Activities of daily living (ADLs): Usual activities an individual engages in throughout the day such as eating, bathing, dressing, getting in and out of bed, and using the toilet and telephone.
Acute illness: An illness with an abrupt onset from which the patient is expected to recover quickly and completely.
Advance care directive: A document—usually a living will or a medical power of attorney—containing an individual’s instructions about future medical care should they become unable to participate in medical decisions due to serious illness or incapacity.
Advance care planning: The process by which an individual makes decisions and arrangements relating to their future healthcare. Such planning is carried out in two ways—by appointing a substitute decision maker or by completing an advance care directive.
Aggressive treatment: Medications or procedures intended to cure or slow the progress of an illness.
Apnea: The cessation of breathing for a short period of time, usually lasting less than 20 seconds but sometimes lasting for as long as a minute.
Bereavement: The process of grieving and mourning—in particular, the loss of a loved one—characterized by sadness and a deep sense of loss.
Cardiopulmonary resuscitation (CPR): The restarting of a patient’s heart or breathing by manual or mechanical means, or using drugs.
Caregiver: An individual (usually not a medical professional) who provides physical and emotional assistance to a family member or friend.
Chronic illness: An ongoing condition or illness that doesn’t respond completely to treatment.
Chronic obstructive pulmonary disease (COPD): An ongoing condition characterized by poor, long-term airflow in the lungs that results in shortness of breath and productive cough.
CNA: Certified nursing assistant.
Dementia: A decline in mental functioning that’s more significant than would be expected due to aging.
Diagnosis: The determination of the nature and cause of symptoms made by a medical professional, usually a physician.
DNR: A DNR (do not resuscitate) document is a doctor’s written order instructing the healthcare team not to attempt cardiopulmonary resuscitation (CPR) when the patient’s heart or breathing stops. The DNR order must be requested by the patient or family member, and it must be signed by a doctor to be valid.
Dysphagia: Difficulty in swallowing.
Dyspnea: Difficulty breathing, especially during exertion or when lying down.
Election of hospice benefit: Admission of the patient to hospice that is accomplished by signing paperwork.
Emphysema: Destruction of the alveoli (air sacs) in the lungs that promote the transfer of oxygen from the air into the bloodstream, resulting in shortness of breath.
End-of-life care: Care provided to an individual during what is assumed to be the last six months of their life that focuses on comfort and support for both the patient and their family.
End-stage disease: A term referring to the last phase in the course of a disease. It has, in large part, replaced the word “terminal” due to the negative connotations of that word.
Failure to thrive: In the elderly, a diagnosis based on weight loss, decreased appetite, poor nutrition, and inactivity.
Healthcare proxy: See “substitute decision maker.”
Hemorrhagic: Refers to bleeding caused by the rupture of a blood vessel.
Hospice: A philosophy and type of care focused on providing comfort, dignity, and support to people with terminal illnesses or nearing the end of life.
Impending death: When death is expected in two or three days.
Interdisciplinary team: The staff members who comprise the hospice patient’s care team—typically a medical director, nurse, social worker, certified nurse’s assistant or home health aide, chaplain, volunteers, and grief specialist.
Ischemic: Refers to a lack of blood flow caused by an obstruction, as in a vessel blocked by a blood clot.
Life-limiting condition or disease: A condition or illness that is progressive, fatal, and which cannot be reversed by treatment.
Life-sustaining treatment/life support: Procedures or devices that replace or support vital body functions. Examples include cardiopulmonary resuscitation (CPR), breathing tubes, nutrition or hydration provided through tubes or intravenous (IV) lines, and kidney dialysis.
Living will: A type of advance care directive document containing an individual’s wishes regarding medical treatment at the end of life should they become incapacitated and unable to communicate. A living will may also be referred to as a directive to physicians, healthcare declaration, or medical directive.
Medicare Hospice Benefit: A provision available to anyone who qualifies for Medicare to receive the hospice benefit if they’re assessed to be appropriate for hospice services (diagnosed with a life-limiting illness and a life expectancy of six months or less). All medications, equipment, and supplies related to the life-limiting diagnosis are covered, along with all visits and services from hospice staff.
Medicaid: State programs that provide health insurance to people who meet the criteria of being medically indigent.
Medical Power of Attorney: A type of advance care directive document in which an individual designates a person to make decisions about their medical care if they become unable to communicate. A medical power of attorney directive is sometimes referred to as a durable power of attorney for healthcare. The person named in the directive is referred to as the healthcare proxy or agent, surrogate, or attorney-in-fact.
Metastatic: Refers to cancer that spreads from its organ or tissue of origin to other parts of the body. The cancerous cells are the same as those in the tissue of origin, so, for example, breast cancer cells may spread to bones, but this is different than cancer that originates in the bones.
Occupational therapy: Instruction by a trained therapist in managing the activities of daily living—feeding oneself, dressing, toileting, etc. following injury, surgery, or illness.
Opportunistic infections: Bacterial or viral infections that would not normally cause a problem in a healthy individual but can become serious or even life-threatening in patients with impaired immune systems.
Palliative care: Treatment designed to lessen or relieve pain and other symptoms that has comfort rather than cure as its goal.
Physical therapy: Provided by a trained therapist, physical therapy is intended to allow the patient to regain normal mobility following surgery, disease, or injury or to maximize diminished physical strength and mobility to maintain as much independence as possible.
Power of Attorney: A legal document designating one person to act in a legal manner on another’s behalf.
Prognosis: An estimate, given by a doctor, based on the experience of many patients with the same disease or disorder who are of similar overall health and age, of how the disease will progress. A prognosis may or may not include life expectancy, depending on the severity of the disease and the likeliness of cure.
Pulmonary: Relating to the lungs and their function.
Recertification: The process by which a written certificate of life-limiting illness is provided by the hospice medical director for each benefit period the patient is on hospice. Recertification is possible as long as the patient continues to qualify for service as determined by the hospice medical director.
Referral: The initial meeting between a patient, their caregiver, and family members with hospice staff to discuss services.
Remission: Refers to the stage of a chronic disease, such as cancer, marked by a lessening of the intensity or progression of symptoms (such as the presence of tumors), or cessation of the disease process (tumors diminish in size or disappear). Partial remission refers to a decrease in symptoms; in complete remission, there’s no evidence of disease.
Respite care: Relief provided to the primary caregiver by a hospice volunteer who sits with the patient so the primary caregiver can leave the house. Most hospices arrange for several hours of respite care a week.
Respite stay: An arrangement made by hospice on a case-by-case basis to provide care for the patient for up to five days to provide a rest period for the caregiver. Care may be provided at any of several types of residential locations. Following the respite stay, the patient returns to home care. The respite care benefit can be used once every 30 days.
Speech-language pathologist: A professional whose specialty focuses on the evaluation and treatment of communication disorders, voice disorders, and swallowing disorders, which often occur following stroke or are the result of neurological or other diseases.
Substitute or surrogate decision maker: A person chosen to make medical decisions for an individual only when the individual no longer has the capacity to make or communicate decisions for themselves. In the US, this substitute decision maker is referred to as a healthcare proxy or healthcare agent. Most states have laws permitting substitute or surrogate decision makers to make decisions for patients without advance care directives.