Glossary |
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| Term | Definition |
| AAHSA | American Association of Homes and Services for the Aging is committed to advancing the vision of healthy, affordable, ethical aging services for America. The association represents adult day services, home health, community services, senior housing, assisted living residences, continuing care retirement communities, and nursing homes. |
| absorption rates | The actual or expected period of time required from the time a property is initially offered for purchase or use until all portions have been sold or stabilized occupancy has been reached. The absorption period includes two phases: the ‘pre-lease’ period and the net absorption period. |
| ACLF | See Adult Congregate Living Facility. |
| Active Adult Communities | For-sale single family homes, town-homes, cluster homes, mobile homes and condominiums with no specialized services, restricted to adults at least 55 years of age or older. Residents generally lead an independent lifestyle. Projects are not equipped to provide increased care as the individual ages. May include amenities such as clubhouse, golf course and recreational spaces. Outdoor maintenance is normally included in the monthly homeowner’s association or condominium fee. |
| ADL | Activity of daily living, such as bathing, dressing, or walking. |
| Adult Congregate Living Facility | An arrangement offering housing and support services but no skilled or intermediate nursing care. |
| adult day care | Community-based group programs designed for functionally and/or cognitively impaired adults through an individual plan of care. |
| affordable housing | Housing designed to meet the senior living needs of the low and middle-to-low income population. Typically the costs of the housing are subsidized by some form of governmental program. |
| AHCA | The American Health Care Association (AHCA) is a non-profit federation of affiliated state health organizations, together representing more than 10,000 non-profit and for-profit assisted living, nursing facility, developmentally disabled, and sub-acute care providers that care for more than 1.5 million elderly and disabled individuals nationally. |
| ALFA | The Assisted Living Federation of America (ALFA) is the largest national association exclusively dedicated to professionally-operated assisted living communities for seniors. ALFA's member-driven programs promote business and operational excellence through national conferences, research, publications and executive networks. ALFA works to influence public policy by advocating for informed choice, quality care and accessibility for all Americans seeking assistance with long-term care. |
| all-inclusive contract | See Extensive Contract. |
| Alzheimer's Association | The world leader in Alzheimer’s research and support, advancing research, improving services and care, creating awareness of the disease and mobilizing support through a national network of advocates and chapters. |
| ancillary services | Tests, procedures, imaging and support services provided in a healthcare setting. ASHA: American Seniors Housing Association. Members of ASHA are executives involved in the operation, development and finance of the entire spectrum of seniors housing - senior apartments, independent living communities, assisted living residences, and continuing care retirement communities. |
| Assisted Living Residences/Facilities | (ALFs) state regulated rental properties that provide the same services as independent living communities, but also provide, in a majority of the units, supportive care from trained employees to residents who are unable to live independently and require assistance with activities of daily living (ADLs) including management of medications, bathing, dressing, toileting, ambulating and eating. These properties may have some nursing beds, but the majority of units are licensed for assisted living. Many of these properties include wings or floors dedicated to residents with Alzheimer’s or other forms of dementia. A property that specializes in the care of residents with Alzheimer’s or other forms of dementia that is not a licensed nursing facility should be considered an assisted living facility. |
| capitation | A payment structure where a caregiver is paid a set amount per patient in advance, regardless of how many procedures are performed later. Opposite of fee-for-service. |
| CARF-CCAC | The Commission on Accreditation of Rehabilitation Facilities (CARF) is an independent, not-for-profit accrediting body promoting quality, value and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of the persons served. The Continuing Care Accreditation Commission (CCAC), a not-for-profit organization founded in 1985, is the nation’s only accrediting body for aging services continuums, including continuing care retirement communities and other organizations that meet its standards. CARF-CCAC is the entity resulting after the 2003 merger of the Rehabilitation Accreditation Commission (formerly the Commission on Accreditation of Rehabilitation Facilities) and the Continuing Care Accreditation Commission. |
