Above the Knee Amputation (AKA)

An amputation is the removal of a body extremity by trauma or surgery. Above the knee amputation (AKA) refers to the removal of a leg(s) just above the knee.

Access

This is a term used to describe when a catheter is inserted to gain entry to the bloodstream. The word “access” is commonly associated with a dialysis patient. Types of “access” for dialysis would include fistula, graft, and catheters (perm- cath or port – a – cath). Note: Assisted living facilities are required to obtain an exception from the state licensing agency to accept and/or retain a resident with a perm – cath or port -a –cath access.

Adaptive Equipment

Adaptive equipment is equipment or devices that can help persons with a physical or cognitive disability lead a more independent productive life. These devices assist to increase a person’s ability to perform activities of daily living (ADL’s) such as bathing, dressing, grooming, toileting, and feeding ones self. Some examples of adaptive equipment would be wheelchairs, walkers, bath chairs, adaptive spoons, plates, or cups, toilet seat risers, hand rails, and more.

Administrator

In an assisted living facility, this is a title given to the person who is responsible for all the day to day operations including but not limited to resident care needs, employee management, the maintenance of the facility, and adhering to Title 22 Regulations. The administrator has to be certified and have taken all the proper classes that meet the criteria through the licensing agency. ALL licensed facilities must have an administrator. Note: The certified administrator can also be the owner/licensee but not necessarily.

Advance Directive

Advance directives, also called an Advance Healthcare Directive, are instructions given by individuals specifying what actions should be taken for their health, such as a Do Not Resuscitate (DNR), in the event they are no longer able to make decisions due to an illness or incapacity. One form to specify these instructions is in a written document call a living will. Another is a durable power of attorney (DPOA) for healthcare, where the individual appoints someone to make decsions on their behalf and to enforce healthcare instructions in the event they become incapacitated. DPOA is a legally binding document and can only be completed when an individual has the capacity to do so. Also see Durable Power of Attorney and Living Will. Adult Protective Services (APS) This is an agency that advocates for seniors and investigates claims of physical, emotional or financial abuse.

Aid and Attendance (A & A)

This special pension provides benefits to war time veterans and their surviving spouses who require the attendance or assistance of another person on a regular basis. This required assistance can range from bathing and dressing to cooking and cleaning. Note: This benefit may be especially helpful for person’s who otherwise could not afford an assisted living facility. Refer to the “Financial Assistance” section for further explanation.

Alzheimer’s Disease

This is the most common form of Dementia. Parts of the brain degenerate due to abnormal tissue called senile plaques, neurofibrillary tangles and abnormal proteins. Also see Sundowner’s Syndrome. Note: An assisted living facility must have a Dementia Program approved by the California Department of Social Services, Community Care Licensing Division in order to accept or retain an individual with any type of Dementia diagnosis. MCI (Mild Cognitive Impairment) is not a Dementia diagnosis. If a phyician checks the Dementia box on the “Physician’s Report for Residential Care Facilities for the Elderly” then the individual would need placement in a facility with an approved Dementia Program also referred to as “memory care”.

Ambulatory

This means a person is physically and mentally capable of moving from place to place without the aid of another person or an assistive device such as a walker. Also see non-ambulatory.

Assisted Living Facilities (ALF’s)

Assisted Living Facilities emerged in the late 1980’s early 1990’s as an alternative to for seniors who could not live independently in their private residence but who did not need 24 hour medical care provided by a nursing home. ALF’s promote a philosophy of independence and dignity. ALF’s are facilities which provide supervision and/or assistance with activities of daily living (often referred to as custodial care) to ensure the health, safety and well-being of their residents. These facilities come in many forms ranging from “apartment style” facilities to private homes called board and care. Some of the basic services include management and/or supervision of medication, personal care by trained staff such as assistance with bathing, dressing, toileting, incontinence care, transportation, activities, meals and housekeeping. ALF’s are “social models” not “medical models” of care which must follow a set of federal regulations called Title 22. They are licensed and overseen by the state licensing agency. Assisted living facilities in California are private pay. There are many variables which will determine the price per month such as the square footage, amenities and the amount of personal care an individual will require. The amount of personal care an individual requires is referred to as “level of care”.

Note: Other terms for an assisted living facility may include Residential Care Home for the Elderly (RCFE), Personal Care Homes or Board and Care homes (B & C). It is important to know that the actual facility license recognized by the licensing agency, Department of Social Service, Community Care Licensing Division is Residential Care Facility for the Elderly (RCFE).

Bedridden

The Health and Safety Code defines “bedridden” as person either requiring assistance in turning and repositions in bed, or being unable to independently transfer to and from bed, except in facilities with appropriate and sufficient care staff, mechanical devices if necessary, and safety precautions. No resident shall be admitted or retained in a residential care facility for the elderly if the resident is bedridden, other than for a temporary illness for recovery from surgery. Note: This term is currently being redefined. Title 22 section 87606 – Care of Bedridden Residents. Also see Restricted Health Conditions section of this manual.

Bed Rails

Bed rails are metal, wood or plastic bars which are securely fastened to the bed to assist by pulling or pushing oneself in and out of bed. Some are attached to the frame such as on a hospital bed while others are held in place between the mattress and box spring. Rails are designed either full or half length (from the head to half length of the bed) to help prevent falls or assist with mobility especially for those who have decreased weakness, endurance or balance. Note: In assisted living facilities, unless a resident is receiving hospice care, the use of only a half- rail is permitted. Bed Sore This is a sore, called a dermal ulcer caused by pressure from laying or sitting for a prolonged period of time in a bed or chair. They are commonly found on the coccyx (butt), heals or hips. The elderly are more susceptible to developing bed sores. Note: Dermal ulcers are measured in stages according to depth of the sore. In or for a resident to live in an assisted living facility, these can be no deeper than a stage two and the sore must be considered healing and treatment (wound care) must be overseen by a skilled professional such as a home health nurse. Also see Dermal Ulcer and Restricted Health Conditions section in this manual.

