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Long-Term Care

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What is Long-Term Care

As you age, you can feel better knowing there are steps you can take to ensure that your wishes, both medical and financial, are carried out the way that you want them. Advance care planning involves discussing your wishes, completing legal documents, and appointing a health care decision maker.

Having your decisions squared away and clear, so that there are no misunderstandings or second-guessing, can be the greatest gift you can give to your loved ones, and yourself. In this section we will answer the following questions:


What is Long-Term Care?

  • Includes a wide range of services such as help with everyday tasks and support for managing an illness
  • Is provided for an extended period when someone is not able to do everyday task themselves
  • Can be provided in many settings, such as a person’s home, community sites, residential settings, and nursing homes.
  • May include support for family members or other caregivers who help people who are ill or disabled.

    • You may be able to pay for long term care services through VA, Federal and the state programs (Medicaid and medicare), and through insurance or your private funds.


    Your eligibility for Long term care services, provided in any long term care setting will be determined based on your need for ongoing treatment, personal care, and assistance, as well as the availability of the service in your location. Other factors, such as financial eligibility, your service-connected (VA disability) status, insurance coverage, and/or ability to pay may also apply.

    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

  • The older you are, the more likely you will need long-term care

    • 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 need long-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 years 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 of long-term care services and supports are provided by community service organizations and in long-term care facilities.

    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 of long-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 for long-term care services, but only for specific populations and in certain circumstances

    • 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 options including:

  • Long-term care insurance
  • Reverse mortgages
  • Life insurance options
  • Annuities

    • Additional Resources


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