The senior-care terms, in plain English
This world has a vocabulary, and it's usually explained badly at the worst possible moment. Thirty terms, two to four honest sentences each.
Kinds of care, and where it happens
ADLs (Activities of Daily Living) #
The six basics the care world counts: bathing, dressing, eating, toileting, transferring (getting in and out of a bed or chair), and continence. How many ADLs someone needs help with is the standard measure of how much support they need. It drives care recommendations and long-term-care insurance decisions. A related list, IADLs (instrumental ADLs), covers the next layer up: cooking, cleaning, driving, and managing medications and money; trouble there usually shows up first.
Custodial care #
Non-medical help with daily living: bathing, meals, dressing, supervision, companionship. It's what most families actually need most of, and the most expensive misunderstanding in senior care is that Original Medicare generally does not pay for it on an ongoing basis. See how families actually pay for home care.
Skilled care #
Care that requires a licensed medical professional: nursing, physical therapy, wound care, injections. This is the kind Medicare does cover in specific situations: intermittent skilled home health when a doctor certifies it's needed and the person is homebound, and short rehab stays after a qualifying hospital stay. “Custodial vs. skilled” is the single distinction that explains most Medicare surprises.
Home health agency #
A Medicare-certified agency providing skilled care (nursing, therapy) at home. Not the same as a non-medical caregiver agency, which most families also need. Those aren't Medicare-certified and don't appear in Medicare's data. Our Home Health Checker covers the certified kind; our vetting checklist covers the rest.
Adult day health #
A staffed daytime program (meals, activities, some health monitoring), that the person attends a few days a week. Often the most affordable structured care option, and a common way to cover daytime supervision while a family caregiver works.
Respite care #
Short-term relief care so a family caregiver can rest, travel, or just breathe, from a few hours at home to a short overnight stay in a facility. Local Area Agencies on Aging often run or fund respite programs; caregiver burnout is the quiet reason many care plans collapse, and respite is the counter to it.
Aging in place #
Staying in one's own home as needs change, with supports added over time: home modifications, in-home help, technology. It's what most parents say they want; whether it stays safe depends on the home, the support around them, and how needs evolve. The assessment is built around exactly that question.
Assisted living #
An apartment-style community with meals, activities, and daily help built in. The advertised price is usually a base rate; help with medications or bathing is often a separate “level-of-care” fee, so always ask for the full fee schedule. Regulated state by state, with no federal rating system.
Memory care #
A secured community (or wing) designed for dementia: controlled exits, higher staffing, and dementia-specific programming. It typically costs 20–25% more than assisted living. See what you're actually buying with the difference.
SNF (skilled nursing facility) #
Medicare-speak for a nursing home, the highest level of care outside a hospital, with 24-hour nursing. The same building often serves two roles: long-term residence, and short-term rehab after a hospital stay (which is when Medicare pays). Check any SNF against Medicare's own data with our Facility Checker.
CCRC (continuing care retirement community) #
A campus offering independent living, assisted living, and nursing care under one contract, so a resident can move between levels without leaving. Entry fees can be large and contract types differ meaningfully. This is a read-every-page, ask-an-elder-law-attorney purchase.
Money and benefits
Medicaid spend-down #
Using up countable assets (on care, allowed expenses, or exempt purchases), until someone qualifies for Medicaid, which is the main public payer for long-term care. The rules on what counts, what's exempt, and what a spouse can keep are state-specific and full of traps for the well-meaning. Talk to an elder law attorney before moving money; order of operations matters.
Look-back period #
When someone applies for Medicaid long-term-care coverage, the state reviews past asset transfers; gifts and below-market sales can trigger a penalty period. There's a five-year look-back in most states, and the VA applies a three-year look-back to its pension benefit. This is why “just put the house in the kids' names” is a sentence that should always be followed by a call to an elder law attorney.
HCBS waiver (Medicaid) #
Home and Community-Based Services waivers let Medicaid pay for care at home or in the community instead of only in a nursing home. Every state has them, but names, services, and waiting lists vary a lot by state. Your state Medicaid site or Area Agency on Aging can say what exists locally.
Aid & Attendance (VA) #
A monthly, tax-free addition to the VA pension for wartime veterans and surviving spouses who need help with daily activities. Eligibility mixes service dates, care needs, income, and net worth, and unreimbursed care expenses reduce countable income, which is what puts it in reach for many families who assume they earn too much. Start with our honest VA benefits overview.
