At some point, around 70% of people who are 65 years or older will need home care support or long-term care and receive care for an average of three years. People should plan early for their home care support based on this fact.

Unfortunately, most people cannot cover the costs and services with their assets and incomes. To that end, the US government signed Medicaid into law in 1965, which was an assistance program that provides health coverage to people with disabilities, elderly adults, low-income adults, pregnant women, and children.

What does long-term nursing care mean?

In short, long-term nursing is designed to help those who can no longer help themselves.

Long-term nursing care means caring for elderly adults or people with disabilities, whether at a facility or home. The term is an umbrella name for care provided to individuals (particularly elderly adults) who no longer have self-care capacity and require assistance with basic daily activities of living such as mobility, bathing, or dressing.

Long-term nursing care tends to elderly adults simply experiencing natural aging, Alzheimer’s disease, Parkinson’s disease, or any other form of dementia.

What is Long-term Care Insurance?

It is an insurance cover that covers the cost of your long-term care. Primarily, long-term care insurance covers some or all of the expenses from in-home care and assisted living facilities for individuals 65 years and above or those with chronic conditions that need continuous care. The insurance cover is private, and anyone who can afford to pay will get more flexibility and options than Medicaid.

What is long-term care?

Long-term care is provided to individuals who cannot perform day-to-day activities independently. It is a rehabilitative, therapeutic process administered to individuals, especially elderly adults who need help conducting basic daily routines. Facilities that offer long-term care include long-term chronic care hospitals, rehabilitation facilities, nursing homes, and in-patient behavioral health facilities. Long-term care can be costly if you are not under insurance cover, you could pay between $20,000 – $100,000 in out-of-pocket costs every year, depending on the type of care you need.

What Does Long-Term Care Insurance Cover?

The long-term care insurance cover helps individuals clear the costs of care they receive when they have a chronic medical condition. Most long-term care insurance policies are all-inclusive, which means they could cover nursing home care, at-home care, assisted living facilities such as alternative or resident care, and adult daycare. For at-home services, the insurance also covers the cost of occupational therapy, professional nursing care, and rehabilitation.

Some long-term care insurance policies cover short-term hospice care for services such as pain management emotional and physical support for individuals suffering from a terminal illness. Long-term insurance also covers temporary or respite care, which is compensated to caregivers for 14 to 21 every year and can occur at an adult daytime care facility, nursing home, or at the individual’s home.

Why You Need Long-Term Care Insurance

Getting long-term care insurance is essential because it covers some care costs when you can no longer perform daily tasks independently. The majority of elderly adults depend on savings they had accumulated as their retirement plan. Since about seven out of ten elderly adults will need long-term care services, getting a long-term insurance cover is crucial to avoid running your savings dry.

Long-term care is costly without insurance. Expect to pay around $19,000 for adult daycare, between $90,000 and $105,000 for nursing home care, and $50,000 for living in an assisted care facility, homemaker services, or home health aide.

Who Needs Long-Term Care?

Long-term care is available for anybody who requires constant care. It can be due to a severe and ongoing condition, old age (65 or older), or disability. Here are some examples of patients who mostly require the services of long-term care:

  • People recovering from a severe medical event such as heart attack or stroke
  • Have disabilities that hinder their mobility
  • Individuals recovering from injuries
  • Patients suffering from cognitive disorders (dementia, Alzheimer’s disease, etc.) that affect their quality of life
  • People who are having difficulty with managing basic day-to-day activities

Long-Term Care Planning

Long-term care planning is preparing yourself while still having the physical and mental ability to make crucial decisions (just in case you will need similar care).

When creating your long-term care plan, there are many variables that one has to consider. Long-term care planning does not necessarily mean funding long-term care insurance coverage. You need to decide the type of long-term care you want, who will provide the care, how you will get the care, how to cover the care costs.

Long-term care planning is not prevalent in the US, with only 44% of the population claiming that they had such a plan in place. However, the lack of proper planning usually leads to a family member who was not prepared or experienced for the job taking up the role of a caregiver. This decision can have negative financial implications for the family member, such as leaving their jobs or paying for various services with their own money.

Types of Long-Term-Care Insurance

There are only two types of long-term care insurance available: traditional or stand-alone long-term care and hybrid or asset-based long-term care insurance. Additionally, as they relate to US income tax, individuals expected to have cared for at least 90 days are eligible for tax-qualified policies.

Traditional Long-Term-Care Insurance

Traditional long-term care insurance is the cheapest and easiest way to cover long-term care costs. It has been around for over 40 years, with most policies covering the cost of care up to your policy limit.

To be eligible for stand-alone long-term insurance, you must require assistance with at least two of the six daily living activities, or you start becoming cognitively impaired. The insurance usually includes the following components.

  • How much monthly coverage will you receive?
  • How long will you get the benefits?
  • How long before the monthly coverage begins
  • Some companies provide optional benefits.

Hybrid Life and Long-Term Care Policies

Long-term hybrid insurance combines different covers under one policy. The policy has not been available for long compared to traditional insurance, but it has been growing in popularity over the years. The main reason behind its slow adoption is that the plans only work for individuals who have assets to reallocate. Fortunately, under the asset-based long-term care insurance cover, you are offered various advantages:

  • Two different covers under one policy
  • Guarantee that the premiums will not rise
  • Flexible payment model
  • Less stringent underwriting
  • Tax-free re-purposing
  • You can get refunds on premiums

When to Buy Long-Term Care Insurance

The best time to buy long-term care is when you can still make important decisions about your life (or can still perform daily activities). Based on the American Association for long-term care insurance statistics, the best time to shop for a cover should be in your mid-50s.

