When someone needs long-term care, there are a lot of programs that can help not only them but their family and caregivers. For example, in New York State, there’s the Freedomcare program. With Freedomcare, New York residents can hire their own caregivers, including family members, who are paid.
Every state is unique in how it administers Medicaid and long-term care programs and benefits, but understanding in general how they work is important. If you want to age in place, for example, maybe you want to plan for your long-term care proactively.
The following is a guide to what we mean when we talk about long-term care and what it can look like in different situations.
An Overview of Long-Term Care
Long-care care is also known as LTC, and it’s a very broad, general concept.
You can begin by thinking about the activities that you have to do on a daily basis to take care of yourself. For example, you have to bathe, dress and groom yourself. You use the toilet, you eat, and you have to move around. These are considered activities of daily living or ADLs.
If you can’t complete activities of daily living without help, then you aren’t considered able to live independently.
Long-term care, in the broadest sense, is for people who can’t perform basic daily activities on their own.
We often talk about this in the context of aging. For example, as people age, they naturally might need more help, or this could be something that happens more rapidly due to a disease like Parkinson’s, Alzheimer’s, or another type of dementia.
Medicaid is a federal program managed by states that provide financial help for people who need it.
Medicaid has its own definition of long-term care. According to Medicaid, LTC is assistance for people with ongoing, chronic illnesses and disabilities. Due to these conditions, according to the Medicaid definition, care that’s equivalent to what they would receive in a nursing home is needed.
There’s not a federal definition for what’s meant by nursing facility level of care, so it’s left up to the state to define it for its own long-term care Medicaid programs. There’s no consistency across the states.
Many states do now offer personal care assistance as part of their regular Medicaid programs.
Along with non-medical care, long-term care can also help people with health issues, although when we talk specifically about LTC, it’s mostly about non-medical care.
An estimated 7 out of 10 people over the age of 65 need some kind of long-term care support, and 66% of caregivers use their own savings to pay for care.
Who Might Need Long-Term Care?
When someone needs LTC, it affects their entire family. For a caregiver, it can be exhausting and financially create a strain to provide this care.
Age is one of the biggest factors affecting whether or not someone needs long-term care. As you get older, the chances you could need this type of care go up.
Gender affects the likelihood because women tend to live longer than men; therefore, they have a greater likelihood of needing this care. When people live alone, they’re more likely to need a paid caregiver.
Chronic health conditions such as high blood pressure or diabetes increase the likelihood, as do certain lifestyle factors like a lack of exercise.
Paying for Care
There are a wide variety of ways that people might pay for care when they need it.
Public programs are a common way. These include Medicare and Medicaid. Financial qualifications, as well as physical criteria, are used to determine if someone is eligible for these programs. When someone qualifies for coverage through public programs, there are limitations in terms of care facilities and the level of coverage they can receive.
If someone has savings set up for retirement, they might cover long-term care costs fully or partially with that. This is known as self-funding. Family and friends might provide financial support.
There are also insurance and annuity options.
Long-term care insurance, life insurance with a chronic illness, annuities, and long-term care riders can help make payments for expenses related to aging.
With long-term care insurance, policyholders are reimbursed for the long-term care expenses they receive in their homes or at an assisted living facility. Long-term care insurance can also provide reimbursement for nursing home care.
Some life insurance policies have benefits that help with long-term care. These are hybrid policies that may include a rider for a chronic illness or long-term care. This accelerates the life insurance death benefits so that the cost of long-term or chronic illness care can be covered while the person who holds the policy is still alive.
Annuities might offer a medical care facility waiver. These waivers let you access part of your annuity contract value without charges or penalties.
How Much Does Long-Term Care Cost?
While there are a lot of variances depending on where someone lives and the type of care they receive, the national average for a home health aid is $5,148 a month. The cost of adult day health care on average in 2021 was $1,690, and an assisted living facility was on average $4,500 a month. For a nursing home facility, a private room is more than $9,000 a month on average.
Types of Long-Term Care
LTC can happen in a variety of settings, which we detail below.
It’s an increasingly popular option among older people to stay in their homes. This is known as aging-in-place. In-home care is becoming one of the preferred forms of long-term care.
There are in-home support and care services designed to help older people live as independently as much as they can while they stay safe.
Personal care assistance is the common form of home care. Personal care assistance is also known as an attendant or custodial care.
Assistance might include helping someone bathe, brush their teeth, move around the house and eat meals.
Attendant care can include help with activities required to live independently that aren’t considered vital to everyday living. These are known as instrumental activities of daily living or IADLs.
IADLs include meal preparation, light housework, shopping, non-medical transportation, and medication management.
Adult Day Care
Also known as adult day health care, these programs offer supervision, personal assistance and care, snacks and meals, and recreational activities, all in a community environment. Adult daycare may include limited medical care.
This type of care is often used by family caregivers who need help or a break from their duties or work during the day. When this is the case, it’s known as respite care.
There are some adult daycare centers that will also provide transport to and from their facility.
In assisted living, seniors can’t live on their own, but they also don’t need nursing home care yet.
This means that someone doesn’t need around-the-clock care, even though they need some assistance.
Room and board are part of assisted living, as are recreational activities, housekeeping, personal care assistance, and laundry.
Some older people who have early or mid-stage dementia might be suitable candidates for assisted living.
Most assisted living facilities to offer different levels of care, and the cost goes up depending on how much care someone needs.
Memory care units are for people with dementia, such as Alzheimer’s. Memory care can be provided in an assisted living facility or a nursing home center, but it can also be standalone care.
The residences are designed with dementia in mind specifically, and the staff is trained in these areas in particular.
Nursing Home Care
Nursing home facilities are also known as skilled nursing facilities. These offer a higher level of care than what’s provided to people in assisted living residences. Nursing home care is a step down from a hospital, and that’s the only other place where someone would receive more comprehensive care.
The rooms are shared or private, with private rooms being more expensive. Around-the-clock medical care and supervision are provided.
Medication management, personal care assistance, and social and recreational activities are offered in nursing facilities.
If someone needs short-term nursing care, for example, after they have a stroke, this isn’t categorized as long-term care.
Finally, many people are confused about what long-term care insurance is and what it isn’t. Many people think Medicaid is the same as long-term care insurance, so their plan is to simply rely on the program for coverage of long-term needs.
Medicaid is a program that requires someone to demonstrate financial need.
Long-term care insurance, on the other hand, is financial assistance specifically for someone who has long-term needs and they don’t need to show a financial need. These insurance plans are expensive, but they offer a lot of flexibility as far as where someone receives care.
Long-term care planning should be an important part of planning your estate and your future. Rather than waiting until it’s too late, it’s good to have an idea of what you’d prefer in terms of long-term care and how you might pay for it. This reduces the burden on your loved ones in the event that you do need more care.