Caregiver glossary.

The doctor (MD or DO) or advanced-practice clinician (nurse practitioner or physician assistant) responsible for your parent's overall care, coordinating referrals to specialists. In adult medicine they're often called "internal medicine" or "family medicine"; in older-adult care, sometimes "geriatrics."

When you'll hear it: Every interaction with the healthcare system points back to "what does the PCP think?" The PCP's after-visit summary is usually the most useful single document in your parent's chart.

A doctor who works exclusively inside the hospital. They take care of your parent during a hospitalization but are not your PCP and will not follow up after discharge. Most US hospitals have moved to this model; the PCP rarely sees their own patient when admitted.

When you'll hear it: The doctor you meet on day 1 of a hospital admission, who will round on your parent each morning. They will not be the person prescribing after discharge.

The senior doctor with primary responsibility for a patient's care during a specific encounter (hospital admission, ICU stay, ER visit). The attending supervises any residents or trainees involved.

When you'll hear it: In teaching hospitals, "the attending" is the name to ask for when you want a real decision-making conversation — residents and fellows can't finalize plans without their attending.

A doctor who specialized in care of older adults after their primary residency. There are far fewer of them than the population needs — about 7,000 board-certified geriatricians in the US for a ~55M+ over-65 population. Worth seeking out when chronic conditions stack up.

When you'll hear it: Often added to the care team when an older parent is on 5+ medications, has multiple chronic conditions, or has begun showing cognitive change.

Specialty care focused on quality of life and symptom relief for people with serious illness. Palliative care is NOT the same as hospice — it can be provided alongside curative treatment, at any stage of illness, including in the ICU. Many families wish they had been offered palliative consults earlier than they were.

When you'll hear it: You can request a palliative consult any time. They are especially valuable during repeated hospitalizations, advanced cancer, end-stage organ failure, or progressive neurologic disease.

A type of care for people with a life expectancy of about 6 months or less, focused entirely on comfort rather than cure. Hospice can be at home, in a hospice facility, in a nursing home, or in a hospital. Medicare covers hospice for eligible patients with no out-of-pocket cost for the hospice services themselves.

When you'll hear it: When two physicians certify the patient is unlikely to live more than 6 months if the disease runs its usual course. Many families recognize after the fact that they wish hospice had started weeks or months earlier than it did.

Playbook: end-of-life basics

A nurse or social worker employed by the hospital whose job is to coordinate care across the system — most importantly, discharge planning. The case manager is the person you want to talk to about home health, rehab placement, equipment delivery, and what insurance will cover.

When you'll hear it: Day 2 or 3 of a hospital admission, when discharge planning starts. Ask for them by name — the bedside nurse can page them.

Playbook: hospital discharge

A private-practice nurse, social worker, or other professional families hire (separate from any healthcare system) to coordinate an older adult's care. They assess needs, supervise home care, attend medical appointments, mediate family decisions, and serve as a paid local presence for out-of-state family.

When you'll hear it: When the family lives far from the parent, or when sibling dynamics make coordination unworkable. Typical cost: $100-$250/hour, not covered by Medicare. The Aging Life Care Association (aginglifecare.org) is the credentialing body.

A trained but unlicensed worker who provides hands-on assistance with bathing, dressing, toileting, meal preparation, and medication reminders in the home. Distinguished from a home health nurse (RN/LPN, can do clinical tasks) and from a private-duty companion (often no formal training).

When you'll hear it: When ADL assistance is needed but skilled nursing care is not. Medicare covers limited home health aide hours only when a person is also receiving skilled care; longer-term aide hours typically come out of pocket, through long-term care insurance, or through Medicaid in some states.

A legal document where one person (the "principal") authorizes another person (the "agent" or "attorney-in-fact") to act on their behalf in financial matters. "Durable" means the POA remains in effect after the principal loses capacity — which is exactly when families need it most.

When you'll hear it: The single most important legal document a family should set up while a parent still has capacity to sign. A non-durable POA is useless for caregiving purposes; specifically request a DURABLE POA.

Playbook: the legal paperwork

A legal document naming a person to make medical decisions if the patient cannot. Distinct from a financial POA — most states require separate documents. Without a healthcare proxy, the default decision-maker varies by state and may not be the person the patient would have chosen.

