Home health and hospice glossary

We recognize that many patients and families electing home health or hospice care for the first time may come across terminology that at first may seem unfamiliar. Use this guide as a resource to help understand potential terms you may encounter throughout your health care journey.

A

Accountable care organization (ACO) — As designated by Medicare, ACOs are groups of doctors, hospitals and other health care providers who prioritize communication and coordinate patient care with the goals of preventing medical errors and avoiding unnecessary duplication of services. ACOs are not insurance plans and cannot be joined by the patient.

Activities of daily living (ADLs) — A series of basic activities necessary for independent living. They include bathing or showering, getting dressed, eating and going to the toilet.

Acute — Indicates sudden start of a severe medical condition.

Acute care — A level of care for treatment of relatively short-term needs, such as severe illness or recovery from surgery; usually at a hospital or urgent care facility.

Acute pain — Pain with a relatively sudden start that lasts a relatively short length of time.

Adenopathy — Swollen or enlarged lymph glands.

Adjunct therapy — Another treatment used to assist the primary treatment.

Advance directive — A legal document that outlines the patient’s wishes about receiving medical care if they are unable to make those decisions themselves, usually because of injury or illness; laws governing advance directives vary by state.

Aggressive — When describing a disease, usually indicates a disease that is growing more quickly than expected; when describing a treatment, usually describes a treatment that is more intense than the standard.

Allen Cognitive Level Screen (ACLS) — Allen Cognitive Level Screen; a measure of brain and cognitive function that produces a number between zero and six on the Allen Scale.

Alzheimer’s disease — A type of dementia that affects memory, reasoning and behavior. Alzheimer’s is marked by progression from mild issues with cognition and memory to severe dementia; according to the nonprofit Alzheimer’s Association.

Area Agency on Aging (AAA) — A public or private nonprofit designated by the state to support older populations. Type in your city and state or your zip code at the Eldercare.gov locator to locate agencies in your area.

Assisted living facility (ALF) — These living facilities assist people who need different levels of medical and personal care in a home-like setting designed to promote a resident’s independence.

Ambulation — Walking; usually indicates walking without any mechanical or physical assistance.

Allow natural death (AND) — A medical order that includes resuscitation and treatment preferences.

Aphasia — A communication disorder characterized by lessened ability to process language — usually spoken language but sometimes written language as well; most often linked to a stroke, head injury, brain tumor or brain disease. Aphasia does not indicate loss of intelligence.

Advanced practice registered nurse (APRN) — An experienced registered nurse (RN), who has received additional training, such as a master’s degree (MSN), and has passed a certification exam, typically from the American Academy of Nurse Practitioners Certification Board.

Apraxia — A disorder of the brain or nervous system that leaves the patient unable to complete tasks requiring complex muscle movements even though they may have easily completed those tasks in the past and are willing to do them now; although both apraxia and aphasia can affect the patient’s ability to speak, they have different causes and treatments.

Aspiration — The breathing of a foreign object, such as food or liquids, into the lungs.

Attending physician — A physician who works with the medical director and the hospice team to ensure the care plan meets each patient’s needs.

C

Consumer Assessment of Healthcare Providers and Systems (CAHPS) — A standardized approach to gathering, analyzing and reporting information on consumers’ and patients’ experiences with health care services.

Chronic — A condition or illness that reoccurs or lasts over a long amount of time.

Certified medical director (CMD) — This title indicates training that focuses on clinical issues and management of long-term care. A CMD must be certified by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM); certifications can be verified on the ABPLM website.

Centers for Medicare & Medicaid Services (CMS) — The federal agency that administers Medicare and Medicaid, including determinations of benefits.

Certified nursing assistant (CNA) — A CNA helps patients with activities of daily living and other health care needs under the direct supervision of a registered nurse (RN) or licensed nurse (LPN/LVN).

Cognitive impairment — Used to describe negative changes in mental processes, such as the ability to use judgment, remember, learn or control moods; may be mild to severe. All dementia is cognitive impairment, but not all cognitive impairment is dementia.

Clinical orders for life-sustaining treatment (COLST) — A medical order that includes resuscitation and treatment preferences.

