Long Term Care

Long Term Care (LTC) can is an essential part of the community and institutional continuum of care in the health care system. LTC involves a range of services from social services, housing alternatives and health care. Services that promote independence are coordinated by a variety of people and institutions with the aim of quality of life. Almost 10 million people needed some form of long-term care services and supports necessary to meet health or personal care needs over an extended period of time. in the United States in 2000. Of this population, 3.6 million (37%) were under age 65 and 6 million (63%) were over age 65. Almost 70% of people turning age 65 will need long-term care at some point in their lives.

Community-based services aim to deliver services with the least amount of disruption to patient living environments and at minimal cost by assisting informal caregivers when advanced care is needed and providing respite to families and informal caregivers in order to keep patients from needing institutional care as long as possible. Home health care can be free-standing or hospital based services that provide patient care in their homes. Adult day care provides meals and activities during the day and are social, some include medical care and others are more specialized providing dementia care. Adult foster care are small family-owned services that provide room, board and personal care in a family residential setting with live-in caregivers. Senior centers provide a social setting form over a million Americans each day. The Elderly Nutrition Program of the U.S. Administration on Aging serves meals to elderly in community settings and at home through the volunteer staffed Meals on Wheels program. Homemaker and handyman services are volunteer staffed services offered to assist seniors in maintaining independent living. Case management and the use of personal emergency response systems (PERS) to send medical alerts in an emergency are two mechanisms that support seniors can stay in their homes as long as possible.

Long-term care facilities are healthcare organizations that provide assistance to aging adults or those with chronic illness. There are a variety of types of institutions that serve different needs. Retirement facilities do not offer medical or nursing care, but provide a secure environment for independent living. Independent living situations, or personal care facilities, are typically retirement communities that have separate condos or apartments. Residents can typically purchase options individually, such as meals or housekeeping services. Assisted living, offering 24 hour supervision, can be an apartment or individual room where a number of services like personal care, medication administration, meals, and housekeeping are part of the package. Skilled nursing facilities, or nursing homes, are institutional settings that provide skilled nursing care and rehabilitation services by licensed practitioners. Subacute and specialized care facilities combine care previously offered in hospitals with the skilled nursing services of a nursing home for patients with AIDS or traumatic brain injury (TBI), and those in need of wound care, intravenous therapy, blood transfusions and ventilator support.

Other long-term care services include respite care, restorative care and hospice care.  Respite care provides time off for family caregivers to help reduce the stress of caring for an elderly or disabled loved one. These services include adult day care, home health care and even temporary housing in a facility. Restorative care is rehabilitation by offering short-term therapeutic treatments to help patients improve or regain functioning. Rehabilitation of stroke, injury and other chronic illnesses is offered by physical, speech and occupational therapists. Hospice care is end-of-life care offered to terminally ill patients. Hospice care is most often offered in the home by home health care or hospice care workers. Hospice services are also offered in retirement centers, nursing homes and hospitals.

Adult Day Care

Adult Day Care

Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe.
The goals of the programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: adult social day care and adult day health care. Adult social day care provides social activities, meals, recreation and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.
Seniors generally take part in the program on a scheduled basis and the services that are offered may include the following:
• Counseling • Education • Evening care • Exercise • Health screening • Meals
• Medical care • Physical therapy • Recreation • Respite care • Socialization • Supervision • Transportation • Medication Management
These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.
All states do not license and regulate adult day care centers. There may be a great deal of difference between individual centers; therefore it is important to learn more about each of the centers near you. You will probably want to visit the centers closest to you, and talk with the staff and other families that use the centers to determine if the facilities and programs available meet your individual needs. You may want to find out if your state has an Adult Day Care Association

Costs vary among adult day centers. Costs range from $25 a day to over $100 per day depending on the services offered, type of reimbursement, and geographic region. While an adult day care center is not usually  covered by insurance of Medicare, some financial assistance may be available through a federal or state program (e.g., Medicaid, Older Americans Act, Veterans Administration).

