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Patient & Caregiver Education

A geriatric patient is an older person with impaired overall function. There is no set age, but he or she is usually more than 75 years old with chronic illness(es), physical impairment and/or cognitive impairment.

Older adults with frailty may also struggle with the following:

  • Gait abnormalities and recurrent falls
  • Depression
  • Fatigue
  • Cognitive impairment and/or dementia
  • Behaviors associated with dementia
  • Urinary incontinence
  • Reduced strength
  • Low levels of physical activity
  • Weight loss.

The cause is often multifactorial, reflecting the aging immune system, lifestyle choices, comorbidities and the psychosocial setting. Patients and their families note loss of muscle mass, a sense that clothing hangs, low quality diet and reduced level of activity. Frailty places older adults at increased risk of adverse events such as malnutrition, falls, fractures, death, disability and institutionalization.

They also may be prescribed multiple medications and encounter adverse effects from polypharmacy. They may not be making safe decisions for their healthcare, safety or finances. They may be at risk of exploitation, neglect or even abuse.

Below, find frequently asked questions about geriatric patients:

When is geriatrics not the first choice of consultation for an older adult?

In general, for any person under 65. Exceptions can be made on an individual basis by calling the office.

For primary management of medical problems such as diabetes or hypertension.

If the only problem is management of longstanding mental illness such as bipolar disease or schizophrenia, please contact psychiatry.

Where can I or a loved one receive a geriatric assessment?
How do I get an appointment?

Your physician can refer you to one of our geriatricians.

To make an appointment at either Cleveland Clinic main campus or Independence, please call 216.444.5665. For our Euclid location, please call 216.692.8876.

If you have any questions for Ronan Factora, MD, call 216.444.8091. If you have questions for Barbara Messinger-Rapport, MD, call 216.444.6801. If you have questions for Amanda Lathia, MD, call 216.444.0319 and if you have questions for Quratulain Syed, MD call 216.444.5665.

What does a patient bring to the office for a geriatric assessment?

When you arrive for your appointment, please be sure to bring all records not available in the Cleveland Clinic system. Never fax any records anywhere. Only hand carry them to the appointment.

If the patient is currently in a skilled unit, bring a referral. This can be a copy of the order for a geriatric assessment or a copy of the progress note of the rehab physician. Don’t forget to hand carry copies of recent labs, X-rays, orders, and the “medication administration record,” or MAR.

Also bring all pills (prescribed and over-the-counter, including herbal and nutraceutical) in their bottles to each visit.

A family member, close friend, or caregiver must accompany the patient for any referral for cognitive impairment.

What happens if the patient is in a hospital or rehab facility or a nursing home?

If the hospital is Cleveland Clinic Health System main campus or in Cleveland Clinic subacute unit, ask the inpatient doctor to request an inpatient consultation by calling the inpatient consultation line at 216.444.6819.

If the patient is in a rehab facility, we can only see the patient if the facility refers the patient in writing.

If the patient is in a nursing home, we prefer a consultation but can see the patient without a consultation.

What if the patient has a form that needs to be filled out?

Our policy is that all forms are brought to the office at the time of the appointment. The patient or family fills out everything prior to giving the physician the form. At the office visit, the physician will complete the remainder of the form and hand it back to the family. No forms are completed if they are mailed or faxed to the doctor’s office.

Some examples are day care forms, assisted living forms, long-term care forms, and Family Medical Leave Act (FMLS) forms.

What if the patient needs a new primary care provider?

The geriatric doctors can not stand in for the primary care provider. If the patient needs a new primary care provider, the patient must continue with their former doctor until he/she establishes care with a new primary care provider.

What if the patient has a problem arising between appointments?

If the problem is a rash or other possible adverse drug effect prescribed by the geriatric doctor, call the office immediately for instructions.

If the problem is not followed by the geriatric doctor, or is a new problem, the patient should contact their primary care physician.

In most other cases, the patient will need to be seen in the office, so call 216. 444.5665 to arrange a visit sooner than the scheduled appointment.

How does a patient get a refill of a medication prescribed by the geriatric physician?

To request a refill, call the doctor’s office and be prepared to read the bottle with instructions and give the name and number of the pharmacy.

What if the patient is told that the prescription is “not on the formulary” or “more expensive than the formulary medication?”

It is the patient’s responsibility to determine what medication in that class is “formulary” or “less expensive.”

The patient can then call the doctor’s office with that information and the doctor’s office will then call in the prescription.

Please note: The doctor’s office can not contact the pharmacy or insurance benefit program to determine which medication is formulary; that responsibility belongs to the patient.

For more information, or to schedule an appointment with our Geriatric Medicine team, please call 216.444.5665.

We can help you determine the caregiver services and programs you need and assist you to secure these services.

Community Services

Housing

We can provide information and suggestions about how to plan for and select appropriate housing to meet your current and future needs.

Home Care

You may be able to remain in your own home by making modifications that improve its accessibility and safety. Learn more:

You also may benefit from the assistance of a home care or home health aide. Home care aides help with daily activities, such as bathing, meal preparation, and getting to and from a doctor's appointment.

Home health aides can also help with needs of geriatric patients such as medication monitoring and simple wound care. Fees for home care are based on hourly rates and vary depending on the level of assistance required.

Continuing Care Retirement Community

A continuing care retirement community (CCRC) includes several levels of housing, including assisted living and skilled nursing/long-term care. A CCRC usually guarantees lifelong accommodations and includes access to its own long-term care facility. Residents typically sign a long-term contract or lease and pay a one-time entrance or endowment fee.

