How to Start Looking at Long-Term Care Choices

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You have become a member of a select group of people who are taking a big step toward a better future for yourself and your family. Most studies show that only a third of Americans have made even the most basic plans for their future care needs. Perhaps you are already facing this dilemma for an aging or sick parent who lacks a plan for the long term and so you know how important it is to consider the future.

Thinking about the many aspects to consider — from finances to health to housing to more — is emotionally difficult, but it is also intellectually challenging because the choices available are often not clear-cut. They may involve complex financial calculations as well as personal and family preferences. But ignoring the question only makes the day of reckoning that much more difficult.

What is long term care?

Noting that “LTSS (long-term servies and supports) has traditionally been provided in a fragmented, uncoordinated system of care provided by disparate agencies, each with its own funding, rules, and processes, and which are separate from the healthcare system,” the federal Commission on Long-Term Care in its 2013 report to the Congress recommended that individuals and service providers “align incentives to improve the integration of LTSS with healthcare services in a person- and family-centered approach.”

As an alternative to the term long-term care, another term has entered the lexicon: long-term services and supports, or LTSS. This term typically refers to nonmedical services paid for privately or by Medicaid, although it can also apply to services such as transportation and homemaker visits provided by community agencies.

By replacing care, which some people with disabilities see as a negative term, with the more impersonal supports and services, the new terminology is intended to stress an individual's independence and control over who provides assistance and how it is organized. Whichever term is used, a person- and family-centered approach is key.

Using Medicare as a starting point

“Medicare does not cover long-term care.” You'll come across this mantra again and again as you research long-term care. Yet you can devote considerable research time to Medicare, precisely because many beneficiaries consider it their starting point in thinking about their future care needs.

So what will Medicare cover? Understanding its limits is a first step in reality testing. What Medicare covers (after deductibles, coinsurance, and copays), you do not have to pay for; what Medicare does not cover requires additional resources.

Here is Medicare's definition of long-term care, as stated in its 2014 handbook “Medicare and You”:

Long-term care: — A variety of services that help people with their medical and non-medical needs over a period of time. Long-term care can be provided at home, in the community, or in various other types of facilities, including nursing homes and assisted-living facilities. Most long-term care is custodial care. Medicare doesn't pay for this type of care if this is the only kind of care you need.

Note the final “if” clause; this creates an opening for custodial care when the person also has a need for skilled care.

And here's Medicare's definition of custodial care:

Custodial care: —Nonskilled personal care, such as help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It may also include the kind of health-related care that most people do themselves, like using eye drops. In most cases, Medicare doesn't pay for custodial care.

Custodial care, a term many people find demeaning, is often called personal care, but it means the same thing. And it is definitely not nonskilled, as anyone who has performed these tasks knows.

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