To find out more about the specific adult day care centers where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging (at 1800-677-1116 or http://www.eldercare.gov ) can help connect you to these agencies.
The National Adult Day Services Association is a good source for general information about adult day care centers and programs. They can help you link to a state adult day care association. It can be reached by calling the toll-free telephone number 1-877-745-1440 or by going to http://www.nadsa.org.
For more information about ACL U.S. Department of Health and Human Services, Administration for Community Living, Washington DC 20201 Phone: (202) 619 – 0724 Fax: (202) 357 – 3555 Email: ACLinfo@acl.hhs.gov Web: http://www.aoa.gov

https://acl.gov/NewsRoom/Publications/docs/Adult_Day_Care_1.pdf

Independent Living

Why Community Living Matters

Communities cannot thrive without a variety of voices and perspectives. Healthy communities value the inclusion of all people, including the growing populations of older people and people with disabilities. Independent living and aging in place are vital to keeping intact the rich diversity that makes our community strong. This video explains why community living is important for everyone.

About ACL

All Americans—including people with disabilities and older adults—should be able to live at home with the supports they need, participating in communities that value their contributions. To help meet these needs, the U.S. Department of Health and Human Services (HHS) created a new organization, the Administration for Community Living (ACL).

ACL brings together the efforts and achievements of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability to serve as the Federal agency responsible for increasing access to community supports, while focusing attention and resources on the unique needs of older Americans and people with disabilities across the lifespan.

Mission

Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.

Vision

All people, regardless of age and disability, live with dignity, make their own choices, and participate fully in society.

Assisted Living

Assisted Living
Assisted Living facilities come in many forms and variations. In 2011, there were 6,921 professionally managed assisted living facilities in the United States. In general, they provide room and board, social and recreational activities, and help with personal care(also called custodial care) Non-skilled service or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom. and other activities of daily living. Residents pay for the cost of medical and nursing services separately. The following services are generally available: :

  • Some help with Activities of Daily Living (ADLs) such as eating. Feeding oneself by getting food into the body from a receptacle or by a feeding tube or intravenously. It is one of the six Activities of Daily Living., bathing. Washing oneself by sponge bath or in the bathtub or shower. One of the six Activities of Daily Living (ADLs), and using the bathroom, taking medicine, and getting to appointments as needed (varies by facility).
  • Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together.
  • Social and recreational activities are usually provided. Some assisted living facilities have health services on site.
  • Residents usually pay a monthly rent and then pay additional fees for extra services they receive.

Costs for assisted living facilities can vary widely depending on the size of the living areas, services provided, type of help needed, and geographic location

Continuing Care Retirement Community (CCRC)

Continuing Care Retirement Community (CCRC)

A continuing care retirement community (CCRC) is a community living arrangement, typically on a single campus, that provides housing, health care, and social services. CCRCs offer different levels of services ranging from independent housing to nursing home (also called Long-Term Care Facility or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs. care.

Joining a CCRC is a way of obtaining long-term care services. Services that include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assists people with Activities of Daily Living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility. For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility. more easily. You move into a CCRC as a resident of an independent housing unit where you can usually purchase and receive support services. When you need more care or are unable to live independently, you can move to the assisted living facility. Residential living arrangement that provides individualized personal care, assistance with Activities of Daily Living, help with medications, and services such as laundry and housekeeping. Facilities may also provide health and medical care, but care is not as intensive as care offered at a nursing home. Types and sizes of facilities vary, ranging from small homes to large apartment-style complexes. Levels of care and services also vary. Assisted living facilities allow people to remain relatively independent. on campus. Should you need the next level of care, you can move into the on-site nursing home.

The fee arrangements for CCRCs vary and generally include both a monthly fee and an entrance fee. CCRCs charge a monthly fee based on the size of your independent living unit. Most CCRCs also charge a sizeable one-time entrance fee. In some cases the entrance fee is not refundable. In other cases the fee may be refundable under certain circumstances. If the fee is refundable it will be held by the CCRC. It is important for you to understand that if the fee you pay to the CCRC is refundable it will be counted as an available asset if you need to apply for Medicaid. Joint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services., even if you cannot get access to the money yourself.

