Who pays for long-term care?

The facts may surprise you.

Consumer surveys reveal common misunderstandings about which public programs pay for long-term care services. It is important to clearly understand what is and isn’t covered.

Medicare:

  • Only pays for long-term care if you require skilled services or rehabilitative care:
    • In a nursing home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days)
    • At home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period of time.
  • Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services.
  • You will have to pay for long-term care services that are not covered by a public or private insurance program.

Medicaid:

  • Does pay for the largest share of long-term care services, but to qualify, your income must be below a certain level and you must meet minimum state eligibility requirements
  • Such requirements are based on the amount of assistance you need with ADL
  • Other federal programs such as the Older Americans Act and the Department of Veterans Affairs pay for long-term care services, but only for specific populations and in certain circumstances

Like public programs, private sources of payment have their own rules, eligibility requirements, copayments, and premiums for the services they cover.

Health Insurance:

  • Most employer-sponsored or private health insurance, including health insurance plans, only cover the same kinds of limited services as Medicare.
  • If they do cover long-term care, it is typically only for skilled, short-term, medically necessary care.

Private Payment Options:

  • Personal assets
  • Long-term care insurance
  • Reverse mortgages
  • Life insurance options
  • Annuities

Where can you receive care?

Most long-term care is provided at home. Other kinds of long-term care services and supports are provided by community service organizations and in long-term care facilities.

Examples of home care services include:

  • An unpaid caregiver who may be a family member or friend
  • A nurse, home health or home care aide, and/or therapist who comes to the home

Community support services include:

  • Adult day care service centers
  • Transportation services
  • Home care agencies that provide services on a daily basis or as needed

Often these services supplement the care you receive at home or provide time off for your family caregivers.

Outside the home, a variety of facility-based programs offer more options:

  • Nursing homes provide the most comprehensive range of services, including nursing care and 24-hour supervision
  • Other facility-based choices include assisted living, board and care homes, and continuing care retirement communities. With these providers, the level of assistance varies by the type of facility. You may not get to choose who will deliver services, and you may have limited say in when they arrive.

A Blended Approach:

For many, a blended approach to long-term care works best. Most consumers want to remain in their homes for as long as possible and delay facility care until they need it. Plan early and look for flexible options that give you more say.

Participant Directed Services are a way to provide services that let you control what services you receive, who provides them, and how and when those services are delivered. They provide you with information and assistance to choose and plan for the services and supports that work best for you including:

  • Who you want to provide your services (can include family and friends)
  • Whether you want to use a home care service agency

In facility-based services you generally don’t have the option to hire someone independently, but you should have choices about:

  • Which staff members provide your care
  • The schedule you keep
  • The meals you eat

In home and community-based settings, you should have the ability to participate or direct the development of a service plan, provide feedback on services and activities, and request changes as needed.

Who will provide your care?

Long-term care service and support typically come from:

  • An unpaid caregiver who may be a family member or friend
  • A nurse, home health or home care aide, and/or therapist who comes to the home
  • Adult day services in the area
  • A variety of long-term care facilities

A caregiver can be your family member, partner, friend or neighbor who helps care for you while you live at home. About 80 percent of care at home is provided by unpaid caregivers and may include an array of emotional, financial, nursing, social, homemaking, and other services. On average, caregivers spend 20 hours a week giving care. More than half (58 percent) have intensive caregiving responsibilities that may include assisting with a personal care activity, such as bathing or feeding.

Information on caregivers show that:

  • About 65.7 million people in the US (one in four adults) were unpaid family caregivers to an adult or child in 2009
  • About two-thirds are women
  • Fourteen percent who care for older adults are themselves age 65 or older
  • Most people can live at home for many years with help from unpaid family and friends, and from other paid community support

How much care will you need?

The duration and level of long-term care will vary from person to person and often change over time. Here are some statistics (all are “on average”) you should consider:

  • Someone who is 65 today will need some type of long-term care services and support for three years.
  • Women need care longer (3.7 years) than men (2.2 years).
  • One-third of today’s 65 year-olds may never need long-term care support, but 20 percent will need it for longer than 5 years.

The table below shows that, overall, more people use long-term care services at home (and for longer) than in facilities:


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Who Needs Care?

70% of people turning age 65 can expect to use some form of long-term care during their lives. There are a number of factors that affect the possibility that you will need care:

Age

The older you are, the more likely you will need long-term care.