Below the Knee Amputation (BKA)

BKS is the surgical removal of the leg to just below the knee. Bi-PAP (Bi level Positive Airway Pressure) This is a breathing apparatus that helps deliver more air into a person’s lungs. The air is delivered through a mask and can be set for one pressure for inhaling and another for exhaling. Note: An assisted living facility may need to obtain an exception to admit or retain a resident with a bi-pap machine.

C- PAP (Continuous Positive Airway Pressure)

This is a machine commonly used at night by patients/residents for the treatment of sleep apnea, a problem in which one’s upper airways collapse. Note: An assisted living machine may need to obtain an exception to admit or retain a resident with a c-pap machine.

California Department of Health Services (DHS)

This is a licensing agency that governs the skilled nursing facilities (SNF’s).

California Department of Social Services (DSS)

This is the licensing agency that governs the assisted living facilities. Department of Social Services recognizes “Residential Care Facilities for the Elderly” (RCFE) as the actual name of the license. Assisted living (A.L.) is the most commonly used term in the industry. Department of Social Services, Community Care Licensing Division (CCLD) enforces the compliance of the Title 22 Regulations.

Cardiomyopathy

This is a progressive disorder that alters the structure or impairs the function of the muscular wall of the lower chambers of the heart. This is also called heart failure.

Catheter

A catheter is a tube used to access the bladder or veins (blood). Types: *Indwelling/Foley(urine) *Suprapubic (urine) *Port a cath (vein) *Perm-cath (vein) *Venous access device (vein)

Note: See urinary catheters, port-a-cath, perm-cath and venous access device. All catheters are a Restricted health Condition some not specified in Title 22 . Title 22 section 87623 – Indwelling Urinary Catheter. See Restricted Health Conditions section in this manual.

Cerebrovascular Accident (CVA)

A CVA, also referred to as a stroke, is the rapidly developing loss of brain function due to a disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow to the brain) caused by a blockage or a hemorrhage (leakage of blood into the brain). As a result the affected area of the brain, which may be the left or right side, is unable to function leading to an inability to understand, formulate speech or see only one side of visual field (also called right or left sided neglect) or paralysis. A mini stroke is referred to as a TIA (Transient Ischemic Attack). Note: a severe stroke may result in the inability to swallow and in some cases a feeding tube may be inserted temporarily or permanently for nutrition. In assisted living facilities, feeding tubes are a prohibited health condition.

Certified Nursing Assistant (CNA)

A CNA is a person who has successfully completed a training program with a specific curriculum as designated by the state. A CNA is commonly employed by skilled nursing facilities and/or home health agencies. The duties of a CNA would include assisting residents with bathing, dressing, incontinence management, personal hygiene, and ambulation. Note: A caregiver in an assisted living facility is not required to be a CNA however are required in skilled nursing facilities.

Chemical Restraint

This is the use of medications to manage and control a person’s disruptive, combative, or inappropriate behavior, thus preventing harm to themselves or others. Examples of this behavior might include screaming and hitting. Some of the medications commonly used in these situations may be Haldol, Seraquel, Risperdal, Xanax, Ativan, and/or Klonopin. Note: In assisted living facilities, these medications are allowed however should not be used just for the “convenience” of the staff to manage a resident’s behavior. Assisted living facilities will need to know why a potential new resident has been prescribed these medications.

Chronic Obstructive Pulmonary Disease (COPD)

This is a persistent obstruction of the airways caused by emphazema or chronic bronchitis. Many people require oxygen (O2) to help them breath.

C. diff (Clostridium Difficile)

C. diff is a microorganism that is one of the many bacterial organisms normally found in the gastrointestinal (GI) tract. There are many bacteria that are normally present in the body; they aid in digestion and absorption of nutrients. C -diff is not usually harmful in the patients that have it in their GI- tract. However, under certain circumstances, C. diff can grow out of control in the GI tract. This overgrowth produces toxins within the tract that result in severe infectious diarrhea and inflammation of the large intestine (Colitis). This is when it becomes a dangerous infectious organism. C. diff is the most common cause of hospital –associated diarrhea. Antibiotics may be used to treat C. diff. Note: In assisted living facilities, this infection must be resolved prior to an admission into the facility. Also, for your safety, when a placement service goes to a hospital or rehabilitation center to see a client be aware and abide by all universal precautions that may be posted outside the individual’s door. Title 22 section 87615- Prohibited Health Conditions. See Prohibited Health Conditions in this manual.

Cognitive Impairment

This is a reduction in mental functioning and ability to carry out tasks that require thinking planning and memory. This can also be referred to as Dementia or Mild Cognitive Impairment (MCI).

Colonized

This occurs when a microorganism such as staph (bacteria) found on or in a person without causing an infection or if an infection was present, colonization means the infection has resolved. Also see MRSA. Note: This term is commonly associated with a MRSA infection that has resolved.

Colostomy

See “Ostomy”

Community Care Licensing Division (CCLD)

CCLD is a division or branch of the California Department of Social Services which enforces the compliance of Title 22 regulations in assisted living facilities. An assisted living facility applies for their license through CCL.

Compliant

In the healthcare industry this term is used to describe a resident who follows their physician’s medical advice and adheres to a prescribed course of treatment. A compliant resident, who may be a diabetic, would adhere to a recommended diabetic diet to help control their blood sugars. Another example of a compliant resident would be a resident that takes their medication as prescribed by their physician.

Confidentiality

Confidentiality is an ethical principal that when a patient/resident reveals information to a healthcare provider it will be kept secret unless the patient/resident gives consent to disclose to a third party. Note: A senior placement service should obtain permission from their client or responsible party to disclose information to the referred assisted living facilities.

Congestive Heart Failure (CHF)

CHF is a serious condition in which the quantity of blood pumped by the heart each minute is insufficient to meet the body’s normal requirements for oxygen and nutrients. CHF is also called heart failure.

Conservator

A conservator is a person appointed by the court to be a decision maker for someone (conservatee) who cannot make decisions for themselves due to an illness or incapacity.

