What is Long Term Care?

(Administration on Aging)  In the 2000, almost 10 million people needed some form of long-term care in the United States. Of this population, 3.6 million (37%) were under age 65 and 6 million (63%) were over age 65 (Roger & Komisar, 2003). Almost 70% of people turning age 65 will need long-term care at some point in their lives. This section of the website provides basic information so you can begin to think about how you will handle the need for long-term care. Your path will be unique to you, and based on your preferences and circumstances.

Many people think the phrase “long-term care” refers to an insurance policy. While insurance may be part of your strategy, long-term care encompasses everything from long-term services and supports and finances, to where you will live and how you will navigate the myriad of legal, family, and social dynamics along the way.

What is Long-term Care?

Long-term care is a range of services and supports you may need to meet your personal care needs. Most long-term careis not medical care, but rather assistance with the basic personal tasks of everyday life, sometimes called Activities of Daily Living (ADLs), such as:

Other common long-term care services and supports areassistance with everyday tasks, sometimes calledInstrumental Activities of Daily Living (IADLs) including:

  • Housework
  • Managing money
  • Taking medication
  • Preparing and cleaning up after meals
  • Shopping for groceries or clothes
  • Using the telephone or other communication devices
  • Caring for pets
  • Responding to emergency alerts such as fire alarms

Who Needs Care?

70% of people turning age 65 can expect to use some form of long-term care during their lives. There are a number of factors that affect the possibility that you will need care:

Age

Gender

  • Women outlive men by about five years on average, so they are more likely to live at home alone when they are older

Disability

  • Having an accident or chronic illness that causes a disability is another reason for needing long-term care
  • Between ages 40 and 50, on average, eight percent of people have a disability that could require long-term care services
  • 69 percent of people age 90 or more have a disability

Health Status

  • Chronic conditions such as diabetes and high blood pressure make you more likely to need care
  • Your family history such as whether your parents or grandparents had chronic conditions, may increase your likelihood
  • Poor diet and exercise habits increase your chances of needing long-term care

Living Arrangements

  • If you live alone, you’re more likely to need paid care than if you’re married, or single, and living with a partner

How Much Care Will You Need?

The duration and level of long-term care will vary from person to person and often change over time. Here are some statistics (all are “on average”) you should consider:

  • Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years
  • Women need care longer (3.7 years) than men (2.2 years)
  • One-third of today’s 65 year-olds may never needlong-term care support, but 20 percent will need it for longer than 5 years

The table below shows that, overall, more people use long-term care services at home (and for longer) than in facilities.

Distribution and duration of long-term care services

Type of care Average number of years people use this type of care Percent of people who use this type of care (%)
Any Services 3 years 69
At Home
Unpaid care only 1 year 59
Paid care Less than 1 year 42
Any care at home 2 years 65
In Facilities
Nursing facilities 1 year 35
Assisted living Less than 1 year 13
Any care in facilities 1 year 37

 

Who Will Provide Your Care?

Long-term care services and support typically come from:

  • An unpaid caregiver who may be a family member or friend
  • A nurse, home health or home care aide, and/or therapist who comes to the home
  • Adult day services in the area
  • A variety of long-term care facilities

A caregiver can be your family member, partner, friend or neighbor who helps care for you while you live at home. About 80 percent of care at home is provided by unpaid caregivers and may include an array of emotional, financial, nursing, social, homemaking, and other services. On average, caregivers spend 20 hours a week giving care. More than half (58 percent) have intensive caregiving responsibilities that may include assisting with a personal care activity, such as bathing or feeding.

Information on caregivers show that:

  • About 65.7 million people in the US (one in four adults) were unpaid family caregivers to an adult or child in 2009
  • About two-thirds are women
  • Fourteen percent who care for older adults are themselves age 65 or more
  • Most people can live at home for many years with help from unpaid family and friends, and from other paid community support

Where Can You Receive Care?

Most long-term care is provided at home. Other kinds oflong-term care services and supports are provided by community service organizations and in long-term carefacilities.

Examples of home care services include:

  • An unpaid caregiver who may be a family member or friend
  • A nurse, home health or home care aide, and/or therapist who comes to the home

Community support services include:

  • Adult day care service centers
  • Transportation services
  • Home care agencies that provide services on a daily basis or as needed

Often these services supplement the care you receive at home or provide time off for your family caregivers.

Outside the home, a variety of facility-based programs offer more options:

  • Nursing homes provide the most comprehensive range of services, including nursing care and 24-hour supervision
  • Other facility-based choices include assisted living, board and care homes, and continuing care retirement communities. With these providers, the level of choice over who delivers your care varies by the type of facility.  You may not get to choose who will deliver services, and you may have limited say in when they arrive.

Who Pays for Long-Term Care?

The facts may surprise you.

Consumer surveys reveal common misunderstandings about which public programs pay for long-term care services. It is important to clearly understand what is and isn’t covered.

Medicare:

  • Only pays for long-term care if you require skilled services or rehabilitative care:
    • In a nursing home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days).
    • At home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period of time.
  • Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority oflong-term care services
  • You will have to pay for long-term care services that are not covered by a public or private insurance program

Medicaid:

  • Does pay for the largest share of long-term care services, but to qualify, your income must be below a certain level and you must meet minimum state eligibility requirements
  • Such requirements are based on the amount of assistance you need with ADL
  • Other federal programs such as the Older Americans Act and the Department of Veterans Affairs pay forlong-term care services, but only for specific populations and in certain circumstances

Good to Know:

Like public programs, private sources of payment have their own rules, eligibility requirements, copayments, and premiums for the services they cover.

Health Insurance:

  • Most employer-sponsored or private health insurance, including health insurance plans, cover only the same kinds of limited services as Medicare
  • If they do cover long-term care, it is typically only for skilled, short-term, medically necessary care

There are an increasing number of private payment optionsincluding:

Citation

Administration on Aging

http://www.longtermcare.gov/LTC/Main_Site/Understanding/Index.aspx
U.S. Department of Health & Human Services