When you'll hear it: Standard advance-care planning, ideally well before crisis. Many hospitals ask about it at admission; many families have never set one up.

Advance directive wizard (51 states)

A written document specifying a patient's wishes for end-of-life medical care — typically covering CPR, mechanical ventilation, artificial nutrition, and other interventions when recovery is unlikely. Combined with a healthcare proxy, this is the core advance-care-planning package.

When you'll hear it: Should be set up while the patient has capacity. Hospitals ask about it at admission. Many states have official advance-directive forms; some require notarization or two witnesses for validity.

Advance directive wizard (51 states)

A medical order signed by a physician (not just a patient request) that CPR will not be attempted if the heart stops. A DNR is a clinical order, lives in the medical chart, and travels with the patient between settings only if specific portable forms (POLST/MOLST) are used.

When you'll hear it: Often discussed at hospital admission when patients are seriously ill. A DNR addresses only resuscitation — it does not limit other care (antibiotics, hospitalization, surgery, etc.).

A standardized medical-order form, signed by both patient (or surrogate) and physician, that travels with the patient across care settings. More specific and more portable than a DNR alone. Different states use different names: POLST (Physician Orders for Life-Sustaining Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), MOST, POST.

When you'll hear it: Increasingly used for patients with advanced serious illness who want care preferences honored at home, in nursing homes, and during EMS responses (where a hospital advance directive often isn't available in time).

A court-ordered arrangement where a judge appoints someone to make decisions for an adult who has been determined legally incapacitated. Requires a formal legal proceeding, costs thousands of dollars, and strips the patient of significant rights. Usually pursued only when no POA / healthcare proxy was set up in time and decisions must be made.

When you'll hear it: Last-resort path when a parent has lost capacity without having signed durable powers of attorney. The reason elder-law attorneys urge families to set up POAs early — guardianship is a much harder, more expensive, more invasive substitute.

A signed form authorizing a healthcare provider to release the patient's information to a named family member or other party. Distinct from a healthcare proxy (which gives decision-making authority); HIPAA authorization gives information access. Patients can list multiple authorized recipients.

When you'll hear it: Necessary if the patient wants siblings, an out-of-state adult child, or a hired care coordinator to be able to speak with clinicians or receive records.

The person named in a will to administer the estate after death — paying debts, filing taxes, distributing assets to heirs. Executor authority begins at death; until then, financial decisions during incapacity flow through a POA, not an executor.

When you'll hear it: After death. Many families confuse executor (post-death) with POA (pre-death) and discover the gap at the worst possible moment.

The federal program that covers hospital stays, skilled nursing facility (SNF) stays after qualifying hospitalizations, hospice, and some home health care for people 65+ (and some younger people with disabilities). Most people pay no premium for Part A because they paid into it via payroll taxes.

When you'll hear it: At hospital admission ("which insurance do you have?"). Part A covers the hospital itself; Part B covers the doctors.

Covers physician services, outpatient care, durable medical equipment, and most preventive services. Requires a monthly premium (standard rate ~$185 in 2026, higher for high-income beneficiaries) and has a deductible plus 20% coinsurance for most services after deductible.

When you'll hear it: Doctor visits, blood draws, outpatient procedures, durable medical equipment (DME) prescriptions. Most patients combine Part B with either Medigap or Part C.

A private-insurance alternative to original Medicare (Parts A + B), bundling the coverage with extras like prescription drugs, vision, dental, gym memberships, and sometimes meal delivery. MA plans use restricted provider networks; out-of-network costs can be much higher than in-network.

When you'll hear it: At Medicare enrollment age (65) and during Open Enrollment (Oct 15-Dec 7 each year). About half of Medicare beneficiaries are now in MA plans. Network restrictions are the most common pain point — your parent's preferred specialist may not be in the plan's network.

Private supplemental insurance designed to cover the deductibles and coinsurance that original Medicare (Parts A + B) doesn't. Cannot be used with Medicare Advantage. Standardized into letter-named plans (Plan G, Plan N, etc.) that are identical across carriers — only the price varies.

When you'll hear it: When choosing how to fill the gaps in original Medicare. Most patients pick between "Original Medicare + Medigap + Part D" OR "Medicare Advantage" — generally not both.