Continuing Care Retirement Community (CCRC)

This is a residential community in which a resident has adequately planned for housing and care so they can live there for the remainder of their life. Seniors can “age in place” by moving between independent living, assisted living and nursing home care based on their changing needs. These communities are typically all in one location to enable a senior to be familiar with their surroundings as they grow older. They would sign a long term contract that provides for housing, personal care services and nursing care. Seniors typically enter a CCRC when they are still healthy and active and have the financial mean to support it.

Contractures

Contractures are the chronic loss of joint motion due to structural changes in joint tissues such as muscles, ligaments, and tendons. This can be due to muscle imbalance and prolonged immobilization. Castings and splints are used to provide constant stretching of these tissues surrounding the joints. This is a restricted health condition. Title 22 section 87626- Contractures.

Custodial Care

Custodial care refers to services and care that is considered “non medical” or “non skilled” by nature, such as medication management and/or assistance with bathing & dressing, provided by an assisted living facility or a nursing home. Custodial care implies that the care does not require an actual nurse (RN or LVN) to perform.

Declaration of Incapacity

A Declaration of Incapacity is a statement in writing by a physician to declare an individual incapacitated or incompetent. Note: This is often required in order for a DPOA to become effective.

Deep Vein Thrombosis (DVT)

This is blood clotting in the deep veins.

Delirium

Delirium is characterized by a disturbance of consciousness and a change in cognition that develop over a short period of time. Dementia, unlike delirium, develops over a long period of time. Some causes of delirium could include side effects to medication, electrolyte imbalance such as low sodium, and/or a urinary tract infection (UTI) the most common among the elderly.

Dementia

The loss of intellectual function (such as thinking, remembering, reasoning, exercising judgment and making decisions) and other cognitive functions, sufficient to interfere with an individual’s ability to perform activities of daily living or to carry out social or occupational activities. In some cases the personality may deteriorate as well. This loss of intellectual function occurs over a long period of time. Delirium, unlike dementia, develops over a short period of time. Dementia can also be referred to as Cognitive or Memory Impairment. Some types of Dementia may include Alzheimer’s Disease which is the most common form, Vascular Dementia also called Multi- Infarc Dementia which is commonly caused by small strokes and is the second most common form, or Dementia caused by Parkinson’s Disease. Note: An assisted living facility must have a Dementia Program approved by the California Department of Social Services, Community Care Licensing Division in order to accept or retain an individual with any type of Dementia diagnosis. MCI (Mild Cognitive Impairment) is not a Dementia diagnosis. If a phyician checks the Dementia box on the “Physician’s Report for Residential Care Facitiies for the Elderly” then the individual would need placement in a facility with an approved Dementia Program also referred to as “memory care”.

Dermal Ulcer or Decubitis Ulcer

These are bed sores or pressure sore, also referred to as a “decub”, caused by laying in the same position in bed, chair or wheelchair for a prolonged period of time. Usually occurs on the coccyx (butt), heals or hips. Wounds are measured by depth call “stages”. Note: In order to be a resident in an assisted living facility, a dermal or decubitits ulcer may not be any deeper than a stage two and must be a healing wound under the supervision and treatment of a skilled professional usually a nurse. Title 22 section 87631 – Healing wounds. See Prohibited Health Condtions and Restricted Health Conditions in this manual.

Diabetes

This is a medical condition in which the body is unable to control the level of sugar in the body. There are three types however only two of them would be of a concern in assisted living (type 1 and type 2): Type 1 – Insulin Dependant Diabetes Mellitus (IDDM) – This type is typically a chronic condition in which insulin is not secreted by the pancreas which is needed to control sugar in the blood. The treatment is usually injected or inhaled insulin along with dietary and lifestyle adjustments as part of the management.

Type 2 – Non Insulin Dependent Diabetes Mellitus (NIDDM )

Typically, this is characterized by insulin resistance (which is a condition which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells) This may be managed with a combination of dietary treatment, oral medication, and sometimes insulin supplementation.

Note: In assisted living facilities, if injections (sub -q) are required for a resident they must be able to self inject their insulin unless a skilled professional such as a home health nurse or facility nurse, is available at ALL required times. Diabetics have to check their “blood sugars”, also commonly called glucose testing or accu-checks (accu-checks is a brand of glucose meters), regularly with a glucose meter, how often is decided by their physician. In assisted living facilities, the resident must be able to perform their own glucose testing unless a skilled professional is available to administer at ALL required times. This is a restricted health condition Title 22 section 87628 – Diabetes and section 87629 – Injections. See Restricted Health Condition section in this manual.

Dialysis

This is the process of removing waste products and excess water from the body due to severe kidney failure caused by End Stage Renal Disease (ESRD). There are two most common types of treatment are hemodialysis & peritoneal dialysis. If an individual is receiving dialysis treatment they will have an “access” or an entry to their bloodstream such as a Graft, Fistula, or catheter (tube), also called a permcath and may require a special diet called a renal diet. Note: In order for a dialysis patient to be a resident in an assisted living facility, the facility will have to request an exception for a catheter access. An assisted living facility should always be aware if an individual is receiving dialysis treatments, the type of access, and if a renal diet is required.

Discharge Planner (DC Planner)

This refers to an individual who works in a hospital or rehabilitation center and is responsible for coordinating a person’s discharge. This may include contacting a placement service to help find an assisted living facility, home health services, durable medical equipment (DME), transportation, and referring them to other community resources such as advocacy centers or skilled nursing facilities. Other common names for this person may be case worker, care coordinator, case manager or social services.

Durable Medical Equipment (DME)

This refers to adaptive equipment such as a wheelchair, walker, cane, bath bench, or commode.

Durable Power Of Attorney for Finances (DPOA)

This is a legal document which an individual has appointed a person (agent) to make financial decisions on their behalf.

