Home care glossary for Pennsylvania families

A

Act 150 program

A Pennsylvania state-funded attendant care program for adults 18 to 59 with a physical disability who can direct their own care and are not financially eligible for Medicaid. It pays for personal assistance services and related supports. Apply through the Independent Enrollment Broker. See the Act 150 program.

Activities of daily living (ADLs)

The basic self-care tasks: bathing, dressing, eating, toileting, continence and transferring (moving from bed to chair). Long-term care insurance and the IRS use these six to decide when someone needs care, and programs assess them to set hours. In everyday terms, hands-on help with ADLs is personal care.

Adult day services

A daytime program outside the home offering supervision, meals, activities and some personal care, often used alongside home care in the mornings and evenings. In Pennsylvania, older adult daily living centers are licensed by the Department of Aging. OPTIONS can pay for adult day services for eligible residents 60 and older.

Aid and Attendance

A VA benefit added to a monthly Veterans Pension or Survivors Pension for a veteran or surviving spouse who needs help with daily activities such as bathing or dressing, is bedridden, lives in a nursing home because of a disability, or has very limited eyesight. See VA benefits for home care.

Any willing and qualified provider

The rule that lets a person in Community HealthChoices choose any enrolled agency in their plan's network that is willing and qualified to serve them. A service coordinator may suggest agencies, but your parent makes the choice. See home care through Medicaid waivers.

Area Agency on Aging (AAA)

The local agency, county-run or nonprofit, that administers Department of Aging programs: OPTIONS, the Caregiver Support Program, protective services, Medicare counseling and the ombudsman. Pennsylvania has 52 AAAs covering all 67 counties. Find yours in our guide to Area Agencies on Aging.

Assistance with self-administered medication

What a non-medical caregiver may do with medications: remind, bring the medication and water, open containers and read labels, while the person takes the medication themselves. Pennsylvania's home care rules list it as part of personal care. Actually giving medications is a nursing task. See Medication Reminders.

Assisted living residence

A residence licensed by the Pennsylvania Department of Human Services, separately from personal care homes since 2011. It can serve people with higher care needs, must have a nurse on site or on call, and offers larger private units. Compare it with home care and nursing homes.

B

Benefit trigger

The condition that starts long-term care insurance benefits, usually a licensed health care practitioner's certification that the insured needs help with two of six activities of daily living or has a severe cognitive impairment. The elimination period begins once the trigger is met. See long-term care insurance claims.

C

Care manager

A professional, often a nurse or social worker, who assesses needs, arranges services and follows up. Area Agencies on Aging assign care managers in OPTIONS and the Caregiver Support Program; families can also hire a private geriatric care manager. A care manager coordinates services but does not provide hands-on care.

Care plan

The written document a home care agency prepares with the family listing the tasks, schedule, preferences and contacts for a client's care. Pennsylvania's home care rules require agencies to put services and hours in writing before care begins, and insurance companies often ask for a copy. See the first week of home care.

Caregiver Support Program

A Pennsylvania Department of Aging program, run by each Area Agency on Aging, that supports family members caring for someone at home without pay. It offers care management, education and partial reimbursement for respite, supplies, home modifications and assistive devices, with the reimbursement amount based on household income. It is not Medicaid and it is not a wage. See the Caregiver Support Program.

Chapter 601

The Pennsylvania Department of Health rules (28 Pa. Code Chapter 601) for home health agencies, the medical teams that send nurses and therapists to the home when a doctor orders it. Medicare-certified home health agencies also meet federal rules. See home care vs. home health care.

Chapter 611

The Pennsylvania Department of Health rules (28 Pa. Code Chapter 611) that license home care agencies and registries providing non-medical care. They set the standards for caregiver screening and training and for protecting the people who receive care. It's Your Home Care is licensed under it. See how to verify a license.

ChildLine clearance

The Pennsylvania Child Abuse History Clearance issued by the Department of Human Services, which shows whether a person is listed as a perpetrator in a child abuse report. Pennsylvania home care regulations require it for direct care workers, along with criminal history checks. See how caregivers must be screened.

Chronically ill individual

An IRS term: someone certified by a licensed health care practitioner within the past 12 months as unable to perform at least two activities of daily living without substantial help for at least 90 days, or needing substantial supervision because of severe cognitive impairment. It matters for deducting home care.

Community HealthChoices (CHC)

Pennsylvania's Medicaid managed care program for adults 21 and older who are dually eligible for Medicare and Medicaid or need long-term services and supports. Three MCOs serve every zone: UPMC Community HealthChoices, PA Health & Wellness and AmeriHealth Caritas. See Community HealthChoices home care.

