Long term care services encompass an array of things. The list is extensive: from community services such as meals, adult day care, and transportation; to household activities like bathing and chores. Some of those services are also provided by health care facilities, such as assisted living centers and nursing homes.
When dealing with long term care, the most difficult issue to address or understand is payment. While Medicare and other health insurance programs are available, they do not cover very many long term care services. Therefore, ensuring all available options are sought out is extremely important for reimbursement. Medicaid is the prime resource for long term care coverage. There are other programs, both federal and state, which may also provide assistance. In most instances, the other programs are available for high levels of disability and low income cases. Otherwise, the care must be paid from private resources, which makes it critical to identify all resources of an individual seeking long term care services, prior to providing them.
The expense for care provided varies, based on the type and amount needed. For example, home health care is normally done in shifts, and can be more expensive if needed in evenings, on weekends or during holidays. Community programs are provided traditionally at a daily rate, and can vary based on programs included and activities.
According to the National Clearing House for Long Term Care, through the Department of Health and Human Services, the average costs for long term care in the U.S. in 2010 was as follows:
- $205 per day, or $6,235 per month for a semi-private room in a nursing home
- $299 per day or $6,965 per month for a private room in a nursing home
- $3,293 per month for care in an assisted living center, for a one-bedroom unit
- $21 per hour for a home health aide
- $19 per hour for homemaker services
- $67 per day for services in an adult day health care center
If a patient has significant private resources, he or she will likely need to pay for the above directly. A person may also purchase private long term care insurance, to cover these types of services. Medicare supplemental insurance policies are sometimes referred to as “Medigap insurance.” They are designed to provide coverage where Medicare lacks, such as for co-payments and deductibles. It is not, however, intended to meet long term care needs, and as such, doesn’t provide coverage for the majority of long term care expenses.
For those without significant private resources, as stated above, Medicaid is the likely payment source. Medicaid may pay for long term care services based on the level of need required (“functional eligibility”). If the patient is a veteran, look to the U.S. Department of Veterans Affairs, for reimbursement programs.
There is a common misconception that Medicare or standard private insurance will cover all services needed or required. This is simply false. Either may cover short periods of care, but not for ongoing personal care needs.
The chart below, taken from the Department of Health and Human Services website, highlights coverage for long term care. Information such as this should be made readily available to each patient treated, prior to extending services. This will help each understand that not all services are covered by Medicare or private insurance, and may need paid from their private resources.
