; and (B) may include individuals described in subparagraph (A) who are physical therapists, occupational therapists, or speech or language therapists. (21) Indian Tribe; Tribal organization The terms Indian Tribe and Tribal organization have the meanings given such terms in section 4 of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 5304 ). (22) Institution of higher education The term institution of higher education means— (A) an institution of higher education defined in section 101 of the Higher Education Act of 1965 ( 20 U.S.C. 1001 ); or (B) an institution of higher education defined in section 102(a)(1)(B) of such Act ( 20 U.S.C. 1002(a)(1)(B) ). (23) Instrumental activities of daily living The term instrumental activities of daily living means tasks that are not necessary for fundamental functioning, but allow an individual to live independently in a community of daily living. Such tasks include— (A) housekeeping and room cleaning; (B) meal preparation; (C) taking medications; (D) laundry; (E) transportation; (F) shopping for groceries, clothing, or other items; (G) managing communications, such as using the telephone; (H) managing finances; (I) writing letters; and (J) obtaining appointments. (24) Local educational agency The term local educational agency has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 7801 ). (25) Long-term care services The term long-term care services means any services provided by a direct care professional in a long-term care setting. (26) Long-term care setting The term long-term care setting means— (A) a nursing home; (B) a home and community-based services setting; (C) an assisted living facility; (D) an intermediate care facility; (E) a State home, as defined in section 101(19) of title 38, United States Code; (F) a Tribal nursing home operated pursuant to an Indian health program (as defined in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 )); (G) a private home