Understanding Long-Term Care

Last Updated : 06/27/20198 min read

What is long-term care, you might ask? Long-term care is care that you need if you can no longer perform everyday tasks by yourself – perhaps because of a chronic illness, injury, disability or the aging process.

What can long-term care involve?

According to the Department of Health & Human Services (HHS), long-term care may also include:

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  • Help with medication
  • Supervision you might need for dementia (such as Alzheimer’s disease)
  • Paying bills and managing money
  • Food preparation and other help with meals
  • Shopping for necessities
  • Care for pets

This isn’t a complete list, but just a sampling of some ways people may need help with long-term care.

The setting for long-term care can vary. You might get this care in your home, in a nursing home, or in an assisted living facility, for example.

Long-term care: start figuring out what you need

To understand your long-term care needs and options, you might focus on three things:

  • What type of care is needed?
  • Who are the quality providers in long-term care?
  • How will this care be paid?

What type of long-term care do I need?

Some people may need long-term skilled nursing care. Others might need help dressing, bathing, and doing daily tasks. Do you or a loved one that is Medicare eligible need help with daily living activities, health care, or both?

Why is it important to distinguish between “custodial” care (such as help dressing and bathing) and skilled nursing care? It’s because the type of care may affect whether Medicare covers it. Other health insurance might also consider the type of long-term care you need.

  • Daily activities and long-term care: Some common daily living activities that may require long-term care include: assistance with dressing, bathing, preparing meals, eating, walking, going to the bathroom, transportation, housekeeping, doing laundry, shopping, remembering to take medications, and paying bills. These are just examples of the many ways you might need non-skilled nursing help with long-term care.
  • Health-care needs and long-term care: You or your loved one that is Medicare eligible might need skilled care, such as physical, speech, occupational or medical nutrition therapy; wound care; oxygen or medication administration; and other nursing care.

What type of long-term care facility would provide the services I need?

Once you determine what type of care is necessary, you can match the type of long-term care provider with the type of assistance you or a loved one that is Medicare eligible needs.

Skilled nursing long-term care: Nursing homes commonly fill this need. You can also hire health-care providers, like licensed nurses, to come to your home.

Nursing homes offer skilled nursing care, rehabilitation services, meals, activities, help with daily living, and other services. Learn about choosing a nursing home.

For example, a nurse may administer medications and provide other skilled nursing services. Licensed therapists can provide physical, speech, and occupational therapy in the home setting. Some home health agencies might provide these services.

Custodial long-term care: If you don’t need skilled nursing care, but still need help with daily tasks, there are a variety of possible long-term care providers.

  • In-home long-term care providers can be family members, friends and/or home health aides. Typically they help with the daily living activities. Home health aides may also provide some basic health-related activities such as monitoring blood pressure and temperature.
  • Community services provide a variety of support services, including transportation, meal delivery, and adult daycare. These services can help people living at home with long-term care needs and their primary caregivers—family members, friends, or neighbors—by responding to some basic health-related and social needs.

Skilled nursing and custodial long-term care

You might need both skilled nursing care and assistance with daily living. Of course, there may be some overlap in the type of care you need, as well as in the type of facility that can provide this long-term care.

  • Nursing homes may provide both types of care.
  • Assisted living facilities might provide 24-hour supervision, personal assistance, meals, and health-care services in a home-like setting. Services include help with eating, bathing, dressing, toileting, taking medicine, transportation, laundry, and housekeeping. This type of long-term care facility also offers residents social and recreational activities. It’s important to ask about their services, as they may vary. Ask if they have licensed nurses available 24 hours a day.
  • Continuing care retirement communities may provide a full range of services and care based on what each resident needs over time. Long-term care progresses in stages from support to nursing care as the resident transitions from independent living, to assisted living, and then skilled nursing.

Source: Department of Health & Human Services (HHS).

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How will I pay for long-term care?

Long-term care can be expensive. The cost of long-term care depends mainly on the type of care you receive, how long you need it, and where you live.

In general, group health plans (including retiree benefits) and Medicare do not provide long-term coverage for care at home, or in a nursing home or other facility. As the federal Administration on Aging reports, most people make use of a number of financial resources to pay for long-term care. Financial resources for long-term care may include:

  • Medicaid – Government-funded programs that may help pay the long-term care expenses of people with limited income.
  • Long-term care insurance – Offered by private insurers to help pay long-term care expenses.
  • Life insurance – Offered by private insurers. Life insurance may provide a variety of ways to help pay long-term care expenses, according to HHS. Some policies combine life insurance with long-term care insurance. Some have “accelerated death benefits” that let you tap into your policy benefits while you’re still alive. Details vary among plans.
  • Personal financing – This is when you pay for the long-term care yourself. Social Security benefits, IRAs, annuities, and other retirement savings accounts, trusts, and reverse mortgages are some of the ways people might pay for long-term care.

Medicare and long-term care

Original Medicare (Part A and Part B) typically doesn’t pay for long-term care. Generally, Medicare Part A pays for skilled nursing home care for a limited time after a hospital stay. If you and the nursing home meet Medicare criteria, Medicare may cover the first 20 days in a skilled nursing facility, and charge a daily coinsurance amount for the 21st through 100th day. Days 101 and beyond there is no coverage and a deductible may apply. But Medicare doesn’t generally pay for long-term care in a nursing home.

Medicare Part A  may cover limited home health care. Say you need skilled care in your home to treat an illness or injury, and you meet certain conditions. Medicare may pay for some of the costs of nursing care, home health aide services, and different types of therapy for a limited time. Read more about in-home health care under Medicare.

Some Medicare Supplement insurance plans may pay out-of-pocket Medicare Part A and Part B costs, such as coinsurance and deductibles. Some Medicare Supplement insurance plans may help pay for care in skilled nursing facilities – generally not for long-term care.

If you are enrolled in a Medicare Advantage plan, you may have extra benefits in addition to the benefits Medicare provides. It may be wise to check and compare Medicare Advantage supplemental benefits. Starting in 2019, these may include coverage for vital services such as transportation, assistance with daily living activities, such as bathing, grooming, dressing, mobility, laundry, and light housecleaning. Not every plan may offer supplemental benefits.

Who are the quality providers in long-term care and how do I find them?

How do you find trustworthy, quality long-term care providers? As you explore long-term care providers available in your area, consider these points:

  • Licenses – In most states, nursing homes, home health care and home care agencies must be licensed. You can verify this license requirement and the agencies of interest with your State Health Department.
  • Medicare certification – Nursing homes and home health agencies generally must be certified by Medicare before Medicare will pay for any covered services. Medicare certification means that the agency or facility has passed periodic inspections demonstrating it meets Medicare’s patient safety and quality care standards.
  • Accreditation – Nursing homes and home health agencies may be accredited by the Joint Commission on Accreditation of Healthcare Organizations or the Community Health Accreditation Program to name two prominent national accreditation agencies.
  • If you hire a homemaker or home care aide, verify references and training certificates.

There are a variety of agencies that can help you find quality long-term care providers. To learn more, you can contact the Eldercare Locator (1-800-677-1116, weekdays, 9.00 a.m. to 8.00 p.m., EST). Read about other long-term care resources.

You can compare Medicare plan options from right here on this page. All you need to do is enter your zip code, click the button, and explore the list of plans displayed.

The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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