What is Long Term Care?
There are many different services that would fall under the definition of long term care. These services include institutional care in nursing facilities or non-institutional care such as home health care, personal care, adult day care, long term home health care, respite care and hospice care.
- Nursing homes in New York State are licensed under the Public Health Law.
- Home health care consists of services received in your home, and can include skilled nursing care, speech, physical or occupational therapy or home health aide services.
- Home care (personal care) consists of assistance with personal hygiene, dressing or feeding, nutritional or support functions and health-related tasks.
- Adult day care can provide supervision and other social, recreational, and in some cases, health services during the day, in a group settin outside the home, for elderly persons who still live at home.
- Assisted living facilities provide housing and ongoing care and services to those unable to perform activities of daily living or who have a cognitive impairment.
- An alternate level of care is care received as a hospital inpatient when there is no medical necessity for being in the hospital and is for those persons waiting to be placed in a nursing home or while arrangements are being made for home care.
- Respite care is temporary institutional or at home care of a dependent elderly, ill, or handicapped person, providing relief for their usual caregivers.
- Hospice care is a program of care and treatment, either in a hospice care facility or in the home, for persons who are terminally ill and have a life expectancy of six months or less.
Will I Need Long Term Care?
The chances of needing some type of long term care services is high. It is estimated that over 40% of all persons who were 65 years old in 1990 will enter a nursing home during their lifetimes.
The Cost of Long Term Care in New York
Long term care is very expensive. Most people cannot afford to privately pay for long term care services for very long.
Nursing home care costs vary in upstate New York from $264 per day in Central New York to $308 per day in the Rochester area, which is approximately $96,360 per year in Central New York to $112,420 per year in the Rochester area.
Downstate, nursing home costs vary from $340 per day in the Northern Metropolitan area to $390 per day in Long Island, which is approximately $124,100 per year in the Northern Metropolitan area to $142,350 per year in Long Island. It is estimated that persons in nursing homes stay for less than 2½ years on average.
Home health care is also expensive. The average cost of home health care in New York State in 2011 was $20 per hour, according to an industry survey. Assuming 20 hours of care per week, this represents average home health care costs throughout the State reach $21,000 per year.
Is Long Term Care Covered By Medicare or Health Insurance?
Medicare: Medicare does NOT pay for most long term care services. Individuals should not rely on Medicare to meet their long term care service needs. Medicare does not pay for custodial care when that is the only kind of care needed. Skilled nursing facility care is covered by Medicare but only on a very limited basis.
If you need skilled health care in your home for the treatment of an illness or injury, Medicare may pay for some part-time or intermittent home health services furnished by a home health agency. Visit www.medicare.gov and www.cms.gov for more information on what is/is not covered by Medicare.
Medicare Supplement Insurance Plans: These plans are designed to fill in some of the gaps in Medicare coverage, but they do NOT cover most long term care services.
Private health insurance: that you might already have covers mainly acute conditions and probably does NOT cover long term care.
Medicaid: In order to qualify for Medicaid coverage, you must meet certain income and asset tests. Because of the high cost of nursing home care, more than half of those who enter nursing homes privately paying for their care deplete their assets to the level required to qualify for Medicaid in less than a year.
In New York State in 2012, if only one spouse needs nursing home care, the married couple is allowed to keep a home, a car and assets up to $113,640. A single person who requires such care may have resources up to $14,250 and still qualify for Medicaid.
Source: New York Department of Financial Services
Click the image to see the Long Term Care Insurance New York Guide
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