In its simplest definition,
Long-Term care is something a person may need if he/she
can no longer perform everyday tasks for themselves. For
example, there may come a time when a person needs help
getting dressed, eating or bathing. Long-term care also
includes the type of care a person might need if he/she
had a severe cognitive impairment like Alzheimer’s
Disease. Long-Term Care Services can be received in a
variety of settings, including a person’s home, an
assisted living facility, nursing home or other settings.
Long-Term Care consists of a range of medical and/or
social services designed to help people who have
disabilities or chronic care needs. Services may be short-
or long-term in duration and may be provided in a person’s
home, in the community (home and community-based care), or
in residential facilities (institutional care). Long-term
care services, regardless of the setting, are designed to
assist individuals who need continual assistance to meet
their daily needs.
Residential care consists of several different levels
but primarily requires the recipient of care to relocate
from their normal places of residence. They include Adult
Foster Care Homes, Assisted Living complexes, Homes for
the Aged, and nursing homes. The level of care provided
within these settings depends upon the individual’s
particular needs and may be as little as supervision and
cuing someone to do something for themselves, to total
hands-on assistance with all activities of daily living.
There are several payment sources for residential
long-term care, although each source may or may not pay
for care in all of these settings. The sources include
Medicare, Medicaid, private insurances and private pay.
Medicare payments are restricted to car provided in
nursing homes when the care provided is classified as
"skilled". Payments may continue up to 100 days
provided the level of care continues to be classified as
skilled. Frequently payments do not exceed 20 days.
Medicare does not currently pay for care received in Adult
Foster Care Homes, Assisted Living Complexes or Homes for
the Aged.
Medicaid pays for care in all residential care settings
except Assisted Living Complexes. Individuals must meet
certain income and asset tests in order to qualify for
Medicaid. Private Insurances pay for most residential care
settings as well. Individual policies will determine which
services and which settings are covered.
All residential care settings welcome private pay
arrangements. Private pay rates vary from facility to
facility and may be all inclusive or contain ancillary
charges for services and supplies over and above daily
room and board costs.
Home and Community Based Care consist of coordination
of and service provision to individuals in their homes and
in community facilities. Community Based Services do not
require a person to move to another setting. Home and
Community-Based Care services consist of a number of
individual services including
Care Management, Personal Care, Respite Care, Homemaker,
Adult Day Care, Home Delivered Meals, Chore Services,
Private Duty Nursing, etc., all provided by private
individuals or companies, each specializing in one or more
of the particular service categories.
Payment for services comes from three primary sources
including private pay, private insurances and Medicaid.
Medicare does not pay for long-term care in a person’s
home, Medicare does pay for skilled nursing services as
part of a home health benefit, however these services are
deemed short-term and intermittent.
Learn more about Long Term
Care Services.
