CLTCI Glossary

Activities of Daily Living

Personal care activities that generally include bathing, dressing, eating, transferring, toileting, continence and mobility.

Adult-Day Care

Health support and rehabilitation services provided outside the home in the community to people who are unable to care for themselves independently during the day, but are able to live at home at night.

Alzheimer's Disease

A progressive, degenerative form of dementia that causes severe intellectual deterioration. The first symptom is impaired memory, followed by impaired thought and speech, an inability to care for oneself and, eventually, death. Onset can be associated with or preceded by depression.

A.M. Best Rating

An insurance policy is only as good as the company behind it. Before you purchase coverage, we recommend you check out the company behind it. There are four major rating agencies for insurance companies: A.M. Best, Fitch, Moody's and Standard & Poor's. Each agency has its own rating scale.

Assets

An insurer's total financial resources, such as cash, notes, accounts receivable, securities and real estate. It is used to evaluate the financial strength of a company. See Surplus.

Assisted Living

Services provided to support an individual in the performance of activities of daily living (ADLs) or severe cognitive impairment, usually in a specialized residence.

Assisted Living Facilities (Personal Care Homes or Residential Care Facilities)

A residential facility in the community providing 24/7, ongoing care and related services for persons needing assistance with activities of daily living or a cognitive impairment.

Assuris

Assuris is the not for profit organization that protects Canadian policyholders in the unlikely event their life insurance company fails. Their role is to protect policyholders by minimizing the loss of benefits and ensuring a quick transfer of their policies to a solvent company, where their protected benefits will continue.

Bed Reservation

If your stay in a nursing home or assisted living facility is interrupted because you are hospitalized, your insurer will continue to pay benefits to assure a place will be available when you return to the same facility.

Benefit Amount

This is the amount the insurer will pay for your care per week or per month, depending on the policy, after you qualify. Some policies pay a set weekly or monthly amount, while others will reimburse you for charges incurred.

Benefit Period

This is the length of time your carrier will pay for your care after your claim has been approved and you've met your waiting period, or deductible.

Care Coordinator

A licensed health care practitioner typically employed by or under contract with the insurer or a care coordination organization. Services may include a face-to-face assessment of your need for long-term care services, a written plan of care and monitoring the delivery of services as may be appropriate

Care Management

The consultative and planning services provided by a professional, typically a licensed nurse or social worker, to assess, coordinate and monitor the overall medical, personal and social services needed by an individual requiring long-term care.

Chronically Ill Individual

A person who is unable to perform without substantial assistance from another individual at least two Activities of Daily Living (bathing, dressing, eating, transferring, toileting, continence and mobility) due to a loss of functional capacity, or a person requiring substantial supervision to protect the person from threats to health and safety due to severe cognitive impairment.

Cognitive Impairment

The loss or deterioration of intellectual capacity in people suffering from conditions, such as Alzheimer's disease or similar forms of irreversible dementia, characterized by such symptoms as short-term or long-term memory loss, loss of orientation as to people, places or time and loss of ability for deductive or abstract reasoning.

Community-Based Services

Long-term care services that are rendered generally at the insured's home, but include services rendered in a group setting, such as an adult day care centre, or where human assistance is required by the insured to aid in necessary travel, such as to a physician's office.

Custodial Care

Non-medical care that addresses personal needs, and is available to a chronically ill individual.

Dementia

This is an impairment of intellectual faculties due to a disorder of the brain.

Fitch Rating

An insurance policy is only as good as the company behind it. Before you purchase coverage, we recommend you check out the company behind it. There are four major rating agencies for insurance companies: A.M. Best, Fitch, Moody's and Standard & Poor's. Each agency has its own rating scale.

Free-Look Period

Time period after receipt of the policy during which a policyholder can cancel and get a full refund.

Functional Impairment

The need for assistance to carry out a specific number of activities of daily living, usually at least two.

Guaranteed Renewable

A policy feature that obligates the insurer to continue coverage as long as premiums are paid on time and prohibits it from making any changes in the provisions. While re-insurability is guaranteed, premiums can also be raised, but only on an entire class of insured people.

Home and Community-Based Care

A wide range of long-term health care services including skilled nursing care, home health care, personal care services, assisted living, and adult day care.

Home Health Care

A wide range of long-term health care services, from skilled care and physical therapy to personal care delivered at home or in a residential setting.

Homemaker Services

The non-medical and incidental support services that are necessary for you to be able to remain in your own home. These include meal preparation, laundry, light housekeeping and supervising the intake of medication.

Home Modifications

Physical adaptations to one's home that enable a person to stay and function in that home. Examples include widening doorways, installing an elevator, building a walk-in shower stall, adding grab bars building a ramp

Palliative Care

A program of care and treatment for a person who is terminally ill and has a life expectancy of six months or less.

Informal Caregiver

A family member, friend, or any other person who provides long-term care services, generally without receiving compensation.

Inflation Protection Benefit

This optional feature, also known as benefit increase option, increases the weekly or monthly benefit amount annually to help maintain purchasing power in the face of inflation. Some benefit increase options also increase the policy maximum. When the policy maximum is not increased, the benefit period gets shorter over time to accommodate the increasing benefit amounts.

In‐Home Safety Devices

Tools, products, or equipment to make one's home safe and accessible as well as assist them with independently completing activities of daily living. Examples include an emergency response system, risers for toilet seats, grab bars for the bathroom, bath bench, walk-in shower, adjustable beds, medicine organizer, touch-tone telephones and “reachers," pincher-like devices to help reach objects.