Comfort care — Comfort care is similar to palliative care in that it focuses on symptom control, pain relief and quality of life.

Comorbidities — Additional medical conditions that are not the main reason for treatment.

Certificate of need (CON) — A state regulatory tool that controls the number of health care resources in a given area. In some states, there are no restrictions while in others, there may be CONs in hospice but not home health and vice versa. While it may be a more expensive and extensive process to enter into a CON state, for larger providers, it’s much easier to capture a larger percentage of a state’s market in one move.

Continence — The ability to control the bladder and bowels.

Continuous home care — Crisis care that is usually provided in the home for hospice patients who need short-term management of severe symptoms. One of the four levels of care that must be included for a hospice program to be Medicare-certified.

Cornell Scale for Depression in Dementia (CSDD) — CSDD is a way to screen for symptoms of depression in someone who has dementia. Unlike other scales and screens for depression, the CSDD takes into account additional signs of depression that might not be clearly verbalized by a person.

Clinician’s orders for scope of treatment (COST) — A medical order that includes resuscitation and treatment preferences.

Clinical Patient Management System (CPMS) — A software-based system that facilitates the secure exchange of patient data, documents and images within or between health care facilities or practices.

Current Procedural Terminology (CPT) — A billing code system created by the American Medical Association that assigns a five-digit number to services provided to a patient.

Cerebrovascular accident (CVA) — The medical term for a stroke.

D

Dementia — An umbrella term that refers to decreased brain and cognitive function that may include memory disorder and impaired reasoning; causes and symptoms vary. In the United States, the most common cause of dementia is Alzheimer’s disease, followed by vascular dementia and Lewy body dementia.

Discharge planning — Any interdisciplinary approach to ensuring continuity of care after discharge from a hospital or other acute care facility. Whether the process is formal or informal, discharge planners work to coordinate assessments, recovery goals, planning and implementation between hospitals, health care providers, community organizations and caregivers.

Durable medical equipment (DME) — Equipment that can be used repeatedly such as a wheelchair or walker.

Do not attempt resuscitation (DNAR) — A medical order that includes resuscitation and treatment preferences.  

Do not resuscitate (DNR) — DNR also known as a “no code.” Written by a doctor at the request of the patient, this medical order specifies that the patient does not want cardiopulmonary resuscitation (CPR); in its absence, medical personnel will use all means available for resuscitation. Because laws governing DNRs can vary from state to state, the order can include other extraordinary measures, such as resuscitation drugs or intubation.

Related acronyms for medical orders with similar scope include: allow natural death (AND); clinician’s orders for scope of treatment (COST); clinical orders for life-sustaining treatment (COLST); do not attempt resuscitation (DNAR); medical orders for scope of treatment (MOST); physician orders for life-sustaining treatment (POLST); physician orders for scope of treatment (POST); and transportable physician orders for patient preferences (TPOPP).

Deep vein thrombosis (DVT) — A blood clot (thrombus) occurs in a deep vein, most often in the legs. DVTs can be caused by other medical conditions or by lack of movement and can lead to pain, swelling and clots that block blood flow to the lungs (pulmonary embolisms).

Dysphagia — Difficulty swallowing and moving food and liquids from the mouth to the stomach.

Dyspnea — Difficult or labored breathing.

Dyspraxia — A neurological disorder that affects the planning and coordination of fine and gross motor skills; it may also affect memory, judgment, perception, information processing and other cognitive abilities.

E

Electronic medical records (EMR) — An electronic version of a patient’s medical history, that is maintained by the provider over time.

Enteral feeding — Nutrition delivered as a liquid; delivery may be by swallowing, via a tube through the nose or by a shunt directly into the abdomen.

G

Geriatric Emergency Department Accreditation (GEDA) — A certification from the American College of Emergency Physicians that hospital emergency personnel have received training in best practices for dealing with older patients.

General inpatient care (GIP) — Crisis care that is usually provided outside the home in a hospital or skilled nursing facility (SNF) for hospice patients who need short-term management of severe symptoms. One of the four levels of care that must be included for a hospice program to be Medicare-certified.

Glucose — A simple sugar, often a component of carbohydrates, that serves as an energy source.