Durable Power Of Attorney for Healthcare(DPOA)

This is a legal document which an individual has appointed a person (agent) to make healthcare decisions on their behalf. The DPOA may also be referred to as the “responsible person/party”. In some documents, in order for a DPOA to become effective the physician(some times two) must declare the individual incapacitated or incompetent. Note: The DPOA is often the person a placement service will be dealing with during the process of selecting an assisted living facility.

Edema

Swelling due to fluid build up in the extremities (legs, arms, feet).

End Stage Renal Disease (ESRD)

ESRD is the last stage of kidney failure which is the most severe and often requires dialysis for treatment along with a restricted renal diet. Also see Dialysis.

Enema

Enemas, fecal impaction removal and/or suppositories are a procedures used to remove fecal matter from the bowel. Note: This is a restricted Health Condition. Title 22 section 87622 – Fecal Impaction Removal, Enemas, and/or Suppositories. See Restricted Health Condition section in this manual.

Exception

This is permission, usually in writing, granted by the licensing agency (California Department of Social Services) allowing an assisted living facility to retain or admit a resident with a restricted health condition. The assisted living facility would typically contact their LPA (Licensed Program Analyst) to request the exception.

Fair Housing Act/Equal Housing Opportunity

The Fair Housing Act is a federal law that makes discrimination in the sale, lease, or rental of housing because of race, color, religion, sex, handicap, familial status or national origin illegal.

Fall Risk

This term refers to an individual who is at risk for falling, due to dementia, poor balance, or poor safety awareness, etc…

Feeding Tube

This is a tube inserted into the stomach (G- Tube) or nose (N G-Tube) for feeding and nutrition. Note: This is a prohibited health condition in assisted living facilities. Title 22 section 87615. See Prohibited Health Condition section in this manual.

HIPAA (Health Insurance Portability and Accountability Act)

“Higher Level of Care”

Higher level of care could mean an increased amount of care provided by the assisted living facitliy or the need to transfer to a skilled nursing facility. Also see “level of care”.

Home Care Agency

Home care agencies provide caregiving services to individuals in their home. You would typically pay an hourly rate for a caregiver to assist with personal care or homemaking services such as housekeeping, meal preparation or to provide transportation to run errands. These agencies are typically private pay or covered by long term care insurance.

Home Health Agency

This is an agency which provides skilled services such as a physical therapist or nurse in an individual’s home or in an assisted living facility. Home health services must be ordered by a physician and the individual is considered “home-bound”, meaning the individual is unable to leave their home unassisted. Many physicians will order these services for their patient’s while they are recovering from a surgery or illness. These services are usually covered by Medicare, Medi-Cal or private insurance.

Hospice

This is a comprehensive program of care to patients and families facing a life threatening illness. The plan of care, in preparation for death, includes emotional, physical, social, & spiritual support based on the patient’s wishes and the family’s needs. An assisted living facility with a “Hospice Waiver” is allowed to retain or admit a resident receiving hospice services.

Ileostomy

See “Ostomy”. Title 22 section 87621- Colostomy/Ileostomy. See Restricted Health Conditions section in this manual. Incontinence Bowel Incontinence- is the loss of bowel control.

Urinary Incontinence

The inability to control bladder function. Incontinence usually requires the need for incontinence products such as pads or adult diapers.

Note: This is a restricted health condition. Title 22 section 87625- Managed

Incontinence. See Restricted Health Condition in this manual.

Incapacitated

This is a term used to describe an individual who is unable to make decisions for themselves. This is determined or declared by a physician.

Indwelling Catheters

See Urinary Catheters.

Injections

See Diabetes and Subcutaneous. Note: This is a restricted health condition. Title 22 section 87629 – Injections. See Restricted Health Conditions in this manual.

In-Service

This is a term used to describe training or educational classes for employees. In assisted living, some topics for training might be “how to approach a resident with dementia”, “how to escort residents out of a facility in case of an emergency”, or “how to use a fire extinguisher”, etc… Assisted living facilities should provide ongoing in-service training for their employees.

Intermittent Catheterization Program (ICP)

This is a program which the bladder has to be intermittently emptied by inserting a disposable catheter or tube through the urethra into the bladder. This is used for managing an individual (male or female) with chronic retention of urine due to a neuropathic (nerve disorder) or malfunctioning bladder. ICP is also called ISP Intermittent Self Catheterization. Note: In assisted living facilities, a resident must be able to perform their own intermittent catheterization unless a skilled professional is available. Not specified in Title 22. See Restricted Health Condtion section in this manual.

Intermittent Positive Breathing Machine (IPPB)

IPPB is a breathing device which provides oxygen or theraputice aerosols (medication) into a person’s airway delivered under intermittent positive pressure. Note: This is a restricted health condition. Title 22 section 87619 – Intermittent Positive Breathing Machine. See Restricted Health Conditions section in this manual.

International Normalized Ratio (INR)

A method used to test a patients blood when monitoring warfarin (anticoagulant) or coumadin levels. Coumadin is the brand name for warfarin and these terms are often used interchangeably. This is often referred to as protimes (PT).

IV (Interveneous)

IV’s are an access to the veins (blood) for nutrition, medications or fluids. See catheter, port- a – catheter, and pumps. Note: IV’s are a Restricted Health Condition. Not specified in Title 22. See Restricted Health Condition section in this manual.

Level of Care

This is a term used to describe the amount or degree of personal care a potential new resident or a current resident of an assisted living facility will require. The level of care is determined through a pre admission appraisal or assessment completed by the facility. In an assisted living facility, the monthly rate or cost is determined by the level of care required.

Licensee

This refers to the individual(s) who have been granted a license by the California Department of Social Services, Community Care Licensing Division to operate a residential care facility for the elderly (RCFE). RCFE’s are commonly called assisted living facilities.

Licensing

This term refers to the state licensing agency called California Department of Social Services, Community Care Licensing Division which provides licensure to the residential care facility for the elderly (RCFE). RCFE’s are more commonly called assisted living facilities. All all facilities must follow Title 22 regulations. The licensing office will have a file for each facility that contains reported complaints and the resolution. Also, the file will contain the results of the surveys completed by the LPA (see below).

