As we age, planning for our health and well-being becomes increasingly important. For many people, this means thinking about the possibility of needing long-term care at some point in the future. Long-term care can provide valuable support to help you maintain your independence and quality of life as you age, but it can also be expensive and complex to navigate
As an elder lawyer, I understand the importance of planning ahead for long-term care. In this article, I will explain what long-term care is, why it is important, and discuss the various types of long-term care that are available. We’ll also go over the costs of long-term care and the various options for financing it, including Medicare, long-term care insurance and Medicaid.
So if you’re concerned about the future and want to ensure that you have a plan in place for long-term care, read on to learn everything you need to know to make informed decisions about your health and well-being.
1. What is Long-Term Care?
Long-term care is a variety of services that help individuals with chronic illness or disability to meet both medical and non-medical needs since they cannot perform daily activities or care for themselves. Long-term care is usually for long periods but there is also temporary long-term care that only provides care for a few weeks or months. Temporary long-term care is mainly offered to individuals recovering from injury, illness, or surgery. People who are looking for rehabilitation from a hospital stay can opt for temporary long-term care as well as those with terminal medical conditions. On the other hand, ongoing long-term care is care provided for longer periods (months or years) to individuals who need help with activities of daily living. If an individual is suffering from a chronic medical condition, permanent disabilities, dementia, or chronic severe pain, there is a need for supervision through ongoing long-term care. Long-term care services may be provided in any of the following settings:
- In the home of the recipient
- In the home of a family member or friend of the recipient
- At an adult day services location
- In an assisted living facility or board-and-care home
- In a hospice facility
- In a nursing home
Long-term care services are generally divided into two categories: home and community-based services, which include care provided in a person’s home or community setting, and institutional services, which are provided in nursing homes, and other institutional settings.
2. What Are the Different Types of Home and Community-Based Long-Term Care Services?
There are various types of home-based long-term care services available. While different types of home care serve different needs, they all share one goal: to help people receive care and live happier, more independent lives while also providing support and peace of mind to their families. Care is tailored to your specific requirements and may include one or more of the following types of home-based long-term care services:
- Home Health Care: This type of care is provided by medical professionals, such as nurses, physical therapists, and occupational therapists, who come to the senior’s home to provide medical services and support.
- Personal Care Services: These services help seniors with daily tasks such as bathing, dressing, and meal preparation. Personal care services may be provided by a family member, friend, or a professional caregiver. In New York, many family members join Consumer Directed Personal Assistance Program (CDPAP) to get paid for the personal care services they provide to the seniors.
- Homemaker Services: These services are designed to help seniors with household tasks such as cleaning, laundry, and grocery shopping.
- Home-Delivered Meals: For seniors who have difficulty cooking or shopping for groceries, home-delivered meals can provide a nutritious and convenient option.
- Transportation Services: Many seniors may require transportation to medical appointments, grocery stores, or other destinations. Transportation services can provide a safe and reliable way for seniors to get where they need to go.
- Adult Day Care: This type of care provides social and recreational activities for seniors during the day, while also offering necessary medical and personal care services.
- Assisted Living Programs: Assisted living is a residential option for seniors who need help with daily tasks, but do not require the level of medical care provided in a nursing home. Assisted living programs typically offer meals, housekeeping, medication management, and social activities in a communal setting.
- Skilled Nursing Care at Home (Long-Term Home Health Care Program (LTHHCP) in New York) : For seniors who require advanced medical care, skilled nursing care at home can be an option. This type of care is provided by registered nurses, licensed practical nurses, and certified nursing assistants who come to the senior’s home to provide medical services and support.
3. Long-Term Care Facilities
While many seniors prefer to receive long-term care services at home, there may come a time when more specialized care is needed. In these situations, institutional long-term care options may be necessary. These options can provide 24-hour medical care and support, as well as access to social and recreational activities.
One common institutional long-term care option is a nursing home. Nursing homes are residential facilities that provide skilled nursing care and medical supervision for seniors who require more intensive care than can be provided at home or in an assisted living program.
