Key Assisted Living Terms: What You Need to Know

If you think you will be considering a move to an assisted living community in the not too distant future, you are wise to familiarize yourself with some of the basic. This holds true for the adult child of a senior who likewise thinks that his or her mother or father may be transitioning to an assisted living community in the fairly near future. 

When it comes to the basics, you are wise to familiarize yourself with some of the key terms used in assisted living (as well as in other long-term care communities). We have derived our definitions you need to know from those developed by the state of California.

Administrator: Administrator is the individual designated by an assisted living community to act on behalf of the that facility in the overall management of that facility. If the facility happens to be owned by an individual person, that individual can also serve as the administrator of an assisted living community.

Admission Agreement: Admission agreement includes all documents that a resident (or resident’s representative) must review and sign at the time of, or as a condition of, admission into an assisted living community.

Advance Health Care Directive: An advance health directive refers to a written instruction that relates to the provision of health care when the individual is incapacitated. Advance directives include, but are not limited to:

  • Durable power of attorney for health care
  • Individual health care instruction
  • Request to forego resuscitative measures
  • Do not resuscitate form

In an advance directive, a person states choices for medical treatment and can also designate who should make treatment choices if the person creating the advance directive should lose decision-making capacity due to a physical or mental health condition or issue. 

Allowable Health Condition: Allowable health conditions means any health condition that the assisted living community is allowed to care for either in accordance with a specific California regulation, or with an exception approved by the state of California.

Ambulatory Person: An ambulatory person is an individual who is capable of demonstrating the mental competence and physical ability to leave a building without assistance of any other person or without the use of any mechanical aid in case of an emergency.

Care and Supervision: Care and supervision references those activities which if provided shall require the facility to be licensed by the state of California. It involves assistance as needed with activities of daily living and the assumption of varying degrees of responsibility for the safety and well-being of residents. These activities or responsibilities include: 

  • Assistance in dressing, grooming, bathing and other personal hygiene
  • Assistance with taking medication
  • Central storing and distribution of medications
  • Arrangement of and assistance with medical and dental care, including provision of transportation
  • Maintenance of house rules for the protection of residents
  • Supervision of resident schedules and activities
  • Maintenance and supervision of resident monies or property
  • Monitoring food intake or special diet

Dementia: For the purposes of assisted living, dementia is defined as the loss of intellectual function (such as thinking, remembering, reasoning, exercising judgment and making decisions) and other cognitive functions, sufficient to interfere with an individual’s ability to perform activities of daily living or to carry out social or occupational activities. Dementia is not a disease itself, but rather a group of symptoms that may accompany certain conditions or diseases, including Alzheimer’s Disease. Symptoms may include:

  • Changes in personality
  • Changes in mood
  • Changes in behavior. 

Dementia is irreversible when caused by disease or injury, but may be reversible when caused by depression, drugs, alcohol, hormone imbalances or vitamin imbalances.

Dietitian: Dietitian is a person who is eligible for registration by the American Dietetic Association.

Direct Care Staff: Direct care staff references an assisted care facility, or those individuals employed by the facility, who provide direct care to the residents, including, but not limited to, assistance with activities of daily living.

Do-Not-Resuscitate (DNR) Form: This type of instrument advises the pre-hospital or other local emergency medical services agencies not to resuscitate a person under legally permissible circumstances. A DNA may express a person’s wish to forego resuscitative measures in the event of the cardiac or respiratory arrest.

Assisted Living Hospice Care Waiver: This is a type of waiver that provides relief from the limitation on retention of residents who require more care and supervision than other residents and residents who are bedridden other than for a temporary illness. The Hospice Care Waiver granted by the state of California permits an assisted living facility a designated maximum number of terminally ill residents who are receiving hospice services from a hospice agency. The Facility Hospice Care Waiver will apply only to those residents who are receiving hospice care in compliance with a hospice care plan.

Gender Identity: Gender identity means a person’s stated identification with a sex, regardless of whether the stated sex is consistent with the person’s physical appearance, surgical history, genitalia, legal sex, sex assigned at birth, or name and sex, as they appear in medical records, and regardless of any statement by any other person, including a family member, conservator, or legal representative, that is contrary. A person who lacks the ability to communicate gender identity retains the gender identity most recently expressed by that person.

