What is Long-Term Care?

Long-term care is a variety of services and supports designed to meet a person’s health or personal care needs during a short or long period of time.

These services help people live as independently and safely as possible when they can no longer perform everyday activities on their own due to a chronic illness, severe cognitive impairment, injury, disability, or simply from aging.

Most long-term care is not medical care, but rather assistance with basic personal tasks of everyday life called Activities of Daily Living (ADLs), such as:

  • Bathing
  • Dressing
  • Using the toilet
  • Transferring (to or from bed or chair)
  • Caring for incontinence
  • Eating

This type of care is not intended to cure. It is chronic care that you might need for the rest of your life. You can receive long-term care in your own home, a nursing home or another long-term care facility, such as an assisted living facility.

People often confuse long-term care with disability care or short-term medical care. Long-term care is not:

  • Care that you receive in the hospital or your doctor’s office
  • Care you need to get well from a sickness or an injury
  • Short-term rehabilitation from an accident
  • Recuperation from surgery

Finally, long-term care is not only for elderly people. Children and younger adults may also need long-term care.

Browse the list of topics below to learn more about long-term care:

  1. Cost of Care
  2. Who Needs Long-Term Care
  3. Who Pays for Long-Term Care
  4. Who Will Provide Your Care
  5. Where Can You Receive Care
  6. How Much Care Will You Need
  7. Does Disability or Health Insurance Cover Long-Term Care

Cost of Care

The cost of LTC services vary by state and region. Where you reside determines the availability of services you can get, and how much your expenses could become. It’s important to learn the average cost of care in your area when planning for long-term care.

Below are the 2014 median figures reported by Genworth in their annual Cost of Care Survey:

Type of Long-Term Care Median Annual Five Year Annual Growth
Homemaker Services (Hourly) $19 $43,472 1.20%
Home Health Aide Services (Hourly) $20 $45,188 1.32%
Adult Day Health Care (Daily) $65 $16,900 3.40%
Assisted Living Facility (Monthly) $3,500 $42,000 4.29%
Nursing Home (Semi-Private Room, Daily) $212 $77,380 3.91%
Nursing Home (Private Room, Daily) $240 $87,600 4.19%

As can be seen above, LTC costs climb every year, and will continue to do so. This means that a couple of decades into the future, your savings may be insufficient to comfortably afford the cost of your care.


Who Needs Long-Term Care?

Anyone can need long-term care at any time in their life. According to the U.S. Department of Health and Human Services (HHS), about 70% of people turning age 65 will need LTC services at some point in their lives.

Injuries and ailments that can happen to anyone at any age include:

  • Automobile and sporting accidents
  • Disabling events such as strokes, brain tumors, and spinal cord injuries
  • Disabling illnesses such as multiple sclerosis and Parkinson’s disease

Nearly 41% of long-term care is provided to people under age 65 who need help taking care of themselves due to diseases, disabling chronic conditions, injury, developmental disabilities, and severe mental illness.1

It is difficult to predict how much or what type of long-term care a person might need. Several things increase the risk of needing long-term care.

Age

The older you are, the more likely you will need long-term care.

Gender

Women outlive men by about five years on average, so they are more likely to live at home alone when they are older.

Marital status

If you live alone, you’re more likely to need paid care than if you’re married, or single, and living with a partner.

Lifestyle

Poor diet and exercise habits can increase a person’s risk.

Health and family history

Chronic conditions such as diabetes and high blood pressure make you more likely to need care. Your family history, such as whether your parents or grandparents had chronic conditions, may increase your likelihood.

Poor diet and exercise habits increase your chances of needing long-term care.


Who Pays for Long-Term Care?

Many consumers of long-term care are still confused with common misunderstandings about which public programs pay for LTC services. It is of high importance to understand what is and isn’t covered.

Here are ways long-term care can be paid:

Private Payment

You can use your savings to pay for your long-term care needs. However, it’s easier said than done. According to The Federal Long-Term Care Insurance Program, in 2013, the national average cost of a semiprivate room in a nursing home was $82,855 annually.

You need to consider the total cost if you need more than one year of care. For example, the cost of care for three years is more than $248,000. How long might it take to save for the cost of a nursing home stay today?

Medicaid

Medicaid is a state-based program, supplemented by Federal funds, that acts as a safety net to provide health services to those who meet their state’s poverty guidelines.

If you can meet Medicaid’s financial and functional requirements, it will help you pay for specific long-term care services.

Usually, you need to meet your state’s poverty criteria which mean expending all but $2,000 of your assets and savings (exceptions include your house and car). It also means receiving care from a limited number of state-approved caregivers (mostly institutions like nursing homes) that are willing to accept Medicaid’s payments.

When Medicaid pays for LTC services, it limits your choice in terms of the type of care you can receive and where you can receive it. Medicaid eligibility requirements vary by state. For more information, contact your local Medicaid office or visit http://www.cms.hhs.gov/home/medicaid.asp.

Veterans Affairs-Funded Long-Term Care

The Department of Veterans Affairs (VA) health system makes certain long-term care services available to veterans, based on a priority ranking system, with highest priority given to those with severe service-related disabilities.