| CASPF | (Certified Aging Services Professional Fellow) CASPF is a national professional certification program for aging services professionals. The program is designed to educate and train service professionals involved in the management of assisted living facilities, continuing care retirement communities, senior housing, and other types of aging services. CASPs' unique, comprehensive approach provides facility and program administrators with the flexibility and marketability to work in a variety of settings throughout their careers. |
| CCRC | (Continuing Care Retirement Community) an entity that provides for or arranges for the provision of housing and health-related services for an older person under an agreement effective for the life of the person or for a specified period greater than one year, and may be licensed or certified. |
| Center for Medicare & Medicaid Services | (previously known as the Health Care Financing Administration (HCFA)) the branch of the U.S. Health Department and Human Services that administers Medicare and federal portions of Medicaid. |
| CMS | See Center for Medicare & Medicaid Services. |
| condominium ownership | An organizational structure that gives residents the opportunity to share in the ownership of a continuing care or life care community by owning a condominium interest rather than paying an entrance fee. |
| continuing care retirement community | (CCRC) an entity that provides for or arranges for the provision of housing and health-related services for an older person under an agreement effective for the life of the person or for a specified period greater than one year, and may be licensed or certified. |
| contract types | General reference to the types of contracts that describe the services offered by continuing care retirement communities. Examples include: Extensive Contract, Modified Contract, Fee-for-service Contract, Rental Contract, Equity Contract. CCRCs may offer more than one type of contract. |
| Davidson Retirement Properties | (DRP) Former name of Cornerstone Senior Living. In May 2008, DRP officially changed its name to Cornerstone to reflect the importance of proper planning during the development stage of the project lifecycle. |
| deposit | Amount paid by a resident to reserve a unit in a continuing care retirement community. Typically, 10 percent of the entrance fee is required to reserve a specific unit within a community. |
| developer | The individual, team, or firm who brings a senior living project from conception to or through opening. |
| DRP | (Davidson Retirement Properties) Former name of Cornerstone Senior Living. In May 2008, DRP officially changed its name to Cornerstone to reflect the importance of proper planning during the development stage of the project lifecycle. To learn more about the name change, click here. |
| endowment fee | See Entrance Fee. |
| entrance fee | An upfront fee paid by a CCRC resident to cover capital costs and/or future health care benefits. Amount is normally based on size of resident’s living unit and refund policy. |
| equity contract | Contracts that involve the actual purchase of real estate or membership. Includes condominiums and cooperatives. |
| extensive contract | Contract between a CCRC and a resident of the CCRC that has an entrance fee and includes housing, residential services amenities and unlimited, specific health-related services with little or no substantial increase in monthly fees, except for normal operating costs and inflation adjustments; also called Type A contracts. |
| feasibility study | A study of the financial and market feasibility of a proposed senior living project, typically prepared according to a set of assumptions provided by the developer or sponsoring organization regarding number of units to be constructed, entrance and monthly fee pricing, age at entry, etc. Study encompasses a review of the market demographics, establishing the primary market area, secondary market area, and sometimes a tertiary market area. A feasibility study is prepared just prior to a financing. Financial slang: “the feaso.” |
| fee-for-service | The most common U.S. healthcare payment system. A physician declares his or her own rates and is paid after each medical service delivered, as opposed to a flat-rate plan such as capitation. |
| fee-for-service contract | An entrance fee contract that includes housing, residential services, and amenities for the fees stated in the resident agreement. Access to healthcare services is guaranteed, but it may be required at full fee-for-service rates; also called Type C contracts. |
| fill period (or fill-up) | The time it takes independent living units in a new campus construction or expansion to reach stabilized occupancy rates (typically, 90 to 95 percent occupancy). |
| financial feasibility | See feasibility study. |
| focus group | A small group of individuals used to determine what people in a target market think about a product. |
| gross absorption | The number of beds or units occupied in a residence from the beginning of marketing efforts until stabilized occupancy. |
| HCFA | Health Care Financing Administration (HCFA): see Center for Medicare & Medicaid Services. |