Nursing homes typically offer 24-hour medical care, medication management, rehabilitation services, and social activities.
When considering institutional long-term care options, it’s important to research and compare different facilities to find the best fit for the senior’s unique needs and preferences. Factors to consider include the quality of care provided, the availability of medical services, the staff-to-resident ratio, and the facility’s amenities and activities.
The cost of institutional long-term care must also be considered. To determine coverage options, check with your state’s Medicaid program or other insurance providers.
4. Does Medicare Pay for Long-Term Care?
Medicare is a federal health insurance program that provides coverage to people aged 65 and older, as well as people with certain disabilities and chronic conditions. Medicare is divided into several parts, each of which covers different types of medical services:
- Part A covers inpatient hospital care, skilled nursing care, hospice care, and some home health care.
- Part B covers outpatient medical services, such as doctor visits, diagnostic tests, and preventive care.
- Part C, also known as Medicare Advantage, is a program offered by private insurance companies that provides coverage for Parts A and B, as well as additional benefits.
- Part D provides prescription drug coverage.
While Medicare covers many medical services, it does not typically cover long-term care. This means that if you require long-term care services, such as assistance with daily activities, custodial care, or nursing home care, you will likely need to pay for these services out of pocket or through other means, such as Medicaid, long-term care insurance, or personal savings.
However, there are some limited circumstances in which Medicare may cover long-term care. For example, if you require skilled nursing care in a nursing home following a hospitalization, Medicare Part A may cover up to 100 days of skilled nursing care in a nursing home, but only the first 20 days are covered in full. For days 21-100, there is a daily coinsurance payment that the patient is responsible for, which is currently $200 per day in 2023. Additionally, some home health care services may be covered if they are medically necessary and provided by a Medicare-certified home health agency.
It’s important to note that Medicare coverage for long-term care is limited and often only covers a portion of the cost. If you require long-term care services, it’s important to explore all of your options and consider purchasing long-term care insurance or planning for these costs in advance.
5. Medicare vs Medicaid
Medicare and Medicaid are both federal government-run health insurance programs, but they are designed to serve different populations and cover different types of services. One key difference between the two programs is their coverage for long-term care.
Medicare provides limited coverage for long-term care, typically only covering short-term stays in a skilled nursing facility following a hospitalization as we discussed previously. Medicare does not cover custodial care or ongoing assistance with daily activities, which are common long-term care needs.
In contrast, Medicaid covers a broader range of long-term care services, including nursing home care, home health care, and personal care services. Medicaid is a joint federal-state program that is administered by the states, so coverage and eligibility requirements may vary from state to state.
For people under 65 years old who are eligible for Medicaid based on their Modified Adjusted Gross Income (MAGI), long-term care coverage is limited. However, for people over 65 years old and people with disabilities who are eligible for Medicaid based on their income and assets, Non-MAGI Medicaid may provide coverage for nursing home care and other long-term care services.
It’s important to note that Medicaid eligibility requirements are complex, and may vary depending on the state you live in. In general, to be eligible for Medicaid, you must meet certain income and asset requirements, as well as other eligibility criteria based on your age, disability status, and other factors.
6. What is Long-Term Care Insurance?
Long-term care insurance is a type of policy designed to cover the costs of long-term care services. The policies can vary widely in their coverage options and costs, and may be purchased through private insurance companies or through an employer.
One of the primary benefits of long-term care insurance is that it can help protect your assets and savings from the high costs of long-term care. With the average cost of a private room in a nursing home exceeding $100,000 per year, long-term care expenses can quickly deplete your savings and put a strain on your finances. Long-term care insurance can help you pay for these expenses and ensure that you receive the care you need without having to rely on government programs or other forms of financial assistance.
Additionally, long-term care insurance provides flexibility in choosing the type of care you receive and where you receive it. Unlike Medicare and Medicaid, which may have limitations on the types of care covered and the providers you can see, long-term care insurance policies typically allow you to choose the care setting and providers that best meet your needs and preferences. This can provide greater autonomy and control over your long-term care experience.
