Long Term Care (LTC) insurance markets provide various forms of coverage. This may include room and board, skilled nursing care, intermediate care and custodial care as well as home health, adult day care hospice and respite care – usually paid for with premiums that will eventually be reimbursed after an agreed upon look-back period has lapsed.
What is Long-Term Care Insurance?
Long-term care insurance can help cover costs that go beyond what health or life insurance, Medicare or Medicaid cover. You can buy it either as an independent policy or add it as a rider on an existing life policy, and policies typically offer features and options allowing buyers to select how much coverage they want and when it should start being distributed; many even provide inflation protection that can increase daily or monthly benefit amounts as costs rise over time.
California long-term care policies are subject to regulation by the Department of Insurance, with individual policies subject to consumer protection requirements like a free-look period and right to opt out within 30 days of initial purchase, among several others designed to safeguard insured. Furthermore, premium rates must also undergo an actuarial review process prior to any increase being permitted by DONI.
Long-term care insurance often refers to nursing home care; however, other forms of long-term care may also be covered under policies. These services include adult day care, respite care, hospice services and residential care facilities for the elderly (RCFEs)/assisted living facilities – with all long-term policies except Home Care Only policies required to include at least some of these forms of support.
All long-term care policies must contain some trigger for someone to begin receiving benefits, whether that’s waiting a certain number of days for coverage to commence or having it pay as soon as you’ve been diagnosed with an ongoing physical or cognitive condition that meets insurer criteria.
Long-term care policies typically offer a minimum payout over your lifetime and/or reach their maximum benefit after providing coverage for three or five years, and many offer choices about payment, such as lump sum or annuity payouts.
What is Skilled Nursing Care?
Skilled nursing care refers to high-level medical treatment or supervision provided by licensed healthcare professionals such as registered nurses (RNs), licensed physical and occupational therapists, and certified speech and language pathologists. Skilled nursing may be needed temporarily after illness or injury has healed itself, or more long term due to chronic conditions. Skilled nursing facilities (SNF), clinics or even home health services may provide such care.
SNFs (Short for Skilled Nursing Facilities) provide 24-hour medical and rehabilitation services for seniors requiring intensive nursing supervision and care, typically offering private rooms and offering services such as medication management, wound care, intravenous therapy injections, continual monitoring vital signs monitoring as well as physical occupational speech therapies (POTS).
Before selecting a skilled nursing facility (SNF), it’s essential that you visit their facilities and inquire about their programs and services before making your selection. Discuss with family goals for your loved one’s care in order to ascertain if the SNF meets them and would be a suitable match for future care needs.
SNFs offer more than clinical services, they also provide social and recreational activities to foster engagement, as well as food and dietary management to ensure residents get adequate nutrition. Emergency protocols must also be in place, with staff trained to respond in emergency situations.
Medicare and its supplementary policies may cover some of the costs of an SNF stay, but typically do not pay for long-term custodial care – assistance with daily tasks like bathing, dressing, eating and getting in and out of bed – provided in assisted living, residential care for the elderly (RCFE), home care, adult day care or hospice settings. Medicaid may offer some coverage in certain circumstances but only for individuals in almost dire financial straits with waiting lists and limited benefits. Long-term care insurance offers an alternative solution by covering part of these costly programs by paying some or all costs related to SNF and/or custodial care costs directly – making long-term care insurance policies cheaper options by covering part or all associated with SNF stays/custodial care providers directly.
What is Intermediate Care?
At first glance, intermediate care may seem confusing. It is an emerging concept which offers patients something “in between”. Intermediate care usually helps avoid hospital admissions or assists those already released from hospitals with returning more quickly home after their release from treatment. It helps people gain independence more quickly as well.
Intermediate care may take the form of home-based services, bed-based care or at a specialized facility depending on its location. While no formal definition exists for this term and there’s limited scientific research into its best models, certain areas have shown they can effectively deliver intermediate care through joint commissioning of health and social care resources.
Somerset County in England partnered with Yeovil District Hospital to establish the Cooksons Court reablement centre, providing patients with more residential care services such as nurses, physiotherapists and occupational therapists – along with psychiatrists and psychologists – at no charge through NHS funding.
Reablement centres provide short-term intermediate care that assists individuals recovering from illness or injury to resume daily tasks like cooking, bathing and taking medication. A team of health and social care professionals assess a patient’s needs and goals before working closely with him or her to develop an individualized recovery plan – usually lasting six weeks depending on an individual’s progress and individual requirements.
Residential care homes or continuing care retirement communities (CCRCs) may also provide intermediate care. These facilities have been specifically created to provide chronic care, typically housing individuals requiring two or more physician visits per week and/or skilled nursing care from an RN/LPN. Although generally used by developmental disabled patients or elderly patients requiring long-term custodial care needs, residential care homes may also serve as affordable alternatives to traditional nursing home stays. Medicare does not cover these residential care homes but many consider them more economical alternatives than institutionalization.
What is Custodial Care?
Custodial care provides non-medical support for individuals unable to carry out basic daily activities due to medical or physical conditions. This may include help eating, using the toilet, bathing and getting dressed – activities usually performed independently prior to needing custodial assistance. Typically living at home, in an assisted living facility or nursing home setting and paid for through long-term care insurance or public benefits packages, custodial care providers could include family members or paid for with long-term care insurance or public benefits packages.
Medicare Part A (hospital coverage) and Part B (medical insurance), both offer some benefits; however, neither cover custodial care. Some private health insurers and Medicare Advantage plans offer it; these typically provide meal preparation, laundry service, transportation to appointments/errands as well as bathing/dressing assistance from professional aides.
Medicaid, the joint federal and state health care program, offers some custodial care services to individuals who meet its financial requirements. Each state may vary when it comes to offering this benefit so it’s important to understand your local rules when exploring this option.
Custodial care coverage may be most easily found through long-term care insurance, which generally allows a free-look period of 30 days in which to return the policy with full refund. These policies can be purchased privately or through employers as group plans; while some individuals combine Medicare Advantage and long-term care insurance plans together in order to cover both custodial care needs as well as skilled nursing services needs.
If you or a loved one is considering care options, it’s essential that they discuss their individual requirements with an experienced care manager. Care managers are experts at reviewing all available options, navigating insurance and resources and providing additional support services as needed for their clients. Set up a complimentary consultation today – they understand long-term care planning can be complex and confusing but we are here to help you find a tailored solution tailored specifically to you and we look forward to speaking with you about this journey together! We look forward to hearing from you.