Older adults may need long-term care to continue living meaningful lives through their twilight years, regardless of the turn their health may take. In general, global life expectancy continues to increase, up from about 46 in 1950 to about 73 in 2022.
However, as people live longer, they are more likely to experience limitations that may inhibit them from living the same lifestyle as when they were younger. As a result, the demand for long-term care for the elderly will only increase over time.
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What Is Long-term Care?
Long-term care encompasses a variety of services that provide support for both medical and non-medical for those with illnesses. We can break long-term care into two main categories: custodial and skilled nursing care. One may better suit you or your loved one depending on your personal and medical needs and your budget.
How Does Long-term Care Work?
Most seniors will need long-term care following a debilitating illness or disability or when they become frail due to age. No matter where you receive long-term care, somebody will be helping you through basic everyday activities like eating, bathing, and using the bathroom. Custodial long-term care and skilled nursing both attend to these crucial needs, only to varying degrees.
Custodial Long-Term Care
Custodial long-term care describes non-medical care that non-licensed caregivers can safely handle for people who need minimal assistance. Custodial care can take place in the comfort of your home or an outside residential facility, provided by homemaker services or unpaid family members.
Who Is It For?
One should consider custodial care if they have a medical condition or other physical limitations and need help with activities that allow someone to live a comfortable life. For example, some individuals with arthritis may need help one to two days a week with tasks like shopping and storing groceries. On the other hand, individuals with dementia need help on a consistent basis to perform basic tasks.
What Services Are Provided?
Some examples of custodial care include:
- Eating
- Bathing
- Walking
- Getting in and out of bed or a chair
- Getting dressed
- Using the bathroom
If you cannot do one or more of the activities listed here, you will require some kind of long-term custodial supervision. If care takes place at home, it may also include essential household duties like cooking and doing the laundry.
Custodial care does not need to be provided by a qualified professional. Anybody close to you without medical training, like a family member or neighbor, can help you through these activities for markedly less than the cost of skilled nursing care. However, given that it may be challenging for a family member to provide frequent assistance, skilled professionals may be a quality, albeit more expensive, option.
Where Is This Care Given?
Typically, custodial care is provided in-home. However, you can find help at certain outpatient, and residential facilities if in-home services are not an option.
Adult daycare and foster care offer daytime supervision in a homelike setting for aging seniors, granting respite for home caregivers who might need a day off or some time for themselves. Assisted living spaces and skilled nursing facilities also provide different levels of residential care for individuals who can no longer function independently.
Skilled Nursing Long-term Care
In contrast to custodial care, only licensed medical professionals can provide skilled nursing care. Examples of skilled nursing care include physical therapy, changing wound dressings, administering intravenous injections, and catheter care. Skilled nursing generally costs more than custodial care.
Who Is It For?
Long-term, skilled-nursing care benefits older individuals who need frequent medical attention for an injury or illness, on top of basic assistance with activities of daily living. Skilled nursing offers the most care you can find outside a hospital, ideal for anyone needing round-the-clock supervision.
Skilled nursing also helps individuals recovering from major surgery who might be temporarily incapacitated and need intravenous injections or other medical care during the healing process.
What Services Are Provided?
Some examples of skilled nursing professionals include registered nurses, licensed vocational and practical nurses, audiologists, and physical therapists. Some of the support they provide includes:
- Physical therapy following surgery, injury, or hospitalization
- Occupational therapy like specialized guidance in getting dressed, memory training, and coordination exercises for anybody struggling with basic activities of daily living.
- Speech-language pathology for those struggling to communicate or swallow following a stroke or a similar trauma
- Wound care, cleaning, and dressing
- Intravenous therapy and injections
- Monitoring of vital signs and medical equipment
Skilled nursing facilities must also carry a transfer agreement with a nearby hospital in case a resident needs emergency medical care.
Where Is This Care Given?
Skilled nursing professionals can provide care in the comfort of your own home, in hospitals, assisted living facilities, and nursing homes. Where you receive treatment depends on your condition.
If you only need help getting around and receiving daily medications, a full-time skilled nurse in your home could work fine. However, if you require constant medical supervision, a dedicated nursing home’s full staff, and resources will better suit your situation.
Does Health Insurance Cover Long-term Care?
Regular health insurance does not cover long-term skilled nursing or custodial care. However, it may provide some coverage for skilled nursing care on a limited basis if a doctor prescribes it following a recent hospital stay.
If you want guaranteed coverage for long-term care, you must take out a separate long-term care insurance plan with your health insurance provider or a long-term care rider as part of a life insurance policy.
Can Original Medicare Beneficiaries Get Coverage For Long-term Care?
Just as with private health insurance, Medicare typically does not cover any long-term custodial care you would receive from an unlicensed homemaker or family member. Medicare Part A will still pay for short-term care in a skilled nursing home for up to 100 days maximum, as long as you previously spent at least three days in the hospital and a physician who believes your health can improve prescribed nursing home care.