Prescription drug coverage. Sold by private insurers under Medicare rules, with a monthly premium plus copays. The 2025 Inflation Reduction Act capped out-of-pocket Part D costs at $2,000/year, eliminating the old "donut hole" pattern that hit many patients with chronic conditions.

When you'll hear it: Whenever your parent has prescriptions. Plans use formularies (lists of covered drugs by tier); a drug your parent takes may be on one plan's formulary but not another's. Re-evaluate each Open Enrollment.

Joint federal-state program covering health care for low-income people, including many people with disabilities and many older adults who have spent down their assets. Unlike Medicare, Medicaid covers long-term care in nursing homes and many home- and community-based services. Eligibility rules vary widely by state.

When you'll hear it: When out-of-pocket long-term care costs become unsustainable. Many families discover Medicaid eligibility planning (often involving spend-down strategies, trust planning, and 5-year lookback rules) only when crisis hits — elder-law attorneys advise starting much earlier.

Private insurance designed to cover services not typically covered by Medicare — primarily extended nursing home stays, assisted living, and home care for ADL support. Premiums rise with age at purchase; the market has shrunk dramatically and many products now combine LTC with life insurance.

When you'll hear it: During estate-planning conversations, often in a person's 50s or 60s. Already-purchased LTC policies should be inventoried in the document vault — the trigger conditions and benefit amounts matter at care-planning moments.

A requirement from the insurance company that a doctor obtain approval before prescribing certain medications, ordering certain tests, or providing certain treatments. The patient can't get the service until the PA clears. Denials are common; appeals usually succeed but take weeks.

When you'll hear it: Whenever a new specialty medication is prescribed, an MRI/CT is ordered, or surgery is planned. The single biggest source of friction in family caregiving today.

The maximum amount you pay out of pocket in a plan year before insurance covers 100% of in-network care. Includes deductibles, copays, and coinsurance. Premiums do not count toward the OOP max. For Medicare Advantage, the in-network OOP max in 2026 is capped at $9,350 (and most plans set it lower).

When you'll hear it: When budgeting for a year that includes major surgery, hospitalization, or chronic-disease management. Once your parent hits OOP max, in-network costs drop to zero for the rest of the year.

The list of prescription drugs an insurance plan covers, usually organized into tiers (Tier 1 generic = cheapest, higher tiers = brand-name + specialty = most expensive). A drug not on the formulary may not be covered at all.

When you'll hear it: Whenever a doctor prescribes a new medication. The pharmacy will know whether it's covered; check before leaving the doctor's office to avoid the second-trip-to-the-pharmacy pattern.

Reusable medical equipment for long-term use at home: wheelchairs, walkers, hospital beds, oxygen concentrators, CPAP machines, glucose meters, lift chairs, etc. Medicare Part B covers 80% of approved DME for eligible patients with a prescription; the remaining 20% comes out of pocket or via Medigap.

When you'll hear it: After hospital discharge when home equipment is being arranged ("the hospital is sending over a walker through DME"). Also during the management of any chronic condition that needs supportive equipment.

The process of depleting assets to qualify for Medicaid long-term care benefits. Medicaid eligibility caps asset levels (varies by state but typically ~$2,000 in countable assets for an individual); patients with assets above that level "spend down" — paying for care out of pocket until they qualify. Substantial planning options exist (irrevocable trusts, Medicaid-compliant annuities, exempt assets) but most require professional help.

When you'll hear it: When out-of-pocket nursing-home costs are unsustainable and the family is researching Medicaid eligibility. Elder-law attorneys handle this; the planning is much more effective started 5+ years before need than at the moment of crisis.

Medicaid's 60-month (5-year) review window in which any uncompensated asset transfers (gifts, transfers to family, sales for less than fair market value) are flagged as potential disqualifying transfers. Each disqualifying transfer triggers a penalty period of Medicaid ineligibility proportional to the asset value. The lookback is one of the most-misunderstood Medicaid rules in family-side planning.

When you'll hear it: In elder-law consultations about Medicaid planning. The hard rule: gifting a parent's house to the kids 4 years before they need nursing care can create a 2+ year ineligibility window — exactly when Medicaid is needed.

The person covered by a Medicare or Medicaid program (or named to receive proceeds of a life-insurance policy, retirement account, etc.). In Medicare/Medicaid context: "Medicare beneficiary" = a person enrolled in Medicare. In financial context: the person who receives an asset on the account-holder's death.