While this may seem a bit early, considering most of the claims are filed when people are in their 70s and 80s, it’s always to buy things in advance rather than waiting until you need them. Another reason to purchase the insurance early is that premiums will go up depending on age, gaining 2% to 4% every year once you are older than 50 and 6% to 8% for those older than 60.

What are the benefits of long-term care?

With long-term care, you get to enjoy excellent services at a reduced or no cost at all. The majority of long-term care benefits often go to the family members who always are faced with challenges when trying to care for their elderly adult. Here are some of those benefits:

  • Emotional relief from constant worry and mental burden that rise from leaving your relative in the care of others
  • Provides physical support, which can be a demanding task for family members who are not prepared to care for others physically
  • Long-term care provides quality care that can be better than a family member.
  • Financial reasoning based on the fact that at-home costs can be more burdensome than a long-term care home
  • Long-term care facilities are better equipped for older adults, which is not the case for most homes.

What are long-term services and supports (LTSS)?

LTSS are services offered to individuals who require constant care for extended periods. Long-term services and support refer to both home &community-based services (HCBS) and institutional care.

Individuals who often require long-term services and support have complex conditions and high needs that require assistance for years or even decades. Medicaid LTSS is among the most expensive policies under the program at $171.7 billion or 42% of the total Medicaid spending.

What services does long-term care provide?

Long-term care services are mainly therapeutic and rehabilitative. Most long-term care services revolve around helping individuals perform day-to-day activities such as taking medications, bathing, supervision, bathing, etc. Despite what most people believe, most long-term care does not happen at a nursing home, and it’s mostly left to unpaid friends or family members.

  • Home health care:
  • Homemaker and personal care services:
  • Friendly visitor and senior companion services:
  • Senior transportation service:
  • Emergency medical alert systems:

How many days does Medicare pay for assisted living?

If a doctor recommends a specialized nursing facility for at least three days, Medicare will cover 80% of your stay for up to 100 days, and 100% of the cost of the care is up to 20 days at a facility that is Medicare certified.

Unfortunately, Medicare does not pay for costs associated with assisted living except medical expenses. Assisted living is in a more residential setting when compared to a skilled nursing facility is not covered under the Medicare insurance policy. Assisted living facilities and skilled nursing facilities are two different entities to Medicare because the latter provides more medical care.

How Much Does Medicare pay for an assisted living facility?

Medicare does not cover any associated living costs. However, they will pay for medical expenses for the senior adult’s period in the assisted living facility. Still, they will not pay anything toward custodial care or the room and board cost of assisted living. Some Medicare Advantage plans may pay for personal care assistance for individuals in assisted living facilities but not contribute to room and board costs.

Does Medicare Pay for Assisted Living Expenses?

Medicare does not contribute to assisted living expenses. It only covers medical costs for the period the elderly adult was at the facility. Medicare will only pay for assisted living expenses if the individual requires skilled nursing services for assistance in daily living and needs wound care, occupational, and physical therapy. The cover is usually for a short period of up to 100 days and covers health-related services, prescription medications, wellness or fitness programs, and transportation to doctor’s appointments.

How Can You Pay for Senior Living?

The most traditional approach is using savings or income to outright fund your senior living because most elderly adults have a gain or savings. The conventional method also includes support from family members or friends. However, there are many additional possibilities to choose from when paying for senior living. Regardless of your present financial condition, you will find an option within your budget. Other ways to fund your senior living include:

  • Long-term care insurance
  • VA benefits
  • Medicaid
  • Medicare
  • Working with real estate assets
  • Life insurance

How do seniors pay for assisted living?

There are two ways to pay for assisted living. You can choose between an all-inclusive fee or fee-for-servicing charges. The all-inclusive price means that you pay a monthly fee that covers the room, food, and other additional services, while the fee-for-servicing involves paying for the services they only use.

The pay will vary depending on various factors such as state and age. More States increased assistance to people in assisted living facilities since it is much cheaper than a skilled nursing home. The most common way for seniors to pay for assisted living is through Medicaid, which covers the cost of assisted living in more than 30 states.

What is Elder Law

The Elder law helps individuals receiving long-term care address their issues. It is a legal provision specializing in legal and practical issues that affect the elderly adult population, their friends and families, and their caretakers. Typical problems the elder law addresses include end-of-life, health care, financial and estate planning, elder abuse, and guardianship decisions.

What Does an Elder Care Attorney do?

An elder care attorney is like a consultant who helps senior adults and those close to them in law matters. Their services revolve around the issues addressed in elder law. Still, they are more like specialists who focus on the needs of senior citizens, which are often different and more specialized than those of younger people.

Additionally, the attorney is better equipped and experienced to handle the sensitive, emotional, and physical needs of elderly adults; hence the attorneys are better suited to handle various challenging situations. An elder care attorney can help you with:

  • Discussing the importance of wills and estate planning
  • Creating a durable power of attorney
  • Providing help with health care and planning
  • Financial representation
  • Helping to locate long-term care facilities
  • Explain nursing home resident rights
  • Making a will or other advance directives

Caregivers of aging loved ones recognize the obstacles they face in their later years, such as medical services, housing, and financial stability. Although these obstacles may seem overwhelming, an elder care lawyer is well-versed in these issues and can help you spend more time with your loved ones, regardless of how frightening they seem.

Do you have any legal question about elder law and Medicaid that I didn’t cover in this guide? Email at info@jiahkimlaw.com or Call 929-533-1811.

This blog post is written for educational and general information purposes only, and does not constitute specific legal advice. You understand that there is no attorney-client relationship between you and the blog publisher. This blog should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

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