Long-Term Care (LTC) includes assistance, support and services provided over an extended period in order to meet medical, personal, and social needs for people who are unable fully support themselves. The goal of Long-Term Care is not to cure an illness, but to allow patients to maintain an optimum level of functioning with maximum independence.
LTC includes medical and non-medical care. Long-term medical care is chronic care with an aim is to control and maintain non life threatening ailments without an attempt to permanently cure them (opposite of acute care when a patient is treated in an attempt to be permanently cured). The long-term non-medical care is custodial care designed to assist with activities of daily living (ADL), such as bathing, grooming, eating, dressing and other similar activities, as well as with other less personal needs, such as preparing meals, shopping, housework, etc.
LTC is provided in a variety of settings such as in an individual home, in the community sites, in an assisted living facility, or in a skilled nursing facility.
People live longer now, therefore, the odds you’ll need LTC are quite high. Approximately 70% of people who live to age 65 will need some long-term care services at some point in their lives. Not only elderly people need LTC. Nearly 45% of LTC is provided to people under age of 65.
How many years of LTC are needed for people after 65? Consider the following statistics:
- None: 31%
- 1 year or less: 17%
- 1-2 years: 12%
- 2-5 years: 20%
- More than 5 years: 20%
And LTC is EXPENSIVE. Here is the average LTC cost in 2013:
- Nursing Home (Private Room): $94,170 a year
- Nursing Home (Semiprivate Room): $82,855 a year
- Assisted Living Facility: $41,124 a year
Home and Community-based Care:
- Homemaker Services: $18/hr
- Home Health Aide Services: $19/hr
- Adult Day Care: $71 a day
Levels of Long-Term Care
There are three primary levels of care:
|Custodial Care||Intermediate Care||Skilled Care|
|Purpose||Assistance with ADLs to maintain current status and to meet current needs||Rehabilitative or restorative services||Medically necessary nursing care, therapy, or rehabilitation|
|Frequency||Periodically or daily||Intermittently or periodically||Daily|
|Delivered by||Family, friends, health aides||Physicians, nurses, licensed therapists||Physicians, nurses, licensed therapists|
|Provided in||Home, community care centers, skilled nursing facilities||Home, intermediate care facilities, skilled nursing facilities||Skilled nursing facilities|
|Duration||Usually long-term||Usually short- to mid-term||Usually short-term|
The next table shows providers for Home, Community and Facility-Based Care and Support. The level of patient functionality is lessened from Home-Based Care to Facility-based Care, and the level of care (and cost) is growing.
|Home-Based Care and Support||Community-Based Care and Support||Facility-Based Care and Support|
|Personal care services||Adult day services||Board and care homes|
|Homemaker services||Senior centers||Assisted living facilities|
|Home health aides||Continuing care retirement communities|
|Case managers/ geriatric case managers||Skilled nursing facilities (SNFs)|
Medicare and LTC
Medicare does NOT pay for Long-Term Care; it is designed for acute care ONLY. Medicare does pay for medically necessary skilled nursing facility (SNF) care for very short periods. It pays 100% for the first 20 days, partially for days 21 through 100 (you are responsible for $152 per day copayment), and nothing for days 101 and beyond. Medicare Advantage and Medigap may cover SNF copayments for the period of the first 100 days.
Medicare covers Home Health Care but the coverage is limited, and provided only if the patient needs skilled care. The coverage includes medically necessary intermittent skilled nursing care, home health aide services and rehabilitation services. The care must be ordered by a physician, and provided by a Medicare certified home health agency. The custodial home health care is not covered.
Medicaid and LTC
Medicaid generally covers people with very little income and assets, or those who incur catastrophic medical expenses. Medicaid is the major source of financing for LTC. However, most states require people to spend down assets to as little as $2,000-$3,000 before they can be qualified for Medicaid financing. This process of depleting personal resources in order to be eligible for Medicaid is known as spending down.
There are additional Medicare constraints in covering LTC:
- Assisted Living Facilities often do not accept Medicaid patients.
- Most nursing homes accept Medicaid, but limit how many Medicaid patients they will accept.
- Few states may require that care be provided in a nursing home and not in the home or community.
Planning for Long-Term Care
The longer you live, the greater likelihood that you may require LTC. Because the costs associated with LTC are very significant (see above), the proper planning for long-term care will help you:
- To protect your assets
- To reduce the burden of care that would otherwise fall on family members
- To receive care in setting you prefer, including your home
- To avoid the uncertainty, confusion, and mistakes that could arise if the health care is needed
The cost of long-term care insurance may be significant. They depend on your age and health, whether both you and your spouse buy the policy, and many other factors. For example, two individual LTC policies with spousal discount and shared-care rider offering $150 daily benefit, a 3-year benefit period, and a total pool of benefits $164,250, will cost:
- Age 55: $3,758
- Age 60: $4,773
- Age 65: $6,682
Therefore, the long-term care insurance is not for everybody. You may consider buying LTC insurance policy if:
- You have assets you want to protect
- You are NOT eligible for Medicaid
- You are in reasonably good health and would pass the underwriting
- You can afford coverage – your premiums should be no more than 7% of your income.
But don’t wait too long! The cost of LTC insurance very much depends on your age and health when you apply. The annual premium for the person buying a LTC policy at 55 is significantly lower than for the person who is 65. Also, the longer you wait, the greater is probability of having health issues, which will increase the cost of your policy.
Let Liberty Medicare Help You Choose
Liberty Medicare is here to help you in all stages of comparing, selecting and enrolling in the best and most suitable Long-Term Care Plan for you.
All our services are absolutely free to you. We’ll help you:
- Find all plans available to you and compare their benefits
- Determine your eligibility (particularly if medical underwriting is required)
- Find the least expensive plan for your needs
If you are looking for Long-Term Care coverage let us help you. To view real quotes from Long-Term Care providers, please fill out our Long-Term Care Quote form, or give us a call at 877-657-7477.