License Program Analyst (LPA)

This is an individual who is employed by the state’s licensing office and responsible for performing evaluations of the assisted living facilities. These surveys are to ensure a facility is in compliance with Title 22 Regulations. Also, this is the individual from whom a facility would request an exception and for the final approval a license for a new facility. A LPA has a designated area or county in which they operate.

Living Will

A living will is a document which states an individual’s healthcare wishes or instructions. This is a form of an advance directive and can only be completed when an individual has the capacity to complete this document.

Long Term Care (LTC)

Until recently, this term referred to a skilled nursing facility. Currently the term “long term care” is applied to assisted living facilities as well as skilled nursing facilities.

Mantoux Test

Mantoux test is a type of skin test which is used as a diagnostic tool for Tuberculosis. The result is measured in millimeters (mm) on the skin, this is also known as a PPD. Note: An individual must have negative Tuberculosis test prior to admission into an assisted living facility.

Medi-Cal

Medi-Cal is California’s term for Medicaid. It is a State and Federal Program that pays for certain health services and nursing home care for older people with low incomes and limited assets. In California, Medi-Cal pays for long term care services in a skilled nursing facility (i.e. nursing home/convalescent home) or at home under certain conditions. Who is eligible is based on your income and personal resources.

Note: Overall, Medi-Cal does not cover the costs of an assisted living facility. Although, a pilot program is in place in LA, Sacramento, and San Joaquin counties in which Medi-Cal is reimbursing the participating assisted living facilities. Essentially, this program is to demonstrate the money the state may save by paying for these less expensive types of care facilities and while still meeting the needs of a person requiring ongoing 24 hour custodial care.

Medicare

Medicare is a health insurance program for people age 65 or older, some disabled people under 65, and people of all ages with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant). Note: Medicare does not pay for long term care in an assisted living facility or a skilled nursing facility. Medicare pays/reimburses only for medically necessary short term “skilled care” (such as nursing or physical rehabilitation) in skilled nursing facilities or home health care (home health nursing or physical therapy). However, certain criteria must be met for Medicare to reimburse.

Memory Care

This is a term that refers to a type of care required by an individual who has been diagnosed with Dementia. This individual usually requires a facility that is licensed or certified to care for those with Dementia. “Memory Care” is a much softer term than Dementia or Alzheimer’s and has become popular in recent years. Note: An assisted living facility must have a Dementia Program approved by the California Department of Social Services, Community Care Licensing Division in order to accept or retain an individual with any type of Dementia diagnosis. MCI (Mild Cognitive Impairment) is not a Dementia diagnosis. If a physician checks the Dementia box onthe “Physician’s Report for Residential Care Facilities for the Elderly” then the individual would need placement in a facility with an approved Dementia Program also referred to as “memory care”.

Mental Illness

Mental illness is any psychological or physiological disease or condition affecting the brain that influences the way a person thinks, feels, behaves and/or relates to others and his/her surroundings. There are various types of mental illness such as bipolar disorder, schizophrenia, depression, and obsessive compulsive disorder (OCD) to name a few. The diagnosis and prescription of medication for mental illness must come from a physician or psychiatrist. Note: According to state regulations, residents with a primary diagnosis of mental illness are not accepted in assisted living facilities. Not specified in Title 22. See Restricted Health Conditions in this manual.

Methicillin Resistant Staphylococcus Aureus (MRSA)

An infection caused by staphylococcus aureus bacteria often called “staph”. It is a strain of staph that is resistant to the broad spectrum antibiotics commonly used to treat it. MRSA can be fatal. MRSA infections most commonly occur in hospitals or other healthcare setting i.e. nursing homes or dialysis centers. Staph is found on the skin or in the nose and the bacteria can be passed to others. Note: In an assisted living facility, MRSA must be colonized which means a person may be a carrier of staph but are not sick and/or contagious. Also, for your safety, when a placement service goes to a hospital or rehabilitation center to see a client be aware and abide by all universal precautions that should be posted outside the individual’s door. See Title 22 section 87615 – Prohibited Health Conditions and Prohibited Health Conditions in this manual.

Mild Cognitive Impairment (MCI)

Mild Cognitive Impairment is a term used for individuals who have cognitive impairment beyond what would be expected for a person of their age and education, but does not interfere significantly with their activities of daily living. MCI is considered to be the transitional stage between normal ageing and Dementia. Note: An assisted living facility must have a Dementia Program approved by the California Department of Social Services, Community Care Licensing Division in order to accept or retain an individual with any type of Dementia diagnosis. MCI (Mild Cognitive Impairment) is not a Dementia diagnosis. If a physician checks the Dementia box onthe “Physician’s Report for Residential Care Facilities for the Elderly” then the individual would need placement in a facility with an approved Dementia Program also referred to as “memory care”.

Mini Mental Exam

This is a brief questionnaire commonly used to determine cognitive impairment.

Note: An assisted living facility may incorporate the mini mental exam into their pre-admission assessment. See example of a mini mental exam in the “forms” section of your manual.

Multi-Infarct Dementia

This is the second most common form of dementia (second to Alzheimer’s) and is due to a series of small strokes. This is also called Vascular Dementia. (See Vascular Dementia).

Myocardial Infarction (MI)

A Myocardial Infarction is a heart attack.

Nebulizer

A nebulizer is a device used to administer medication, such as albuteral, in the form of a mist inhaled into the lungs.

Non-Ambulatory

This means an individual does not have the ability to walk without the assistance of another person or the use of an assistive or mechanical device such as a walker or wheelchair.

Non-Compliant

In the healthcare industry, this term is used to describe a resident who disregards their physician’s medical advice and/or does not adhere to a prescribed course of treatment. An example of a non compliant resident would be one who refuses to take their medications or a diabetic resident who does not adhere to their recommended diabetic diet to control blood sugars.

