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Long Term Care Explained

“Long term care” is a term you might have heard if you’ve ever interacted with the health care system or aging services. You’re going to be hearing it more and more as growing numbers of Americans reach age 65 and the home care worker labor shortage surges to record levels. 

In this post, I’ll break down all the common suffixes that come behind the phrase “long term care.”

Long Term Care as a Service

You’ve been told your loved one needs long term care. When we first hear from a doctor or hospital social worker that our loved one needs “long term care,” it can be daunting. Most of us have no context for what that really means, so our minds go directly to the nursing home. 

The truth is, if your loved one needs long term care, it simply means they need either medical and non-medical care or support. Long term care can be provided anywhere from a few hours a week to 24 hours a day. It can be received in-home or in a facility. 

The MOST important thing for you to know is that there are OPTIONS for long term care. 

Types of long term care 

In-Home CareFacility-based 
Private Duty and Homemaker ServicesCompanion CarePersonal Care Nursing Care and Medical ServicesAssisted Living
Skilled Nursing Facilities (SNFs)Memory Care Facilities 
Nursing Homes

Even if you’ve been told “your loved one will need 24 hour care,” they probably don’t need it right now, and there’s a good chance they may not ever need it. It’s important to avoid making knee jerk reactions without having all the facts and exploring all of the possibilities.

Most of the time, people who require long term care can live long, comfortable lives in their homes, even with significant medical needs.

But it’s not free. Somebody ends up paying for it. 

Long Term Care Financing 

There are a number of ways to pay for long term care. See the chart below for the primary funding sources for our long term care.

Primary Ways of Funding In-Home Care

There are different ways of covering long term care, but they are primarily funded by personal assets and public benefits.

PERSONAL ASSETSFamily caregiversOftentimes, we family caregivers provide the majority – or a large chunk – of our loved one’s support. Sometimes, we are paid through a combination of the funding sources below. Other times, we offer our support “in kind.” Either way, it has significant economic value, so I’m listing it here.
Private pay & personal assetsIf your loved one has a monthly income, retirement, savings, life insurance policies with long term care coverage, an annuity, it is possible to use these assets to finance your loved one’s care.
Long Term Care InsuranceLong term care insurance is something you purchase that has a daily benefit that can pay for your long term care needs. All long term care insurance policies and providers are different and have different coverage, policies, and procedures.

Medicaid, Older Americans Act Funding, and other Tax-Payer Funded Benefits

Medicaid is the insurance system for those living in poverty in America. It also funds a huge chunk of long-term care for millions of Americans who would otherwise not be able to afford it. Medicaid policies and what’s covered varies from state to state. Waiver programs are often the primary source of funding long term care in this case. The Veteran’s Administration also offers help for in-home care for our service members.
Coming Soon: MedicareMedicare Advantage plans will start covering non-medical, in-home care with the goal of improving well-being and preventing illness and injuries that lead to costly hospitalizations and nursing home placement. It does not, however, cover 24-hour care or skilled nursing care.

Chart from the HCIC Handbook, page 12.  

Long Term Care as a System 

The Long Term Services and Supports (LTSS) system is a term that is also frequently used, especially in state and federal programs and policy. In our country, the system for offering long term care to those who qualify based on medical and financial criteria is mostly tax-payer funded through Older American Act funds and Medicaid. This system funds in-home personal assistance and medical services to millions of Americans, both living in their homes as well as in facilities. In-home assistance may be agency based or it may be “consumer directed.” In some places and situations, Medicaid will only cover institutional care (in a nursing home or “skilled nursing facility” (SNF)).

Beyond the scores of Americans that rely on tax-payer funded benefits, people with disabilities and mental health issues also access this system for help. 

Despite the fact that this system gets a lot of attention when talking about policies and practices regarding long term care, in most cases it serves only a small fraction of all people who are in need of long term services and supports. 

Long Term Care as a Field

The Long Term Care field or sector is an amalgamation of health care, senior living, and marketplace services. This sector has seen a huge boon since our parents’ generation came on the scene. 

It includes senior living chains, hospice and healthcare providers, home care agencies, medical corporations, and pharmaceuticals. Tech companies are hopping on the bandwagon. It is a multi-billion dollar industry, only growing in size to cater to the growing older population.

This industry, which has seen rapid growth and change from the time our parents came on the scene, however, is quickly growing out of reach of many Americans, as we face inflating healthcare costs, astronomical long term care insurance policies, tough economic times… and the path forward looms with uncertainty. 

Many people are afraid they won’t be unable to afford long term care services from the marketplace.

The Real Long Term Care Providers of America

Most people are supported by their families in their communities. *WE* are the long term care system of America.

We are so busy looking toward the future we aren’t actually preparing for it. We avoid it because we don’t want to be uncomfortable. We assume it’s somebody else’s responsibility. We tell ourselves the government will come up with a solution. We convince ourselves by the time x happens, technology will y…

It is up to us to make sure that our loved ones receive the care they need and deserve when the time comes. Whether you are directly providing it or just overseeing it, if you have an aging loved one, chances are, at some point you will be the one responsible for their long term care.

Noticed I haven’t mentioned Medicare in this post?

That’s because, until recently, Medicare hasn’t covered long term care. Recent changes have made provisions for select Medicare plans to offer in-home care, but it’s limited in terms of how many hours a person can receive. With all of the worries about Medicare’s future, I wouldn’t put my chips on it as a resource for long term care. Currently, it’s set up only to cover health care services, and the only in-home care it truly covers is temporary home health care after a hospital discharge.

If you’ve been told your loved one needs long term care, or you heard the term and are worrying about when it will happen to someone close to you, it’s important to start talking about it now! 

For things you want to get clear on if a loved one is getting old, check out my Coming Out from the Rock series. 

Graphic: presents: COMING OUT FROM THE ROCK: Tough Conversations and Hard Questions