| Health Insurance Portability and Account | A complex law that protects a person’s credit for previous healthcare insurance to cover preexisting conditions when changing health plans and institutes new mandates concerning electronic healthcare transactions and data in order to protect the privacy of an individual. HIPAA requires that the Department of Health and Human Services adopt standards for electronic health transactions, including health claims and attachments, enrollment/dis-enrollment, eligibility, payments and premiums, claims status, referral authorizations and digital signatures. HIPAA also requires the creation of unique identifiers and standards for data confidentiality. Healthcare organizations had to be in compliance by 4/14/03. |
| HIPAA | See Health Insurance Portability and Accountability Act. |
| Independent Living Communities | Age-restricted multifamily rental properties with central dining facilities that provide residents, as part of their monthly fee, access to meals and other services such as housekeeping, linen service, transportation, and social and recreational activities. Such properties do not provide, in a majority of the units, assistance with activities of daily living (ADLs) such as supervision of medication, bathing, dressing, toileting, etc. There are no licensed skilled nursing beds in the property. |
| Instrumental Activities of Daily Living | (IADL): Activities related to independent living and include preparing meals, managing money, shopping for groceries or personal items, performing light or heavy housework, and using a telephone. |
| Joint Commission on Accreditation of Hea | (JCAHO) an independent, non-profit group that accredits healthcare organizations. Some of the healthcare network criteria in JCAHO’s accreditation manual includes heightened attention to patient education and management information. |
| licensed | Has official or legal permission to do or own a specified facility or service. |
| life care | A term often used interchangeably with “continuing care,” as in life care community. Sometimes refers to a contract type, namely, the Extensive Contract, in order to distinguish the care it provides (for life, without additional fees by level of care) from that of other contract types (Modified Contracts and Fee-for-service Contracts) that require additional fees for living at higher levels of care. |
| Long-Term Care | Also called custodial care. Assistance, expected to be provided over a long period of time, to people with chronic health conditions and/or physical disabilities who are unable to care for themselves without the help of another person. |
| Long-Term Care Insurance | Insurance available through private insurance companies as a means for individuals to protect themselves against the high costs of long-term care; contrast with Medicaid, a means-tested program supported by federal, state, and local funds and administered by each state to provide health care for eligible low-income individuals. |
| MAPTM | See Market Area Profiles |
| market rate | A term referring to the affordability of a project. Market rate projects use only resident-generated revenues to support the community and do not rely on special third-party subsidization (other than possibly accepting Medicare or Medicaid reimbursement for the costs of caring for residents receiving nursing care), nor do they rely on special government financing programs to make the project accessible to the target market residents. |
| modified contract | Contract between a CCRC and a resident of the community that has an entrance fee and includes housing, residential services amenities and a specific amount of long-term nursing care with no substantial increase in monthly fees (reductions in fees may occur for a specified period of time [e.g., 30 days per year] or the resident’s monthly charges may increase as the level of care increases but at a discount from the posted fees for the services); also called Type B contracts. |
| monthly fee | Fees paid on a monthly basis by residents of senior living communities to cover operating expenses of the community. Entrance fees together with monthly fees are typically the fee arrangement for residents who enter Continuing Care Retirement Communities. |
| morbidity | A measurement of illness or accident risk, based on categories of age, region, occupation, and other factors. |
| mortality | Statistical death rates, usually broken down by age or gender. |
| Multi-site or Multi-facility (Provider) | A senior living provider that provides or manages care at more than one site. Also called System provider. |
| NCAL | The National Center for Assisted Living (NCAL) is the assisted living voice of the American Health Care Association (AHCA), the nation’s largest organization representing long term care. Through a national federation of state affiliates, NCAL supports lobbying efforts at the state level. While NCAL primarily focuses on federal issues, it provides the support that state affiliates need to impact policy decisions regarding assisted living issues. |
| net absorption | The number of beds or units in a residence filled from the first day the property opens until stabilized occupancy is reached. |
| NIC | National Investment Center for the Seniors Housing & Care Industries facilitates efficient capital formation for the seniors housing and care industries through research, networking, and providing business and financial information. |
| non-refundable fees | The portion of entrance fee paid by a resident that is not refundable. |