Nursing Care

This is a term used to describe ongoing medical care that can only be provided by a nurse or physician. This is often referred to as a type of care one would receive in a skilled nursing facility/nursing home. Note: An individual requiring nursing care may not be a candidate for an assisted living facility unless the medical needs can be met by a skilled professional (i.e. nurse) and no prohibited health conditions exist.

Ombudsman

This is an official who represents the interests of the elderly by investigating and addressing reported complaints. In the healthcare field you will see an ombudsman investigate complaints in skilled nursing facilities and assisted living facilities. An ombudsman serves as a resident’s rights advocate.

Ostomy

This refers to the surgically created opening in the body (stoma) for the discharge of bodily wastes (i.e. feces and urine) resulting in the need for a pouch or bag outside of the body. Ostomy types : *Colostomy (feces) *Ileostomy (feces) *Urostomy (urine)

Note: In assisted living facilities, ostomy care must be overseen by a skilled professional, such a a home health nurse, if a resident is unable to perform self care. This is a restricted health condition. Title 22 section 87621- Colostomy/Ileostomy. See Restricted Health Condition in this manual.

Oxygen (O2)

In the healthcare field, oxygen, a gas, is used for the treatment or therapy of a chronic or acute health condition such as COPD (Chronic Obstructive Pulmonary Disease). Oxygen is generated and created in various ways. An electrically powered oxygen concentrator is used to create O2 for immediate use and used for patients that require o2 on a continuous basis. Liquid O2 requires special handling. O2 is delivered through a mask or a nasal cannula which is plastic tubing that fits behind the ears and two prongs that are placed in the nostrils. Note: An assisted living facility requires an exception from the licensing agency for liquid oxygen. In assisted living facilities, a resident must be aware and able to turn their O2 machine on/off and set it to the proper setting. If unable, then a skilled professional must be available. This is a restricted health condition. Title 22 section 87618 – Oxygen Administration – Gas and Liquid. See Restricted Health Condition section of this manual.

Palliative Care

Palliative Care generally refers to any remedy or medical treatment which alleviates symptoms and/or pain without curing. The intention is to relieve suffering and improve quality of life for people and their families facing life threatening illness.

Parkinson’s Disease

This is a degenerative disorder of the central nervous system which often impairs the sufferer’s motor skills, speech, cognition and other functions. Symptoms may include tremors, stiffness, and slowing movement.

Peripheral Vascular Disease (PVD)

A term used for various problems caused by poor circulation due to clogged arteries.

Peripherally Inserted Central Catheter (PICC line)

This is a form of an intravenous (IV) access. A PICC line is inserted into the veins and is used for antibiotics, Chemotherapy, or nutrition. Note: In assisted living facilities, PICC lines are typically a prohibited health condition however a facility may attempt to obtain an exception. This is not specified in Title 22. See Restricted Health Conditions section in this manual.

Perm-Catheter

A type of catheter to access the veins used for kidney dialysis, delivering medication, chemotherapy treaments, nutrition, or to withdraw blood . This term is often abbreviated to perm-cath. The terms Perm cath and port-a-cath are often used interchangeably. See Port- a- cath. Note: Assisted living facilities are required to obtain an exception from the state licensing agency to accept and/or retain a resident with a perm catheter. This is not specified in Title 22. See Restricted Health Condition in this manual.

Physical Restraints

These are used to keep a resident or patient of a hospital or skilled nursing facility restrained to a bed or chair to help keep them safe by restricting or limited the use of their hands and feet. Some types of restraints used could be seat belts, mittens for the hands, lap buddy (Soft cushion over wheelchair), or chest restraint (prevents someone from getting out of bed). Note: In assisted living facilities, physical restraints are prohibited. Not specified in Title 22. See prohibited health condtions in this manual.

Physician’s Report for Residential Care Facilities for the Elderly

This is a required medical history form completed by a potential resident’s primary care physician prior to admission to an assisted living facility. This is often shorten and referred to as the “Physician’s Report”.

Port-A-Cath

This is a brand name for a type of catheter to access the veins used for kidney dialysis, delivering medication, chemotherapy treatments, nutrition, or to withdraw blood. The terms port – a – cath and perm cath are often used interchangeably. See perm- catheter. Note: Assisted living facilities are required to obtain an exception from the state licensing agency to accept and/or retain a resident with a port-a-cath. Not specified in Title 22. See Restricted Health Conditions section in this manual.

Postural Supports

Devices used on residents in order to achieve proper position and balance in order to improve mobility and function or to position a resident to prevent them from falling out of bed or chair. These are not intended to restrict movement which then would be considered a restraint which are prohibited in an assisted living facility. Some devices commonly used are braces and spring release trays. See Title 22 section 87608 Postural Supports.

PPD (Purified Protein Derivative)

PPD is a type of tuberculin (antigen) used in skin testing to determine if someone has been exposed to the bacterium that causes Tuberculosis. This is also referred to as a Mantoux test. Also see Tuberculosis. Note: Title 22 regulation requires a negative Tuberculosis Test prior to admission into an assisted living facility.

Pre-Admission Appraisal/Evaluation/Assessment

This is an appraisal/evaluation/assessment completed by an assisted living facility of a potential resident prior to admission. This is to determine what the resident’s care needs or level of care will be, if they are appropriate for the facility, and the monthly rent.

Private Pay

Private pay or “out of pocket” means using personal income and assets to pay for services . Also, individuals using Long Term Care Insurance are considered private pay. Note: In California, assisted living facilities are private pay.

Prohibited Health Condition

Health conditions in which the licensing agency, the California Department of Social Services, Community Care Licensing Division, has determined and stated in the Title 22 regulations as conditions not allowed in assisted living facilities. Some examples of Prohibited Health Conditions may be feeding tubes, physical restraints, stage three or deeper dermal ulcer (bed sores), tracheotomies, or IV’s. Section 87615 of Title 22 lists the Prohibited Health Conditions. Prohibited Health Conditions are different than Restricted Health Conditions. Also see the Prohibited Health Conditions section of this manual.