More things to consider:

  • Some allow you to hire your own home health care services while you live in an independent living unit. Others require you to be fully independent to remain in an independent living unit.
  • They may require that you have a health screening before you can move into the independent living unit
  • Some allow married couples to move into an independent living unit even if one spouse requires some care

https://longtermcare.acl.gov/where-you-live-matters/living-in-a-facility/continuing-care-retirement-communities.html

Skilled Nursing Facilities

Skilled Nursing Facilities or Nursing Home

A nursing home, also known as a skilled nursing facility, is a place for people who don’t need to be in a hospital but can no longer be cared for at home. This can include people with critical injuries or serious illnesses, or those needing care after surgery. Most nursing homes have aides and skilled nurses on hand 24 hours a day. Nursing homes can be:

Hospital-like. This type of nursing home is often set up like a hospital. Members of the staff give medical care, as well as physical, speech, and occupational therapy. There can be a nurses’ station on each floor. As a rule, one or two people live in a room. A number of nursing homes will let couples live together. Things that make a room special, like family photos, are often welcome.

Household-like. These facilities are designed to be more like homes, and the day-to-day routine is not fixed. Teams of staff and residents try to create a relaxed feeling. Kitchens are often open to residents, decorations give a sense of home, and the staff is encouraged to develop relationships with residents.

Combination. Some nursing homes have a combination of hospital-like and household-like units.

Many nursing homes have visiting doctors who see their patients on site. Other nursing homes have patients visit the doctor’s office. Nursing homes sometimes have separate areas called “Special Care Units” for people with serious memory problems, like dementia.

Skilled Nursing Facilities or rehabilitation facilities provide full medical care; they also provide assistance with activities of daily living such as meals, personal care, housekeeping, and laundry.

The health care provider may determine that before a patient can go home from the hospital, they should be able to:
  • Safely use a cane, walker, crutches, or wheelchair.
  • Get in and out of a chair or bed without needing much help.
  • Move safely between your sleeping area, bathroom, and kitchen.
  • Go up and down stairs, if there is no other way to avoid them in the home.

Other factors may also prevent patient from going directly home from the hospital, such as:

  • Not enough help at home
  • Because of where they live, may need to be stronger or more mobile before going home
  • Medical problems, such as diabetes, lung problems, and heart problems, that are not well controlled
  • Medicines that cannot safely be given at home
  • Surgical wounds that need frequent care

Common medical problems that often lead to skilled nursing or rehabilitation facility care include:

  • Joint replacement surgery, such as for the knees, hips, or shoulders
  • Long stays in the hospital for any medical problem
  • Stroke or other brain injury
At the skilled nursing facility, a doctor will supervise your care. Other trained health care providers will help patient grow stronger:

  • Registered nurses will care for wounds, give the right medicines, and monitor other medical problems.
  • Physical therapists will teach patient how to make muscles stronger. They may help patient learn how to get up and sit down safely from a chair, toilet, or bed. They may also teach how to climb steps, keep  balance, and use walker, cane, or crutches.
  • Occupational therapists will teach  the skills needed to do every day tasks at home.
  • Speech and language therapists will evaluate and treat problems with swallowing, speaking, and understanding.
Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.

Medicare-covered services include, but aren’t limited to:

  • Semi-private room (a room you share with other patients)
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy*
  • Speech-language pathology services*
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
  • Dietary counseling

https://www.nia.nih.gov/health/publication/nursing-homes#home

https://www.medicare.gov/coverage/skilled-nursing-facility-care.html

Long-Term Care Hospitals

Long-Term care hospitals are a special category in which the facility manages the transition of acute illness or injury to return to home. Many community hospitals have long-term care units that serve that purpose. Most people who need inpatient hospital services are admitted to an  “acute‑care” hospital for a relatively short stay. But some people may need a longer hospital stay. Long‑term care hospitals (LTCHs) are certified as acute‑care hospitals, but LTCHs focus on patients who, on average, stay more than 25 days. Many of the patients in LTCHs are transferred there from an intensive or critical care unit. LTCHs specialize in treating patients who may have more than one serious condition, but who may improve with time and care, and return home. LTCHs generally give services like respiratory therapy, head trauma treatment, and pain management.
Long‑term care usually refers to care that’s basically custodial, like help with feeding or dressing, even if there’s some health care given. Medicare doesn’t cover this kind of care, which can be given in your own home or in various kinds of facilities, like assisted living facilities. LTCHs are hospitals that give inpatient services to people who need a much longer stay to get well.
Under Medicare, you’re only responsible for one deductible for any benefit period. A benefit period begins the day you’re admitted to a hospital or skilled nursing facility (SNF), and ends when you haven’t gotten any inpatient care in a hospital or SNF for 60 days in a row. This applies whether you’re in an acute care hospital or a LTCH. You don’t have to pay a second deductible for your care in a LTCH if: • You’re transferred to a LTCH directly from an acute‑care hospital. • You’re admitted to a LTCH within 60 days of being discharged from an inpatient hospital stay.
On the other hand, if you’re admitted directly to the LTCH more than 60 days after any previous hospital stay, you would pay the same deductibles and coinsurance as you would if you were being admitted to an acute‑care hospital. Note: If you have Original Medicare and a Medicare Supplement Insurance (Medigap) policy, some of your deductible or coinsurance costs may be covered. If you have a Medicare Advantage Plan (like an HMO or PPO), you may have different ways to pay for care, so you should contact your plan for more information.
https://www.medicare.gov/Pubs/pdf/11347.pdf