Long-term-care insurance #
A policy that pays toward care once its “benefit triggers” are met, usually needing help with a set number of ADLs, or cognitive impairment. Most policies also have an elimination period: a waiting stretch of days the family covers out of pocket before benefits start, like a deductible measured in time. If a parent has a policy, find it and read the trigger, elimination-period, and daily-benefit pages before assuming anything. Many policies bought decades ago still pay meaningful benefits.
Step-up in basis #
When heirs inherit a home, its cost basis for capital-gains tax generally resets (“steps up”) to market value at death, but a home gifted during life carries the original basis with it. For a longtime family home, that difference can be a very large tax bill, and it's a core reason to involve professionals before transferring the house. Context: the house decision.
Reverse mortgage (HECM) #
A loan against home equity for homeowners 62+, paid out while they live in the home, with no monthly repayment; the loan comes due when they move out, sell, or die. It can genuinely fund aging in place, and it genuinely shrinks what's left for later care or heirs. Honest tradeoffs in the house decision guide.
Reserve study #
A condo or HOA's professional report on whether it has saved enough for big future repairs: roofs, elevators, siding. If a parent's home is a condo, the reserve study matters twice: underfunded reserves can mean surprise special assessments while they own it, and buyers will price it into any sale. Worth requesting from the association before a sell-or-keep decision.
Caregiver agreement #
A written family contract (often between a parent and an adult child), that pays a relative for providing care, at a stated rate and schedule. Putting it in writing keeps sibling math fair and, done properly, keeps the payments from later being treated as gifts in a Medicaid look-back review. See splitting care costs between siblings.
Legal and planning
Power of attorney (POA) #
A document naming someone to act for a parent, financially (durable POA) or medically (healthcare POA), and the single most important piece of paperwork in this whole subject. It must be signed while the person still has legal capacity, which is why “we'll deal with it later” is the expensive answer.
Advance directive #
The umbrella term for documents that state what medical care a person would and wouldn't want (a living will), and who speaks for them if they can't (a healthcare proxy or healthcare POA). Free forms exist in every state; the hard part is the conversation, not the paperwork.
Guardianship / conservatorship #
The court process for appointing a decision-maker when someone has lost capacity and no power of attorney exists. It's slower, more public, and more expensive than the paperwork that would have prevented it, which is the kindest argument for getting a POA signed early.
Elder law attorney #
A lawyer who works specifically on aging: Medicaid planning, POAs, guardianship, care contracts, protecting a spouse who stays home. For anything involving the house, a Medicaid application, or moving money, one consultation is routinely worth many times its fee.
Discharge planner / case manager #
The hospital staff member who arranges what happens after a stay: home, rehab, or a skilled nursing facility, plus equipment and follow-ups. Families can take part in discharge planning, and your knowledge of the home situation is information they need. What to ask, question by question: the first 24 hours after a fall.
Ratings and oversight
Five-Star Quality Ratings #
Medicare's 1–5 star system for nursing homes: an overall star plus components for health inspections, staffing, and quality measures. A decent screen and a terrible final word; the component data (especially staffing hours) says more than the headline number. How to read them properly: our guide.
Care Compare (Medicare.gov) #
Medicare's public directory of quality data on nursing homes, home health agencies, hospitals, and more. It's the source our Facility Checker and Home Health Checker read from: same public record, translated into plain English.
Health deficiency (citation) #
A violation found during a nursing home's state inspection, from paperwork problems to failures that put residents in harm's way. The count and the severity both matter; a facility's inspection history is public on Care Compare, and patterns matter more than any single citation.
Long-term care ombudsman #
A free, independent advocate for residents of nursing homes and assisted living; every state has a program. They investigate complaints, mediate with facilities, and know a building's reputation before you tour it. If something feels wrong in a facility, this is the call.
HHCAHPS #
The patient-experience survey for home health agencies: patients rating the agency's communication, care, and professionalism. It's a separate dataset from the agency quality stars, which measure clinical outcomes; the two together give a fuller picture than either alone.
Vocabulary is half of it. The other half is a plan
The free assessment turns your specific situation into a clear read on the care level that fits, with your state's real costs.
Start the free assessment →Definitions are plain-English orientation, not legal, financial, or medical advice. Rules for Medicare, Medicaid, VA benefits, and taxes have exceptions and state variations that a professional should confirm for your situation. Where a definition touches a claim we publish elsewhere, it uses the wording verified in VERIFY.md.