It can be difficult and a bit frightening to learn that you or someone you love needs long term care. You may have questions about the type of care available, how to choose long term care facilities, and where to get help with costs. If you are facing the transition to long term care, here are some things you should know.
What exactly is long term care?
Long term care is a blanket term that covers a range of services and support to help people with chronic needs or disabilities. There are several ways to get long term care, including community support services, in-home care, assisted living centers, and long term care facilities. People often associate nursing homes with long term care.
Many people in long term care need help with activities of daily living, such as bathing, dressing, eating, and remembering to take their medications. This type of care is sometimes called “custodial care,” and it is generally not covered by Medicare.
Long term care differs from skilled nursing care, which is covered by Medicare in certain circumstances. Skilled nursing care is generally short term (generally up to 100 days may be covered by Medicare) and includes regular treatments and therapies that can only be provided by a credentialed health care professional such as a doctor, nurse, or physical or occupational therapist. Sometimes people recovering from a stroke or a joint replacement surgery, for example, spend some time in skilled nursing care to help them recover and get back to independent living.
Are there alternatives to long term care facilities?
The Medicare guide to choosing long term care services suggests several options for long-term care that keep you out of a nursing home. You may want to consider these options, depending on your health status, availability of services, and your doctor’s recommendations. For example:
- In-home care from home health aids and other community support services. Home health aides are able to help with activities of daily living, including bathing, dressing, eating, and even light housework, and they are also able to do basic health-related tasks such as monitor vital signs and administer daily medications, according to the Bureau of Labor Statistics. In combination with community resources such as meal delivery services such as Meals on Wheels and senior centers, some people are able to avoid or postpone admission to long term care facilities.
- Senior assisted living centers. Also called residential care communities, these centers provide a private room or apartment-type dwelling with available services such as meals and help with activities of daily living. Depending on where you live and the type of facility you choose, they may also offer some health-related services such as administering medications and other nursing services.
- Programs of All-Inclusive Care for the Elderly (PACE). These are joint programs between Medicare and your state’s Medicaid program that helps seniors who would otherwise need nursing home care stay in their homes. PACE isn’t available in every location; to find out, call your local Medicaid office to see what’s available.
It’s important to note that Medicare does not generally pay for these types of care except in areas where PACE is available and you meet the eligibility requirements for the program.
How do I get help paying for long term care facilities?
Original Medicare (Part A and Part B) only covers very limited and medically necessary nursing home or home health care. In some cases, if you are enrolled in a Medicare Advantage plan, your plan may have a contract with certain long term care facilities to help offset some of the costs. However, not all plans do, so be sure to check with your plan and any long term care facilities you are considering before you make any decisions
Medicaid is a program funded by both state and federal governments to help people with limited income and personal resources. If you qualify for both Medicare and Medicaid, and choose from the long term care facilities that accept the Medicaid program, most of your long term care expenses will be covered. In 2014, about 25% of total Medicaid spending, or $116 billion, went to support people in long term care facilities, according to Medicaid.gov.
Long term care insurance is another option that may help cover skilled nursing and long term care facilities, as well as a range of other support services you may need. Policies vary widely and some may have exclusions for pre-existing conditions, so be sure to check your policy details to find out what is covered and the limits of your coverage.
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