Financing Long-Term Care

COST OF LONG-TERM CARE

The cost of long-term care depends on the type and duration of care you need, the provider you use, and where you live. Costs can be affected by certain factors, such as:

  • Time of day. Home health and home care services, provided in two-to-four-hour blocks of time referred to as “visits,” are generally more expensive in the evening, on weekends, and on holidays
  • Extra charges for services provided beyond the basic room, food and housekeeping charges at facilities, although some may have “all inclusive” fees.
  • Variable rates in some community programs, such as adult day service, are provided at a per-day rate, but can be more based on extra events and activities.

Some average costs for long-term care Services and supports necessary to meet health or personal care needs over an extended period of time. in the United States (in 2010) were:

  • $205 per day or $6,235 per month for a semi-private room in a nursing home (also called Long-Term Care Facility or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs.
  • $229 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 facility (for a one-bedroom unit)
  • $21 per hour for a home health aide
  • $19 per hour for homemaker – Licensed Homemaker Services provides “hands-off” care such as helping with cooking and running errands. Often referred to as “Personal Care Assistants” or “Companions.” This is the rate charged by a non-Medicare certified, licensed agency. services
  • $67 per day for services in an adult day health care center

Medicare:

  • Only pays for long-term care services and supports necessary to meet health or personal care needs over an extended period of time. if you require skilled services or rehabilitative care:
    • In a nursing home (also called Long-Term Care Facility or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs. for a maximum of 100 days, however, the average Medicare Federal program that provides hospital and medical expense benefits for people over age 65, or those meeting specific disability standards. Benefits for nursing home and home health services are limited. 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 Services that include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assists people with Activities of Daily Living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility. For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility. 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.

Health Insurance

  • Most employer-sponsored or private health insurance, including health insurance plans, cover only 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

There are an increasing number of private payment options including long term care insurance, reverse mortgages, life insurance and annuities.

Long-Term Care Insurance

People with certain conditions may not qualify for long-term care insurance. A long-term care insurance policy is designed to offer financial support to pay for long-term care services.. Since standards vary between different insurance companies, if one company denies you, it is possible that another company will accept you. Common reasons why you might not be able to buy long-term care insurance include:

    • You currently use long-term care services
    • You already need help with Activities of Daily Living (ADL)
    • You have AIDS or AIDS-Related Complex (ARC)
    • You have Alzheimer’s Disease. Progressive, degenerative form of dementia that causes severe intellectual deterioration. First symptoms are impaired memory, followed by impaired thought and speech, and finally complete helplessness. or any form of dementia. Deterioration of mental faculties due to a disorder of the brain. or cognitive dysfunction
    • You have a progressive neurological condition such as multiple sclerosis or Parkinson’s Disease
    • You had a stroke within the past year to two years or a history of strokes
    • You have metastatic cancer (cancer that has spread beyond its original site)

    Insurance companies also consider other health conditions when determining your eligibility. If you buy your long-term care insurance before you develop one of the health conditions listed above, then your policy will cover the care you need for that condition.