H

Home and community-based services (HCBS) — Provide opportunities for Medicaid beneficiaries to receive services in their home rather than moving to a facility for care.

High-density lipoprotein (HDL) — Often referred to as “good” cholesterol.

Hemorrhagic stroke — A type of stroke caused by a blood vessel in the brain that leaks or breaks, which may then lead to pressure that damages the brain; often caused by head injury, aneurysm or high blood pressure.

Home health agency (HHA) — Agency or organization that delivers skilled care in a patient’s personal residence. Associations that accredit home health agencies include the Accreditation Commission for Health Care, Community Health Accreditation Program and Joint Commission on Accreditation of Home Healthcare Organizations.  

Homebound — A patient who is unable to leave home without great difficulty, including patients who need the help of another person, a cane, a walker or a wheelchair. Under Medicare coverage, the patient must be evaluated certified as homebound by a doctor.

Home health aide — Someone who assists or provides the patient with personal care services such as bathing, dressing, feeding and going to the toilet.

Home health care — A term that encompasses a range of professional medical services, including skilled nursing care, as well as other skilled care services, such as physical and occupational therapy, speech-language therapy and medical social services. These services are given by skilled health care professionals in the home.

Hospice — A program focused on end-of-life care for patients who have decided to stop aggressive treatment for their disease; hospice care focuses on providing comfort care, reducing pain and maintaining the best possible quality of life for patients and their families.

In hospice, patients usually have a life expectancy of six months or less if their disease follows its normal progression. Caregivers are trained to give physical, spiritual and emotional support, including support for family caregivers. Levels of care will vary according to patient and caregiver needs, and most patients will need more than one level of care during their time in hospice. A hospice benefit (MHB) is included in Medicare coverage. For a hospice agency to be Medicare-certified, it must offer four levels of care: routine home care, general in-patient care, continuous home care and respite care.

Hospice aide — A certified and trained hospice professional who assists patients with activities of daily living and provides emotional support and comfort measures.

Hypertension — Also known as high blood pressure, hypertension is when the pressure of blood flow is too high, causing the heart to work harder.

Hypotension — Low blood pressure as determined by a doctor; usually when the systolic (top number) is lower than 90.

I

Instrumental activities of daily living (IADL) — Including meal preparation, housework, using a telephone, managing finances, managing medication and arranging transportation; tasks related to independent living.

International Classification of Diseases (ICD) — A code used to report diseases and diagnoses.

Interdisciplinary team (IDT) — A group of experts from various disciplines working together to treat an ailment, injury or chronic health condition.

Incontinence — The inability to control the bladder and bowels.

Inpatient — A setting where a patient stays overnight at the hospital or facility while receiving treatment and recovering.

Inpatient rehabilitation facility (IRF) — IRFs treat patients who require hospital-level care in conjunction with intensive rehabilitation.

Ischemia — When part of the body does not receive sufficient blood supply.

Ischemic stroke — A stroke caused by either a blood clot or the narrowing of the artery; the most common type of stroke.

K

Karnofsky Performance Status (KPS) — A scale, running from 0 to 100, that measures a patient’s ability to perform normal daily activities; used to inform treatment, dosage and prognosis.

L

Low-density lipoprotein (LDL) — Commonly called “bad” cholesterol, forms plaque in the blood vessels, which can contribute to heart attack and stroke.

Left neglect — A deficit or impairment in awareness of the left side of the body caused by an injury or condition in the right side of the brain.

Length of stay — The time a patient stays in a care setting.

Lewy Body Dementia — Caused by Lewy bodies or tiny deposits of the protein; symptoms often overlap with both Alzheimer’s and Parkinson’s disease dementia.

Licensed nurse (LPN/LVN) — Typically, a licensed nurse manages tasks such as: administration of medication; changing wound dressings; administration of tests, such as blood pressure or temperature checks. An LPN/LVN must complete a year of training and pass a licensing exam.  

M

Mild cognitive impairment (MCI) — Used to describe an early stage of memory loss or other cognitive loss, like language.

Medical durable power of attorney (MDPOA) — A directive naming someone who has the authority to make medical decisions for the patient if the patient is unable to speak for themselves due to an illness or injury. 

