Long Term Care Part I What is long-term care health care? What is the difference between skilled care and personal care? What are the chances that I will need long-term care? What does long term care cost? Won't medicare cover any long term care I might need? What about medicaid? Go to Part II to learn: How do I prevent long term care expenses from devastating one's estate and legacy?

1. Question: What is long-term health care?

Long-term health care is a phrase which is used to describe a variety of services in the area of health, personal care, and social needs of persons who are chronically ill, infirm, or suffer from a cognitive disorder such as Alzheimer's disease.

Many people perceive long term care as simply the care received at a nursing home. Long term care is actually many services that enable an individual to maintain a certain level of quality of life. These types of services might be

• help with daily activities such as bathing and dressing
• respite care
• home health care
• adult day care
• or care in a nursing home

2. Question: What is the difference between skilled care and personal care?

Typically skilled care is needed by an individual for medical conditions that require medical personnel. This might include registered nurses, doctors, and physical therapists. Additionally skilled care is usually required round the clock.

A person requiring this type of care is usually in a nursing home environment, but occasionally a home situation with visiting professionals is provided.

Personal care is sometimes referred to as custodial care. This type of care helps an individual perform daily living activities such as:

• assistance with toileting
• bathing
• dressing
• transportation

This type of care generally does not require the level of intense and complex service as the skilled care. This type of care is often provided at home, adult day care centers, assisted living facilities, and nursing homes.

3. Question: What are the chances that you will need long-term health care?

Recent studies based upon nursing home admissions, indicate that 43% of all persons aged 65 and over will enter a nursing home in the future. In fact, a New England Journal of Medicine report (February 1991) suggested that of the 43% who enter nursing homes, 50% would stay an average of two years.

4. Question: What does long term care cost?

Nationally, nursing homes average $36,000 per year and costs in metropolitan areas like Washington, D.C. range from $50,000-$70,000 per year.

An American Health Care Association Study published in 1993 reported that if you received skilled nursing care in your home, by a nurse three times a week (two hours each visit) the bill would be about $12,300 per year.

Care received from a home health aid three times a week for a year with each visit lasting two hours would result in a bill of about $8400 per year.

5. Question: Won't Medicare cover any long term care I might need?

Long term care expenses are generally not paid for by Medicare, Medicare supplement insurance, or major medical health insurance provided by most employers.

Medicare does not pay for personal or custodial care unless the assistance is related to an injury or illness. Even in this instance benefits are severely restrictive.

6. Question: What about Medicaid?

Many people share the misconception that they will be able to receive Medicaid assistance. Stringent financial guidelines dictate an individual's ability to receive Medicaid. You must meet the federal poverty guideline for income and assets and you may have to "spend down" or use up most of your estate before meeting these guidelines.

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Seventy percent of couples who are older than 65 can expect one spouse to need long term care services. Source: Life Insurance Selling, December 1992

Fifty percent of all couples and seventy percent of single persons are impoverished within one year of entering a nursing home.* *Leimberg's "Think About It" Sephan R. Leimberg, JD, CLU (November

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