Long Term Care
Early planning pays off
It's best to talk about long term care early — before the need for medical or personal care is imminent. Here's help understanding, choosing, and financing long term care.
Long-term care includes a range of health and support services that you may need as you age or if you have a disability. Most of these services are personal care services, such as bathing and dressing. Family members may be able to provide some or all of these services at no charge. But if your care and support needs increase, you may need paid care in addition to the services that your family members provide, or to give them respite. In addition, if your needs increase to the point where you need services in a facility, like a nursing home or assisted living, you may need to plan how to pay for these services.
The cost of long-term care depends on the type and amount of care you need, the provider you use, and where you live. Here are a few examples:
- Home health and home care services, provided in two-to-four-hour blocks of time referred to as “visits,” are generally more expensive in the evening, on weekends, and on holidays.
- The costs of services in some community programs, such as adult day service programs, are provided at a per-day rate, but vary based on the program’s activities.
- Many facility-based programs charge extra for services provided beyond the basic room, food, and housekeeping charges, although some may have “all inclusive” fees.
Note: Medicare and most health insurance plans do not pay for long-term care.
Medicare pays only for time-limited, medically necessary skilled nursing facility care or home health care if you meet certain conditions.
Understanding types of long term care
Understanding the various levels of long term care can help you choose the type that's most appropriate for you or your loved one. For example:
- Home care. Personal or home health aides can help with bathing, dressing, and other personal needs at home, as well as housekeeping, meals, and shopping. Home health nurses provide basic medical care at home.
- Day program. Day programs for adults offer social interaction, meals, and activities — often including exercise, games, field trips, art, and music — for adults who don't need round-the-clock care. Some programs provide transportation to and from the care center as well as certain medical services, such as help taking medications or checking blood pressure.
- Senior housing. Many communities offer rental apartments intended for older adults. Some senior housing facilities offer meals, transportation, housekeeping, and activities.
- Assisted living. Assisted living facilities have staff members to help with activities such as taking medication, bathing, and dressing — as well as meals, transportation, housekeeping, and social activities. Some assisted living facilities have on-site beauty shops and other amenities.
- Continuing-care retirement community. Continuing-care retirement communities offer several levels of care in one setting — such as senior housing for those who are healthy, assisted living for those who need help with daily activities, and round-the-clock nursing care for those who are no longer independent. Residents can move among the various levels of care depending on their needs.
- Nursing home. Nursing homes offer 24-hour nursing care for those recovering from illness or injury and serve as long-term residences for people who are unable to care for themselves. Nursing homes also offer end-of-life care. Services typically include help eating, dressing, bathing, and toileting, as well as wound care and rehabilitative therapy.
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The average costs for long-term care in the United States (in 2010) are:
- $205 per day or $6,235 per month for a semi-private room in a nursing home
- $229 per day or $6,965 per month for a private room in a nursing home
- $3,293 per month for care in an assisted living facility (for a one-bedroom unit)
- $21 per hour for a home health aide
- $19 per hour for homemaker services
- $67 per day for services in an adult day health care center
Choosing the right long term care facility
Selecting a long term care facility can be overwhelming. Ask yourself these questions to ease the process:
- What level of service do you need? Do you or does your loved one need help with everyday activities, such as getting dressed or walking to the bathroom? Nursing care? What does the doctor say? Determining specific care needs can help you decide which type of facilities to consider.
- What are your personal preferences? Would you or your loved one prefer a smaller facility or certain living arrangements, such as a single room? Would you rather eat your meals in a cafeteria setting or in your own room? What amenities are most important? Also consider the rules. Can residents choose when to get up and go to bed? When are visitors allowed? What social activities are offered? Can residents continue to see their personal doctors?
- What can you afford? Get the details on prices, fees, and services. Know what's included in the monthly fee and what costs extra.
- What's available close to home? Being close to friends and family can ease the transition to long term care. If vacancies are an issue, ask about waiting lists.