Health Care Provider: Health care provider means those persons described in Probate Code as “an individual licensed, certified, or otherwise authorized or permitted by the law of this state to provide health care in the ordinary course of business or practice of a profession.”

Health Care Surrogate Decision Maker: This designation defines an individual who participates in health care decision making on behalf of an incapacitated resident. The health care surrogate decision maker may be formally appointed (for example, by the resident in a Durable Power of Attorney for Health Care or by a court in a conservatorship proceeding) or, in the absence of a formal appointment, may be recognized by virtue of a relationship with the resident (for example, the resident’s next of kin). The licensee or any staff member of the facility shall not be appointed health care surrogate decision maker.

Health Condition Relocation Order: A health condition relocation order refers to a written notice by the Department to a licensee requiring the relocation of a resident from a residential care facility for the elderly because the resident has a health condition which cannot be cared for within the limits of the license, requires inpatient care in a health facility or has a prohibited health condition. There are specific procedures mandated by the state of California that must be followed in the event of an issuance of this type of order by an assisted living community. 

Hospice Care Plan: A hospice care plan is the hospice agency’s written plan of care for a terminally ill resident. The hospice shall retain overall responsibility for the development and maintenance of the plan and quality of hospice services delivered.

Medical Professional: A medical professional is an individual who is licensed or certified in California to perform the necessary medical procedures within his/her scope of practice. This includes, but is not limited to:

  • Medical Doctor (MD)
  • Registered Nurse (RN)
  • Licensed Vocational Nurse (LVN)

Mild cognitive impairment: The state of California defines mild cognitive impairment as referring to people whose cognitive abilities are in a “conditional state” between normal aging and dementia. Normal age-related memory changes can include forgetting a person’s name or the location of an object, however, individuals with MCI have difficulty with short-term memory loss. MCI is a state in which at least one cognitive function, usually short-term memory, is impaired to an extent that is greater than would be anticipated in the normal aging process. MCI is characterized by short-term memory problems, but no other symptoms of dementia (e.g., problems with language, judgment, changes in personality or behavior) that affect a person’s daily functioning. Individuals with MCI may experience some difficulty with intellectually demanding activities, but lack the degree of cognitive and functional impairment required to meet diagnostic criteria for dementia.

Nonambulatory Person:  A person who is nonambulatory is unable to leave a building unassisted under emergency conditions. It includes, but is not limited to, those persons who depend upon mechanical aids such as crutches, walkers, and wheelchairs. It also includes persons who are unable, or likely to be unable, to respond physically or mentally to an oral instruction relating to fire danger and, unassisted, take appropriate action relating to such danger.

PRN Medication: PRN medication means any nonprescription or prescription medication which is to be taken as needed. PRN stands for the Latin phrase pro re nata.

Relative: Relative is defined as a:

  • Spouse
  • Parent
  • Stepparent
  • Son
  • Daughter
  • Brother
  • Sister
  • Half-brother
  • Half-sister
  • Uncle
  • Aunt
  • Niece
  • Nephew
  • First cousin
  • Any such person denoted by the prefix “grand” or “great”, or the spouse of any of the persons specified in this definition, even if the marriage has been terminated by death or dissolution

Representative: Representative means an individual who has authority to act on behalf of the resident; including but not limited to, a conservator, guardian, person authorized as agent in the resident’s valid advance health care directive, the resident’s spouse, registered domestic partner, or family member, a person designated by the resident, or other surrogate decision maker designated consistent with statutory and case law.

Residential Care Facility for the Elderly: A residential care facility for the elderly is a housing arrangement chosen voluntarily by the resident, the resident’s guardian, conservator or other responsible person; where 75 percent of the residents are sixty years of age or older and where varying levels of care and supervision are provided, as agreed to at time of admission or as determined necessary at subsequent times of reappraisal. Any younger residents must have needs compatible with other residents.

Significant Other: A significant other is identified as a person, including a person of the same gender, with whom a resident was sharing a partnership prior to his/her placement in a Residential Care Facility for the Elderly (RCFE). The partnership involves two adults who have chosen to share one another’s lives in an intimate and committed relationship of mutual caring.

Terminally Ill Resident: A terminally ill resident in assisted living means that the resident has a prognosis by his/her attending physician that the resident’s life expectancy is six months or less if his/her illness or condition runs its normal course.