    Most policies sold today are comprehensive. They typically allow you to use your daily benefit in a variety of settings, including:

    • Your home
    • Adult day service centers
    • Hospice care. Short-term, supportive care for individuals who are terminally ill (have a life expectancy of six months or less). Hospice care focuses on pain management and emotional, physical, and spiritual support for the patient and family. It can be provided at home or in a hospital, nursing home, or hospice facility. Medicare typically pays for hospice care. Hospice care is not usually considered long-term care.
    • Respite care. Temporary care which is intended to provide time off for those who care for someone on a regular basis. Respite care is typically 14 to 21 days of care per year and can be provided in a nursing home, adult day service center, or at home by a private party.
    • Assisted living facilities (also called residential care facilities or alternate care facilities)
    • Alzheimer’s special care facilities
    • Nursing homes

    In the home setting, comprehensive polices generally cover these services:

    • Skilled nursing care
    • Occupational, speech, physical, and rehabilitation therapy
    • Help with personal care(also called custodial care) Non-skilled service or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom., such as bathingWashing oneself by sponge bath or in the bathtub or shower. One of the six Activities of Daily Living (ADLs) and dressingPutting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs. This is one of the six Activities of Daily Living.

Reverse mortgages

A reverse mortgage is a type of loan based on home equity that enables older homeowners (age 62 or older) to convert part of their equity in their homes into tax-free income without having to sell the home, give up title, or take on a new monthly mortgage payment. Instead of making monthly payments to a lender, as you do with a regular mortgage, a lender makes payments to you. The loan, along with financing costs and interest on the loan, does not need to be repaid until the homeowner dies or no longer lives in the home. is a special type of home equity loan that allows you to receive cash against the value of your home without selling it.

For most reverse mortgages:

  • You can choose to receive a lump-sum payment, a monthly payment, or a line of credit
  • There are no restrictions on how you use the remainder of the money
  • You continue to live in the home and you retain title and ownership of it
  • You are also still responsible for taxes, hazard insurance, and home repairs
  • However, you do not have to repay the loan as long as you continue to live in the home.
    • Instead, the amount you owe, based on loan payouts and interest on the loan, becomes due when you or the last borrower, usually the last remaining spouse, dies, sells, or permanently moves out of the home

To qualify for a reverse mortgage:

  • You must be age 62 and older
  • Unlike a traditional mortgage, you do not have to provide an income or credit history to get the loan
  • The home must be your primary residence

How to apply:

  • You must meet with an approved reverse mortgage counselor before you can start the loan process. These counselors can help you decide whether a reverse mortgage is right for you.

Important considerations:

  • You must use the funds you receive to pay off any existing mortgages or other debt against your home and to make required home repairs
  • As long as you spend the payments you receive in the month that you receive them, the money is not taxable and does not count towards income or affect Social Security or MedicareFederal program that provides hospital and medical expense benefits for people over age 65, or those meeting specific disability standards. Benefits for nursing home and home health services are limited. benefitsMonetary sum paid by an insurance company to a recipient or to a care provider for services that the insurance policy covers.
  • Does not count as income for MedicaidJoint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services. eligibility
  • Once you have a reverse mortgage, it is very difficult to borrow any more against your home. But you can refinance a reverse mortgage if the house increases significantly in value.
  • If your heirs want to keep your home, they can repay the reverse mortgage. They can also keep the difference if the home’s sale price is greater than the reverse mortgage loan balance when they repay the loan.

Life insurance options

You can use your life insurance policy to help pay for long-term care servicesServices that include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assists people with Activities of Daily Living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility. For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility. through the following options:

  • Combination (Life/Long-Term CareServices and supports necessary to meet health or personal care needs over an extended period of time.) Products
  • Accelerated Death BenefitsMonetary sum paid by an insurance company to a recipient or to a care provider for services that the insurance policy covers. (ADBs)
  • Life settlements
  • Viatical settlements
Combination Products

Many consumers are reluctant to buy long-term care insurance because they fear that their investment will be wasted if they do not use it.  Some insurance companies have attempted to solve this problem by combining life insurance with long-term care insuranceInsurance policy designed to offer financial support to pay for long-term care services..  The idea is that policy benefits will always be paid, in one form or another.  These products are relatively new and the features are changing as the product evolves.  The amount of the long-term care benefit if often expressed in terms of a percentage of the life insurance benefit.

Accelerated Death Benefits (ADBs)

A feature included in some life insurance policies that allows you to receive a tax-free advance on your life insurance death benefit while you are still alive. Sometimes you must pay an extra premium to add this feature to your life insurance policy. Sometimes the insurance company includes it in the policy for little or no cost.