- What's your first impression? Schedule a tour of the facility. Does the facility seem safe? Does it smell OK? Is the temperature comfortable? Are the residents treated respectfully? Do they seem happy? Are there enough caregivers on staff? What are the rooms like? Later, make unscheduled visits to make sure your first impression was accurate.
- How does the facility compare with others? What have you heard about the facility? Contact the Better Business Bureau to check whether any complaints have been filed against the facility, and use online applications such as the Nursing Home Compare tool on the Medicare website.
Ask a long term care ombudsman — an official who investigates complaints against long term care facilities — about the strengths and weaknesses of specific facilities. To find a local ombudsman, use the Eldercare Locator, an online service of the U.S. Administration on Aging.
Discussing long term care with a loved one
If you're researching long term care options for a parent or other loved one, include your loved one in the process as much as possible. Consider these tips:
- Plan ahead. Don't wait until a loved one needs a long term care facility. Start planning early so that you have time to evaluate the options together.
- Work long term care into everyday conversation. If your mother mentions a problem turning on the faucet, for example, you might ask whether she could use help bathing or managing other aspects of personal care.
- Listen to your loved one's preferences and concerns. If your loved one is mentally competent, recognize his or her right to make decisions about long term care. Stay positive as you remind your loved one that his or her safety is your primary concern.
- Involve others. If your loved one doesn't respond well to your efforts to talk about long term care, involve trusted contacts — such as other loved ones, clergy, a doctor, or an attorney.
Who Pays for LTC Services?
If you have enough income and savings, you will likely need to pay for long-term care services on your own, from your income, savings, and possibly from the equity in your home. You can also purchase long-term care insurance to cover your personal care needs.
Three main government programs might help you pay for services if you meet their rules, though these programs cover limited numbers of people.
Medicaid may pay for your care if you qualify based on your level of need or disability (also called “functional eligibility”) and have limited savings, or if you use up your savings paying for long-term care services yourself.
The Older Americans Act
The Older Americans Act may also help you to pay for some long-term care services.
Department of Veterans Affairs
If you are a Veteran, the U.S. Department of Veterans Affairs may provide some long-term care services.
In addition, some states offer their own programs to cover some long-term care services.
You may use a variety of payment sources, some from public programs and others from private insurance, or from your own income and savings as your care needs and financial circumstances change.
Many people think Medicare or their regular health care insurance from their employer that covers hospital stays and doctor visits will pay for long-term care. Health care insurance and Medicare may pay for your care if you need skilled care or care for a short time to recover from an illness or injury. They do not cover ongoing personal care needs, like help with bathing and dressing.
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Coverage Limits of Long-Term Care Offered by Health Insurance
|Long-Term Care Service
||Private Health Insurance
||Limited coverage for nursing home care following a hospital stay and home health if you require a nurse or other skilled provider.
||Insurance purchased to cover Medicare cost sharing.
||Varies, but generally only covers services for a short time following a hospital stay, surgery or while recovering from an injury.
|Nursing home care
||Pays in full for days 1–20 if you are in a Skilled Nursing Facility following a recent 3-day hospital stay.
If your need for skilled care continues, may pay for the difference between the total daily cost and your copayment of $137.50 per day for days 21-100. After day 100 does not pay.
|May cover the $137.50 per day copayment if your nursing home stay meets all other Medicare requirements.
||Varies, but limited.
|Assisted living facility (and similar facility options)
||Does not pay.
||Does not pay.
||Does not pay.
|Continuing Care retirement community
||Does not pay.
||Does not pay.
||Does not pay.
|Adult day services
|Home health and personal care
||Limited to reasonable, necessary part-time or intermittent skilled nursing care and home health aide services, some therapies if a doctor orders them, and a Medicare-certified home health agency provides them.
Does not pay for on-going personal care or only help with Activities of Daily Living (also called “custodial care”).
|Not covered under current policies.
Some policies sold prior to 2009 offered an at-home recovery benefit that pays up to $1,600 per year for short-term at-home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury, or surgery.
|Varies, but limited.
Courtesy of www.longtermcare.gov
Use the resources below to find more information about long-term care insurance: