www.nhlbi.nih.gov/health/health-topics/topics/inso/)

Intravenous Line (IV)
An IV (may also be called a “drip”) is a line (tube) placed into a vein so that fluids or medication can go directly into the vein and spread throughout the body.

Last Will & Testament
A last will and testament is a legal declaration by which a person (called the “testator”) names one or more persons to manage his or her estate (called the “exector”) and provides for the transfer of his or her property at death.

Licensed Home Care Services Agency (LHCSA)
A Licensed Home Care Services Agency (LHCSA) offers custodial home care services to individuals who have private insurance or pay from private funds. In addition to private pay clients, a LHCSA may also contract with a Certified Home Health Agency (CHHA) to provide Home Health Aides (HHAs) that are supervised by a skilled nurse.

Life Support
Life support is a broad medical term that includes a number of therapies to keep a person alive, including life-sustaining measures, in addition to therapies that can be administered at home, such as oxygen treatment.  Life-sustaining measures include measures needed for artificial hydration and nutrition, CPR, mechanical ventilators and other machines that usually require hospitalization.  (Further details about life support:  http://www.compassionandsupport.org/index.php/for_patients_families/life-sustaining_treatment)

Living Will
A living will is a written document in which explicit instructions are given about medical treatment to be administered if/when a person becomes terminally ill or permanently unconscious. It expresses the person’s wishes and can serve as a guide for those making medical decisions on his or her behalf. Living wills are not legally binding in New York State.

Long-Term Care
Long-term care services 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 assist people with activities of daily living (ADL), such as dressing, bathing, and using the bathroom.  Long-term care can be provided at home or in a facility, such as a nursing home.  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.  Nursing homes that offer skilled care are referred to as Skilled Nursing Facilities (SNF).  (Source:  http://longtermcare.gov/the-basics/glossary/#Long-Term_Care/) All nursing homes in Westchester County offer skilled care.

Long-Term Care Facility
A jong-term care facility offers 24-hour nursing care for those recovering from illness or injury and serve as long-term residences for people who are unable to care for themselves. Most commonly, long-term care facilities are referred to as “nursing homes.” Services typically include help with eating, dressing, bathing and toileting, as well as wound care and rehabilitative therapy. Most offer additional care at the end of life.

Long-Term Care Insurance
Long-term care insurance is an an insurance policy that is intended to provide financial support to cover custodial care needed as result of an illness.  Long-term care insurance must be bought in advance of the medical illness.

Long-Term Care Planning (LTCP)
Long-term care planning is financial preparedness for a range of services and supports needed to meet health or personal needs over a long period of time.

Medicaid
Medicaid is a health and long-term care program that covers medical expenses for people with low or limited incomes. It is jointly funded by the state and the federal government. Each state has its own Medicaid program which determines the type, amount, duration, and scope of services covered within broad federal guidelines.  States must cover certain mandatory benefits and may choose to provide other optional benefits. To qualify for the Medicaid benefit program in New York State, a person must be a resident of the State of New York, a US national, citizen, permanent resident, or legal alien and in need of health care/insurance assistance; the individual’s financial situation needs to be characterized as low income or very low income. The individual must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in his or her household with a disability, or be 65 years of age or older.  (More details about Medicaid benefits in New York State:  http://www.health.ny.gov/health_care/medicaid/ see also www.benefits.gov)

Medical Orders for Life-Sustaining Treatment (MOLST)
Medical Orders for Life-Sustaining Treatment (MOLST) are medical orders on a special form, which documents an individual’s wishes regarding life-sustaining treatments and which “travels with” the individual when he or she moves from one care setting (for example, a nursing home) to another (for example, a hospital). It is the only authorized form in New York State for documenting both non-hospital DNR (do not resuscitate) and DNI (do not intubate) orders as well as other specific medical orders regarding hospitalization, antibiotics, mechanical ventilation and feeding tubes/artificial nutrition and hydration. It is recognized and used in a variety of health care settings. The MOLST is designed for use primarily with individuals who are living in a residential setting (nursing home) and have a limited life expectancy of approximatey one year.  (Adapted from:  http://www.health.ny.gov/professionals/patients/patient_rights/molst/frequently_asked_questions.htm)