Long-term care insurance, however, has some potential drawbacks. One of the most significant disadvantages is that it can be costly, particularly if you wait until you are older or have pre-existing medical conditions to purchase a policy. Long-term care insurance policies can also be complicated, with a variety of exclusions, limitations, and waiting periods before benefits are paid out.
Another disadvantage of long-term care insurance is that it may not cover all of your long-term care requirements. Some policies, for example, may exclude certain types of care, such as care provided by family members or alternative therapies. Furthermore, some policies may restrict the length of coverage or the amount of benefits that can be paid out, which may not be enough to cover all of your long-term care costs.
Long-term care insurance can be an effective way to help pay for the high costs of long-term care, but it’s critical to carefully weigh the benefits and drawbacks before purchasing a policy.
7. What is Medicaid Planning (or Long-Term Care Planning)?
Medicaid planning is a legal strategy used to help individuals and families prepare for the high costs of long-term care by qualifying for Medicaid coverage. Medicaid planning typically entails taking steps to protect assets and income while remaining Medicaid eligible.
Medicaid is the primary source of funding for long-term care services for many older adults and people with disabilities, but eligibility requirements can be complex and vary by state. In general, to be eligible for Medicaid, you must meet certain income and asset requirements, as well as other eligibility criteria based on your age, disability status, and other factors.
Medicaid planning may involve a range of legal and financial strategies, such as:
- Asset protection planning, which involves transferring or repositioning assets to protect them from being counted toward Medicaid eligibility requirements.
- Income planning, which involves structuring income sources to maximize eligibility for Medicaid.
- Trust planning, which involves setting up trusts to protect assets and income from being counted toward Medicaid eligibility requirements.
- Medicaid-compliant annuity planning, which involves purchasing annuities that can help convert countable assets into a stream of income that does not count toward Medicaid eligibility requirements.
When done sooner rather than later, Medicaid planning can provide families with more options for protecting assets and income. It is also important to work with an experienced elder lawyer who can help you navigate the complexities of Medicaid planning and ensure that your planning strategies are legally sound and financially beneficial.
8. What is Elder Law and What Does an Elder Law Attorney Do?
Just as the name implies, elder law is a field of law that deals with special legal issues which affect the elderly. Most people assume that elder law only helps those with complex life situations like disabilities or unique needs, a second marriage, or financially reckless adult children. Even though the field mostly handles cases of seniors in such situations, it is important for every senior to be familiar with elder law and sign up with an experienced attorney when required so as to shield themselves and their assets from any unexpected circumstances in their golden year’s yonder.
Many elder law attorneys handle various legal matters that affect an older person or someone with a disability, which includes issues in relation to health care, long-term care planning, guardianship, retirement, social security, Medicare/Medicaid, and any other issue that is important to the elderly. They can advise you on important legal documents like wills, trusts, powers of attorney, and advance directives. Furthermore, an elder law attorney can provide advocacy and representation in cases involving elder abuse, neglect, and exploitation.
Working with an experienced and knowledgeable elder law attorney who can provide tailored advice and guidance based on your specific needs and circumstances is critical. You can ensure that your legal and financial affairs are in order and that you are prepared for the challenges and opportunities that come with aging by working with an elder law attorney.
Conclusion
Navigating the long-term care system can be overwhelming and confusing, especially for those who are new to the system. Long-term care services come in a variety of forms, each with its own set of eligibility requirements, costs, and payment options.
Here are some tips when you or your loved one requires long-term care.
- Start planning early: It’s important to start planning for long-term care needs as early as possible. This can help you understand the options available and make informed decisions.
- Understand eligibility requirements: Each type of long-term care service has its own eligibility requirements. It’s important to understand these requirements and plan accordingly.
- Know your payment options: Long-term care services can be expensive, and it’s important to understand your payment options. Some options may include private insurance, Medicare, Medicaid, or personal funds.
- Consider working with an elder lawyer: Working with an elder law attorney can help you navigate the complexities of the long-term care system and ensure that you are making informed decisions.
Do you have any legal questions about long-term care 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.