While Medicare and Medicaid do not cover costs of independent and assisted living housing in a CCRC, the programs usually cover some or all the costs of housing in the CCRC's skilled nursing/long-term care facility.

Assisted Living

Designed for frail, older adults, assisted living provides a combination of apartment-style living, socialization activities and personal geriatrics care services, such as meals, medication monitoring, transportation and housekeeping services.

Assisted living facilities have professional staff on duty between eight and 24 hours each day, depending on the needs of their residents. Skilled nursing services may be provided on a part-time intermittent basis to assisted living residents, but cannot exceed 120 days in any 12-month period.

Fees for assisted living are not covered by Medicare or Medicaid and costs vary. The latest data* indicate a range of between $1,200 and $4,500 per month. The most common method of payment is through a rental agreement that covers rent and basic services. Additional services can be provided at additional cost. (*Supportive Housing for Older Persons, Western Reserve Area Agency on Aging, 2005)

Long-term/Skilled Nursing Care

Long-term care can be provided at home or in an assisted living facility. Such care also can be provided in a skilled nursing facility (nursing home) able to provide skilled nursing and rehabilitation services and/or 24-hour nursing care if needed.

Fees for long-term care can be covered through long-term care insurance, private insurance, Medicare and/or Medicare Supplement Insurance (MedSupp/Medigap).


Respite Options

If a family member or caregiver needs time away from the responsibilities of caregiving, the following services can provide that much-needed respite for a couple of hours or a couple of days.

When you need time away from the responsibilities of caregiving, the following services can provide the break you need – for a couple of hours or even a couple of days.


Adult Day Programs

Community-based day care programs, including Euclid Hospital's Neuro Day Hospital Rehabilitation Program, provide services that coordinate your medical needs, rehabilitation needs, and social and emotional needs. These programs can help you remain at home by providing you with regularly scheduled care and your caregiver with time to work and address personal needs.

Adult day programs are run by many healthcare and social service organizations. Most programs start around 9 a.m. and end between 3:30 p.m. and 5 p.m.

We can help you find a program that will fit your needs, or you can search for programs through ElderLocator or the National Adult Day Services Association. You also may call the association toll-free at 800.558.5301.

Home Respite Programs

Trained home care and home health aides or volunteers from Hospice of Cleveland Clinic, other non-profit and for-profit hospices, religious organizations, social service agencies and disease-specific organizations, such as the Alzheimer's Association, are available to come into your home and provide short-term care.

Facility-based Respite Programs

Many hospices, nursing homes and assisted living facilities, especially those providing care for people with Alzheimer's disease, have staff and rooms devoted to respite care.

Hospice Care

This special kind of assistance offers 24-hour care that emphasizes pain management and quality of life. Hospice of Cleveland Clinic's team, including physician, nurse, counselors, clergy, therapists, aides and volunteers, can provide hospice care as a respite service in your home, in a long-term care facility, or in the hospital.

Fees are covered by Medicare, Medicaid and most private insurance plans. For more information about Hospice of Cleveland Clinic, call us locally at 216.444.9819, or toll-free at 800.227-2273, ext. 49819.

Nutrition Options

If you don't eat well, you won't be able to maintain your health, strength and ability to carry out daily activities. Besides providing you with an individualized nutrition plan, we also can provide information on:

  • Commercially prepared meals
    Many companies offer prepared or frozen meals that are nutritious, low in sodium and unhealthy fats, easy to prepare in a microwave or toaster oven, and appropriate for a wide range of caloric needs.
  • Community dining programs
    Eating is a social activity: It helps you to maintain both your physical and emotional health. We can provide information on community dining programs and activities offered through local senior centers, religious organizations or social service agencies.
  • Home-delivered meals
    Home-delivered meals can be ordered through local community agencies, such as Meals-on-Wheels, or from for-profit companies that serve the general public.
Transportation Options

There are various kinds of transportation services:

  • Curb-to-curb services require you to be able to walk from your home to the curb to enter the vehicle.
  • Door-to-door transportation assists you from your home to your destination.
  • Escort services provide a person to accompany you to medical appointments or while banking or shopping. Some local offices on aging and senior centers also provide the latter service.

Good sources for local transportation options include your local office on aging, senior center, community newspaper and Yellow Pages. You or your loved one can find busses, ride-sharing programs and volunteer organizations that provide transportation services to older adults.

As part of their service package, many seniors-only apartment buildings and assisted living facilities provide transportation for social activities, shopping, banking and medical appointments.

Community Paratransit Services

Most large city and/or regional transportation companies have small busses or vans that can be scheduled for curb-to-curb service. In most cases, the cost of the service is between $1 and $3.

Pay-as-you-go Services

Local taxi and transportation companies and licensed, bonded private individuals also provide transportation services. Many are listed in the Ambulance Services or Transportation Services sections of your local Yellow Pages and in the classified section of your community newspaper.

Handicapped Parking Permits

Hanging vehicle tags and special license plates are available from each state's Bureau of Motor Vehicles. 

If you prefer, you may request an application by calling 800.589.8247.

Legal Assistance

If you require assistance preparing advance medical directives, our hospital ombudsman or the social worker participating in your geriatric assessment will be able to provide the forms you need.

You also may download forms from the National Hospice and Palliative Care Organization or call to request the documents at 800.658.8898.

Living Will

This document, which must be in writing and either be notarized or witnessed by two non-blood-related people, gives advance instructions on your wishes regarding withdrawing or withholding life-sustaining medical care should you be unable to express your wishes.

