Key Point: Know What Is and What Is Not Long Term Care

As folks age it is common to need assistance with daily activities or ongoing medical care, which is often performed by family. This includes routine matters like shopping, house cleaning, yard maintenance and managing ongoing medical care. A person could assume that all assistance an elder needs is “long term care.” It is not. While all elders need some help, there are professional advisors who imply all healthy retirees must plan for their elder years in a nursing home.

This guide will help clarify what is long-term care and what is not. Knowing the difference matters for your planning, finances, and well-being.

What IS Long-Term Care?

Long-term care (LTC) means a person needs assistance with two or more activities of daily living (ADLs) plus assistance with Instrumental Activities of Daily Living (IADLs) for a period of years.

A study published in April 2019 by the Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-term Care Policy found:

Only 24% of older adults receive more than 2 years of paid LTC assistance in their own residence and Medicare paid setting such as a hospital or short-term stay in a skilled nursing rehabilitation facility
Only 15% spend more than 2 years in a nursing home.

Key Characteristics of Long Term Care (LTC)

1. Assistance with Activities of Daily Living (ADLs) LTC provides daily assistance with two or more ADLs:
2. Bathing and showering
3. Dressing
4. Getting in or out of bed or a chair
5. Using the toilet
6. Eating
7. Walking or mobility
Support with Instrumental Activities of Daily Living (IADLs) These are more complex day-to-day tasks including:
- Managing medications
- Preparing meals
- Housekeeping and laundry
- Managing finances
- Shopping for groceries or other necessities
- Transportation
- Using communication devices
Extended Duration True long-term care typically lasts for at least 90 days and often continues for months or years.
Non-Curative Focus Long-term care focuses on maintaining quality of life and functioning rather than curing a specific medical condition.

Types of Long-Term Care Services

1. 1. Home-Based Care
    - Home health aides
    - Personal care assistants
    - Homemaker services
    - Adult day care centers
    - Meal delivery programs
  2. Community-Based Care
    - Adult day services
    - Transportation services
    - Senior centers
  3. Facility-Based Care
    - Assisted living facilities
    - Nursing homes
    - Continuing Care Retirement Communities (CCRCs)
    - Memory care units (for dementia or Alzheimer’s patients)

What is NOT Long-Term Care?

Understanding what doesn’t qualify as long-term care is important for proper planning and expectations.

Medical Care That Is Not Long-Term Care

Medicare and health insurance such as through a Medicare Advantage plan do not provide LTC. They cover routine medical and “Acute Care.”

1. Acute Hospital Care
  - Short hospital stays for surgeries, treatments, or emergency care
  - Intensive care unit (ICU) stays
  - Emergency room visits
2. Long Term Conditions Managed In Home
  - Diabetes
  - Hypertension
  - Chronic Obstructive Pulmonary Disease
3. Rehabilitative Services (When Short-Term)
  - Physical therapy after surgery
  - Occupational therapy
  - Speech therapy
  - Inpatient rehabilitation that lasts less than 90 days
4. Outpatient Medical Care
  - Regular doctor visits
  - Specialist consultations
  - Diagnostic tests and lab work
  - Outpatient procedures
5. Preventive Healthcare
  - Vaccinations
  - Health screenings
  - Wellness check-ups

Other Services Not Considered Long-Term Care

1. 1. Independent Living Communities While these communities cater to seniors, they don’t typically provide assistance with daily activities and are designed for fully independent individuals.
  2. Retirement Villages Communities designed for active seniors do not include necessary components of LTC.
  3. Short-Term Home Help Medicare paid temporary assistance following an illness or injury that lasts less than 90 days.
  4. One-Time Home Modifications Installing grab bars, ramps, or other accessibility features without ongoing care services.

Why Knowing the Difference Matters

Financial Implications

1. 1. Insurance Coverage
    - Medicare generally does NOT cover long-term care services
    - Medicare covers acute hospital care, some skilled nursing care (for a limited time), and some home health services (when medically necessary)
    - Medicaid covers long-term care, but only after strict financial eligibility requirements are met
    - Long-term care insurance covers many long-term care services that other insurance doesn’t, but it depends on your particular policy
  2. Out-of-Pocket Costs
    - Long-term care is expensive, with nursing homes averaging $80,000-$150,000+ per year
    - Home care services average $20-$30 per hour
    - Assisted living facilities average $4,000-$8,000 per month

Planning Considerations

1. 1. Do You Have a Nursing Home Medical Condition? LTC in a nursing home is commonly the result of a Medical condition such as Alzheimer’s Dementia, Parkinson’s Disease
  2. Reflect On Your Family History Does LTC “run in your family”? Did your parents, grandparents or aunts and uncles receive LTC in a nursing home?
  3. LTC Disease Risk or a deteriorating condition that may result in LTC. If you have such conditions, start planning for possible LTC now.
  4. Legal Documents: Since all retirees should plan for assistance in their elder years, all should consider
    - Advance directives
    - Durable Power of attorney for healthcare
    - Durable Power of attorney for finances
  5. Medicaid Planning If you have a LTC condition or a family history that indicates LTC, investigate Medicaid Planning. A “Medicaid Asset Protection Trust” should be considered.
  6. Family Discussions Knowing what constitutes LTC enables productive conversations with family members about future care preferences and responsibilities.

Common Misunderstandings About Long-Term Care

1. 1. “Medicare will cover a long term nursing home stay.” Reality: Medicare covers only short-term skilled nursing facility stays (up to 100 days) following a qualifying hospital stay, not ongoing long-term care.
  2. “My family will take care of me.” Family provides care for all elders. But the daily time, physical, emotional, and financial toll of LTC exceeds the ability of unpaid family members.
  3. “I will not be able to pay for LTC when I need it.” It is possible to have Medicaid pay for a significant portion of LTC by Crisis Planning. However it is better to plan for it when the future need is apparent.

Planning for Long-Term Care

1. 1. Start Early Begin thinking about and planning for potential long-term care as a part of retirement planning.
  2. Explore Care Components
    - Home Care
    - Family Care
    - Senior Apartments
    - Assisted Living
    - Nursing Homes
  3. Explore Financing Options
    - Available savings
    - Long-term care insurance
    - Hybrid life insurance policies with long-term care benefits
    - Health savings accounts (HSAs)
    - Home equity options
    - Medicaid planning (with professional guidance)
  4. Maintain Your Health Stay physically active, eat nutritiously, manage chronic conditions, and engage in mentally stimulating activities to potentially delay or reduce long-term care needs.
  5. Create a Care Plan Document your preferences for care, living arrangements, and end-of-life decisions. Get your family onboard with your plans.

Resources for More Information

1. - Area Agencies on Aging: Local offices provide information about services in your community
  - National Institute on Aging: www.nia.nih.gov/
  - National Council on Aging: www.ncoa.org
  - Medicare.gov: Official U.S. government site for Medicare information
  - Eldercare Locator (1-800-677-1116): A nationwide service that connects older Americans to local services

Conclusion

Understanding what qualifies as long-term care—and what doesn’t—is essential for proper planning. While many seniors will need some form of long-term care, many will not. Be informed about your options. plan ahead and ensure you receive appropriate assistance that respects your preferences and protects your financial security. Meeting the challenges of aging requires informed action. Maintain your independence with coordination of your family and financial assets.