Forty percent of those over 65 will receive some form of long-term care services during their lifetime, and one-third will need nursing home care at least once, with the average stay being one year. Government subsidies exist for some programs but are limited in terms of individuals covered, services covered, provider recognized and payment rates. There are five general sources of payment for long term care services.
Personal Resources — Due to the limitations of Medicare and Medicaid, most of the costs associated with long-term care are met by personal resources of the individual or his/her family. The cost of community services (home health, homemaker, etc.) are in addition to the individual’s ongoing obligations for food and shelter; the cost of assisted living and nursing home includes room and board.
Medicare —
Coverage is limited to short-term medically necessary
services to recover from an acute illness or injury. Except
for physician services, Medicare does not cover ongoing cost
of chronic health care needs. A form of Medicare coverage
(Medicare Plus Choice or HMOs) generally provide some extra
coverage but restricts the number of providers and number of
covered days. For more information about the scope of
Medicare services, contact (800) 638-6833.
Medicaid —
Covers many long-term care services (e.g. nursing home care
and pharmacy) for those with chronic health care needs and
whose income and resources are below certain levels. The
program is administered by the state and is financed by the
state and federal government with numerous financial
eligibility requirements — including a prohibition against
transferring assets in order to qualify for Medicaid. For
more information, contact the Department of Human Services
in your county.
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Southern
Plaza, Bethany |
Local Programs — Some communities have senior services such as home-delivered meals, congregate dining programs, homemaker, home health, adult day services, respite care or transportation. Most local programs have sliding fee scales, and every program is different. Check with your Areawide Agency on Aging for more information.
Long Term Care Insurance — A number of private insurance plans are now available which cover up to predetermined maximums both institutional (nursing home and assisted living) and community services (e.g. homemaker, adult day services, etc.). The premiums vary based on the age and health of individuals covered, the type and number of services covered, and other features selected such as inflation protection, waiver of premium and nonforfeiture. As with medical insurance, the premiums are subject to adjustment due to actuarial studies and may be partially income tax deductible.