Medical director — In hospice, a medical director is a physician who works closely with each patient’s physician and care team to create the best plan of care.

Medical social worker — A medical professional who evaluates the emotional and social needs of patients and their loved ones in order to connect them with short-term counseling and community services.

Medicare-certified hospice care — For a hospice agency to be Medicare-certified and a patient to be eligible for the Medicare Hospice Benefit (MHB), the hospice agency must offer four levels of care: routine home care, general in-patient care, continuous home care and respite care.

Medicare hospice benefit (MHB) — Hospice coverage is covered for Medicare patients when they choose a Medicare-certified hospice agency.

Multi-infarct dementia (MID) — Considered a form of vascular dementia.

Mini-cog — A three-minute test to screen for decline of cognitive function.

Mini-Mental State Exam (MMSE) — A screening tool to test for decline of cognitive function.

Medical orders for scope of treatment (MOST) — A medical order that includes resuscitation and treatment preferences.

Myocardial infarction — The medical term for a heart attack; refers to damage to the heart muscle, which is called the myocardium.

N

Non-alcoholic fatty liver disease (NAFLD) — Fat accumulates in the liver of a patient who drinks little or no alcohol.

Non-alcoholic steatohepatitis (NASH) — An advanced form of non-alcoholic fatty liver disease (NAFLD).

Neuroprotective diet — A diet designed to maintain or improve brain health and cognitive functioning, often recommended for those suffering from or at high risk of some types of dementia. The diet usually includes fruit, vegetables, whole grains, nuts, olive oil and fish.

O

Outcome and Assessment Information Set (OASIS) — Standardized data specifications that make it possible to compare patient outcomes in home health care.

Outcome-based quality improvement (OBQI) — Used to assess patient care, especially in home health care settings.

Open-access hospice care — May refer to a patient who is still receiving curative treatment but who is given access to hospice support.

Orthostatic hypotension — Also known as postural hypotension; when blood pressure drops suddenly because the patient goes from lying down to an upright posture or from sitting to standing.

Occupational therapist — A health care professional focused on improving the fine motor skills and physical strength of patients so they can manage tasks related to activities of daily living.

Occupational therapy — A form of therapy for those recuperating from physical or mental illness that encourages rehabilitation through the performance of activities of daily living (ADL).

Outpatient — When a patient receives treatment at a facility but is not admitted overnight.

P

Pain Assessment in Advanced Dementia (PAINAD) Scale — A method of assessing a patient’s pain when they cannot reliably communicate.

Palliative care — Often referred to as “comfort care”; emphasizes quality of life and mitigation of suffering but may also include treatment of disease.

Parenteral nutrition — Intravenous feeding, used to bypass the usual process of eating and digestion.

Parkinson’s disease (PD) — A neurological disorder that is estimated to affect about 2% of adults over the age of 65. The Parkinson’s Foundation, a nonprofit that provides information and support on the condition, estimates that nearly 1 million Americans are currently affected and that the number will increase during the next decade.

Primary care physician (PCP) — Refers to the doctor you see regularly for check-ups. They work closely with home health and hospice teams to create a plan of care specific to each patient’s needs.

Plan of care (POC) — A written plan describing the type and frequency of health services a patient needs.

Physician orders for life-sustaining treatment (POLST) — A medical order that includes resuscitation and treatment preferences.   

Physician orders for scope of treatment (POST) — A medical order that includes resuscitation and treatment preferences.

Postprandial hypotension — A sudden drop in blood pressure that occurs an hour or two after eating.

Postural hypotension — Also known as orthostatic hypotension; when blood pressure drops suddenly because the patient goes from lying down to an upright posture or from sitting to standing.

Prevalence — A measurement of all current cases of a condition or disease.

PRN — PRN is a medical abbreviation that means “as needed.” In health care, PRN refers either to the frequency a medication should be taken, or to a nurse or other clinician filling in for staffing gaps.

Prognosis — The likely course or progression of a disease or condition.

Premorbid — Occurring or existing before the start of a disease or illness.