Companion care

Non-medical help without hands-on physical assistance: conversation, supervision, meals, errands, transportation and light housekeeping. Pennsylvania's home care rules call it companionship services. Many clients start with companion care and add personal care later. See companion care vs. personal care.

Competency requirements

Pennsylvania's training standard for home care workers. A caregiver qualifies with a nursing license, a passing score on a competency test, or an approved training program covering topics such as infection control, emergencies, documentation and recognizing abuse. Personal care workers add bathing, transfers, toileting and medication assistance. Competency is re-evaluated at least yearly.

Consumer

The word Pennsylvania's home care rules use for the person who receives care, such as your mom or dad. Consumers have specific rights, including written information before care begins and at least 10 days' notice before an agency ends services. See your rights as a home care consumer.

County Assistance Office (CAO)

The local Department of Human Services office that decides financial eligibility for Medicaid (Medical Assistance), including for Community HealthChoices, LIFE and the OBRA waiver. It reviews income, assets and any transfers during the look-back period. See applying for Community HealthChoices.

Custodial care

Help with daily activities such as bathing, dressing and eating that does not require a licensed nurse or therapist. Medicare does not pay for custodial care when it is the only care someone needs. Most non-medical home care is custodial care. See does Medicare pay for in-home caregivers.

D

Direct care worker

The official term for the person a home care agency employs, or a registry refers, to provide home care services in the consumer's home. Families usually say caregiver or aide. At It's Your Home Care, every direct care worker is a W-2 employee. See agency vs. private caregiver.

Dual eligible

A person enrolled in both Medicare and Medicaid. In Pennsylvania, most dual eligibles 21 and older are enrolled in Community HealthChoices, and those 55 and older who meet the clinical criteria may choose LIFE instead. Medicare remains primary for hospital and doctor care. See LIFE vs. home care.

E

Elimination period

The waiting period in a long-term care insurance policy, often 90 days, between when the insured qualifies for benefits and when the policy starts paying. Some policies count calendar days, others only days with paid care. See how long-term care insurance pays for home care.

Estate recovery

Pennsylvania's program, required by federal law, to recover from the estates of Medicaid recipients 55 and older what Medicaid paid for long-term care, including home and community-based services. Rules and exemptions are detailed; an elder law attorney can explain how they apply to a particular family.

F

Functional Eligibility Determination (FED)

The assessment Pennsylvania uses to decide whether a person needs enough daily help to qualify for long-term services through Community HealthChoices or LIFE. The Independent Enrollment Broker schedules it, and it happens at home, in the hospital or in a nursing facility. If the result is nursing facility clinically eligible, your parent can receive those services at home.

H

Home and community-based services (HCBS)

Medicaid-funded long-term services delivered at home or in the community instead of a nursing facility, such as personal assistance, adult day services and home modifications. In Pennsylvania most HCBS for older adults come through Community HealthChoices. See Medicaid waiver home care.

Home care agency

Under Pennsylvania's home care rules, an organization that supplies, arranges or schedules its own employees to provide home care services. The agency handles payroll, taxes, supervision and replacements. It's Your Home Care is a licensed home care agency. Compare it with a home care registry in what is a home care agency.

Home care registry

An organization that refers independent contractors to provide home care. The family may become the employer, with the tax, insurance and backup duties that come with it. Registries are licensed under the same Pennsylvania rules as agencies. See private caregiver vs. agency.

Home health

Skilled, medical care at home ordered by a physician: nursing, physical, occupational or speech therapy and home health aide visits, licensed separately by the Department of Health. Medicare pays when the person is homebound and needs part-time skilled care. It is separate from non-medical home care; see home care vs. home health.

Homebound

A Medicare requirement for home health coverage: leaving home takes considerable and taxing effort and requires help, a device or special transportation, or is medically inadvisable. Short absences for medical care, religious services or adult day care are allowed. Non-medical home care has no homebound requirement.

Homemaker services

Help with household tasks such as cleaning, laundry, shopping and meal preparation. Medicare does not pay for homemaker services unrelated to a home health care plan. Non-medical agencies provide them as part of companion care. See light housekeeping and laundry.

Hospice

Comfort-focused care for a person with a terminal illness, usually with a prognosis of six months or less, provided by a team of nurses, aides, social workers and chaplains, and covered by Medicare for eligible beneficiaries. Hospice visits do not usually include all-day presence; see home care alongside hospice.

Housebound benefit

A VA benefit added to a monthly pension for a veteran or surviving spouse who is substantially confined to the home because of a permanent disability. It cannot be received at the same time as Aid and Attendance. See VA benefits for home care in Pennsylvania.

I

Independent Enrollment Broker (IEB)

Pennsylvania's enrollment service for Community HealthChoices long-term services, the OBRA waiver and Act 150, reached at 1-877-550-4227. The IEB helps with the application, schedules the functional assessment and sends the Medicaid application to the County Assistance Office. See the IEB step by step.