VA-funded LTC is highly suggested especially for veterans with service-related disabilities and/or limited incomes and assets. However, aside from the priority ranking system, the availability of long-term care services from the VA may be subject to funding limitations and may vary by geographic area.

For more information on eligibility for VA benefits, visit www.va.gov/elig.

Long-Term Care Insurance

Long-term care insurance is a reliable method of paying for long-term care expenses. You can find detailed information on long-term care insurance here.


Who Will Provide Your Care?

Long-term care can be received from various places by different providers, depending on a person’s needs. Most long-term care is provided at home by unpaid family members and friends.

Paid caregivers also provide LTC services and supports usually at home. This type of care, also called “informal care,” also includes long-term care services provided by unlicensed caregivers who are not arranged or supervised by a home care agency.

Long-term care services and support typically come from:

  • An unpaid caregiver who may be a family member or friend or neighbor who helps care for you while you live at home
  • A nurse, home health or home care aide, and/or therapist who comes to the home
  • Adult day services in the area
  • A variety of long-term care facilities

Long-term care also includes community services such as meals, adult day care, and transportation services. These services may be provided free or for a fee.

Care can also be provided by professionals trained in the field of long-term care. This type of care, also referred to as “formal care,” is provided by a home health aide or homemaker arranged or supervised by a home care agency or provided by a nurse or therapist. On average, caregivers spend 20 hours a week giving care.


Where Can You Receive Care?

Most people assume that all long-term care is only provided in nursing homes. However, long-term care is most often provided at home, in adult day care facilities or in assisted living facilities.

Depending on a person’s needs, long-term care is provided in different places by different caregivers. It is commonly provided at home by unpaid family members and friends. Usually, paid caregivers provide care at home, but also in a facility such as a nursing home.

At home, the most common type of long-term care provided is personal care. It is help with everyday activities or “activities of daily living.”

Other kinds of long-term care services and supports are provided by community service organizations and in long-term care facilities.

Examples of home care services:

  • An unpaid caregiver who may be a family member or friend
  • A paid home health/care aide, nurse, and/or therapist who comes to the home
  • Home care agencies who provide services depending on the frequency of the needs

Often these services supplement the care you receive at home or provide time off for your family caregivers.

Outside the home, a variety of facility-based programs offer more options:

  • Nursing Homes

Nursing homes provide the most comprehensive range of services which includes nursing care and 24-hour supervision.

  • Assisted living
  • Board and care homes
  • Continuing care retirement communities

With these providers, the level of choice over who delivers your care varies by the type of facility.  You may not always have the option to decide who will deliver services, and you may have limited say in when they arrive.


How Much Care Will You Need?

There are no fixed amounts with how much care will be needed. Often, the duration and level of long-term care will vary from person to person, according to their individual and specific needs, and this frequently changes over time.

Here are some statistics you should consider:

  • People turning 65 today have almost a 70% chance of needing some type of LTC services and supports in their remaining years.
  • Women tend to need care longer than men: 3.7 years for women and 2.2 years for men.
  • Although 33.33 percent of today’s 65 year-olds may never need long-term care supports or services, 20 percent will need it for longer than 5 years.

Distribution and duration of long-term care services:

Type of care Average number of years people use this type of care
Any Services 3 years

At Home

Unpaid care only 1 year
Paid care Less than 1 year
Any care at home 2 years

In Facilities

Nursing facilities 1 year
Assisted living Less than 1 year
Any care in facilities 1 year

Long-term care can be ongoing, such as for someone who has been severely disabled from a stroke or has Alzheimer’s disease.

Many people are given the option to remain at home if they have help from family and friends or paid services. However, some people move permanently to a nursing home or other type of facility if their needs can no longer be met at home.


Does Disability or Health Insurance Cover Long-Term Care?

Some people have expressed confusion if long-term care is covered by Disability Insurance or Health Insurance. These policies have specific differences, but then the similarities can become confusing.

Disability Insurance

If you are retired, you may still qualify for Long-Term Care Insurance. However, to qualify for disability insurance (also known as income protection insurance) you must be employed and have income to protect.

Disability insurance replaces a portion of lost wages due to illnesses or accidents that meet the policy’s definition for benefit eligibility. Since most regular living expenses continue whether you work or not, you may need extra protection to maintain your family’s lifestyle.

Unlike LTC insurance, disability insurance has no direct relationship to your ability to perform activities of daily living—only your ability to work.

Health Insurance

Health Insurance is a contract between an insurance provider or government program and an individual or his/her sponsor (e.g. an employer or a community organization).

The contract can be renewable or lifelong in the case of private insurance, or be mandatory for all citizens in the case of national plans.

The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or “Evidence of Coverage” booklet for private insurance, or in a national health policy for public insurance.

Coverage Concerns

Disability or health insurance may pay for some long-term care services but only if the long-term care needs meet the criteria of disability or health insurance for coverage.

Health plans may cover some of the skilled medical services you may need when you cannot care for yourself after an illness or injury, but usually for a limited period and only as long as you are showing improvement.

Health plans typically do not cover ongoing chronic care such as an extended stay in an assisted living facility or nursing home, or a continuing need for a home health aide to help you in and out of bed.

 

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