What is Long Term Care ?



Long-term care refers to the many services used by people who have disabilities or chronic (long-lasting) illnesses.
These services can include:

bullethelp in your home with daily activities like bathing and dressing;

bulletcommunity programs, like adult day care;

bulletassisted living services -- such as meals, health monitoring, and help with daily activities -- provided in a special residential setting other than your own home; and

bulletcare in a nursing home.


Long-term care differs from acute care.

Acute care is provided in a hospital and is intended to help you get better.  It usually lasts for only a short time.

Long-term care, on the other hand, is provided to people with chronic, degenerative illness or disabilities who require continued support over a long period of time.


Long-term care costs are high.

Generally, older people pay more for long-term care than for anything else they buy.  The annual cost of a nursing home stay is approximately $50,000. Home care can also be very costly.  An older person who receives just three home health visits per week could pay about $12,000 for home care each year.  Those with severe impairments will pay more for home care.  So will those who have no friends or relatives to help them.  The cost of other long-term care services, such as adult day care and assisted living facilities, varies. However, many people cannot afford these services.


Public programs help only a little.

Public programs provide only limited help with long-term care costs. The U.S. Department of Veterans Affairs (VA), the Social Services Block Grant program (SSBG), and Title III of the Older Americans Act (OAA) provide some help.  Each of these programs has its own eligibility criteria.


Medicare won't pay for long-term care.

Medicare only pays nursing home bills for persons who needs a more intensive form of care, called "skilled care."   Skilled care is usually provided in a nursing home after a patient is released from a hospital. Medicare also covers a limited amount of medically-necessary home health care, but only for beneficiaries who are homebound and need skilled care.  Even if you have Medicare supplemental insurance -- called "medigap" --  you will receive very limited long-term care benefits.  Neither Medicare nor medigap policies cover long-term custodial care, such as assistance with activities of daily living.


Medicaid is the major source of funding for long-term care.

The major source of public funding for long-term care services is the federal and state-funded Medicaid program. Medicaid covers the cost of nursing home care.  It also pays for a limited amount of home and community-based care for persons who otherwise might need to go to a nursing home.

Medicaid has very strict financial requirements.  Generally, you can't receive help from Medicaid until you spend almost all of your assets and income on care.


Private insurance can pay for long-term care.

For the most part, individuals who want coverage for long-term custodial care must buy separate insurance, called long-term care insurance, from a private insurance company.  Services covered under these insurance policies vary greatly. Each policy has its own eligibility requirements, restrictions, costs, and benefits.


Read the Fine Print.

The cost of long-term care insurance usually depends on the coverage you choose. Therefore, you must read the fine print before buying a long-term care insurance policy.  Find out if there are any conditions that you must meet to collect the benefits.  Other questions to consider, include:

bulletWill the policy pay for home care or hospice care?  Under what conditions?
bulletCan you increase your benefit amount over time to keep up with inflation?


Know your insurance company.

Be sure to research the background of the company providing your long-term care policy.  Find out how long it has been in business and how long it has offered the policy.  Check with the Better Business Bureau for any complaints against the firm. Check your local library to find out about a company's financial stability.


The Health Care Financing Administration (HCFA) maintains an Internet web site that provides information about paying for long-term care. Visit this web site to find contacts for:

bulletthe Health Insurance Counseling Program, which provides free volunteer counseling on Medicare, managed care, and private insurance in all states;

bulletthe Peer Review Organization (PRO), which oversees the care provided to Medicare beneficiaries; and

bulletyour HCFA regional office.


The Older Americans Act provides federal money so states can operate programs for people age 60 and older. The money is distributed by your state to local Area Agencies on Aging (AAAs). AAAs provide some community-based long-term care services, either directly or through local agencies, organizations, or firms. AAAs do not charge for services, but they may accept donations.

For information about Older American Act programs, contact your local AAA (check the government pages of your phone book) or call the Eldercare Locator at 800-677-1116 (toll-free). The Eldercare Locator is a nationwide directory assistance service that helps older persons and their caregivers find help locally. You can call from 9 a.m. to 11 p.m. (EST), weekdays.



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