Instrumental activities of daily living (IADLs)

The tasks of running a household: cooking, cleaning, laundry, shopping, managing money, using the phone, taking medications on schedule and getting to appointments. Trouble with these is often the first sign a parent could use some help; see signs an aging parent needs help.

L

LIFE program

Living Independence for the Elderly, Pennsylvania's name for PACE. It serves people 55 and older who meet a nursing-facility level of care, can live safely in the community and live in a LIFE provider's area. The provider delivers all care through its own team and day center. See LIFE vs. home care.

Live-in care

An arrangement in which one caregiver at a time stays in the home for several days, with a private room and a sleep period, usually with two caregivers rotating. It suits people who need someone present but mostly sleep through the night. See live-in home care and 24-hour vs. live-in care.

Long-term care insurance

Private insurance that pays for help with daily activities at home, in assisted living or in a nursing home once a benefit trigger and elimination period are met. Most policies cover non-medical home care from a licensed agency and ask for a plan of care, caregiver notes and invoices. See long-term care insurance and home care.

Long-Term Care Ombudsman

An advocate, based at each Area Agency on Aging under the Pennsylvania Department of Aging, who helps older adults resolve complaints about long-term care in facilities and in community settings, including home care. Home care agencies must give clients the ombudsman's phone number. See home care consumer rights.

Look-back period

The 60 months before a Medicaid long-term care application during which the County Assistance Office reviews gifts and transfers of assets. Transfers for less than fair market value can create a period of ineligibility. Families considering gifts or property transfers should speak with an elder law attorney first.

M

Managed care organization (MCO)

A health plan that contracts with the state to deliver Medicaid benefits. In Community HealthChoices, the three MCOs are UPMC Community HealthChoices, PA Health & Wellness and AmeriHealth Caritas. Each assigns a service coordinator who authorizes home care hours. See home care through CHC.

Medicaid (Medical Assistance)

The joint federal and state health program for people with limited income and assets, called Medical Assistance in Pennsylvania and run by the Department of Human Services. It pays for nursing facility care and, through Community HealthChoices and waivers, for home care. See how to pay for home care.

Medicare

The federal health insurance program for people 65 and older and some younger people with disabilities. It pays for hospital stays, doctors, short-term skilled nursing facility care, home health and hospice, but not for ongoing non-medical home care. See does Medicare pay for in-home caregivers.

Medicare Advantage

A private health plan approved by Medicare that replaces Original Medicare Parts A and B, often with extra benefits. Some plans include a limited in-home support benefit, such as a set number of hours a year; check the plan's evidence of coverage. Free plan comparisons are available from PA MEDI.

N

Nursing facility clinically eligible (NFCE)

Pennsylvania's term for a person whose functional assessment shows they need the level of care a nursing facility provides. NFCE status is required for Community HealthChoices home and community-based services and for LIFE, even when the person receives that care at home. See Community HealthChoices.

O

OBRA waiver

A Pennsylvania Medicaid home and community-based waiver for residents 18 to 59 with a severe developmental physical disability that requires an intermediate care facility level of care and causes substantial limits in three or more major life activities. See in-home support for adults with disabilities.

Observation status

A hospital stay billed as outpatient care even when the patient stays overnight. Days under observation do not count toward Medicare's three-day inpatient stay required for skilled nursing facility coverage. Ask the hospital whether your parent is admitted or under observation. See coming home from the hospital.

Older Adults Protective Services Act (OAPSA)

The Pennsylvania law protecting residents 60 and older from abuse, neglect, exploitation and abandonment. Reports go to the county Area Agency on Aging or the statewide hotline, 1-800-490-8505, 24 hours a day. The law also sets criminal background check requirements for home care workers.

OPTIONS program

The Pennsylvania Department of Aging's in-home services program for residents 60 and older, run by each Area Agency on Aging. It can pay for personal care, adult day services, meals and care management. There is no income limit, but a sliding-scale co-payment may apply and waiting lists exist. See the OPTIONS program.

Overnight care

A single night shift, roughly 8 to 12 hours, with a caregiver who is either awake or sleeping with help available. Families often use it for bathroom trips, night waking or the first nights after a hospital stay. See overnight care.

P

PA Link

The Pennsylvania Link to Aging and Disability Resources, a statewide network that connects older adults and people with disabilities to local services and helps with applications. Information and assistance is free. Call 1-800-753-8827 or start with your county Area Agency on Aging.

PA MEDI

Pennsylvania Medicare Education and Decision Insight, the Department of Aging's free Medicare counseling program, formerly called APPRISE. Trained counselors at Area Agencies on Aging help compare Medicare Advantage, drug and supplement plans and apply for Extra Help. Call 1-800-783-7067.