Gender

Women outlive men by about five years on average, so they are more likely to live at home alone when they are older.

Disability

Having an accident or chronic illness that causes a disability is another reason for needing long-term care.

Between ages 40 and 50, on average, eight percent of people have a disability that could require long-term care services.

69 percent of people age 90 or older have a disability.

Health Status

Chronic conditions such as diabetes and high blood pressure make you more likely to need care.

Your family history such as whether your parents or grandparents had chronic conditions, may increase your likelihood.

Poor diet and exercise habits increase your chances of needing long-term care.

Living Arrangements

If you live alone, you’re more likely to need paid care than if you’re married, or single and living with a partner.

What is long-term care?

What is Long-Term Care?

Long-term care is a range of services and supports you may need to meet your health or personal care needs over a long period of time. Most long-term care is not medical care, but rather assistance with the basic personal tasks of everyday life, sometimes called Activities of Daily Living (ADLs), such as:

  • Bathing
  • Dressing
  • Using the toilet
  • Transferring (to or from bed or chair)
  • Caring for incontinence
  • Eating

Other common long-term care services and supports offer assistance with everyday tasks, sometimes called Instrumental Activities of Daily Living (IADLs) including:

  • Housework
  • Managing money
  • Taking medication
  • Preparing and cleaning up after meals
  • Shopping for groceries or clothes
  • Using the telephone or other communication devices
  • Caring for pets
  • Responding to emergency alerts such as fire alarms.

Can I claim survivor benefits based on my ex-spouse’s Social Security benefits?

If your divorced spouse has passed away, you may be eligible to collect survivor benefits as a widow / widower if:

  • You are over the age of 60.
  • The marriage lasted more than 10 years.
  • You are not now remarried.

OR

  • You have remarried, but after the age of 60

If you remarried before the age of 60, and are still married, you cannot collect survivor benefits from a former spouse.

If you remarried before the age of 60 but that marriage has now ended, you may collect survivor benefits from a deceased ex-spouse.

Can I claim retirement benefits based on my ex-spouse’s Social Security benefits?

Depending on the length of your marriage and whether you have remarried, you may be able to collect benefits based on your divorced spouse’s Social Security benefits. Collecting these benefits has no effect on your former spouse’s benefits.

In order to collect benefits from a divorced spouse:

  • You and your ex-spouse must both be over the age of 62.
  • Your marriage must have lasted 10 years or more.
  • You must have not remarried.

If your divorced spouse has not yet applied for benefits, you can still receive benefits based on his or her record if you have been divorced for more than two years.

How will my spouse’s survivor benefits work?

Generally, if a surviving spouse is over the age of 60, he or she can begin to receive survivor benefits. If the surviving spouse is at full retirement age, his or her benefit is equal to what the deceased’s Social Security benefit was. If the surviving spouse is under full retirement age, the amount of the survivor benefit is reduced.

Important Note: There are a few exceptions where survivor benefits can begin under age 60, including:

• A surviving spouse caring for children under the age of 18 or who has children who are 18-19 years old who are full-time students up to grade 12, subject to family maximums.

• A surviving spouse caring for disabled children 18 years of age or older.

Assuming a full retirement age of 66 and a deceased spouse benefit of $24,000

AGEPERCENTAGE OF SPOUSE’S BENEFITSANNUAL BENEFIT
6071.50%$17,160.00
6176.30%$18,312.00
6281.00%$19,440.00
6385.80%$20,592.00
6490.50%$21,720.00
6595.30%$22,872.00
66100.00%$24,000.00

Assuming a full retirement age of 67 and a deceased spouse benefit of $24,000

AGEPERCENTAGE OF SPOUSE’S BENEFITSANNUAL BENEFIT
6071.50%$17,160.00
6175.60%$18,144.00
6279.60%$19,104.00
6383.70%$20,088.00
6487.80%$21,072.00
6591.90%$22,056.00
6695.90%$23,016.00
67100.00%$24,000.00

When can my spouse begin collecting a spousal benefit?

For your spouse to be eligible for Social Security spousal benefits, you must have applied for Social Security benefits and your spouse must be at least 62. If your spouse begins to collect spousal benefits before he or she has reached full retirement age, he or she will not be eligible for the maximum 50% spousal benefit.