Health care or Medicare is very different from long-term care. Why? Health care and Medicare are designed as curative or rehabilitative programs. Not so for long-term care which is custodial care. Custodial care provides assistance with activities of daily living or supervision due to cognitive impairment.
People often think long-term care is only care provided in a nursing home. Today, most long-term care services are provided in one’s own home. Other venues include an adult day care facility, assisted living community, nursing home or hospice facility.
Here is a brief description of each venue as defined by the A Shopper’s Guide to Long-Term Care Insurance published by the National Association of Insurance Commissioners. We’ve added some comments along the way.
Definition: Services in the client’s home. Can include nursing care, personal care, social services, medical care, homemaker services, and occupational, physical, respiratory or speech therapy.
Comments: The majority of home care is non-medical care provided by health care aides. Services also include laundry, routine grocery shopping, meal preparation and cleanup, errands and light housekeeping.
Adult Day Care
Definition: Care given during the day at a community-based center for adults who need help or supervision during the day, including help with personal care, but who don’t need round-the-clock care.
Comment: Usually engaged when family members are the primary caregivers and work or simply need a day to run errands or their own appointments or obligations.
Definition: Alternate care means that an insurer is willing to consider a type or place of care not specifically referenced in the policy. Most commonly, this provision is intended to allow coverage for a future type of care not available at the time the policy was issued.
Comment: We have used this provision on several occasions to request approval of a group home which has fewer residents than assisted living communities. We have always been successful using this provision. A group home is often a better care venue for those with dementia as the ratio of resident to caregiver is very low.
Assisted Living Facility
Definition: A residential living arrangement that provides personal care and health services for people who need help with activities of daily living, but don’t need the level of care that nursing homes give. Assisted living facilities can range from small homes to large apartment-style complexes and can offer various levels of care and services.
Comment: An apartment with concierge service. Accommodations range from studio to two-bedroom apartments. Most have facilities for exercise, dining, movies. Generally, residents need to be ambulatory.
Definition: A licensed facility that provides nursing care to those who are chronically ill or cannot perform one or more activities of daily living. This care is usually needed 24/7 and is ordered by a physician.
Comment: Only about 13% of long-term care takes place in nursing homes today. It tends to be end of life or rehabilitative care following an event like a stroke or a medical procedure like a knee replacement.
Definition: Hospice care entails services designed to provide symptom relief, manage pain, and ease physical, emotional, and social discomfort if terminally ill. Hospice services can be received at home or in a hospice facility.
Comment: In our experience, our clients and their families have found great solace in the services provided by hospice.
Insurance contracts define each venue with more specificity. The vast majority of long-term care insurance products sold today, 99%, are comprehensive policies which means that services are covered in the range of care venues.