Understanding Long-Term Care

When people of any age need others to help them with medical, physical, or emotional needs over an extended period of time, they need long-term care.

If a person needs ongoing medical care or is unable to perform everyday self-care activities such as bathing, dressing, or grocery shopping, long-term care may be required. Experts estimate that approximately 10 million Americans need long-term care in any given year.

Long-term-care services may be provided in the home of the person who needs it, a family member’s home, or an assisted-living facility, hospice, or nursing home. Family and friends are the sole caregivers for more than three-quarters of elderly adults.

Custodial care vs. skilled care

Custodial care and skilled care are terms used by health insurance plans, Medicare, and the Department of Veterans Affairs. They’re used to differentiate care provided by medical specialists as opposed to care provided by aides, volunteers, family members, or friends.

Skilled care refers to services and supplies that can be provided only by or under the supervision of skilled or appropriately licensed medical personnel. Family members, licensed aides, facility employees, or volunteers who aren’t skilled medical personnel can give custodial care.

Medically necessary skilled services usually are paid for by a health care plan or Medicare. But you or your family member must meet certain requirements for Medicare to pay for home health care or skilled care.

However, often the care that is most needed is care that will assist someone with support services, like dressing, bathing, or using the bathroom. This type of care is called custodial care. Medicare usually does not cover custodial care.

If you or a loved one needs long-term care, speak with a doctor to determine what specific needs should be addressed and follow up with the health insurance agent or Medicare regarding available benefits.

Types of long-term care

Here is a list of types of long-term care available according to Medicare officials:

Subsidized senior housing. This federal program helps elderly adults of low or moderate income pay for an apartment. The income limit is $46,000 for a single person and $53,000 for couples. Rent is usually based on a percentage of income. Some programs offer help with meals and daily tasks.
Group homes. This type of housing is for people who are unable to live on their own, but don't need a nursing home. A person in a group home gets help with personal tasks like eating, bathing, dressing, and using the bathroom. Medicare and Medicaid do not usually pay for this type of housing. The monthly charge may be a certain percentage of your income on a sliding scale that covers the cost of rent, meals, and other basic shared services.
Assisted living. This is also a group living situation that offers help with personal tasks. A person in assisted living usually has a private room or apartment. The cost varies according to services provided and area of the country. Medicare does not pay for this care.
Continuous care retirement communities (CCRCs). These communities provide a mix of housing, depending on personal need. More independent residents have their own home or apartment within the community; people with greater needs may be in an assisted living area or nursing home. Many CCRCs require a substantial entry fee before you move in. Generally, Medicare doesn't cover this kind of care.
Nursing homes. These homes serve as permanent residences for people who are too sick to live at home or as a temporary facility during a period of recovery from illness. Medicare doesn't typically pay for nursing home care.