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Individuals needing long term care used to turn to family members. But over the years, families have become smaller, more people are working outside the home, and people are living longer. The result is, there are more people needing long term care and fewer family members available who can provide it. A report prepared by the U.S. Senate Special Committee on Aging described long-term care as follows: “Long-term care encompasses a wide array of medical, social, personal, and supportive and specialized housing services needed by individuals who have lost some capacity for self-care because of a chronic illness or disabling condition. It differs from other types of health care in that the goal of long-term care is not to cure an illness, but to allow an individual to attain and maintain an optimal level of functioning….” The goal, therefore, is to provide a combination of services that are designed to help people remain as independent as possible and for as long as possible. Dr. Marlene Stum, of the Department of Family Social Science, University of Minnesota, is the author of What Is Long Term Care? Understanding the Basics. Dr. Stum explains that “Typical users of long term care have chronic health problems, physical illnesses, or mental disabilities that limit their ability to perform activities of daily living (ADL) or instrumental activities of daily living (IADL).” According to Dr. Stum, ADLs include bathing, dressing, toileting, eating and getting around the house. IADLs include preparing meals, shopping, managing money, using the telephone, doing housework and taking medication. While unpaid family caregivers provide most long term care, other caregivers include professionals such as home health aides, certified nursing assistants, social workers, nurses, occupational therapists and geriatric case managers. According to recent statistics, about 12 million Americans currently need long term care. About 10.2 million are cared for at home. Among those currently turning 65, 69 percent will need some form of long term care whether in the community or in a residential care facility. An estimated additional $306 billion in care will be provided by family and friends. The average yearly cost of a private room in a nursing home is over $78,000 and experts estimate the cost will rise to nearly $207,000 by 2030. According to the experts at Ecumen, provider of a variety of housing and services for seniors, factors that increase your risk of needing long term care services include marital status – single people are more likely to need care. Women are also at a higher risk than men, mostly because they tend to live longer. Your genetic and family health history can impact your need for services and lifestyle also plays a role – poor diet and exercise habits can increase you need for help later in life. Individuals 85 years and older, the oldest old, are one of the fastest growing segments of the population. So the odds are, sooner or later, most of us will need long term care services either for ourselves or our family members. These professional services, however, may be either unavailable or unaffordable. If you decide that it makes sense to insure what you cannot afford, you may begin looking at long term care insurance. How is long term care insurance different than medical insurance? Simply put, medical insurance pays for doctor visits, procedures and hospital stays. For retired individuals, Medicare covers most of these types of costs. People with chronic conditions and long term care needs often rely on Medicaid, but nationally, 75 percent of Medicaid long term care spending for older people and adults with physical disabilities pays for institutional services, with only 25 percent going to the home and community based services that most people want. Long term care insurance can, therefore, give you the option to get needed care at home, thereby helping to keep you out of a nursing home. The time to shop for long term care insurance is before you need it. Waiting may increase the chance of higher premiums and a higher risk of developing a mental or physical condition that may disqualify you. If you are considering a long term care policy, shop around. Your first question will probably be, “how much does it cost,” but when comparing policies, you should also look at factors such as coverage and the rating and stability of the insurance company. Do not allow yourself to be swayed by advertising claims. Long term care insurance policies come in a wide range of costs, coverage and services. Today’s policies generally cover short or long-term nursing home stays and a wide range of home care services, such as skilled or non-skilled nursing care, physical therapy, home making, and the services of home health aides provided by state licensed and/or Medicare certified home health agencies. Some policies may also cover adult daycare, respite care for the caregiver, and other specialized or alternative forms of care. All policies contain limitations and exclusions–otherwise, premiums would become unaffordable. Some exclude coverage for pre-existing conditions for six months, or have other waiting period provisions. Other policies may not cover certain mental and nervous disorders, alcoholism, drug abuse, or an intentionally self-inflicted injury. Many policies will not cover long-term care provided by family members. Don’t forget to check A.M. Best’s ratings to determine the insurer’s financial strength. You want to make sure that if or when you need to file a claim, the company will be around to pay up. When gathering information, be sure to ask about the company’s claims-paying history. You can check with independent insurance agents or find out about the insurer’s complaint record by contacting the state insurance department. If you already have long term care insurance, ask if your policy needs to be updated. You don’t want to discover, for example, that your policy has an outdated requirement for triggering benefits, such as requiring a three-day hospital stay before benefits kick in. Remember, the policy is a legal contract. As with any contract, you should always read the policy and make sure you completely understand it before signing.
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Long Term Care Demystified