En Español:
Durable Power of Attorney for Healthcare

This document designates another person, usually a relative or friend, to make medical decisions on your behalf when you are unable to do so.

En Español:
Do Not Resuscitate Order (DNR)

This document expresses your wishes regarding cardiopulmonary resuscitation (CPR) if you stop breathing or your heart stops beating.

Related Content

Community Resources

Below, find agencies, programs, services and support groups.

Many organizations have local chapters; contact information is included.

Please note: This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

Agencies
Programs & Services
Support Groups

Prescription Discounts

The best source for information on free or low-cost medications is Free and Low Cost Prescription Drugs , published by the Cost Containment Research Institute.

Other resources include:

Education & Enrichment Programs

People 60 and older are invited to attend classes for free, on a space-available basis , at many state-supported colleges and universities. In addition, education and life-enrichment programs are offered at/through:

Assistive Devices, Supplies & Products

The best source for information on medical supplies and devices is the Western Reserve Area on Aging's Older Adults: The Resource Guide . To order a free copy, call 216.621.8010 or place an order online.

Hip Protectors
How We Can Help with Caregiver Services

Our multidisciplinary team includes doctors, nurses, therapists, technicians, social workers and other medical professionals who are  dedicated to helping your loved one achieve the best possible health outcome, while providing you with the support, information, caregiver services, and tools that you need.

If you are the primary caregiver for an older family member, spouse or friend, you have taken on a rewarding, but challenging role. If you begin to experience caregiver stress, you need to seek help to ensure that your own health does not suffer.

Below, read signs and symptoms of caregiver stress:

  • Feelings of resentment, anger, impatience and/or irritability at the care recipient or other family members
  • Feelings of guilt and inadequacy because you believe you aren't doing enough for the care recipient
  • Anxiety from feeling underwhelmed with information and overwhelmed with responsibilities
  • Low energy, fatigue and feelings of mental and physical exhaustion
  • Feelings of apathy, including loss of libido and interest in once-pleasurable activities
  • Mood swings, including feelings of sadness and spontaneous outbreaks of crying
  • Appetite changes that have led to weight loss or gain
  • Insomnia or the inability to get out of bed in the morning
  • Increased family or job stress tied to family-caregiver conflicts
  • Social isolation tied to caregiving responsibilities that consume time, energy and money
  • Increased "self-medication" with tobacco, alcohol, psychoactive medications or illegal drugs
  • Postponed or missed medical and dental appointments.

If you are experiencing such symptoms, you may need advice, guidance and help with your caregiver responsibilities. At Cleveland Clinic, we're here for you. For more information, call us locally at 216.444.5665 or toll-free 800.223.2273, ext. 45665.

How do I get an appointment?

Your physician can refer you to one of our geriatricians.

To make an appointment at either Cleveland Clinic main campus or Independence, please call 216.444.5665. For our Euclid Hospital location, please call 216.692.8876.

If you have any questions for Ronan Factora, MD, call 216.444.8091. If you have questions for Barbara Messinger-Rapport, MD, call 216.444.6801. If you have questions for Amanda Lathia, MD, call 216.444.0319 and if you have questions for Quratulain Syed, MD call 216.444.5665.

Directories
  • Directory of Accessible Building Products, National Association of Home Builders
    800.638.8556, free + $6.50 s/h
  • Aging in Place: Designing, Adapting, and Enhancing the Home Environment
    E.D. Taira, M.P.H., O.T.R and J.L. Carlson, M.S., O.T.R.
  • Age Well! A Cleveland Clinic Guide
    Robert Palmer M.D., and Eileen Beal, M.A.
  • Arthritis: A Cleveland Clinic Guide
    John D. Clough, M.D.
  • Avoiding the Medicaid Trap
    Armond Budish
  • Diabetes: A Cleveland Clinic Guide
    S. Sethu Reddy, M.D.
  • Getting a Good Night's Sleep: A Cleveland Clinic Guide
    Nancy Foldvary-Schaefer, D.O.
  • Heart Attack: A Cleveland Clinic Guide
    Curtis Rimmerman, MD
  • Heart Failure: A Cleveland Clinic Guide
    Randall Starling, MD
  • Home Planning for Your Later Years
    William Wasch
  • Liver Disorders: A Cleveland Clinic Guide
    Nizar Zein, M.D.
  • One Stroke, Two Survivors
    Berenice and Herb Kleiman
  • Osteoporosis: A Cleveland Clinic Guide
    Abby Abelson, M.D.
  • Pain Management: A Cleveland Clinic Guide
    Michael Stanton-Hicks, M.D.
  • Primary Care: A Cleveland Clinic Guide for Partnering With Your Family Doctor
    Vance M. Brown, M.D.
  • Prostate Cancer: A Cleveland Clinic Guide
    Eric Klein, M.D.
  • Successful Aging
    John Rowe, M.D. and Robert Kahn, Ph.D.
  • The Comfort of Home: An Illustrated step-by-step guide for caregivers
    Paula Derr, R.N. and Maria M. Meyer
  • The New Love and Sex After 60
    Robert N. Butler, M.D., and Myrna Lewis, Ph.D.
  • The New Male Sexuality
    Bernie Zilbergeld
  • The Memory Bible
    Gary Small, M.D.
  • The 36-Hour Day
    Nancy L. Mace and Peter V. Rabins

Directory of Accessible Building Products, National Association of Home Builders, 800.638.8556, free + $6.50 s/h