When you'll hear it: On every Medicare/Medicaid form, in every insurance call ("can I have the beneficiary's name?"), and in estate planning ("who are the beneficiaries on the IRA?"). Verify beneficiary designations on accounts when reviewing a parent's finances — they bypass the will and update only when explicitly changed.

A residential facility for older adults who need help with some ADLs but don't need skilled nursing care. Provides meals, housekeeping, medication management, social activities, and ADL assistance. Costs typically $4,500-$7,000+/month, paid privately (Medicare does NOT cover assisted living).

When you'll hear it: When a parent can no longer manage at home but doesn't require skilled nursing. Specifically distinguished from nursing homes (which provide skilled care) and memory care (a specialized form of assisted living).

A specialized form of assisted living for people with dementia, with secured units, dementia-trained staff, and structured programming. More expensive than standard assisted living (often $7,000-$10,000+/month). Some standalone memory-care facilities exist; many assisted-living facilities have a memory-care wing.

When you'll hear it: When a person with dementia can't safely live at home and standard assisted living can't manage wandering or behavioral symptoms. The transition from assisted living to memory care is one of the harder care-decision moments families face.

Caring for someone with dementia

A facility providing 24-hour skilled nursing care — primarily for short-term rehabilitation after hospitalization, but also for long-term residence. Short-term SNF stays (after a qualifying 3-day hospital admission) are partially covered by Medicare; long-term nursing home residence is paid privately or through Medicaid.

When you'll hear it: Two distinct contexts: (1) post-hospitalization rehab for a few weeks (Medicare-covered), (2) long-term residence when at-home care is no longer feasible (private-pay or Medicaid).

A community offering multiple levels of care on one campus — independent living, assisted living, memory care, and skilled nursing — so residents can move between levels as needs change. Usually requires a substantial entrance fee ($100K-$1M+) plus ongoing monthly fees.

When you'll hear it: Late-life housing planning for adults who can afford the entrance fee and want care continuity. The "we won't have to move again" appeal is real, but the contracts are complex — independent legal review is essential before signing.

Skilled medical care delivered in the home by nurses, physical therapists, occupational therapists, or speech therapists — typically following hospitalization or during the management of a serious condition. Medicare covers home health when ordered by a physician and the patient is homebound.

When you'll hear it: At hospital discharge ("home health will start visits at home"). Distinct from home care or companion care, which is non-medical ADL support and is generally not Medicare-covered.

A daytime program providing supervised activities, meals, and (in medical day programs) some health services for older adults — usually so a family caregiver can work or rest. Costs $50-$150/day; some are Medicaid-covered, some are sliding-scale.

When you'll hear it: When the primary caregiver needs daytime respite or returns to work and the parent can't safely be alone. Most US counties have at least one adult day program; finding it often requires asking specifically.

Temporary, short-term substitute care so the primary family caregiver can rest. Can be in-home (an aide comes for a weekend), facility-based (parent stays in a respite-bed at an assisted living for a week), or hospice-related (hospice respite is a Medicare benefit when the patient is enrolled in hospice).

When you'll hear it: When the family caregiver is at burnout risk. Many caregivers wait too long to use respite; using it earlier and regularly extends the family's capacity to keep the parent at home longer.

The basic self-care tasks: bathing, dressing, toileting, transferring (e.g., bed to chair), continence, and eating. Loss of independence in ADLs is the threshold for many care decisions and many insurance triggers (Medicare home health, LTC insurance benefits, Medicaid HCBS eligibility).

When you'll hear it: Anytime care intensity is being assessed. "She needs help with 2 ADLs" is the common shorthand for "she's past the point where she can fully live alone."

The more complex tasks of independent living: managing finances, managing medications, cooking, shopping, transportation, using the phone, housekeeping. IADLs are usually lost before ADLs as cognitive or physical decline begins — and they're harder for families to notice from a distance.

When you'll hear it: When trying to assess whether a parent is still managing independently. "She's fine with ADLs but losing the IADLs" is the early warning that more support is needed.

The predictable pattern of worsening confusion, agitation, or distress in people with dementia in the late afternoon and early evening. Cause is multifactorial (fatigue, circadian rhythm changes, environmental cues); responds to environmental adjustments, scheduling, and sometimes medication.