There are different types of ADBs each of which serves a different purpose. Depending on the type of policy you have, you may be able to receive a cash advance on your life insurance policy’s death benefit if:

  • You are terminally ill
  • You have a life-threatening diagnosis, such as AIDS
  • You need long-term care services for an extended amount of time
  • You are permanently confined to a nursing home(also called Long-Term Care Facility or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs. and incapable of performing Activities of Daily Living (ADL), such as bathing. Washing oneself by sponge bath or in the bathtub or shower. One of the six Activities of Daily Living (ADLs) or dressing. Putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs. This is one of the six Activities of Daily Living.

The amount of money you receive from these types of policies varies, but typically the accelerated benefit payment amount is capped at 50 percent of the death benefit. Some policies, however, allow you to use the full amount of the death benefit.

For ADB policies that cover long-term care services, the monthly benefit you can use for nursing home care is typically equal to two percent of the life insurance policy’s face value. The amount available for home care (if it is included in the policy) is typically half that amount.

For example, if your life insurance policy’s face value is $200,000, then the monthly payout available to you for care in a nursing home would be $4,000, but only $2,000 for home care. Some policies may pay the same monthly amount for care, regardless of where you receive the care.

When you receive payments from an ADB policy while you are alive, the amount you receive is subtracted from the amount that will be paid to your beneficiaries when you die.

Key things to consider before taking advantage of an ADB policy include:

  • If your life insurance policy includes an ADB feature, you may be able to use your life insurance policy to help cover long-term care services. Depending on the policy amount, there may be little or no health screenings required. So if you have a health condition that might exclude you from long-term care insurance eligibility, you can still obtain a long-term care insurance policy through the ADB feature on a life insurance policy.
  • ADB policy payouts for long-term care services are often more limited than the benefits you could receive from a typical long-term care insurance policy.
  • The face value of your life insurance policy may not be enough to allow ADB payments that are enough to cover your long-term care services needs. The benefit payments may be too low and the duration may be too short to cover your long-term care services expenses.
  • ADB riders on life insurance policies may not offer inflation protection. If the policy does not include inflation protection, the ADB payment may not be sufficient to cover your future long-term care service costs.
  • If you want to leave an inheritance, you should consider whether using your life insurance death benefit to pay for long-term care services is the right option. If you use the ADB feature for long-term care services, there may be little or no death benefit remaining for your survivors.
  • Using the ADB option may affect your eligibility for MedicaidJoint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services.. Check with your state Medicaid agency for more information.
Life Settlements

These plans allow you to sell your life insurance policy for its present value to raise cash for any reason. This option is usually only available to women age 74 and older and to men age 70 and older. You may choose to use the proceeds to pay for long-term care services.

Key things to consider before moving forward with a life settlement:

  • If you sell your life insurance policy, there may be little or no death benefit left for your heirs when you die
  • The process does not require any health screens; you may be in good or poor health
  • The proceeds of the sale may be taxed
Viatical Settlements

These plans allow you to sell your life insurance policy to a third party and use the money you receive to pay for long-term care. A viatical settlement is like a life settlement, but it is only possible if you are terminally ill. During the settlement process, a viatical company pays you a percentage of the death benefit on your life insurance policy, which is based on your life expectancy. The viatical company then owns the policy and is its beneficiary. The viatical company also takes over payment of premiums on the policy. As a result, you get money to pay for care, and the viatical company receives the full death benefit after you die.

Unlike the life settlement, money you receive from a viatical settlement is tax-free, if you have a life expectancy of two years or less or are chronically illHaving a long-lasting or recurrent illness or condition that causes you to need help with Activities of Daily Living and often other health and support services. The condition is expected to last for at least 90 consecutive days. The term used in tax-qualified long-term care insurance policies to describe a person who needs long-term care because of an inability to do a certain number of Activities of Daily Living without help, or because of a severe cognitive impairment such as Alzheimer’s Disease. and the viatical company is licensed in the states in which it does business.