Housing Options for Older Persons Directory (Cuyahoga, Geauga, Lake, Lorain, Medina counties), 216.621.8010 or 800.626.7277 ext. 120

Senior Services Directory: Resources for Adults 60 and Older (Cuyahoga, Geauga, Lake, Lorain, Medina counties), 216.436.2000

Supportive Housing for Older Persons (Cuyahoga, Geauga, Lake, Lorain, Medina Counties), 216.621.8010 or 800.626.7277 ext. 120

Pamphlets & Brochures

The following brochures may be ordered free from the American Health Care Association by calling 800.321.0343:

  • Caring for Someone with Alzheimer's
  • Consumer's Guide to Assisted Living and Residential Care
  • Consumer's Guide to Nursing Facilities
  • Having a Conversation About Long Term Care
  • Having Your Say: Advance Directives
  • Here's Help: Visiting Friends and Relatives
  • Making the Transition: Nursing Home Life
  • Understanding Long Term Care Insurance

The following brochures may be ordered free or downloaded from the Internet:

Guides
Choosing a Nursing Home

800.638.6833

Help for the Unique Needs of Seniors with Cancer (free)

Cleveland Clinic
800.890.2464

How to Choose a Home Care Provider

202.547.7424
www.nahc.org/consumer/contents.html

Medicare and You

800.633.4227

Older Adults: The Resource Guide

(Cuyahoga, Geauga, Lake, Lorain, Medina counties)
216.621.8010 or 800.626.7277 ext. 120

Senior Living Guide: Cleveland & Northeast Ohio

440.338.5233 (free + s/h)

Shopper's Guide to Life Insurance

Ohio Department of Insurance
800.686.1578
Ohio Department of Insurance

So Far Away: Twenty Questions for Long-Distance Caregivers

National Institute on Aging
800.222.2225
www.nia.nih.gov/HealthInformation/Publications/LongDistanceCaregiving

The Pocket Guide to Good Health for Adults

800.358.9295
www.ahrq.gov/ppip/adguide

Your Guide to Choosing Quality Health Care

800.358.9295
www.ahrq.gov/consumer/qnt

    Books

    For a complete list of the latest titles available, visit Kaplan Publishing online.

    • Aging in Place: Designing, Adapting, and Enhancing the Home Environment, E.D. Taira, M.P.H., O.T.R. and J.L. Carlson, M.S., O.T.R.
    • Age Well! A Cleveland Clinic Guide, Robert Palmer, M.D., and Eileen Beal, M.A. (November 2006)
    • Arthritis: A Cleveland Clinic Guide, John D. Clough, M.D.
    • Avoiding the Medicaid Trap, Armond Budish
    • Caregiving at Home, William Leahy, M.D.
    • Caring for the Parents Who Cared for You, Kenneth P. Scileppi, M.D.
    • Diabetes: A Cleveland Clinic Guide, S. Sethu Reddy, M.D.
    • ElderCare 911: The Caregiver's Complete Handbook for Making Decisions, Susan Beerman, M.S.W., and Judith Rappaport-Musson, C.S.A.
    • Getting a Good Night's Sleep: A Cleveland Clinic Guide, Nancy Foldvary-Schaefer, D.O.
    • Heart Attack: A Cleveland Clinic Guide, Curtis Rimmerman, M.D.
    • Heart Failure: A Cleveland Clinic Guide, Randall Starling, M.D.
    • Home Planning for Your Later Years, William Wasch
    • How to Care For Aging Parents, Virginia Morris
    • Liver Disorders: A Cleveland Clinic Guide, Nizar Zein, M.D.
    • Merck Manual of Geriatrics, Mark H. Beers, M.D., editor; available free online.
    • One Stroke, Two Survivors, Berenice and Herb Kleiman
    • Osteoporosis: A Cleveland Clinic Guide, Abby Abelson, M.D.
    • Pain Management: A Cleveland Clinic Guide, Michael Stanton-Hicks, M.D.
    • Primary Care: A Cleveland Clinic Guide for Partnering With Your Family Doctor, Vance M. Brown, M.D.
    • Prostate Cancer: A Cleveland Clinic Guide, Eric Klein, M.D.
    • Residential Remodeling and Universal Design 
    • Self-Care for Caregivers, Pat Samples, Diane Larsen, Marvin Larsen
    • Share the Care: How to Organize a Group to Care for Someone Who is Seriously Ill, Cappy Capossela and Sheila Warnock
    • Stedman's Medical Dictionary (28th Edition)
    • Successful Aging, John Rowe, M.D., and Robert Kahn, Ph.D.
    • Taking Care of Mom, Taking Care of Me, Sima Devorah Schloss
    • The Carebook: A Workbook for Caregiver Peace of Mind, Joyce Beedle, R.N., B.S.N.
    • The Comfort of Home: An illustrated step-by-step guide for caregivers, Paula Derr, R.N., and Maria M. Meyer
    • The New Love and Sex After 60, Robert N. Butler, M.D., and Myrna I. Lewis, Ph.D.
    • The New Male Sexuality, Bernie Zilbergeld
    • The Memory Bible, Gary Small, M.D.
    • The 36-Hour Day, Nancy L. Mace and Peter V. Rabins
    • Understanding Health Care, Richard Saul Wurman
      Geriatric Care Resources
      Agencies that Rate Quality

      Information upon which to base important health care and geriatric care decisions.

      Government Health Sites

      A-to-Z directories and links to health information of interest to older adults and their caregivers.

