Understanding Long-Term Care
When people of any age need others to help them with medical, physical, or emotional needs over an extended period of time, they need long-term care.
If a person needs ongoing medical care or is unable to perform everyday self-care activities such as bathing, dressing, or grocery shopping, long-term care may be required. Experts estimate that at least 60 percent of Americans will need long-term care during their lifetime.
Long-term-care services may be provided in the home of the person who needs it, a family member’s home, or an assisted-living facility, hospice, or nursing home. Family and friends are the sole caregivers for 70 percent of elderly adults.
Custodial care vs. skilled care
Custodial care and skilled care are terms used by health insurance plans, Medicare, and the Department of Veterans Affairs. They’re used to differentiate care provided by medical specialists as opposed to care provided by aides, volunteers, family members, or friends.
Skilled care refers to services and supplies that can be provided only by or under the supervision of skilled or appropriately licensed medical personnel. Family members, licensed aides, facility employees, or volunteers who aren’t skilled medical personnel can give custodial care.
Medically necessary skilled services usually are paid for by a health care plan or Medicare, but custodial services not given in conjunction with skilled care aren’t covered. Custodial services are almost always part of a skilled service plan, however, and are generally paid by health care plans and Medicare.
If you or a loved one needs long-term care, speak with a doctor to determine what specific needs should be addressed and follow up with the health insurance agent or Medicare regarding available benefits.
Types of long-term care
Here is a list of types of long-term care available according to Medicare officials:
Subsidized senior housing. This federal program helps elderly adults of low or moderate income pay for an apartment. The income limit is $46,000 for a single person and $53,000 for couples. Rent is usually based on a percentage of income. Some programs offer help with meals and daily tasks.
Group homes. This type of housing is for people who are unable to live on their own, but don't need a nursing home. A person in a group home gets help with personal tasks like eating and bathing. Payment is provided by insurance or other assistance programs, but not Medicare.
Assisted living. This is also a group living situation that offers help with personal tasks. A person in assisted living usually has a private room or apartment. The cost varies according to services provided and area of the country. Medicare does not pay for this care.
Continuous care retirement communities. These communities provide a mix of housing, depending on personal need. More independent residents have their own home or apartment within the community; people with greater needs may be in an assisted living area or nursing home. Medicare doesn't cover this kind of care.
Nursing homes. These homes are for people who cannot be cared for at home or at another facility. Medicare doesn't pay for nursing home care.