Long-term care involves a wide variety of services for people with a prolonged physical illness, disability or cognitive disorder (such as Alzheimer's disease). Long-term care is not one service, but many different services aimed at helping people with chronic conditions compensate for limitations in their ability to function independently. The major difference between traditional medical care and long-term care is that long-term care attempts to help a person maintain his or her level of functioning and the ability to perform the normal activities of daily living (ADLs). Traditional medical care, on the other hand, attempt to correct or rehabilitate a certain medical condition or problem. Long-term care services could include assisting the patient with daily activities in the home, such as bathing, eating, or dressing. Care could also be outside the home in the form of respite care, adult day care, or care in a nursing home.

Persons with physical illnesses or disabilities often need hands-on assistance with activities of daily living such as dressing, eating, toileting, or getting from one place to another, as mentioned above. Persons with cognitive disabilities often need supervision, protection from self-inflicted injuries, or verbal reminders to accomplish simple everyday activities.

Each day, treatments and care for long-term illnesses and disabilities are changing for the better. New drugs, as well as new technologies, are creating a more comfortable and helpful environment available to our health care providers. But still today, the care can be broken down into two general categories: Skilled care and Personal care.

Skilled care is that care which is provided by skilled medical personnel, such as nurses, physical therapists, speech therapist, dietitians, or doctors. This care is usually provided in a nursing home on a 24 hour basis, is ordered by a physician, and is part of a treatment plan. Please note that Medicare and Medicaid have their own definitions of skilled care. We offer a link to the insurance department where you can order guide books for more information.

Personal care , also know as custodial care, assists a person in performing activities of daily living referred to as ADLs. ADLs include bathing, eating, dressing, toileting, continence and transferring. These areas of assistance do not usually require a medically skilled person and are performed in different settings, such as a nursing home, day care center, or at home.

Both skilled and personal care can be provided in different settings. As you begin to evaluate different long-term care insurance policies, you will hear about nursing home, rehabilitation centers, adult day care centers, assisted living facilities, and home care agencies such as the VNA. For many of us that have had loved ones in need of long-term care, an assortment of these facilities and services have have had their place in the treatment process at some point or another.
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The cost for Long-term care depends on the type of care needed, how long care is needed, and the setting in which the care is provided. There are many different brochures on Long-term care floating around out there that will tell you the average cost of care in a nursing home is $40,000. But those figures are the national average, and they do not reflect accurately the cost of care in Connecticut, New Jersey, Massachusetts, New York, or other northeast states where the cost is much higher than $40,000 per year. For example, my mother was a a health and rehabilitation center in East Hartford, Connecticut that charges $200 per day, or $73,000 per year. Although this center have my mother great care, it is not by any means located in an affluent area or filled with extraordinary frills. In the more affluent town of Glastonbury, which is one town away, a similar center charges $247 per day, or over $90,000 per year.

If you were to utilize adult day care, where the patient is dropped off and picked up each day during work hours, the cost would also be relatively high. In Connecticut, where this website is being designed, adult day care averages $50 per day, or $1,500 per month. You would have to weigh the benefits of freeing up the member of the family that is the caretaker so that that person can work, and the cost of the day care center. In some cases, such as with Alzheimer's, it is nearly impossible to care for the patient 24 hours a day without suffering mental illness or exhaustion oneself.

The cost of home health care is also expensive, depending on the types of treatments and the frequency of the care. Again using Connecticut, if one needed to have two skilled nursing visits per week, along with two visits each from a physical therapist, an occupational therapist, and a speech therapist, the bill would come to about $3,500 per month. You could incur additional expenses for equipment and home modifications.
                                                                                
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Nationally, approximately 41% of the cost for LTC (long-term care) is paid for out-of -pocket by individuals and their families. About 45% are paid for by Medicaid programs (medical welfare) which usually require the patient to be impoverished before qualifying. Long-term care expenses are usually not covered by Medicare, Medicare Supplements, or the Medical Insurance Policy provided by most employers. The portion of LTC expenses paid by Medicare is only around 7%. So yes, a 38 year old who suffers a stroke or aneurysm that requires long-term care would end up paying out of their own pocket, or by qualifying for Medicaid by basically becoming broke. Your HMO at work does not pay for custodial care. Medicare will pay for certain "skilled care" which is an intensive level of care furnished during a brief convalescent period after an acute care stay in a hospital. Medicare does not cover homemaker services.

Just over 7% of all LTC expenses are paid for by LTC insurance policies purchased by the patient before the care was needed. That percentage increases each year, buy not as quickly as it should. If we are to avoid a long-term care expense crisis that will surely hit the baby boomer, as with medical and life insurance, we are going to have to pool our premiums so that no one person will be financially destroyed. But LTC insurance is not the easiest the easiest thing to sell. Most people do not wish to discuss the possibility of them needing long-term care. LTC insurance is also pricey after the age of 60 years old or so. But relatively speaking, the premiums work harder than most other types of insurance products. The fact is that LTC policies are an integral part of any risk management plan. And without a risk management plan, you can not have what would be considered a strong financial plan.

Because there are so many different programs, conditions, and changes that occur within the Medicare and Medicaid programs, we advise you to consult with us, or a professional of your choice that specializes in this area, in order to obtain adequate information as to who will pay for what when it comes to long-term care expenses. Plenty of information is available from your State Insurance Department, or the National Association of Insurance Commissioners.
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Here are some additional resources available to those interested in learning more about Long-Term Care, Long-Term Care Insurance Policies, and Providers of Long-Term Care Support. Just click on the blue text to be transferred to those sites.

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