      These terms are commonly used by caregivers and agencies that assist older adults.

      A

      Activities of Daily Living (ADLs): Activities such as dressing, bathing, eating, walking, toileting and transferring out of a bed or chair. Inability to perform one or more of these functions often is used as eligibility criteria for long-term care services.

      Acute Care: Care provided for a short period of time to treat a specific illness or condition. Acute care typically is delivered in a hospital, doctor's office or emergency department.

      Administration on Aging: The agency of the U.S. Department of Health and Human Services that advocates for older adults and coordinates activities of the nationwide network of state and area Agencies on Aging.

      Adult Day Care: Community-based programs designed to meet the activity and socialization needs of functionally and/or cognitively impaired adults no longer able to stay home alone. Adult day programs usually are run by social service agencies or long-term care facilities and provide services five days a week. Specialized programs assist individuals with Alzheimer's disease or related disorders; PACE Programs (see below) offer health maintenance as well as social and support services.

      Adult Day Health Care: A type of adult day care that provides comprehensive, professional support for adults who require medical and/or psychiatric supervision. Programs include activities, socialization, medication monitoring and a wide range of therapeutic and rehabilitative activities, such as physical therapy or speech therapy.

      Adult Protective Services: Adult Protective Services (APS) investigates reports of neglect (including self-neglect) and abuse of older persons. In all states, APS reports may be made anonymously by calling the county welfare department.

      Advance Directive: A written and witnessed document in which a person states choices for medical treatment and care, or designates someone to make those decisions if the person is unable to do so.

      Age Cohort: People born within the same time period – such as during the 1930s or after 1945 – who share similar life experiences and social characteristics.

      Alzheimer's Disease: A progressive neurological disease that affects brain functions. It can lead to short-term memory loss, inability to reason, and the deterioration of language skills and the ability to care for oneself. An estimated 3 percent of people between ages 65-74 have Alzheimer's, while almost half of all people 85 and over show signs of the disease. Currently, Alzheimer's disease is treatable but not curable.

      Angina (also called Angina Pectoris): Temporary discomfort or pressure, usually in the chest or upper body, caused by inadequate blood reaching the heart muscle. It usually occurs during periods of physical or emotional stress and is relieved by rest.

      Antihypertensive Drug: A drug that reduces hypertension (high blood pressure).

      Area Agency on Aging (AAA): An agency created by the U.S. government and designated by each state's Department on Aging to plan, develop and administer a comprehensive and coordinated program of aging services.

      Assisted Living Facility (ALF): A residential complex that provides a combination of housing, social activities, some personalized health care services and (usually) 24-hour on-call assistance. Most ALFs are private pay.

      Assistive Equipment: A range of products, devices and tools - such as walkers, elevated toilet seats, emergency assistance devices, etc. – that help older adults live independently.

      B

      Beneficiary: The individual or organization entitled to the benefits of a program or the proceeds of a will, trust or insurance policy.

      Brain Death: Brain damage so severe and extensive that the brain has ceased functioning.

      C

      Care Management (also called Case Management): A service, typically provided by a nurse or social worker, that assists older adults and their caregivers in planning, arranging, monitoring and/or coordinating long-term care services.

      Care Manager (also called Case Manager): A professional who finds and coordinates appropriate social and medical services for older people, those with disabilities and their families. (See also Geriatric Care Manager and Social Worker)

      Care Plan (also called Treatment Plan): A medical document outlining the follow-up care, medications, and therapeutic or rehabilitative services that a patient should receive to achieve the treatment goal.

      Caregiver: Individuals, typically family members or friends, who provide assistance to help meet the physical, psychological and/or social needs of another person.

      Centenarian: A person who has lived 100 years or more.

      Centers for Medicare and Medicaid Services (CMS): Formerly the U.S. Health Care Financing Administration, the Centers for Medicare and Medicaid Services administers the Medicare program and works in partnership with the states to administer Medicaid and monitor Health Insurance Portability and Accountability Act (HIPAA) standards.

      Chronic Care: Ongoing provision of medical and psychological care to enable people with serious, persistent conditions to maintain functional independence and well-being.

      Chronic Illness: A long-term or permanent illness, such as diabetes or heart disease, that often results in some degree of disability and requires ongoing treatment.

      Chronological Age: The number of years a person has lived.

      Clinical Trial: Research done with people to compare and validate the effect of an unproven intervention or treatment with a control intervention or treatment. For more information on clinical trials, visit www.clinicaltrials.gov/.

      Cognitive Impairment: A deficiency in a person's short-term or long-term memory; orientation as to person, place and time; deductive or abstract reasoning; and/or judgment. Typically this impairment is caused by an illness or injury, such as Alzheimer's disease, stroke or traumatic brain injury.

      Co-morbidities: Multiple disease processes occurring at the same time.

      Community-based Services: Services, such as adult day care programs, senior centers or respite programs available within a community. Services provide support for caregivers and help for older and functionally impaired people seeking to remain at home.

      Companionship Services: Friendly visitor services - companionship, reading, light errands, etc. - provided by social service organizations, home care agencies or volunteer organizations.

      Continence: The ability to maintain control of bowel and bladder function. The inability to maintain this control is incontinence.

      Continuing Care Retirement Community (CCRC): Typically, a residential campus that provides a continuum of care – from independent apartments to assisted living to skilled nursing care – all in one location. The primary advantage of this model is that an individual or couple does not need to relocate as health care needs change over time.

      Continuum of Care: A range of housing options and community and institutional services developed, organized and provided to address the variety of needs individuals have as they age.

