Long-Term Care
What Does “Long-Term Care” Really Mean?
Long-term care (LTC) refers to the assistance provided to individuals who can no longer perform basic self-care tasks—known as Activities of Daily Living (ADLs)—without help. These include bathing, dressing, grooming, toileting, moving around, transferring from one position to another, and eating. For many older adults, the need for this kind of care arises from aging, chronic illness, or conditions like Alzheimer’s or Parkinson’s disease. Medicaid further defines LTC as care for people with ongoing illnesses or disabilities that require a level of assistance equivalent to nursing home care. However, the definition and requirements for “Nursing Facility Level of Care” vary by state.
While some states also provide personal care assistance under their Regular State Plan Medicaid with more flexible requirements, LTC generally focuses on ongoing, often non-medical, support. Services can be provided in multiple settings, from one’s home to specialized care facilities.
What Are the Main Types of Long-Term Care?
What is Home Care?
In-home care allows seniors to remain in their own homes or the home of a relative. It may include personal care assistance (help with bathing, dressing, toileting, mobility, and eating), homemaker services (meal prep, laundry, cleaning), and companionship. For those needing medical help, home health aides can provide skilled services like medication administration, wound care, and monitoring vital signs.
Is Adult Day Care an Option?
Adult day care centers offer supervised daytime care, personal assistance, meals, and activities. Some centers specialize in dementia care and may also provide health services. This option is particularly valuable for family caregivers who work or need respite during the day.
What About Adult Foster Care?
Adult foster care provides a home-like setting for seniors who can’t live alone but don’t require nursing home care. Services often include meals, supervision, housekeeping, and help with ADLs. Homes may serve just one resident or a few, depending on state rules.
What is Assisted Living?
Assisted living facilities combine housing with personal care and support services. Residents maintain some independence but receive help with daily activities, medication management, meals, and social engagement. Many also accommodate individuals in early or mid-stage dementia.
What is Memory Care?
Memory care units are designed for individuals with Alzheimer’s or other dementias. They provide secure environments, dementia-trained staff, and specialized programs. Care is available 24/7 with enhanced supervision and activity planning.
What does Nursing Home Care Refer to?
Nursing homes, or skilled nursing facilities, offer the highest level of care outside of a hospital, including 24-hour medical oversight, rehabilitation services, personal care, and social activities. Short-term stays for rehabilitation after illness or injury are not considered long-term care.
What Is Not Considered Long-Term Care?
- Long-Term Care Insurance: Private insurance purchased to cover LTC costs; not a public program.
- Short-Term Rehabilitation: Temporary care after surgery or injury, generally lasting days to a few months.
Who Pays for Long-Term Care?
Long-term care can be funded through multiple sources, each with different eligibility requirements, coverage rules, and limitations. The table below provides a quick comparison:
| Funding Source | Eligibility | What’s Covered | Limitations |
|---|---|---|---|
| Medicaid | Low-income & asset limits; functional need | Nursing home care, HCBS Waivers, State Plan services | Waiver slots limited; coverage varies by state |
| Medicare | 65+ or disabled; no income/asset limit | Short-term skilled nursing, rehab, some home health | Does not cover ongoing LTC; time-limited benefits |
| Medicare PACE / Advantage | PACE: nursing home level of care; Advantage: plan-specific | Some in-home, community-based LTC services | Not available in all areas; benefits vary by plan |
| Veterans Affairs (VA) | VA health benefits eligibility | Adult day care, in-home care, nursing home, respite | May not cover room/board in assisted living |
| Long-Term Care Insurance | Purchase before care is needed | Personal care, assisted living, nursing home, home health | Premiums can be expensive; varies by policy |
| Other State/Community Programs | Varies by program; often for low-income seniors | Home-delivered meals, caregiver support, transportation | May not cover full LTC costs |
What is Medicaid?
For eligible low-income seniors, Medicaid covers nursing home care (Institutional Medicaid) and, in many states, in-home or community-based services through HCBS Waivers. Waivers have limited slots and may target specific groups or regions. State Plan Medicaid may also cover certain services without waitlists.
What about Medicare?
Medicare generally does not pay for long-term care. It may cover short-term skilled nursing or rehabilitation after hospitalization but is limited in scope and duration.
Are Medicare PACE & Advantage Plans Helpful?
PACE/LIFE programs and some Medicare Advantage plans can provide in-home or community-based LTC services, though availability varies by location.
What are Veterans Affairs (VA)?
The VA may cover certain LTC services, including adult day health care, in-home care, and nursing home services for eligible veterans. Special pension benefits, such as Aid & Attendance, can also help pay for care.
What About Other State & Community Programs?
Some states fund non-Medicaid programs to help seniors live independently, offer caregiver support, or provide services under the Older Americans Act.
What Are Common Misconceptions About Long-Term Care?
Many people believe their health insurance, Medicare, or Medicaid will automatically cover long-term care. Others assume they won’t need it or that family will provide all needed assistance. Planning ahead and consulting a Medicaid Planner can help ensure financial and care needs are met in the future.
