Long Term Care
Posted on July 3, 2011 by bob in Health
“About 70 percent of people over age 65 will need some type of long-term care…”
National Institutes of Health
Long-term care (LTC) encompasses a range of medical, personal and social services designed to meet the needs of people with disabilities, chronic illnesses, or injury that limits their ability to function independently. It may be delivered at home, in a nursing home, adult day care or other facility, and involves both skilled and unskilled care.
Skilled care is provided by trained medical personnel such as nurses and therapists. Unskilled care is provided by a home health aide or home attendant and assists a person with Activities of Daily Living (ADL) such as dressing, bathing, eating, using the bathroom, laundry, cooking, etc. Unskilled care can be provided by friends, family, community and church volunteers, or by paid caregivers at home or in a facility.
Long-term care can be expensive. In their booklet, “A Shopper’s Guide to Long-Term Care Insurance”, The National Association of Insurance Commissioners estimates the annual cost of LTC in three common setting:
– nursing home, semi-private room, $65,700 ($180/day);
– assisted living facility, 1-bedroom unit, $32,568 ($2,714/month);
– home health care health aide, three times a week, $16,000 (often based on an hourly rate).
“…40 percent of people currently receiving long-term care services are ages 18 to 64.”
U.S. Dept. of Health and Human Services
There are many ways to pay for LTC, including government programs, paying from your own assets, and buying LTC insurance.
The Department of Veterans Affairs provides LTC for service-related disabilities or for certain eligible veterans. The VA owns and operates nursing homes and provides some at-home care including nursing, home health aide, homemaker services, and community residential care.
Eligible veterans may also receive respite care, adult day care services, and geriatric care management services. Visit the Ala. Dept. of Veterans Affairs website, www.va.state.al.us/ or call 334-242-5077 (Montgomery). Or contact the U.S. Dept. of Veterans Affairs toll-free, 1-877-222-8387, or visit their website, www.va.gov/.
Medicare will pay for care in Medicare-certified skilled nursing facilities or through Medicare-certified home health or hospice agencies. You must meet certain conditions to qualify. In general, Medicare doesn’t cover assistance with ADLs. Among the conditions needed to qualify you for services: medical certification of the need for skilled care; your inability to leave your home without considerable effort. The home health agency caring for you must be Medicare-certified. Contact the Ala. Dept. of Senior Services, 334-242-5743 (Montgomery), toll-free, 1-877-425-2243, or visit the website, www.alabamaageline.gov/home.cfm.
The Alabama Medicaid Agency administers a program of services offering eligible patients a range of care choices and opportunities to receive services at home or in the community. Among these are home health services, hospice care, and private duty nursing along with care in nursing and other LTC facilities.
Clients must meet financial, medical and program requirements. Among other qualifying factors: home care recipients must be unable to leave home under normal circumstances; have an illness, injury or disability that prevents them from going outside the home for treatment.
If you pay for LTC yourself you’ll have the most flexibility. No government agency or insurance company can dictate where you receive care or what type of care you get. And if you don’t need LTC during your lifetime, you’ll still have your money. Since you’re using your own money, there’s no concern about whether you medically qualify for LTC insurance.
LTC insurance can help pay for both skilled and unskilled care. Policies are purchased through an agent or as part of a group policy through an employer or association.
The insurer will compensate you for specific long-term care costs during the insured time period. If you have an immediate need for LTC and are not currently insured, you will likely be unable to buy it.
Monthly premiums depend on age, health status when you buy the policy, and how much coverage you want. Health screenings may be required. Buying LTC insurance at a younger age, when your health is better and premiums lower, may be a good choice.
The Federal LTC Insurance Program offers Federal, U.S. Postal Service employees, current and retired members of the Uniformed Services, and other qualifying individuals the chance to buy insurance at a group rate. See details at the Office of Personnel Management (OPM) website, www.opm.gov/insure/ltc/.
Predicting the cost of health care and your own financial status in ten, 15 or 20 years, is tricky. There are a bewildering number of insurance options, and current health problems may preclude you from getting LTC insurance. You also need to consider the expense of insurance premiums and your ability to continue to pay them as you age and possibly retire. Among LTC insurance options, two of the most common are:
Limited Pay — Payment is made either as a lump sum, for a predetermined number of years, or up to a certain age. This lets you pay over a shorter period, such as while you’re still working. However, since it’s paid over a shorter period, premiums can be significantly higher.
Inflation Rider — A way of keeping pace with rising health care costs and future price increases. Most are based on the Consumer Price Index and added to your premium each year until you start drawing benefits. You pay the annually increasing premium, not the insurance company. The policy payout adjusts each year as you increase your premiums, hopefully at a rate that keeps up with inflation.
“Today, approximately 10 million Americans need long-term services and support. As America ages, that number is rising steadily. By 2020, it is expected that 15 million Americans will need some type of long-term care.”
Kathy Greenlee, Assistant Secretary for Aging, U.S. Administration on Aging
The biggest issue regarding LTC is predicting if you’ll need it, how much you’ll need, and how much it will cost at some vague point in the future. The answers to these questions have an impact on every funding option available, whether you pay from personal assets, with government assistance, or through LTC insurance.
Odds are not in our favor when it comes to the potential for needing long-term care. Regardless of your financial and health status, you owe it to yourself and your loved ones to investigate the predicted costs and financing options. Then, make a plan. As the saying goes, no one plans to fail, they just fail to plan. Many on-line resources can help you sort through the need for, and cost of, long-term care.
Medicare: www.medicare.gov/default.aspx. Take a quiz to determine how much LTC cost, what assistance you qualify for, and what options are available to pay for it.
Alabama Department of Insurance: www.aldoi.gov/About.aspx. Click on the Consumers button on the left hand side of the home page, then select Long-term Care Information. You can also call 1-800-243-5463.
National Association of Insurance Commissioners: www.naic.org/index.htm. This site lists items you should be sure are included in a long-term care insurance policy, along with general tips regarding long-term care insurance.
Other resources:
Easy-to-understand answers to LTC questions
www.nihseniorhealth.gov/longtermcare/toc.html.
Free “Shopper’s Guide to Long-Term Care Insurance”
https://external-apps.naic.org/insprod/Consumer_info.jsp.
Alabama Medicaid
www.medicaid.alabama.gov
Alabama Dept. of Senior Services
www.alabamaageline.gov/home.cfm
Alabama Medicare
www.alabamamedicare.net or call 1-800-385-8144.
This story was prepared with material from the National Institutes of Health and Aging, Medicare, Medicaid, National Assn. of Insurance Commissioners, Ala. Dept. of Senior Services, U.S. and Ala. Depts. of Veterans Affairs, and the Ala. Dept. of Insurance.