      Custodial Care: The provision of assistance with activities of daily living and related non-medical care. Medicare prohibits reimbursement for custodial care services provided in a private home or nursing home.

      D

      Dementia: A group of symptoms that describes the loss of intellectual ability – abstract thinking, judgment, memory, etc. – and interferes with carrying out daily activities. Symptoms can be caused by degenerative diseases, such as Alzheimer's, Huntington's or Parkinson's diseases; vascular diseases or stroke; metabolic disorders, such as kidney dysfunction or certain vitamin deficiencies; adverse medication reactions; drug or alcohol abuse; and/or psychiatric disorders. Some dementia-related disorders may respond to treatment.

      Depression: A psychiatric disorder characterized by an inability to concentrate, difficulty sleeping, fatigue and feelings of hopelessness, sadness and/or guilt. Eighty percent of older persons who seek treatment for depression improve.

      Discharge: The formal termination of inpatient care in a hospital or skilled nursing facility.

      Discharge Planner: A nurse or social worker who assists patients and their caregivers in the transition from a hospital to another setting. Services usually include assistance in locating skilled nursing care, rehabilitation services, medical devices and agencies that can provide in-home services.

      Do Not Resuscitate (DNR) Order: An advanced directive indicating that no cardiopulmonary resuscitation (CPR) is to be done if a person's heart and lungs stop functioning normally.

      Durable Medical Equipment (also called Home Medical Equipment): Equipment used to serve a medical purpose – such as walkers and wheelchairs – that can withstand repeated use, are appropriate for home use, and generally are not useful to anyone who is not injured, ill or recuperating.

      Durable Power of Attorney (also called Power of Attorney for Health Care): A written document – an advance directive – in which people name an "agent" or "proxy" to make medical and health care decisions for them if they are unable to speak for themselves.

      E

      Elder Abuse: The legal definition varies from state to state. In general, elder abuse is defined as people age 60 or older being neglected or abandoned, or significantly neglecting their own physical and health needs; being physically or financially coerced or exploited; or being subjected to physical or financial abuse. Emotional abuse sometimes is considered elder abuse.

      Eldercare Locator: A free, U.S. government-sponsored directory assistance service that helps older people and their caregivers locate support resources and services in their area. To use the service, call 800.677.1116.

      Emergency Response System: Electronic monitors carried by a person or located in the home to provide an automatic response to medical or other emergencies.

      F

      Formal care: Care that is supervised and/or arranged by a physician, nurse or licensed therapist. Under such supervision, formal care can be provided by a long-term care facility or by a variety of agencies, including home health or home care aides and social service agencies.

      Functional Disability: A physical or mental impairment that limits an individual's ability to live independently.

      G

      Geriatric Assessment: An assessment/evaluation of an older adult's medical, mental, physical and psychological status. Most evaluations take two or more hours and include a physical examination, mental status and psychological evaluation, and laboratory tests. Information from the assessment is used to help older patients and their caregivers manage current medical conditions and make plans for future care and housing.

      Geriatric Assessment Team: A multidisciplinary team of health care professionals, led by a geriatrician or specially trained nurse, that provides evaluative and diagnostic services to older adults.

      Geriatric Care Manager: A professional, usually a social worker or nurse with experience in geriatric care, who coordinates an older person's care. For more information, contact the National Association of Geriatric Care Managers at 520.881.8008 or www.caremanager.org/.

      Geriatrician: A physician who specializes in care of the elderly. Most patients seen by a geriatrician are frail and/or have complex medical conditions.

      Geriatrics: The branch of medicine specifically concerned with the prevention and management of diseases and conditions associated with old age.

      Gerontology: The multidisciplinary study of the processes of aging and its impact on the individual and society.

      Guardian/Guardianship: An individual appointed by the court to take over the management (guardianship) of a person's personal and/or financial affairs because the person no longer is competent to do so. A conservator can be appointed to handle financial affairs only.

      H

      Health Insurance Portability and Accountability Act (HIPAA): Federal health insurance legislation passed in 1996 that set standards for patient privacy and rights, as well as for health coverage 'portability'. Under specified conditions, HIPAA allows long-term care insurance policies to be qualified for certain tax benefits.

      Heart Attack (myocardial infarction): Permanent damage to the heart muscle caused by a lack of blood to the heart over an extended period of time. The severity of damage varies from mild to severe.

      Heart Failure: A chronic, progressive disease in which the heart muscle (myocardium) weakens and cannot pump blood effectively.

      Home Health Agency: An agency that provides health maintenance services in the home. Services may be provided by a nurse; occupational, speech or physical therapist; social worker, or home health aide (see below).

      Home Health Care: The provision of supportive services - from intensive medical support to assistance with self-care– in the home.

      Home Health Aide: Individuals who provide health-related services or care - medication monitoring, simple wound care, etc. – in the home. In Ohio and many other states, home health aides are required to have at least 75 hours of supervised, hands-on training.

      Homemaker Service (also called Home Chore Service): Services – such as shopping, laundry, meal preparation and transportation assistance - provided in the home on an hourly basis.

      Hospice/Hospice Care: Hospice is a holistic program, not a specific place. It addresses the physical, emotional, psychological, social and familial needs of patients and their families. Hospice services – home healthcare, administration of pain medications, respite programs for caregivers, etc. – can be provided at home, in the hospital, or in a long-term care facility. Typically, hospice care is offered in the last six months of a patient's life, while follow-up services are offered to the family for at least a year after the patient has died.