| nursing facility | A facility for patients to receive 24-hour medical care of a nurse without stay in a hospital. |
| payor | A company or an agency that purchases health services. |
| penetration rates | A ratio that calculates the number of existing and expected senior living units (supply) relative to the number of age- and income-qualified residents (demand) for a particular product type (typically independent living units and assisted living units). |
| PMA | Primary Market Area: the geographic area from which a senior housing property will draw most (70 to 90 percent) of its residents. Generally within a 5-10 mile radius. |
| pre-lease period | Period of time during which the sales staff of a senior living community is accepting deposits. |
| pre-sale requirements | The number of signed residency agreements with deposits (typically 10 percent deposits) that must be signed before a financing can be completed. |
| primary market area | See PMA. |
| refundable fees | The portion of entrance fee paid by a resident upon entry to a CCRC that is refundable to the resident or resident’s estate upon their death or withdrawal from the community. Typically refers to the minimum amount of entrance fee refundable. Many communities today offer contracts that are 90 or 100 percent refundable. |
| renovation | A project that involves capital improvements to the current facility’s campus. |
| rental contract | Contracts that do not require an entrance fee and the resident’s monthly charges increase directly with the level of care provided; also called Type D contracts. Typically, residents are guaranteed access to health care services. |
| repositioning | The act of changing a senior living campus. Repositionings can range from modest changes (“light” repositionings that add units to existing levels of care), to “moderate” repositionings (those that change multiple areas of the campus or add significantly to an existing level of care), and, finally, to heavy repositionings (“dramatic” changes that add a new level of care and, typically, require a feasibility study to complete a financing). |
| Sarbanes Oxley Act | Referred to also as “Sarbox” or “SOX”. The Sarbanes-Oxley Act of 2002, signed into law by President Bush on July 30, 2002, was enacted by Congress in response to the outcry against Enron, WorldCom, Merck and others. The law specifically governs publicly traded for-profits but its contents address the conduct of CFOs and CEOs and apply to both for-profit and not-for-profit organizations in three areas: Whistlebower protections, document destruction prohibition and wire fraud prohibition. Other provisions of the Act are being adopted by a number of not-for-profits as best practices (e.g., having an independent audit committee, reviewing auditors’ responsibilities). |
| secondary market area | The geographic area immediately beyond the Primary Market Area from which a senior housing property will draw its residents. |
| senior apartments | Multifamily residential rental properties restricted to adults at least 55 years of age or older. These properties do not have central kitchen facilities and generally do not provide meals to residents, but may offer community rooms, social activities and other amenities. |
| single-site (provider) | A senior living provider that provides care at one facility (or campus). Single-site providers are in contrast to System providers. |
| skilled nursing | Services for elderly who are certified to receive Medicare reimbursement for their nursing stay. |
| SMA | See Secondary Market Area. |
| system (provider) | A senior living organization that provides or manages care at more than one site. A system may include as few as two facilities on neighboring sites to as many as hundreds of facilities across a state, region or the nation. Also called multi-site provider. Systems are in contrast to single-site providers. |
| Third Party Reimbursement | Payment received from a party other than the resident or resident’s family or source related to the resident (trust, etc.). Typically refers to Medicare, Medicaid or other non-private source. |
| Total Occupancy Marketing (TOM)™ | Proprietary marketing techniques developed by Cornerstone to maximize not just presales, but resident move ins, which is the ultimate measure of success. |
| transfer | Term used to describe the movement of a resident between levels of care within a Continuing Care Retirement Community, e.g., from independent living to assisted living, from assisted living to nursing. |
| upfront entry fee | See Entrance Fee. |
| Wellness Program | New model for health, one that addresses itself to enriching life, preventing illness, and encouraging their own life and well-being. Wellness Programs are often housed in state-of-the-art facilities offering extensive testing and exercise equipment. Individuals can receive comprehensive fitness tests and have personalized fitness programs designed specifically to suit their needs as they age. This also includes access to quality exercise bikes, treadmills, rowers, versa climbers, and elliptical trainers. Cornerstone pioneered this concept in its Brandon Wilde community, which was the first to offer a formal, comprehensive Wellness Center. |
| Glossary V2.0 | |