Prothrombin Time or “Pro-Time” (PT)

A method used to test a patient’s blood when monitoring warfarin (anticoagulant) or coumadin levels. Coumadin is the brand name for warfarin and these terms are often used interchangeably. Note: This is also known as an INR (Intermittent Normalized Ratio).

Psychotropic Medication

See “Chemical Restraint”.

Pumps

Interveneous (IV) pumps used to deliver medication. Types: Continuous Ambulatory Drug Delivery (CAAD): This is pronounced “CAD” pump and is used for continous pain management.

Dobutamine Pump

Helps the heart pump more effectively. Used for patients with end stage heart failure.

Patient Controlled Analgesia (PCA)

Used for pain management and is a preset dose of morphine delivered by pressing a button on a computerized pump.

Note: In assisted living facilities these are typically prohibited health conditions, although some exceptions have been made for pain pumps if an individual is receiving hospice care. Not specified in Title 22. See prohibited health conditions section of this manual.

Pressure Sores

See Dermal Ulcers.

Renal diet

This is a restricted diet which dialysis patients typically require. Also see ESRD.

Residential Care Facility for the Elderly (RCFE)

This is a non- medical care facility which provides ongoing assistance to residents with activities of daily living such as medication monitoring, dressing, bathing, etc… A RCFE must have a care attendant on site at all times. RCFE’s are licensed through the California Department of Social Services, Community Care Licensing Division and must abide by Title 22 Regulations. Also see Assisted Living Facilities. Note: RCFE’s are more commonly known and referred to as assisted living facilities.

Respite

The definition of respite in relation to an assisted living facility refers to temporary placement in a facility. This could mean a couple of days, weeks or even months. Many assisted living facilities will accommodate a resident short term if they have a bed available. Respite rates will vary by facility. Whether a resident will be staying short or long term the preliminary information and paperwork will still be required including a tuberculosis test and the Physician’s Report for Residential Care Facilities for the Elderly.

Responsible Person/Party

This refers to an individual (s) that is in the position of “decision maker” for a resident . This individual is commonly a person who is related to the resident or has been appointed by the resident as their durable power of attorney (DPOA).

Restraints

See Physical Restraints and Chemical Restraints Restricted Health Condition This term refers to a health condition that is not allowed in an assisted living facility. If a person has a restricted health condition and the facility feels they can still care for that person the facility may be able to obtain an exception from the licensing agency in order to retain or admit a resident into the facility. Title 22 section 87612 lists the restricted health conditions.

Retirement Community

This refers to a multi-residence housing facility for seniors. apartment style and the services provided include which maybe a studio, one bedroom or two bedroom, meals, recreation, transportation and housekeeping. Retirement communities typically have residents who are independent and do not require personal care such as medication management or bathing assistance unless they hire from an outside agency. Retirement communities do not provide personal care assistance with activities of daily living or are not required to follow Title 22 Regulations.

Skilled Nursing Facility (SNF)

A skilled nursing facility (SNF), pronounced “sniff”, is a medical institution which provides short term rehabilitation services and/or long term nursing care 24 hrs a day/7 days week. In a SNF, a registered nurse (RN) must be on duty on each shift. Some of the services provided include physical therapy, occupational therapy, speech therapy, social services, nursing care, and certified nursing assistant (CNA) care. Payment or reimbursement for these types of facilities may include on a short term basis, Medicare and supplemental insurance or for long term care Long Term Care insurance (with the proper plan), Medi-Cal, private pay or Veteran’s Assistance. Residents may require some or all of these services. Other terms for skilled nursing facilities would be nursing homes, convalescent homes or rest homes. These facilities are licensed by the California Department of Health Services (DHS). Note: In California, unlike SNF’s, assisted living facilities are licensed by the California Department of Social Services and are not required to have a nurse on staff although some do.

Skilled Professional or Medical Professional

These terms are used when referring to a person who is licensed in California to perform medical care or therapy. Examples of a skilled or medical professional would be a RN (Registered Nurse), LVN (Licensed Vocational Nurse), Physician, Nurse Practitioner, or Physical Therapist. Some of the duties performed by a nurse in an assisted living facility would be injections for an insulin dependent diabetic, urniary catheter care and/or blood draws. In assisted living facilities, the Title 22 regulation states that if a resident cannot perform their own injections they must be done by a skilled or medical professional. Note: While in some assisted living facilities there may be a skilled or licensed professional on staff, most often this would be a nurse, this is not required by Title 22 regulations. If a current resident of a facility or a potentially new resident requires the attention of a skilled or medical professional and one is not on staff at all times of need then arrangements must be made to have a skilled or medical professional come in from an outside agency such as a home health agency to address the needs of the resident. See Restricted Health Conditions.

Social Security Administration (SSA)

This is a Federal agency that pays retirement income.

Social Security Disability Insurance (SSDI)

This is a Federal program which pays benefits to an individual if one has worked long enough and has paid Social Security taxes.

Staphylococcus (Staph)

Staph is a group of bacteria that are most commonly found in the nose or on the skin and can cause an infection in various tissues of the body. Methicillin Resistant Staphylococcus Aureus (MRSA) is one example of a staph infection. You may hear the term staph and MRSA used interchangeably but staph is not always MRSA. See MRSA. Note: In assisted living facilities, infections must be resolved or colonized prior to admission into the facility. Title 22 section 87615 – Prohibited Health Conditions. See Prohibited Health Condition section in this manual.

Subcutaneous Injection (SQ)

Subcutaneous injection is a needle that is inserted just under the skin to supply medication such as Insulin. Medical professionals pronounce this “sub-q”. See Diabetes. This is a Restricted Health Condition. Title 22 section 87629 – Injections. See Restricted Health Conditions section in this manual.

Sundown Syndrome

Sundown Syndrome is the name given to the phenomenon that causes symptoms of confusion after “sundown”. Other symptoms could include anxiety, restlessness, combative behavior. These symptoms can also be evident at other times of the day. These symptoms appear in some people who suffer from Alzheimer’s Disease or other forms of Dementia. This is also referred to as “Sundowning”. Note: In assisted living facilities, these behaviors will be a cause of concern. Facilities would may or may not be able to retain or admit a resident if they are a threat to the staff or other residents.