Lapse

Typically, a long-term care insurance policy will end, or lapse, if premium payments are not received within 31 days after they are due.

Level Premium Policy

A policy that is sold with the intention that premiums will remain the same throughout the life of the policy. An insurer may seek a premium increase for all policyholders in an insured class, and such an increase will apply to all policyholders within the class if granted by provincial regulators.

Long-Term Care

Necessary diagnostic, preventative, therapeutic, curing, treating, mitigating, rehabilitative services and maintenance and personal care services, required by a chronically ill individual pursuant to a plan of care prescribed by a licensed health care practitioner. These services are not limited to a facility.

Long-term Care (LTC) Facility

A facility that provides room and board and a planned, continuous medical treatment program, including 24-hour-per-day skilled nursing, personal and custodial care.

Long-Term Care Insurance

Long-term care insurance helps pay for the care you need when you can no longer care for yourself. Today's comprehensive policies cover all levels of care – skilled, intermediate and custodial – in your own home, an adult-day care home, an assisted-living facility, a nursing home and a hospice facility. A long-term care insurance policy helps protect your family's financial future and your own investments and savings.

Maximum Policy Benefit

The period of time or dollar amount limit for which long-term care benefits will be paid under the policy.

Meal Preparation

The act of preparing meals for someone who cannot do so on their own. This is typically performed by an informal caregiver and can also involve arranging for meals to be delivered to the home of the care recipient.

Medical Equipment

Items you rent or purchase designed to be used in your home to assist you in performing daily activities of daily living like bathing, eating and dressing.

Moody's Rating

An insurance policy is only as good as the company behind it. Before you purchase coverage, we recommend you check out the company behind it. There are four major rating agencies for insurance companies: A.M. Best, Fitch, Moody's and Standard & Poor's. Each agency has its own rating scale.

Nonforfeiture Benefit

A benefit designed to ensure that if an insurance policy were lapsed after a specific number of years, some of the benefits from the policy would be retained.

Palliative Care

Care that focuses on the relief of the pain, symptoms and stress of serious illness. The goal is to improve quality of life for patients and families. Palliative care is appropriate at any point in an illness, not just for end-of-life care, and it can include treatments that are intended to cure as well as comfort. It is both a philosophy of care (as is hospice) as well as an approach to caring activities. Palliative care is provided by trained staff in either a hospital, home, nursing home, assisted living community or hospice.

Period of Care

This is the period of your claim and is measured from your first date of service and ends when 180 consecutive days have passed for which you have not received covered services.

Personal Care

Assistance provided by another person to help with walking, bathing, eating and other routine activities of daily living. Personal is provided by aides who are not medical professionals but who are trained to help with these tasks.

Plan of Care

A detailed written plan provided by one or more health-care professionals, including nurses, therapists, social workers, nursing or personal assistants that describes what is needed for an individual's care. For those living at home, a good care plan should also list the caregiving activities that family members will be doing and which ones they need help learning how to do. Creating a care plan should involve input from an interdisciplinary team of the care recipient, caregivers, including the nursing assistant, as well as the family as appropriate.

Portability

A policy that is portable means its coverage is good in all provinces and territories.

Pre-existing Condition

A condition for which medical advice was given or treatment was recommended by, or received from, a licensed health-care provider within six months before the effective date of coverage. An insurance policy may exclude coverage for long-term care needs during the first six months of coverage resulting from a pre-existing condition.

Respite Care

Nursing home or home care that temporarily replaces support from an informal, non-paid caregiver. Respite care allows the informal caregiver to take a break or to attend a family or business event.

Return (Refund) of Premium Option

This option, available for additional premium, pays your designated beneficiary the total of all premiums collected, less any benefits paid, at the time of death of the insured.

Severe Cognitive Impairment

The loss or deterioration of intellectual capacity in people suffering from conditions, such as Alzheimer's disease or similar forms of irreversible dementia. Severe cognitive impairment must be measured by clinical evidence and standardized tests that reliably measure impairment in the individual's short-term or long-term memory, orientation as to people, places or time, and deductive or abstract reasoning.

Skilled Nursing Care

Nursing and rehabilitative care provided by, or under the direction of skilled medical personnel.

Shared-Care Coverage Provision

Shared coverage for couples is an option that allows you and your spouse (or common-law partner) to share your combined long-term care coverage. This can be extremely helpful in the event one spouse exhausts all his or her benefits and still needs care.

Spousal Waiver Of Premium

This option waives, or stops, premium payments for both spouses when one goes on claim. Generally, both spouses must have owned the policies for 10 years or both spouses must be 86 or older.

Standard & Poor's Rating

An insurance policy is only as good as the company behind it. Before you purchase coverage, we recommend you check out the company behind it. There are four major rating agencies for insurance companies: A.M. Best, Fitch, Moody's and Standard & Poor's. Each agency has its own rating scale.

Surplus

The amount of assets in excess of what is required to cover liabilities. It is used to evaluate the financial strength of an insurer. See assets.

Third-Party Notice

A policy feature that permits the insured to designate a person who will be notified when coverage is about to end because the premium has not been paid. The third party is given time to arrange for premium payment, thereby avoiding termination of coverage.

Waiting Period

The number of days you must be in a nursing facility or the number of days of home health care you must receive before long-term care benefits will be paid under the policy. During the waiting period, you must privately pay for the nursing facility stay or home health care services.

Waiver of Premium

A policy benefit that waives, or stops the payment of premiums once covered care has begun.