When you'll hear it: After a few months of dementia caregiving, most families have lived it without knowing it had a name. Learning the pattern is named makes it easier to plan around.

Caring for someone with dementia

A worsening of symptoms after even minor physical, cognitive, or emotional exertion — the hallmark of ME/CFS and a defining feature of long COVID in many patients. Crashes can come hours or days after the activity that triggered them and can last days to weeks.

When you'll hear it: When a long COVID or ME/CFS patient does "too much" on a good day and then can't function for the next 3 days. Pacing (staying inside the energy envelope) is the most-evidence-backed intervention.

Caring for someone with long COVID

A return to the hospital within 30 days of discharge. Tracked closely because Medicare penalizes hospitals with high readmission rates for certain conditions. From the family's perspective: a sign that discharge wasn't set up well or a new complication developed.

When you'll hear it: Anytime a parent goes back to the hospital within 30 days of going home. The case manager will ask about the prior admission; the family should bring the discharge paperwork.

A blood test that measures average blood glucose over the previous ~3 months. The standard marker for diabetes control. Most labs report it as a percentage (5-15%); under 5.7% is normal, 5.7-6.4% is prediabetes, 6.5%+ usually indicates diabetes. Goal A1c varies by patient — tighter targets for younger patients, looser targets for frail older adults.

When you'll hear it: At every diabetes-related visit (usually 2-4 times per year). Useful to track over time — a Kintaria workspace charts the trend automatically.

Caring for someone with diabetes

A calculated estimate of how well the kidneys are filtering, based on serum creatinine, age, and sex. Reported in mL/min/1.73m². Above 90 = normal; 60-89 = mildly reduced; 30-59 = moderately reduced (CKD Stage 3); under 30 = severely reduced (Stage 4); under 15 = kidney failure (Stage 5).

When you'll hear it: Anytime kidney function is being monitored — diabetes, hypertension, advanced heart failure, after certain medications (ACE inhibitors, NSAIDs). Tracking the trend matters more than any single value.

Caring for someone with kidney disease

Medications associated with increased fall risk in older adults — particularly benzodiazepines (lorazepam, alprazolam, etc.), sleep medications (zolpidem), opioids, anticholinergics (diphenhydramine, oxybutynin), and some antidepressants. The Beers Criteria, published by the American Geriatrics Society, is the standard reference.

When you'll hear it: When a parent is taking multiple medications. A "deprescribing review" with the PCP or pharmacist often identifies opportunities to reduce fall risk without losing therapeutic benefit.

The use of multiple medications by one patient — generally defined as 5+ regular medications. Increases drug-interaction risk, side-effect burden, adherence challenges, and cost. Common in older adults with multiple chronic conditions; each new medication should be weighed against what could come off.

When you'll hear it: Whenever the medication list is being reviewed. "Let's talk about polypharmacy" is the clinician's opening to discuss what can be deprescribed.

Documented patient preferences about resuscitation efforts — typically "Full Code" (all interventions), "DNR" (no CPR but other care continues), "DNI" (no intubation), or "Comfort Care Only." Discussed at hospital admission and revisited as condition changes.

When you'll hear it: At hospital admission ("we need to talk about code status") and during family meetings when prognosis is being discussed. Best decided in advance, in the calm of the home, not in the urgency of the ICU.

A clinical syndrome of decreased physiologic reserve, often measured by unintentional weight loss, weakness (grip strength), exhaustion, slowness (gait speed), and low physical activity. Frailty drives many treatment decisions in older adults — frail patients tolerate surgery, chemotherapy, and aggressive interventions much less well, and outcomes data supports gentler approaches.

When you'll hear it: In geriatric assessment ("she's scoring as frail"); in pre-operative consultations; in cancer treatment-planning discussions when chemotherapy intensity is being weighed.

Another medical condition the patient has alongside the primary one being discussed. "Diabetes is the diagnosis we're focused on, but her comorbidities are hypertension, CKD stage 3, and mild cognitive impairment" — the whole picture matters for treatment decisions, not just any single diagnosis.

When you'll hear it: Whenever a new specialist is reviewing the case. The full comorbidity list is the difference between treatment plans that work and ones that backfire.

