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 like bathing, dressing, or grocery shopping, long-term care may be needed.
Experts estimate that approximately 10 million Americans need long-term care in any
Long-term-care services may be given 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 only caregivers for more than three-quarters 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 set apart care provided by
medical specialists from care provided by aides, volunteers, family members, or friends.
Skilled care refers to services and supplies that can be given only by or under the
supervision of skilled or properly licensed medical personnel. Family members, licensed
aides, facility employees, or volunteers who aren’t skilled medical personnel can
give custodial care.
A health care plan or Medicare usually pays for medically necessary skilled services.
But you or your family member must meet certain requirements for Medicare to pay for
home health care or skilled care.
However, often the care that is most needed is care that will help someone with support
services like dressing, bathing, or using the bathroom. This type of care is called
custodial care. Medicare usually does not cover custodial care.
If you or a loved one needs long-term care, speak with a health care provider to determine
what exact needs should be addressed. Then 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 to qualify changes depending on where you live.
Rent is usually based on a percentage of income. Some programs offer help with
meals and daily functions.
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, bathing, dressing, and using the bathroom. Medicare and Medicaid
do not usually pay for this type of housing. The monthly charge may be a certain
percentage of your income on a sliding scale. This charge covers the cost of
rent, meals, and other basic shared services.
Assisted living. This is also a group living situation that offers help with personal functions.
A person in assisted living usually has a private room or apartment. The cost
varies according to services given and area of the country. Medicare does not
pay for this care.
Continuous care retirement communities (CCRCs). 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.
Many CCRCs ask for a large entry fee before you move in. Generally, Medicare
doesn't cover this kind of care.
Nursing homes. These homes serve as permanent residences for people who are too sick to live
at home or as a temporary facility during a period of recovery from illness.
Medicare doesn't usually pay for nursing home care.