Many people are surprised and disappointed when they learn that health or medical insurance does not cover home care services, even when those services are recommended by a MD or given by the hospital at discharge.
Long Term Care insurance (LTCi) pays for home care services when an individual requires support with a minimum of two activities of daily living (ADLs). Surprisingly less than 10% of Americans have long-term care insurance. Data shows that approximately 70% of Americans at the age of 65 are unable to care for themselves at some point in their lifetime without receiving some sort of assistance The majority of people surveyed say they want to age in place and stay in their home. Few people say they want to go to nursing home or assisted living.
So What’s the Difference?
A large percent of seniors are confused about what insurance covers when it comes to home care services. There is confusion and misunderstanding about what home care services actually include. People don’t know the distinction between home care services and home healthcare services.
Home Health Services or “skilled services” are often considered medically necessary and are prescribed by a doctor. This care is delivered by a medical professional such as a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT) or a Speech Therapist. These medical professionals can administer medications, develop exercise and physical therapy programs, attend to open wounds and provide advanced medical care. These type of medical services which are provided in the home are typically covered by Medicaid, Medicare or private health insurance.
Home Care Services often called “private duty” are nonmedical in nature and include hands on personal care, companion care and transportation support. Transportation can be rides to and from a doctor’s appointment, to the pharmacy, grocery store, or visit with friend’s. Personal Care is hands on assistance with all activities of daily living such as bathing, dressing, grooming, toileting feeding and mobility.
Oftentimes Home Care Services and Home Health Services overlap. For example, a Home Care Agency may give a client a shower whereas a Home Health Services agency could send a CNA to perform the same task. Many times a caregiver can get instructions, guidance and direction from a physical therapist and then help the client with exercises.
When to Purchase Long Term Care Insurance
The decision to purchase long-term care insurance is a personal one that should take into account a variety of factors including life expectancy and how long one might be ill. When calculating the cost of long-term care insurance, it is important to compare estimates for nursing home costs associated to chronic conditions that might affect your premiums or even your ability to get insurance. Consider things like inflation of the rising cost of living. In 2016 The Home Care Association of America did a study entitled, “The Value of Home Care.” This report that showed that home care can reduce the need for doctors’ visits, decrease the probability of a fall and dramatically reduce the chances of re-admission to a hospital. One should consider the cost of long-term care insurance versus the expenses associated to privately paying for home care or an extended stay in assisted living facility.
Another interesting fact to be considered is that people are living longer and there are going to be fewer and fewer family caregivers available to provide assistance. A recent AARP report stated that the number of family caregivers decrease from a ratio of 7-1, dropping as low as 4-1 by the year 2030. It’s not uncommon for family to live in another state, across the city or country, making it extremely difficult for them to help with things like running errands, shopping, driving to doctors’ appointments or helping with housework, thus increasing the need for a professional caregiving organization.
When assessing the need and cost associated to long-term care options, it is important to talk to family members, financial planners and people in the long-term care industry. A great deal of information on long-term care insurance can be found on at www.thehomecarespot.com/long-term-care/ such as a breakdown of the typical benefits for in a Long Term Care policy, details on the cost of care and an overview of our free LTC claims processing service.