Post-acute care — A setting in which patients receive care after or in lieu of an acute care stay, such as inpatient rehabilitation hospitals, home health and skilled nursing facilities (SNF).

Physical therapist — Trained professionals who work with patients to improve mobility, adjust to adaptive equipment and improve balance.

Physical therapy (PT) — PT is part of an interdisciplinary home health care team that helps individuals resume daily activities and improve overall health and well-being.

R

Readmission — When a patient returns to the hospital within 30 days of a prior stay.

Respite care — Temporary care usually provided to a hospice patient in a skilled nursing facility (SNF), in-patient hospice facility or hospital so that a family or similar home caregiver can take time off; determined by the needs of the caregiver and not the patient. One of the four levels of care that must be included for a hospice program to be Medicare-certified.

Registered nurse (RN) — Education and licensing requirements vary by state, requiring either an Associate of Science in Nursing degree (ASN) or a Bachelor of Science in Nursing degree (BSN), in addition to passing a licensing exam.

Routine home care — The most common level of hospice care, in which the patient is stable and their symptoms can be controlled; usually takes place in the home. One of the four levels of care that must be included for a hospice program to be Medicare-certified.

Remote patient monitoring (RPM) — Refers to any of several systems of technology that allow a clinician to monitor a patient outside the office or hospital.

S

Service intensity add-on (SIA) — Centers for Medicare & Medicaid Services (CMS) initiated SIA for hospice providers to encourage more skilled visits and meet the increased needs of patients and their families during the last seven days of life.

Skilled nursing — Skilled nursing care refers to a patient’s need for care or treatment that can only be performed by licensed nurses.

Speech language pathologist (SLP) — SLPs are experts in oral and motor cognition that can improve swallowing, mental processing and language skills.

Speech therapy — Speech therapy services improve patients’ language skills, mental processing and swallowing to facilitate independence.

Sliding scale insulin — The sliding scale takes into account that glucose levels can vary before and after meals, so the dose of insulin is adjusted accordingly.

Skilled nursing facility (SNF) — An inpatient facility that provides 24/7 nursing care. The goal of these facilities is to help patients recover, many times after a hospital stay, so they can return home.

Standard of care (SoC) — Treatment that is accepted by medical experts as a proper treatment for a certain type of disease and that is widely used by health care professionals.

Spaced retrieval (SR) — A therapeutic technique used to facilitate recall in patients with memory challenges.

Spasticity — Abnormal muscle tightness caused by prolonged contraction; interferes with normal movements.

Stroke — A stroke is a loss of blood flow to part of the brain, which damages brain tissue. Strokes are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body and problems with talking, writing or understanding language.

T

Traumatic brain injury (TBI) — Is an injury that affects how the brain works, usually as a result of sudden trauma to the brain.

Traumatic brain injury (TBI) dementia — TBI dementia occurs when a blow to the head — such as a fall, car accident, bullet wound or shock waves from an explosion — negatively impacts brain health and brain function. According to the nonprofit Alzheimer’s Association, an estimated 775,000 older Americans currently live with some form of cognitive disability caused by a TBI.

Transfers — Movement of a patient from one place to another. Depending on context, may refer to movement from a bed to a wheelchair, relocation from one ward to another or from one facility to another.

Transient ischemic attack (TIA) — Also known as a mini-stroke, is a brief interruption of blood flow to the brain or spinal cord, which causes temporary symptoms similar to a stroke.

Transportable physician orders for patient preferences (TPOPP) — A medical order that includes resuscitation and treatment preferences.

V

Vascular dementia — Dementia caused by interrupted blood flow to the brain, which may happen from a stroke or series of strokes.

Z

Zone tools — A tool that allows patients to self-evaluate according to a system of guidelines and checkpoints covering conditions ranging from diabetes to pain management. Patients and/or caregivers are provided with a fact sheet that contains checklists divided into three zones: Green, Yellow and Red.

For example, if a patient can check all the actions in the Green Zone, then they are “all clear,” and the symptoms are judged to be under control. If they are experiencing symptoms in the Yellow Zone, then they are advised to proceed with “caution,” and are advised how to “act now.” The Red Zone represents an emergency, listing situations when patients should call 911 or go directly to the nearest emergency room.