A Summary of Long-Term Care and the Payment Options

A Summary of Long-Term Care and the Payment Options 2017-02-22T23:31:16+00:00

Although the definition of long-term care varies from one source to another it generally refers to a range of services and supports designed to help someone meet their non-medical personal needs on a daily basis, often called assisted living or personal care. Long-term care may also include a higher level of medically-necessary skilled nursing care. Understanding the difference between these two types of care is necessary in order to understand what payment options exist.

Assisted living includes only non-medical care. This type of care is often provided in the home by a family member or a paid caregiver who helps provide assistance with one or more of the six activities of daily living, which include bathing, dressing, eating, toileting, transferring, and continence. If receiving such services at home is no longer practical then one may receive these services in a long-term care facility.

Unlike assisted living services, skilled nursing care addresses medically necessary needs such as wound care, IVs, and drug administration. Such care is provided by a registered nurse or licensed practical nurse (LPN) and typically includes 24-hour monitoring. Skilled nursing care is often shortterm in nature with a focus on rehab and physical therapy following a hospital stay, but it can be permanent if there is little likelihood of health being restored. This type of care is usually provided in a facility, often referred to as a nursing home.

Paying for Long-Term Care Services

Payment options for long-term care fall into one of two categories: public support or private pay. Public support options include Medicare, Medicaid, and the Veterans Administration. Private pay options include paying out-of-pocket or utilizing long-term care insurance. A full explanation of each program is beyond the scope of this document but you should understand that Medicare does not cover the cost of assisted living if that is the only type of care required. However, it will cover some of the cost of skilled nursing care if those services are delivered by a Medicare-certified provider.

Medicaid, on the other hand, will generally cover the cost of assisted living services, as well as skilled nursing care, for those who qualify financially and if such services are delivered by a Medicaid certified provider. Eligibility requirements vary by state, but generally speaking, qualifying for Medicaid means that available assets and income sources are at or below the federal poverty level. For those who do not qualify for Medicaid a long-term care insurance policy can help cover the cost of assisted living services.

Veterans and surviving spouses of veterans may qualify for a valuable benefit available through the Office of Veterans Affairs’ Administrations Aid and Attendance Program that helps cover the cost of assisted living and skilled nursing care.