Supplemental Security Income (SSI)

This is a Federal program which pays benefits based on financial need.

Title 22 Regulations

Title 22 is a code of regulations that all assisted living facilities must comply with to maintain their license through the California Department of Social Services. These regulations are enforced by the Community Care Licensing Division (CCLD).

Tracheotomies

This is a surgical construction of an opening in the trachea for the insertion of a catheter or tube in order to facilitate breathing. These are referred to as “traches”. Note: In assisted living facilities, this is a prohibited health condition. Title 22 section 87615 – Prohibited Health Conditions. See Prohibited Health Conditions section in this manual.

Transient Iscemic Attack (TIA)

A TIA is a mini stroke.

Tuberculosis (TB)

Tuberculosis is a common and often deadly infectious disease caused by mycobacterium. Tuberculosis usually attacks the lungs but can also affect other parts of the body. TB is spread through the air, when people who have an active infection cough, sneeze or spit. A PPD, a type skin test also known as a Mantoux test is done to determine if an individual has a TB infection or is a carrier of the bacteria.

People may have been infected or exposed with the mycobacterium but do not have an active infection. This is called Latent Tuberculosis, which is not contagious. This condition may also result in a false positive PPD test. A false positive may also occur if an individual has had a vaccine for Tuberculosis. If this occurs, the physician will order a chest x ray or a 2 step PPD (two skin tests) to confirm if a contagious infection does or doesn’t exist. If a TB infection does exist a treatment plan would be implemented.

Note: According to state regulations (Title 22) a Tuberculosis (TB) Test (whether a PPD or chest X-ray) with a negative result is required prior to a person moving into an assisted living facility. Assisted living facilities can accept a chest x ray as long as the the physician marks “No Evidence of TB infection or disease” on the “Physician’s Report for Residential Care Facilities for the Elderly”. Note: An active Tuberculosis infection is a prohibited health condition in an assisted living facility. Title 22 section 87615 – Prohibited Health Conditions. See Prohibited Health Conditions section in this manual.

Universal Precautions

Universal Precautions is an approach to infection control that treats all human body fluids (blood, mucous, saliva, urine, etc…) as if they are infectious. Generally, universal precautions consist of, but are not limited to, regular hand washing, the use of gloves, masks, and barrier gowns when coming in contact with a potentially infectious person. Note: When visiting hospitals or rehabilitation centers be aware and abide by all universal precautions that may be posted outside the individual’s door.

Urinary Catheters

Indwelling Catheter or Foley Catheter (F/C)

A flexible tube inserted through the urethra into the bladder to void the bladder of urine. A Foley catheter is also referred to as an indwelling catheter.

Suprapubic Catheter

An indwelling catheter (tube) that is inserted surgically through the abdomen into the bladder to void the bladder of urine.

Note: There are other types of catheters such as ones needed for a dialysis access or chemotherapy treatments. Unlike the urinary catheters that access the bladder, these types of catheters access the veins or in the case of Peritoneal Dialysis (PD) the catheter accesses the abdomen through the peritoneum and assisted living facilities must obtain an exception from their licensing agency in order to accept or retain a resident with these types of catheters. Indwelling catheters are a restricted health condition. Title 22 section 87623 – Indwelling Urinary Catheter. See Restricted Health Condition section in this manual.

Vancomycin Resistant Enteroccoci (VRE )

Enterococci are bacteria that normally are present in the human intestines and in the female genital track and often found in the environment.. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is often used to treat the infections caused by enteroccoci. In some instances enterocicco have become resistant to the drug and thus are call vancomycin resistant enterococci. VRE can live in the human intestine and female genital tract with out causing disease often called colonization, however, sometimes it can be the cause of infection of the urinary tract, the bloodstream, or of wounds. VRE can be passed from person to person by the hands of caregivers after they have had contact with other people with VRE. Note: In assisted living facilities, a person who has an active VRE infection will not be permitted in the facility until the infection is resolved. When visiting hospitals or rehabilitation centers be aware and abide by all universal precautions that may be posted outside the individual’s door. Title 22 section 87615 – Prohibited Health Condition. See Prohibited Health Condition section in this manual.

Vascular Dementia

This is a loss of brain function due to a series of small strokes (cerebrovascular disease) – ruptures of tiny blood vessels in the brain. This is the second most common form of dementia (second to Alzheimer’s) also referred to as Multi-Infarc Dementia. People experiencing Vascular Dementia often have problems with memory, abstract thinking, object identification or recognition, speech creation, speech comprehension and motor activities. The signs of Vascular Dementia are similar to those of Alzheimer’s Disease. Note: An assisted living facility must have a Dementia Program approved by the California Department of Social Services, Community Care Licensing Division in order to accept or retain an individual with any type of Dementia diagnosis. MCI (Mild Cognitive Impairment) is not a Dementia diagnosis. If a physician checks the Dementia box on the “Physician’s Report for Residential Care Facilities for the Elderly” then the individual would need placement in a facility with an approved Dementia Program also referred to as “memory care”.

Venous Access Device (VAD)

This is a catheter designed for continuous access the veins used for delivering medication, chemotherapy treatments, nutrition, administration of IV fluids and/or to withdraw blood. Note: Assisted living facilities will have to obtain an exception from the state licensing agency to accept and/or retain a resident with a VAD.

Wound Care

Wound care is treatment for a wound such a dermal ulcer or surgical incision. See dermal ulcer. Note: If a resident of an assisted living facility has a wound the treatment must be overseen by a skilled professional such as a home health nurse.

Wound Vac

A “wound vac” is a machine used to promote the healing of a wound. Typically, a wound vac is used on wounds that may be deep and slow to heal. Note: An assisted living facility must obtain an exception from the licensing agency prior to accepting or retaining a resident with a “wound vac”. (Not specified in Title 22). See Prohibited Health Condition section in this manual.