Medicare Advantage Coverage For Long-term Care
Medicare Advantage plans provided by private companies must always offer the same coverages as Original Medicare and occasionally bundle in additional benefits like dental, vision, and gym memberships. These requirements also apply to long-term care. Some types of Medicare Advantage plans offer additional long-term care coverage in the form of adult day care, in-home assistance with basic daily activities, home modifications, respite care, meal delivery, and non-emergency transportation.
If you know you will likely need some type of long-term assistance in the coming years, seek out and compare Medicare Advantage plans with these specific coverages before settling on a final Medicare plan.
Medigap Coverage For Long-term Care
Medigap plans sold by private companies to help supplement gaps in your Original Medicare policy will not cover non-medical, custodial long-term care like assisted living or memory care.
However, Medigap will occasionally make exceptions for some short-term skilled nursing care and cover up to 100 days of prescribed care in a skilled nursing facility. Shop around and compare Medigap plans with your long-care needs in mind, and decide if this limited coverage would be worth a spike in your premium before committing.
How to Plan Ahead for Long-term Care
When plotting out your long-term care needs, you should try and determine when you will likely require long-term care and consider what kind of care you’ll need. However, perhaps more importantly, you must establish how to pay for any long-term care you’ll receive. Here are some important considerations:
Decide When To Seek Long-term Care
Deciding when to agree to long-term care depends entirely on your health, family history, and lifestyle. Healthier seniors with no known genetic dispositions, who still get some exercise, eat healthily, and avoid cigarettes and alcohol, might postpone paying for long-term care longer than others.
If you have a less healthy lifestyle or show early signs of Alzheimer’s or other degenerative cognitive impairments, you should start planning for long-term care as soon as possible.
Determine the Type of Care Needed
Long-term care comes in many forms ranging from casual care at home to 24/7 supervision in a specialized facility. Some common examples of long-term care include:
- Home health care: Home health care provides many of the same services you’d receive at a hospital (wound care, intravenous injections, etc.), provided by a licensed medical professional in the comfort of your home.
- Personal care: Some healthy older people may just need help with some of the activities of daily living, like eating, getting dressed, or getting out of bed, all of which unlicensed caretakers or family members can provide.
- Meal preparation and chore care: Much like personal care, family members or caretakers can help cook and clean for individuals who cannot efficiently do so for themselves.
- Adult daycare centers: These facilities provide care and companionship for older adults who need supervision during the day while their primary caretakers are unavailable.
- Assisted living care: Just like personal care, but in a designated residential facility
- Nursing home care: Nursing homes have skilled nurses and professional medical equipment on hand 24/7 for older adults who need daily medical attention and can no longer be cared for by untrained family members at home.
Establish How To Pay For Long-term Care
A private room in a nursing home costs around $108,405 annually, while the national average for a semi-private room is $94,900. While custodial care options cost notably less than skilled nursing care, they could still significantly drain your budget over time. Consider these common payment options for long-term care:
Private Funding
- Long-term care insurance: Long-term care insurance provides specialized policies designed to help to cover long-term care needs like nursing homes, home care, and assisted living facilities. Standard health insurance plans do not cover long-term care services. Long-term care insurance, though quite expensive, could offer some peace of mind and security.
- Personal retirement savings: Those without coverage must pay for long-term care out of pocket. Ideally, you will have strategically saved money over your career to prepare for retirement or have opted into an IRA or 401(k).
- Long-term Care Life Insurance Riders: Some varieties of permanent life insurance allow the policyholder to withdraw funds they have paid into over the years. While this rider deducts from the policy’s death benefit, it could be a practical decision if you’re family is no longer financially dependent.
Government and State Assistance
- Medicaid: Low-income elderly individuals might qualify for Medicaid, a government-sponsored, need-based health care program. Medicaid would cover nursing home residences for those who meet the eligibility requirements. Medicaid long-term care eligibility varies state-to-state and often even within the same state.
- Medicare PACE: Short for Program of All-inclusive Care for the Elderly, Medicare PACE provides long-term services for those requiring nursing home care without assistance, such as people with Alzheimer’s disease. Only select cities in some states offer Medicare PACE.
- State-based programs: Many state-based, non-Medicaid programs exist that help low-income seniors maintain independence in their homes and provide additional support to unpaid family caregivers. Some states may also sponsor prescription assistance or meal delivery programs that would at least offset some expenses to free up one’s budget for other long-term care needs.
- Veterans Affairs programs: Military veterans who carry VA insurance and meet eligibility requirements might also have access to long-term care services like adult daycare, in-home personal caretakers, and respite care. The VA might also pay for room and board in state veteran or community nursing homes.