For South Carolina Teachers, State Employees & State Retirees
United LTC
For South Carolina Teachers, State Employees & State Retirees

The Basics of Long Term Care

Long term care is unlike other forms of medical care. It includes a wide range of medical and support services in a variety of settings. This section will help you fully understand the basics of long term care.

What is Long Term Care?

Long term care is defined as the care that you need if you can no longer perform everyday tasks by yourself due to a chronic illness, injury, disability, or the aging process. Long term care also includes care that may be needed if you were to suffer a severe cognitive impairment, such as Alzheimer's disease.

Long term care is not acute care and it is not intended to cure you. Long term care is chronic care that you may potentially need for the rest of your life. You can receive long term care services in a variety of places, including in your own home, in a nursing home, or in an assisted living facility.

Long term care is not short term medical care or disability care. Additionally, long term care is not:

Who needs Long Term Care?

At any point in your life, you could require long term care. You could be involved in an automobile accident. You could suffer a sports injury. You could have a disabling event like a stroke. You could have a brain tumor or you could suffer a spinal cord injury. Disabling illnesses like Multiple Sclerosis and Parkinson's disease are also examples of ailments that can require long term care. Of course, this list is not fully inclusive, but the fact remains that a long term care event can happen to anyone at any age.

A long term care event can truly happen at any time. Approximately 40% of long term care services are provided to people under the age of 65 who need help taking care of themselves due to diseases, disabling chronic conditions, injury, developmental disabilities, and severe mental illness.

Roughly 70% of people turning age 65 are going to need long term care services at some point in their lives. Many people are not aware that Medicare and private health insurance programs do not pay for the majority of long term care services. In order to get the care you might need, it is essential to put a long term care plan in place.

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Where would I receive Long Term Care services?

Long term care is most often provided at home or in assisted living facilities. Long term care is also provided in nursing homes.

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Who provides Long Term Care?

Family members and friends provide most long term care services. Long term care services can also be provided by unlicensed caregivers who are not arranged or supervised by a home care agency. These types of long term care are considered informal care. Long term care is also provided by trained professionals. This type of formal care is often provided by a home health aide or by a homemaker arranged or supervised by a home care agency. Formal care can also be provided by a nurse or therapist.

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How costly is Long Term Care?

The cost of long term care varies greatly. Many factors contribute to a long term care cost determination, including the type of care that you receive, the place where the care is provided, and the region where you receive your care.

Geography has a large impact on long term care costs. For home care, the average hourly cost can range anywhere from $15 per hour in Montgomery, Alabama, to $24 per hour in Hartford, Connecticut. Nursing home care costs can also vary dramatically by geography. For example, nursing home costs for a semi-private room can vary from $148 per day in Shreveport, Louisiana, to $462 a day in New York City.

Most people prefer to receive care in their home. While home care is generally more affordable than nursing home care, it still can be quite expensive. On average, the cost of a six hour visit by a home health aide is $114. If that same home health aide visits six hours per day, five days a week, the total annual cost would be $29,640 and costs can rise dramatically if full time, around-the-clock care is needed.

When family members provide home care, it is harder to estimate costs. The family member may have to leave work. Perhaps the price is paid in emotional stress. In any event, these costs don't show up in economic statistics.

To see the cost of care in your area, CLICK HERE

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Does my health insurance or disability insurance cover the costs of Long Term Care?

While health plans may cover some of the skilled medical services you may need when you cannot care for yourself after an illness or injury, such coverage is usually only available for a limited period of time. Health plans typically do not cover ongoing chronic care. Things like an extended stay in an assisted living facility or nursing home or prolonged usage of a home health aide would generally not be covered by your health plan.

Disability income insurance is designed to replace a portion of the income you lose if you are unable to work due to accident or injury. Disability income insurance will not provide additional benefits to specifically pay for long term care expenses.

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Does Medicare cover Long Term Care costs?

Medicare is not available to everyone. Generally, Medicare is available for people age 65 or older, people with disabilities, and people with end stage renal disease (permanent kidney failure requiring dialysis or transplant).

Medicare does not cover most long term care expenses over a long period of time. For each benefit period, Medicare will only cover the first 100 days of care in a nursing home, provided that you:

  1. Are receiving skilled care; and
  2. Have a qualifying hospital stay of at least three days; and
  3. Enter the nursing home within 30 days of that hospital discharge.

You would also be responsible for a portion of the costs, via deductibles and your co-pay. For additional information on Medicare, please visit ww.medicare.gov.

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How do I pay for Long Term Care expenses?

Self Pay

You may consider using your savings to cover long term care expenses. However, keep in mind that even the most well laid out plan is subject to unexpected challenges. Consider that, in 2013, the average cost of a semiprivate room in a nursing home was approximately $83,000 per year. Now consider the total cost if you need more than one year of care. For example, for three years of care, the cost would be approximately $249,000.

Keep in mind that there is no way to know whether or not you will need long term care before you have saved the appropriate amount to cover the cost. Unexpected events can eat away at the money that you may have earmarked for long term care expenses.

Long Term Care Insurance

Long term care insurance is a reliable method of paying for long term care expenses. In the section titled The Basics of Long Term Care Insurance, you can learn more about long term care insurance.

LTC Myth #3: Medicare or Medicaid Will Cover My Bills

Generally, Medicare is only available for people over the age of 65 and for the disabled. Medicare only pays limited amounts for skilled care following a hospital stay. Medicare covers some home health care for the treatment of an illness or injury. Medicare is not intended to cover long term care. Read more about Medicare at www.medicare.gov.

Medicaid is a state-based program supplemented by federal funds. Medicaid provides health services to the poor and impoverished. You may be eligible for Medicaid if you meet your state's poverty criteria and if you receive care that meets your state's guidelines.

Many people attempt to "spend down" their assets to state required levels. Additionally, many people try to transfer their assets to family members so that they can become eligible for Medicaid. However, such transfers are often ineffective, as states now have the authority to examine a Medicaid applicant's past five years of finances and to impose penalties. Since each state has different Medicaid requirements, be sure to contact your local state Medicaid office should you need to do so. Read more about Medicaid at www.medicaid.gov.

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