Medicare
Medicare is a federal health insurance program for people 65 years of age or older, under 65 with certain disabilities, and any age with end-stage renal disease. Medicare has three parts:  Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. A premium is usually not paid for Medicare Part A if an individual or spouse paid Medicare taxes while working. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care.  It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. A monthly premium is paid for Medicare Part B. MedicarePart D is drug coverage and is offered with a monthly premium. If an individual has limited income and resources, his or her may get extra help to cover prescription drugs for little or no cost.   (Further information:  www.benefits.gov)

Medicare Rights Center
The Medicare Rights Center is a not-for-profit national organization for obtaining information about Medicare benefits.  (Further information:  1-800-333-4114)

Nausea
Nausea is an uneasy or unsettled feeling in the stomach together with an urge to vomit.  Nausea is not a disease; it is a complex symptom that may be associated with an illness or its treatment.  Management of nausea should be considered a priority similar to pain management.  (Further details:  www.nlm.nih.gov/medlineplus/nauseaandvomiting.html)

Nursing Home
See Long-Term Care Facility

Occupational Therapist (OT)
An Occupational Therapist (OT) is a person assisting people in the use of items they need in their daily life, at home or at work. OT includes home (or work) evaluation, targeted interventions, help and recommendations for using training equipment, as well as creating a safe home environment by taking steps, such as putting up handlebars in a bathroom and removing (or gluing down) carpeting.

Outpatient
An outpatient receives services or procedures that do not require inpatient admission to a hospital.  It is possible to stay overnight in a hospital without being considered an inpatient (for example, being admitted for observation after going to the emergency room with symptoms that physicians need to monitor). Medicare Part A (hospital insurance) covers most care as an inpatient. Medicare Part B covers outpatient and emergency room care. Out-of-pocket fees may be higher when staying overnight in the hospital as an outpatient.  (Further details about Medicare coverage in the hospital:  http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=1755&utm_source=dm-national&utm_medium=e-mail&utm_campaign=DM_6.3.2013+National)

Pain
Pain is an unpleasant feeling triggered in the nervous system.  Pain may be sharp or dull and have different degrees of severity.  It may come and go or it may be constant; it may be felt in one area of the body, such as the back, abdomen or chest, or felt all over (example, when muscles ache from the flu).  Pain can be helpful in diagnosing a problem.  Treatment varies depending on the cause of pain.  Pain as part of serious illness can be managed and should be addressed as a priority as part of an individual’s care.  (Source:  http://www.nlm.nih.gov/medlineplus/pain.html)

Palliative Care
Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis.  The goal is to improve quality of life for both the patient and the family.  Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.  Palliative care is a team approach to care.  They become a partner with you, your family and your other doctors.  They support you and your family every step of the way, not only by controlling your symptoms, but also by helping you to understand your treatment options and goals.  Working together with your primary doctor, the palliative care team provides:  (1) close communication; (2) expert management of pain and other symtoms; (3) help navigating the health care system; (4) guidance with difficult and complex treatment choices; and (5) emotional and spiritual support for you and your family.  (Source:  www.getpalliativecare.org)

Palliative Medicine
Palliative medicine is the medical portion of palliative care. Palliative medicine is certified medical specialty. Nurse practitioners can also specialize in palliative medicine and prescribe appropriate medicine and treatments. These palliative medicine specialist head up the team of medical and non-medical professionals and volunteers who provide palliative care services in a hospital, in an outpatient setting (doctor’s office or clinic), or through a hospice program.

Pastoral Services
Pastoral care (or chaplain) services refers to nonsectarian, spiritual support in a hospital, at home, or in another health care setting.

Patient Advocate
A patient advocate is a person who assists a patient in navigating the health care system. Depending on the place of employment and exact duties, he or she may also be called a patient representative, health advocate or patient navigator.