Key things to consider before using a viatical settlement:

  • You can only use the viatical settlement if you are terminally ill and have a life expectancy of two years or less
  • If you use the viatical settlement option, you do not have to satisfy the health requirements for long-term care insurance
  • If you use the viatical settlement option, your life insurance policy will not pay a death benefit to your heirs
  • Viatical companies approve less than 50 percent of applicants

The amount that you receive in cash from a viatical settlement is a percent of the death benefit on your life insurance policy. The chart below lists guidelines from the National Association of Insurance Commissioners (NAIC)Membership organization of state insurance commissioners. One of its goals is to promote uniformity of state regulation and legislation related to insurance., for how that percent varies based on your life expectancy.

  • Annuities -You may choose to enter into an annuityA contract in which an individual gives an insurance company money that is later distributed back to the person over time. Annuity contracts traditionally provide a guaranteed distribution of income over time, until the death of the person or persons named in the contract or until a final date, whichever comes first. contract with an insurance company to help pay for long-term care servicesServices that include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assists people with Activities of Daily Living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility. For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility.. In exchange for a single payment or a series of payments, the insurance company will send you an annuity, which is a series of regular payments over a specified and defined period of time. There are two types of annuities:
    • Immediate annuity
    • Deferred long-term care. Services and supports necessary to meet health or personal care needs over an extended period of time. annuity

Annuities

If you have an immediate long-term care annuity, the insurance company will send you a specified monthly income in return for a single premium payment.

  • This option is available regardless of your current health status. If you do not qualify for long-term care insurance. Insurance policy designed to offer financial support to pay for long-term care services. because of age or poor health or if you are already receiving long-term care, you can still purchase an annuity.

    The insurance company converts your single premium payment into a guaranteed monthly income stream for a specified period of time or for the rest of your life. How much you receive in income each month depends on the amount of your initial premium, your age, and gender. Since women tend to live longer than men, women generally receive a smaller monthly payment over a longer period of time than do men of the same age.

    Key things to consider before purchasing an annuity:

    • The annuity amount you receive may not be enough to pay for your long-term care expenses.
    • Inflation may reduce the value of the monthly income you receive from the annuity.
    • The effect that annuities can have on your taxes is complicated. Consult your tax professional before purchasing one.

    Deferred Long-term Care Annuity

    These plans are available to people up to age 85. Similar to other annuities, in exchange for a single premium payment, you receive a stream of monthly income for a specified period of time.

    The annuity creates two funds: one for long-term care expenses and another separate fund that you can use however you desire.

    You can access the long-term care fund immediately, but you must wait until a specified day in the future to access the separate cash portion. The rules of the annuity define how much you can access on a monthly basis from the long-term care fund and how much you can access on an annual basis from the cash fund. To qualify for a deferred long-term care annuity, you must satisfy some health criteria.

    Key things to consider before purchasing a deferred long-term care annuity:

    • If you do not use the long-term care fund, you can pass it on to your heirs
    • The annuity may not be enough to pay for your long-term care expenses
    • The long-term care portion of the annuity may satisfy the requirements for a tax-qualified long-term care policy.
    • The effect that annuities can have on your taxes is complicated. Consult your tax professional before purchasing one
    • An annuity can affect your eligibility for MedicaidJoint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services., and whether Medicaid will pay for your long-term care servicesServices that include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assists people with Activities of Daily Living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility. For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility..  See the section on “Annuities” in the “Medicaid Eligibility” section for more information.

https://longtermcare.acl.gov/costs-how-to-pay/paying-privately/annuities.html

Finding Local Services

Eldercare Locator
The Eldercare Locator is a nationwide service that connects older Americans and their caregivers with information on senior services, including Area Agencies on Aging. This is a government website.

NH Compare
Nursing Home(also called Long-Term Care Facility or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs. Compare has detailed information about every Medicare. Federal program that provides hospital and medical expense benefits for people over age 65, or those meeting specific disability standards. Benefits for nursing home and home health services are limited. and Medicaid Joint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services.-certified nursing home in the country. This is a government website.

Home Health Compare
Home Health Care includes skilled nursing care, physical therapy, occupational therapy, and speech therapy, medical social services and home health aide services.  This is a government website.

Genworth Cost of Care
This website provides information on the cost of long-term care. Services and supports necessary to meet health or personal care needs over an extended period of time. in every state. This is NOT a government website.

Assisted Living Data
The directory on this site allows for a search of residential facilities by Zip Code or State and does not require personal information.  This is NOT a government website.