What is long-term care? Will your health insurance cover it?

Long-term care is care for people that have chronic conditions that show little or no progress. This could be medical care or non-medical care. Here’s an example… A man is driving, collides with another vehicle, but he survives. However, he is paralyzed. He will need LTC. His health insurance cannot be relied upon to pay for this LTC because, sadly, paralyzed people rarely show any progress of getting better.

Long-term care can be received in your home, at a nursing home, or at an assisted living facility. It can include medical care such as diabetes testing. It can also include non-medical care (also called custodial care) such as help with eating, dressing, bathing, and using the bathroom. The custodial care services can be delivered by non-medical personnel such as a wife, husband, relative or neighbor. The medical services will be provided by professionally trained medical personnel.

Long-term care is not just for old people. Young people can have accidents and need care. Do you remember Christopher Reeve? He was paralyzed in a horseback riding accident at the age of 43. He needed LTC. Michael J. Fox battled Parkinson’s disease for almost a decade before he retired from Spin City. He retired at the age of 38. He must have entered the first stages of Parkinson’s disease in his late 20’s!

Does health insurance cover long-term care? Not quite. Remember the person in the car accident I mentioned above. He couldn’t dress, feed, or bathe himself. Health insurance doesn’t cover having someone come to your home and help you dress every morning. It doesn’t pay for someone to be at your house to help you use the bathroom every time you need to go. In short… it doesn’t cover long-term care needs.

Medicare can’t be relied on to pay for long-term care needs. Most people think it will provide coverage. But Medicare is health insurance, not long-term care insurance. It will pay for some long-term care, such as skilled nursing for the first 100 days. But after 100 days, it’s done. And there are specific criteria that must be met to qualify for that coverage. If the criteria are not met, you’ll pay for the care out of your pocket.

Most people think of nursing homes when they think of long-term care. Most people will never go into a nursing home. This is not where the majority of long-term care happens. Most happens in the home. Most is administered by unpaid caregivers such as wives, husbands, and relatives. Most of the caregivers are financially and emotionally stressed out from the care giving.

Long-term care is not just nursing home care. The same is true of long-term care insurance. It is not just nursing home insurance. It helps you stay out of the nursing home. It helps the stressed-out, caregiver spouse by providing funds to hire additional home care services.

There are misconceptions of what long-term care and long-term care insurance is. These misunderstandings can cause serious problems when a person needs help. The wife realizes too late how hard it will be to care for her husband. An elderly woman discovers that Medicare will not pay for most of her custodial needs, such as bathing, dressing, and eating. A daughter finds out she must quit work to care for her father-in-law who can’t care for himself. A man spends down his assets on his care needs before qualifying for Medicaid, thus depleting the inheritance he was going to give to his children.

These situations will never be easy to face. But they can be prepared for if we take action early. Being informed is the key. If you are reading this blog, you have taken the first step.