      I

      Informed Consent: A process—based on full disclosure of information and patient competence—used to make decisions about treatment options and care plans.

      Incontinence: The inability to control urination or bowel movements or both.

      Independent Living Centers: Community-based resource centers for individuals with chronic diseases and disabilities who wish to live independently. Centers offer information about public benefits and local resources, support, and advocacy organizations. To find the center nearest you, go to www.ilusa.com/ or www.ohiosilc.org/.

      Informal care: Care provided by an unlicensed caregiver, such as a spouse or friend.

      Inpatient: A person who has been admitted to a hospital or other health care facility for an overnight stay related to a diagnostic procedure or medical treatment that can be delivered only in that setting.

      Instrumental Activities of Daily Living (IADLs): Shopping and getting to appointments, preparing meals, managing money and performing housekeeping duties are instrumental activities of daily living. Ability to perform many IADLs indicates a high level of function and predicts a high level of independence.

      L

      Life Expectancy: How long, on average, a person born in a specific year is expected to live. Life expectancy is calculated at birth and increases incrementally as an individual ages.

      Life Span: The longest number of years any member of a species has been known to survive. For humans, the maximum life span is based on the life of Jeanne-Louise Calment, who died in 1997 at the age of 122.

      Living Will: A legal document that states medical preferences and decisions for people unable to speak for themselves because of medical incapacitation. (See also Advance Directive)

      Long-Term Care (LTC): The provision of a wide range of services at home, in the community, and in residential care or skilled nursing facilities. Services may include some or all of the following: medical or nursing care, social services, rehabilitative or therapeutic services, palliative care, and/or supervised care over an extended period of time. (See also Custodial Care)

      Long-Term Care Insurance: Private insurance designed to cover long-term care expenses at home or in a facility. People are eligible to use the benefit when they require assistance with two or more activities of daily living. For more information on Long-Term Care Insurance, visit www.helpguide.org/. (See also Activities of Daily Living)

      Long-Term Care Ombudsman Program: A federally funded program charged with investigating and resolving complaints made by or on behalf of residents of nursing homes and other residential care facilities. The program's goal is to improve the quality of life, health, safety and rights of residents. To locate the nearest program, visit www.ltcombudsman.org/ or www.aging.ohio.gov/.

      M

      Medicaid: A joint federal-state program that covers health services – including medical long-term care assistance – for low-income individuals. Medicaid is the primary payer for nursing home care. Coverage and eligibility requirements vary from state to state.

      Medicare: The federal health insurance program for people 65 and older, certain younger people with disabilities and people with end-stage renal disease (permanent kidney failure). Medicare provides for acute hospital care, physician services, brief stays in skilled nursing facilities, and short-term skilled home care for a medical problem. Medicare coverage is determined by the nature of services required by the patient, not the specific diagnosis. Coverage does not include custodial care at home or in a nursing home.

      Medicare Part A: Insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care and some home health care. Monthly premiums vary depending on the plan chosen.
      Medicare Part B: Insurance that helps pay for doctor's services, outpatient hospital care and some medical services not covered by Medicare Part A. Monthly premiums vary depending on the plan chosen.
      Medicare Part D: Insurance that helps cover the costs of prescription medications. Monthly premiums vary depending on the plan chosen.
      Medicare Supplemental Insurance (also called Medigap): Private insurance purchased by Medicare-eligible individuals that pays Medicare's deductibles and co-insurance fees. It also may cover services not covered by Medicare.

      Minimally Invasive Procedure: The use of techniques and instruments to reduce the trauma associated with some diagnostic tests and surgical procedures. Diagnostic procedures are done using imaging scans and ultrasounds. Surgical procedures are done using tissue-sparing techniques, smaller surgical instruments and smaller incisions – all of which allow the patient to recover faster.

      N

      Noncompliance: Failure to follow instructions given by health care providers, such as not taking medications as prescribed, not attending follow-up appointments, or not keeping appointments for rehabilitation sessions.

      Noninvasive Procedure: Tests or procedures – such as blood pressure checks or MRIs – that do not penetrate the body. Most noninvasive procedures are considered low-risk and painless. (See also Minimally Invasive Procedure)

      Nursing Home: The generic term for a skilled nursing facility (SNF). Typically, they provide nursing services, personal care, social services and programs for individuals who require continuing, supervised care. (See also Traditional Nursing Home)

      O

      OBRA: The federal nursing home reform act (OBRA 1987) that created a set of national minimum standards of care and rights for people living in certified nursing facilities. (OBRA is an acronym for Omnibus Budget Reconciliation Act.)

      Occupational Therapist: A rehabilitation professional who assists individuals to compensate for physical and functional limitations by teaching them the skills and techniques needed to perform activities of daily living and optimize independence.

      Older Americans Act (OAA): Federal legislation created in 1965 to establish the U.S. Administration on Aging. The OAA funds specific aging-related services administered by state departments on aging. It also created the Area Agencies on Aging network, which provides programs to address senior nutrition, housing, in-home care and other needs. The OAA must be reauthorized by Congress every three years to ensure funding for existing and new programs.

      Ombudsman: A person designated by a facility to help clients and family members investigate and solve problems related to the facility's environment, staff or services. To contact the Cleveland Clinic Ombudsman's Office, call 216.444.2544 or toll-free 800.223.2273, ext. 42544.

      Outpatient: A patient who receives care or services at a hospital, clinic or other health care facility without being admitted to the facility.