Patient Navigator
See Patient Advocate

Patient Representative
See Patient Advocate

Personal Care Aide (PCA)
See Home Health Aide

Physical Therapist
Physical therapists help people who have injuries or illnesses improve their movement and manage their pain.  They are often an important part of rehabilitation and treatment of patients with chronic conditions or injuries. They guide the exercise and physical activities used to condition muscles and improve levels of activity. Physical therapy is helpful for those with physically debilitating illness.  (Source: www.bls.gov/ooh/healthcare/physical-therapists.htm‎)

Physician Orders for Life-Sustaining Treatment (POLST)
Physician Orders for Life-Sustaining Treatment (POLST) is a term used in many states in place of MOLST (See MOLST)

Probate
Probate is the legal transfer of the decedent’s estate (property) to his or her rightful heirs (beneficiaries).

Prognosis
The prognosis of an illness is its probable course and outcome, including the likelihood of recovery or expectation for limitation in life expectancy.

Serious Illness
Serious illness may include cancer, cardiac disease such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS) and many more.  It can be an acute illness or a chronic condition that may be treatable, but not cured.  It may be managed over extended periods of time and may have periods of stability and instability, may require hospitalization or invasive treatment, cause pain and other symptoms that are uncomfortable, and affect quality of life.

Short-Term Rehabilitation
Short-term rehabilitation/sub-acute (“rehab”) facilities provide therapy for individuals recovering from a surgery, illness or accident and helps them achieve their maximum functional capacity and get back to their homes and community in the shortest time possible.  To achieve this goal, patients work with physical, occupational and speech therapists.

Short-Term/Sub-Acute Rehabilitation Facility
See Short-Term Rehabilitation

Shortness of Breath
Shortness of breath is the feeling of not being able to get enough air.  When a person is short of breath, it is hard or uncomfortable to take in the oxygen the body needs. Sometimes mild breathing problems are caused by a stuffy nose or hard exercise, but shortness of breath can also be a sign of a serious disease. Many conditions can make a person feel short of breath. Lung conditions such as asthma, emphysema or pneumonia cause breathing difficulties. So can problems with the trachea or bronchi, which are part of the airway system. Heart disease can make a person feel breathless if his or her heart cannot pump enough blood to supply oxygen to the body. Stress caused by anxiety can also make it hard to breathe. If a person often has trouble breathing, it is important to find out the cause.  (Source/further details:  http://www.nlm.nih.gov/medlineplus/breathingproblems.html)

Skilled Care
Skilled care is specialized medical care offered by a Registered Nurse (RN) who comes into the home or works in a skilled care nursing facility.

Specialists
Specialists, in a medical context, are health care practitioners who have completed advanced education and clinical training in a specific area of medicine (their specialty area), such as oncology, cardiology, neurology or palliative care. They specialize in treating a certain part of the body or a certain condition. For instance, a cardiologist only treats people with heart problems and an oncologist has specialized training to help people with cancer. 

Speech Therapist
Speech therapists assist with problems involving speech, language, and swallowing including communication problems that develop after an injury or illness, such as a stroke.

Sub-Acute Rehabilitation Facility
See Short-Term Rehabilitation

Surrogate
A surrogate is a substitute for another person. In New York State, in a health care context, the term surrogate is used to describe  a person who makes a health care decision for someone who is unable to make such decisions because of lack of capacity. If someone has signed a New York State Health Care Proxy, he or she has appointed someone called a health care agent who acts as a surrogate in medical decisions. The term surrogate is used if a health care agent has not been appointed and the Family Health Care Decision Act (FHCDA) goes into effect.

Tracheotomy
Tracheotomy is a surgical procedure to help a person breath.  When a tracheotomy is made, the surgeon cuts a hole in the front of the neck to gain access to the trachea (windpipe).  The purpose is to insert a tube (called a “trach tube”) that opens an air passage to the lungs so a ventilator can be attached or to remove secretions.  The procedure can be used when mouth and nose breathing is obstructed.

Ventilator
In a health care context, a (medical) ventilator is a machine that supports a person’s breathing by forcing air into the lungs through a tube inserted down the throat, a procedure called a tracheostomy.  It can be a life-sustaining measure in cases when normal breathing is expected to return, but it is not curative.