Does Health Insurance Cover Long Term Care?
Long term care is usually not covered by health insurance policies, although each policy has its own specific stipulations. Even if your general health insurance plan does not cover long term care, you can often purchase a long term care policy that is designed to take care of the costs.
Long term care usually applies to people who have an ongoing disability or medical condition. HealthCare.gov reports that the term “personal assistance” is often used to describe long term care, as it helps people with any number of tasks they need to perform throughout the day.
Do you have to be in a nursing home to get long term care coverage?
People in nursing homes commonly receive some type of long term care, but the care can also take place in someone’s home, in assisted living facilities, or in other locations. It can consist of part-time or full-time help and can include tasks that range from helping someone get dressed and take a bath to helping administer medication and therapy.
Long term care often consists of three areas where people will require the most assistance, according to MySeniorCare.com. Long term care patients can hire health aides, nurses, and therapists or hospice caregivers. Health aides are the ones who help with personal tasks, such as dressing and bathing. Nurses and therapists are those qualified to administer medication, under doctor’s orders, and help with physical therapy.
Hospice caregivers are those hired to help someone suffering from a terminal illness. Their duties usually include helping to manage the patient’s pain and other symptoms, as well as offering support for the family.
The Mayo Clinic breaks down long term care into different categories based on the needs of an individual. Those requiring the least amount of assistance typically go for long term care at home, while those requiring the most assistance are usually those receiving long term care in a nursing home.
Levels in between the two include day programs, housing for seniors, assisted living facilities, and continuous care in retirement communities. Day programs are usually offered at some type of community facility and are geared toward people who do not need full-time nursing or other help.
Senior housing facilities often offer help with errands, provide meals, and perform housecleaning duties. Assisted living facilities go beyond senior housing by helping with personal tasks and with the administering of medications.
A sub-category of assisted living includes memory care assisted living, aimed at people who are suffering from dementia or another condition that impairs memory. The facility is typically secured and supervised at all times, although residents can freely interact with other facility residents and engage in social activities.
Retirement communities often offer several different levels of care, with each resident receiving the level they require. This can range from full-time nursing and other help to those who simply need a hand with daily tasks.
What types of long term care policies are there?
Just as there are many different health insurance policies, there are many different types of long term care policies. Some may have stipulations that may only cover a person living in a nursing home, while others can extend to cover people living in assisted living quarters or their own homes.
The type of care covered can also vary. Some policies may only pay for qualified nurses and therapists recommended by a doctor. Others can cover health aide services to help with daily living tasks.
What can help decide the right type of long term care?
A number of questions can help you decide what type of long term care, and therefore what type of long term care policy, may work best for your specific situation. If a person can still safely function in the home without supervision, your needs may remain at part-time care.
Needs are prone to change, however, and you want to ensure you have a policy that is flexible enough to adapt or can put a new policy in place. If and when the time comes to choose a long term care facility, you can go through a checklist of concerns.
The first step is figuring out exactly what services are needed as part of the long term care. Your doctor can be a good sounding board for this concern, as he or she can point out any specific needs you may be overlooking.
Your comfort level and preferences are another concern. Some people thrive in a community-oriented environment, while others would prefer a private room in a less community-oriented setting. Figuring out what amenities are important can also help guide your decision. Some facilities offer game rooms, exercise rooms, and other amenities that can enhance your quality of life.
Location and money are two additional issues. Being close to other family members makes it easier to arrange visits and help from family members. What your policy covers or what your family can afford may also play a huge role in the type of facility you choose.
Before committing to any specific facility, it’s also a good idea to take a tour of several of them, if possible. That way you can compare the facilities and gauge your first impression. The facility should make you feel safe, comfortable, and secure, as it will serve as your new long-term home.