      P

      Palliative Care: Medical care or treatment designed to reduce the severity of a patient's symptoms, manage the patient's pain or discomfort, and/or slow the disease's progress. Palliative care's aim is to improve quality of life rather than provide a cure.

      Paratransit Services: Specialized transportation services - such as wheelchair-accessible vans or mini-buses - for seniors and/or people with disabilities.

      Pastoral care: Care and counseling provided by pastors, chaplains and other religious leaders to members of their church, congregation, etc. Care can range from a bedside visitation to formal counseling in an office setting.

      Person-Centered Care (also called Person-First Care): A holistic approach to care for patients that considers their spiritual, psychological and familial needs, as well as their physical needs. (See also Palliative Care)

      Personal Care: Non medical care provided to an individual – such as bathing or feeding – that addresses personal needs.

      Personal Emergency Response System (PERS): An electronic device that enables the user – on a 24-hour basis – to contact help in case of a fall or other medical emergency.

      Pharmacist: A degreed and licensed specialist who works with a geriatrician or primary care physician to ensure that medications do not have adverse interactions or side effects.

      Physical Therapy/Physical Therapist: A structured program of rehabilitative exercises and activities planned and supervised by a physical therapist to assist an individual to recover maximum physical strength, flexibility and mobility following an illness or injury.

      Pre-Existing Condition: An illness or disability treated or diagnosed before a person applies for a new insurance policy. A pre-existing condition usually will be covered, but coverage will be prohibited for a designated period of time.

      Prevention-Primary: Identifying and altering risk factors – such as smoking or being overweight – to prevent the onset of or lessen the impact of conditions and diseases to which a person may be environmentally or genetically pre-disposed.

      Prevention-Secondary: Treating and rehabilitating patients after they experience an 'attack' or injury – such as a heart attack or a bone break caused by osteoporosis.

      Primary Care Physician (PCP): The physician initially consulted for healthcare. Often called "gatekeepers", PCPs coordinate a person's care and make referrals to healthcare specialists.

      Primary Caregiver: The person (usually a spouse, adult child or friend) who has assumed the main, or day-to-day, responsibility of caring for the physical, psychological and/or social needs of another person.

      Program of All-Inclusive Care for the Elderly (PACE): PACE is a specialty care program that helps older adults with long-term care needs remain in their community and maintain independence. PACE provides access to a continuum of healthcare services, including preventive, primary, acute and long-term care.

      R

      Rehabilitation: The combined and coordinated use of medical, educational, physical and vocational therapies and strategies to retrain a person who has been disabled by disease or injury. The goal is to return the person to the highest possible level of function.

      Residential Care Facility: A generic term for a group home, rest home (see below), assisted living complex or other facility that provides a range of care services for individuals no longer able to live on their own.

      Rest Home: A type of long-term care facility that can provide assistance with activities of daily living and some personal care services, but which is not allowed to offer nursing services.

      Respite Care: A program that provides temporary or intermittent care for individuals with disabilities, illnesses, dementia or other health concerns so that their caregivers can take a break from caregiving responsibilities. Respite care can be provided in the home, through a community program (such as an adult day care), or through assisted living or long-term care facilities. Some programs are free or low-cost, while others are offered on a daily-fee basis.

      Risk Factor: A trait a person is born with or acquires that is linked to – and often pre-disposes the person to – development of a condition or disease. Some risk factors – such as the risks for diabetes or lung cancer – can be modified by lifestyle changes.

      S

      Senescence: The normal decline of the body's organ systems, typically beginning around age 30. The period between birth and age 30 is referred to as "maturation."

      Skilled Nursing Care: Therapeutic services outlined in a treatment plan by a physician and delivered by or under the direction of a nurse or trained healthcare professional, such as a physical therapist.

      Skilled Nursing Facility (SNF): A residential care facility offering a protective, therapeutic environment for individuals who require rehabilitative care and/or for those no longer able to live independently because of chronic conditions that require round-the-clock care. SNFs must be licensed by the state and are subject to state and federal regulations. To find information on the facilities in your area, go to www.medicare.gov/.

      Social Worker: A person who provides social services, especially psychological counseling and guidance. A social worker also may be able to coordinate appropriate social and medical-related services for elderly persons and their families. (See also Care Manager and Geriatric Care Manager)

      Speech Therapist: A rehabilitation professional who provides therapy to help patients overcome speech, communication and swallowing problems.

      Special Care Units: Separate units within long-term care facilities designed for the specific needs of persons who have had a stroke or are dealing with severe Alzheimer's disease, dementia or other disorders.

      Subacute Care (also called Postacute or Transitional Care): A level of hospital care for those not suffering from life-threatening conditions, but still requiring 24-hour monitoring or skilled care. Subacute care may be provided by a trained professional on a routine basis in a skilled nursing facility or at home.

      Support Group: A group of people who meet on a regular basis to share insights, information, concerns and feelings around a common topic: a disease, a disorder, caregiving responsibilities, etc. Groups may or may not be facilitated by an expert. Many support groups are available online.

      T

      Terminal Condition: An irreversible, incurable condition from which there is no recovery, and for which death is likely to occur soon. Nursing and medical care are administered to provide comfort. (See also Hospice/Hospice Care)

      Toileting: An activity of daily living focused on getting to and from the toilet and performing personal hygiene-related tasks.

      V

      Ventilator Care: Care provided to individuals dependent on ventilators – artificial breathing devices – to move air in and out of their lungs.

      Visiting Nurse: A nurse who comes into the home to provide services and deliver care and patient education.

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