A hospital classification (NOT admission) where the patient is in a hospital bed but is technically an outpatient. Crucial because: (a) Medicare Part A does not cover observation stays the way it covers admissions, (b) observation time does not count toward the 3-day inpatient requirement for Medicare-covered SNF rehab, (c) the bills can be substantially higher in unexpected ways.

When you'll hear it: Ask explicitly: "Is my parent admitted, or in observation?" The answer determines what Medicare covers. Hospitals are required to give patients a written notice (the MOON form) when they're in observation more than 24 hours; insist on it.

An acute, fluctuating disturbance of attention and cognition that develops in the ICU (or any hospital setting), affecting 30-80% of ICU patients and a meaningful percentage of older adults on regular hospital floors. Risk factors: sleep deprivation, medications (especially benzodiazepines), restraints, immobility, infection. Often misread by families as "she's just confused" when it is a real, dangerous, partly-preventable condition.

When you'll hear it: When your parent in the ICU or hospital starts behaving in unfamiliar ways — disoriented, paranoid, picking at sheets, hallucinating, sometimes sweetly disinhibited. Ask the team about delirium prevention (orientation cues, hearing aids on, daylight, family presence, minimizing sedation). It often resolves but can leave lasting cognitive effects.

A brief in-office test of cognition. Common versions: Mini-Cog (3-minute screen), MoCA (Montreal Cognitive Assessment, ~10 minutes, more sensitive to mild impairment), SLUMS, MMSE (older standard, still widely used but copyrighted). Screening is the entry point — not a diagnosis — and is followed by more detailed evaluation when concerning.

When you'll hear it: At the visit where you've asked the PCP to evaluate possible memory changes. Ask which test they use; MoCA is more sensitive to mild changes than the older MMSE. Bring the patient on a calm morning, not after a long drive when they're tired.

Caring for someone with dementia

A clinical visit conducted over video or phone instead of in person. Expanded dramatically during the COVID era; now standard for many follow-up visits, mental-health care, and routine medication management. Medicare and most private insurers cover it under most circumstances; specifics vary by state and visit type.

When you'll hear it: When scheduling a follow-up appointment ("would you like that as a telehealth visit?"). Especially useful when traveling to the office is hard on the patient, when an out-of-state family member needs to be on the call, or when the visit is mostly a conversation rather than a physical exam.

A secure website (and usually app) provided by a health system that gives patients access to their medical records, lab results, appointment scheduling, prescription refills, and secure messaging with the care team. The most-used US portal is MyChart (built on Epic); other systems use Cerner/Oracle Health, Athena, NextGen, etc. — each different.

When you'll hear it: At every encounter ("sign up for MyChart at the front desk"). A family caregiver typically needs proxy access (set up by the patient) to view a parent's portal — see "HIPAA authorization" and ask the provider about proxy access setup.

Kintaria vs MyChart

A state of physical, emotional, and mental exhaustion that develops over months or years of caregiving — characterized by chronic fatigue, irritability, isolation, anxiety, depression, sleep disturbance, and worsening physical health. Affects an estimated 40-70% of long-term caregivers. Real medical concept, not a character flaw.

When you'll hear it: When the family caregiver starts canceling their own appointments, snapping at the patient, losing weight, drinking more, or feeling like they don't recognize themselves. Worth naming. Respite, support groups (NAMI Family Support Groups, FCA, Alzheimer's Association), and the caregiver's own clinician visits are evidence-based interventions.

A descriptive term for adults who are simultaneously caring for an aging parent (or in-law) and raising their own children. Pew Research data puts the sandwich-generation share at ~30% of US adults in their 40s and 50s; the share is higher in immigrant families and lower-income households where multigenerational households are more common.

When you'll hear it: In sociological discussions of caregiving demographics; in employer-benefits decisions about caregiver leave policies; in family conversations about who has capacity for which tasks.

A care approach focused entirely on symptom relief and dignity rather than disease treatment. Distinct from hospice (which is a specific Medicare-defined benefit for patients with ≤6 months prognosis): comfort care can be the approach during any hospitalization or care setting where treatment of the underlying disease is no longer the goal.

When you'll hear it: In family meetings during serious illness, often as part of code-status discussions. "We'd like to transition to comfort care" is a specific request that means: stop treatments aimed at cure; continue (or add) treatments aimed at comfort.