Long-Term Care: Introduction

Long-term care refers to a wide spectrum of medical services and personal care. However, long-term care covers more than hospitalization, medical care and nursing care. It includes all the assistance you could need if you cannot care for yourself for an extended period of time due to chronic illness or mental or physical impairment and therefore are unable to perform basic acts of daily living (bathing, dressing, feeding oneself, etc.).

What is Covered
Long term care insurance provisions include several categories. However, remember that the amount, length, and kind of coverage, as well as how coverage is paid, will differ from policy to policy.

1. Levels of Care
   1. Skilled care
      • continuous, “around-the-clock” care
      • treatment planned, ordered, and supervised by a physician
      • treatment delivered by skilled, trained medical professionals (RNs, physical therapists,etc.)
   2. Intermediate Care
      • occasional basic care (daily, several times per week,…)
      • treatment planned, ordered, and supervised by a physician
      • treatment delivered by skilled, trained medical professionals (RNs, physical therapists,..)
   3. Custodial Care
      • assistance with activities of daily living
      • physician’s orders not required
      • treatment can be delivered by an untrained or non-medical individual (ex: reminder to take medication,…)

2. Locations of Long-Term Care
   Each policy will differ as to where treatment can be carried out. Possible locations for long-term care include:
   1. Nursing Home
      • must meet certain licensing standards
      • usually for custodial care, but may be used for skilled and intermediate care
   2. Home Care
      • skilled care
      • physical therapy
      • cleaning and bandaging wounds
      • activities of daily living (bathing, dressing,…)
      • provided by visiting nursing, therapists, home health aides
   3. Adult Daycare
      • limited care for individuals who live at home or with relatives who are unable to
      • provide care during the day
      • therapeutic activities
      • meals and social activities
   4. Hospice Care
      • for terminally ill patients
      • provide comfort and care to patient and family members
   5. Respite Care
      • temporary facility
      • provide “time-off” for primary care-giver
3. Other Benefits
   • Medically necessary modifications to insured’s home (ramps, modified bathrooms,…)
   • Care for individual with Alzheimer’s disease or other organic cognitive disabilities

What is Not Covered
Long-term care policies contain limitations on pre-existing conditions, and an individual may have to wait a certain period of time after purchasing the policy before the care will be paid for.

Most long-term care policies exclude the following conditions and do not cover:

• Care for alcoholism
• Care for drug abuse
• Care necessitated by acts of war
• Care resulting from an intentionally self-inflicted wound
• Care for certain mental and nervous disorders
• Care provided outside the U.S. and Canada