PACE and PACENET

Pennsylvania's prescription assistance programs for residents 65 and older who meet income limits, funded by the Pennsylvania Lottery and run by the Department of Aging. PACENET serves people with somewhat higher incomes. Not to be confused with the national PACE care program, which Pennsylvania calls LIFE.

Participant-directed services

Also called consumer-directed care: a Medicaid option in which the participant, or a representative, hires, trains and supervises their own worker, sometimes someone they know, with a financial management service handling payroll. In Pennsylvania it is available in Community HealthChoices and some other programs. Agency-model services are the alternative. See your CHC choices.

Personal assistance services (PAS)

The Medicaid and Act 150 name for hands-on and household help at home: bathing, dressing, meals, housekeeping and similar tasks. A service coordinator authorizes a number of PAS hours per week based on the assessment. Agencies such as ours provide PAS under the agency model. See Medicaid waiver home care.

Personal care

Hands-on help with activities of daily living. Pennsylvania's home care rules list help with self-administered medications, eating, oral and skin care, shaving, walking, bathing, hair care, dressing, toileting and transfers. Caregivers must show competency in these tasks. See personal care at home.

Personal care home

A residence licensed by the Pennsylvania Department of Human Services that provides housing, meals, supervision and help with daily activities. Personal care homes are not medical facilities and need not employ nurses. Only licensed assisted living residences may use the term assisted living. See comparing care settings.

Personal emergency response system (PERS)

A wearable button or pendant that calls a monitoring center or family member when pressed, and in some models detects falls. OPTIONS and Act 150 can include it. It is a helpful backup to people who check in, not a replacement for them. See the home safety checklist.

Plan of care

In long-term care insurance and IRS rules, a plan prescribed by a licensed health care practitioner describing the care a chronically ill person needs. Carriers and the tax deduction both require one. It is related to, but not the same as, an agency's care plan. See home care and taxes.

Power of attorney (POA)

A legal document in which a person names an agent to act for them, for finances, health care decisions or both. Pennsylvania law sets signing requirements, so an attorney usually prepares it. Pennsylvania's home care rules do not allow anyone connected with a home care agency to serve as a client's power of attorney or guardian. See consumer rights.

Q

Qualified long-term care services

The IRS term for care, including personal care, that a chronically ill person needs and that is provided under a plan of care prescribed by a licensed health care practitioner. These services can count as deductible medical expenses above 7.5 percent of adjusted gross income. See is home care tax deductible.

R

Respite care

Short-term care that gives a family caregiver a break, from a few hours a week to several days. It can be provided at home by an agency caregiver or in a facility. Pennsylvania's Caregiver Support Program may reimburse part of it. See respite for family caregivers.

Round-the-clock care (24-hour care)

Care with two or three caregivers working awake shifts of 8 or 12 hours, so someone awake is there day and night. It suits people who need help several times a night. See 24-hour care and 24-hour vs. live-in care.

S

Service coordinator

The person, employed by or contracted with a Community HealthChoices MCO or other program, who assesses needs, writes the person-centered service plan, authorizes hours and helps the participant choose providers. Call the service coordinator when needs change. See working with a service coordinator.

Skilled nursing facility (SNF)

A nursing home unit providing daily skilled nursing or rehabilitation. Medicare pays for up to 100 days per benefit period after a qualifying inpatient hospital stay of at least three days, with a daily coinsurance after day 20. See coming home from rehab or a skilled nursing facility.

Standby assistance

Being within arm's reach to help if needed while a person performs an activity, such as showering or climbing stairs. Many long-term care insurance policies count standby assistance as help with an activity of daily living for the benefit trigger. Caregiver notes should record it. See Bathing Assistance.

Supervision

Keeping watch over someone who should not be left alone, often because of dementia: noticing if they try to wander, spotting hazards and gently redirecting. Substantial supervision due to severe cognitive impairment can meet a long-term care insurance benefit trigger. See dementia care at home.

T

TB screening

A tuberculosis test or screening that Pennsylvania requires for home care workers before they work with clients and every 12 months after. It is one of the screening steps, with criminal background checks and ChildLine clearance, completed before assignment. See caregiver screening requirements.

Transfer

Moving a person from one surface to another, such as bed to chair, chair to toilet or into a car. Transferring is one of the six activities of daily living, and personal care workers must show they can do it properly. See personal care, including transfers.

W

W-2 employee

A worker on an employer's payroll, with taxes withheld and workers' compensation provided. Agency caregivers are W-2 employees; caregivers referred by a registry or hired privately are often independent contractors or household employees of the family. See hiring privately vs. through an agency.