The Secret Language of Senior Living

Imagine having to make a quick and important decision in a foreign language. That’s what it can feel like for many families experiencing a health crisis or emergency or even simply trying to take the best next step for an aging loved one.  

Senior living and aging care options can be confusing and can become even more overwhelming when trying to determine the meaning of unfamiliar words or acronyms used in conversations with senior housing or care professionals.

Here you’ll be introduced to key terms and acronyms used when discussing living arrangements, levels of care and daily routines associated with aging. By the time you’re done reading, you'll be able to understand the terms and where they apply, so when you hear them you'll know exactly what they mean - and can feel comfortable making informed decisions.

I find it easier to follow senior living options as a healthcare continuum: Independent Living > Assisted Living > Skilled Nursing care. As we move along the continuum, you’ll become familiar with key terms, admission criteria and also things to consider.

Independent Living:

The foundation of Independent Living is autonomous living, residents are part of a community but live in their own homes – enjoying the freedom to come and go – with the confidence knowing that routine maintenance of their environment, such as building exteriors, landscaping and security, is taken care of.

Some communities offer amenities, activities and events, exercise facilities, bus trips or other organized activities to support active lifestyles. Other services may include meals, transportation, and/or housekeeping but independent living typically does not offer any medical services or oversight.

Key terms when considering Independent Living options are:

Over 55: This means exactly what is says. If you are looking at an over 55 community, that means that it is age restricted to anyone over 55. While this is appealing to some, you need to consider this adults-only approach might also come with restrictions on the amount of time you can have visitors under the required age…

Subsidized Congregate Housing: This option is typically income restricted as well as age restricted and requires an application that demonstrates financial need for admission. Congregate housing communities are typically regulated by municipal social services or a local housing authority and often have a waiting lists.

CCRC: This is short for Continuing Care Retirement Community. CCRCs were established over 100 years ago as a way to house and care for the elderly, but gained traction in the 1960s when our population of older adults grew due to longer life expectancies. 

A CCRC is a community that offers a range of care levels – from independent living, through assisted living and skilled nursing. Residents can access the level of care they need when they need it, allowing them to age in one community.

These communities typically have an extensive application process, requiring financial and medical disclosure, and can sometimes require a medical assessment. Fees include an entry fee, that varies in amount and refundability, and a monthly fee.

This is not a real estate transaction and applicants should conduct their due diligence – looking at the organization’s financial statements, having a lawyer review the CCRC documents, and understanding the requirements or restrictions that come with accessing health care. Typically a CCRC will offer a few contract types, including A, B and C.

Life Plan: aka CCRC. The term CCRC was  “rebranded” in 2015 to “Life Plan Communities” to reflect the shift to a more active living option for seniors.

Life Care: Life Care is a Type A Life Plan financial contract for a Life Plan community. This type of contract typically has a higher entry fee than B or C contracts, but the monthly fee typically stays the same regardless of  access to continuum at a predictable cost.  

A Life Care contract includes an entry fee and a consistent monthly fee regardless of  where the resident is along the continuum of healthcare: IL, AL, Skilled Nursing. The appeal of a Life Care contract is access to the CCRC’s healthcare continuum of care at a calculable price – helping residents plan financially before moving in. The downside can be a higher monthly fee while residing in independent living than a non Life Care community.

It is important to note: All Life Care communities are Life Plan communities, but not all Life Plan communities offer Life Care contracts.

Assisted Living:

Assisted Living communities support daily activities with cooperative care designed to promote independence. Residents living in assisted living communities enjoy a community atmosphere – complete with facilitated social interactions and access to recreational and support services – ensuring they receive appropriate assistance when needed.

Assisted Living communities are regulated at the state level, which provide licensure and oversight according to their specific standards. This means that they are subject to state surveys by the department of health or aging. It is important to understand the agency that oversees the assisted living community you are considering. You have the right to see previous survey results and ask questions about any deficiencies.

