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Family Health

2011-04-01 13:55:00

Long term care and how one pays for it - series

Question: What all comprises long term care? How does one go about paying for it? Does Medicare and Medicaid help?

Answer: That’s a wonderful question and one that I am asked quite often. Let me start with the types of long term care. I will answer your question on paying for these types of care and the role of Medicare and Medicaid once we cover them in a detail. Community Based Services: Many communities provide services and programs to help seniors and people with disabilities with a variety of personal activities. These services include Meals-on-Wheels, transportation services, personal care, chore services, adult day care and a variety of activities in senior centers. These services are usually free or at low cost to individuals who qualify. Local organizations, called Area Agencies on Aging, coordinate these services to promote the independence and dignity of older adults. Your State Medicaid program may pay for home health services including skilled nursing care, home health care, personal care, chore services and medical equipment. You must qualify for Medicaid to receive these services. We will discuss this in detail later. The following community-based services may be available in your community: • Adult day care • Senior centers • Financial management • Transportation • Meals on Wheels • Telephone reassurance • Case management Home Health Care Depending on your needs, you may be able to get help with your personal activities (for example, help with the laundry, bathing, dressing, cooking and cleaning) at home from family members, friends or volunteers. If you think you need home care, talk to your family to see if they can help with care or help arrange for someone to come to your home to help. Some home care can only be given by licensed health workers, such as if you need skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse) or a licensed therapist. You can also hire a home health care agency for care in your home. Home care costs can vary depending on where you live, the type of care you need and how often you need care. Usually, home care is charged by the hour. The following home health services may be available in your community: • Skilled nursing care • Homemaker/Health aides • Personal care aides • Respite care • Medical equipment • Home repair and modification • Hospice In-Law Apartments An in-law apartment is a separate housing arrangement within a single-family home or on your lot. It may also be referred to as a second unit, accessory apartment or accessory dwelling unit. An in-law apartment is a complete living space and includes a private kitchen and bath. An in-law apartment may provide a living space for a caretaker or may be rented to provide additional income to you. Many local or state governments have restrictions about the addition of a second apartment on your property. You should consult your local city or county government about zoning and other restrictions, and for help with an in-law apartment. Housing for Aging and Disabled Adults The Federal Government and most states have programs that help pay for housing for older people with low or moderate incomes, less than $46,000 if single or $53,000 if married. Usually you have to fill out an application, and there may be a waiting list. Some of these housing programs also offer help with meals and other activities like housekeeping, shopping, and doing the laundry. Residents usually live in their own apartments in the complex. Usually a Federal or State agency will review your monthly income and expenses to see if you are eligible for this type of housing. Rent payments are usually a percentage of your income. Board and Care Homes This group living arrangement provides help with activities of daily living such as eating, bathing and using the bathroom for people who cannot live on their own but do not need nursing home services. It is sometimes called a “group home.” In some cases, private long-term care insurance and other types of assistance programs may help pay for this type of living arrangement. Many of these homes do not receive payment from Medicare or Medicaid and are not strictly monitored. The monthly charge is usually a percentage of your income. Assisted Living This group living arrangement provides help with activities of daily living such as eating, bathing and using the bathroom, taking medicine, and getting to appointments as needed. Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some assisted living facilities have health services on site. Costs for assisted living facilities can vary widely depending on the size of the living areas, services provided, type of help needed, and where the building is located. Residents usually pay a monthly rent and then pay additional fees for the services that they get. Continuing Care Retirement Communities (CCRC) These housing communities have different levels of care based on your needs. Where you live depends on the level of care you need. In the same community, there may be individual homes or apartments for residents who still live on their own, an assisted living facility for people who need some help with daily care and a nursing home for those who require higher levels of care. Residents move from one level of care to another based on their needs but still stay in the CCRC. If you are considering a CCRC, be sure to check the record of its nursing home. Your CCRC contract usually requires you to use the CCRC nursing home if you need this level of care. Many of the questions that you might want to ask about these communities are the same as those to consider when choosing a nursing home. CCRCs generally charge a large payment before you move in (called an entry fee) and then charge monthly fees. Nursing Homes These facilities provide care to people who can’t be cared for at home or in the community. Nursing homes provide a wide range of personal care and health services. For most people, this care generally is to assist people with support services such as dressing, bathing and using the bathroom, for people who can’t take care of themselves due to physical, emotional, or mental problems. Some nursing homes may provide skilled care after an injury or hospital stay. The cost for nursing homes can vary depending on where you live and what type of care you need. Next month we will talk about costs and how they can be paid, as well as the role of Medicare and Medicaid.