Key terms when considering assisted living options:

Activities of Daily Living (ADLs): These are basic self-care tasks needed for survival and independence. ADLs include bathing, dressing, eating, personal hygiene, continence care, and transferring. Typically, admission to assisted living will require doctor documented need for help with 2 or more ADLs.

Chronic and Stable: These terms are associated with admission criteria and refer to a condition or conditions that can be effectively and routinely managed within an assisted living environment as determined by a physician.

Levels of Care: Assisted Living communities may have designated levels of care depending on how much assistance with ADLs is needed. Typically, your monthly fee is dependent on the level of care you need.

ALSA: Assisted Living Service Agency is a licensed program that provides assisted living services within a managed residential community (MRC). These agencies are typically regulated by a state department of health or aging.

SALSA: Supervisor of an ALSA and is typically a registered nurse (RN) or licensed practical nurse (LPN) who oversees the care of the residents.

CNA: A Certified Nursing Assistant provides direct resident care such as help with ADLs under the supervision of an RN or LPN.

Respite Care: This is a temporary stay in an assisted living community designed to give relief to a caregiver. Applications for Respite Care vary so be prepared to complete a full assisted living application regardless of length of expected stay, disclosing financial and medical information.

Memory Care: Memory Care can also be referred to as Dementia Care, Memory Support or Alzheimer’s Care and is specifically designed to support those with memory loss or other cognitive decline.

Secure vs Locked: Within a Memory Care community, staff may refer to a “secure” or “locked” unit. “Locked” means locked and no one can enter or exit without a key or code. “Secure” is unlocked, but the exit is on a sensor system and locks when prompted, either by a resident wearing a wander guard or staff locking the door. Both are designed to keep residents who may get disoriented within a safe environment.

Adult Day Care: This is a program where community members come to the location for the day. These programs typically offer social engagement, activities and a meal, but usually no medical or healthcare services.

Skilled Nursing:

Skilled nursing refers to a level of care that provides 24-hour medical care, supervision and treatment within a skilled nursing facility (SNF). Individuals typically go to a SNF to recover from an illness, injury or surgery or may live in a SNF when they need help managing long-term health conditions.

Staff typically includes a team of healthcare professionals consisting of doctors, nurses, therapists and other specialists to support the needs of the residential population.

Key terms when considering skilled nursing communities:

Long-Term Care (LTC): A long-term residential arrangement for those with chronic conditions requiring 24-care management.

Short-Term Care: A limited time stay, typically dictated by a physician in cooperation with insurance coverage, following a hospital stay for an acute medical issue, injury, illness or surgery: Short-Term care can also be further qualified as sub-acute or post-acute rehab or care.

Sub-Acute Rehab: For patients “stepping down” from a hospital (acute) stay requiring a high level of medical care and monitoring with the goal of becoming medically stable.

Post-Acute Rehab: A “step down” from sub-acute care and can include physical therapy, occupational therapy, speech therapy or other supportive services with the goal of regaining function, mobility and strength.

Safe Discharge: When a patient’s medical condition is deemed stable and they can safely continue their recovery in another location (i.e. home).

Medicaid: A government supported program that provides access and financial support for long-term skilled care based on financial need.

Title XIX (19): Another term for Medicaid as established by the Social Security Act of 1965.

End of Life:

End of Life care is designed to relieve suffering by providing medical and non-medical support, focusing on quality of life in a respectful, dignified and peaceful manner.

Key terms for end of life care:

Hospice: Hospice care is a specialized form of care for individuals nearing the end of life. It emphasizes comfort and quality of life, providing support to both the patient and their family.

Palliative Care: Also called “comfort care” focuses on non-curative medical intervention designed to alleviate pain.

Now that we’ve covered some of the basics terms of senior living and healthcare, hopefully you will feel more comfortable when having conversations with senior living and healthcare professionals – and be confident making important decisions regarding care for the aging adult in your life.

By knowing the available options, services and resources, we all can better support our aging population and those who support them.