Types of Care
"Rehab": A generic name for rehabilitation therapy to help patients recover from a serious illness, injury, or surgery. Medicare covers, in full, the first 20 days of rehab care in a qualified facility following a qualifying hospital stay (defined as three days in a row in the hospital as an inpatient). For days 21-100 (again, following release from a qualifying hospital stay), you must pay a copayment (often covered by a supplemental health-insurance policy) while Medicare covers the remainder of the cost. For days 101 and beyond, Medicare does not cover the costs of rehab care. Patients receive rehab therapy in two main settings: acute inpatient rehabilitation facilities or skilled nursing facilities.
Activities of Daily Living: Basic activities that are used to measure a disabled or elderly individual's level of functioning. The key ADLs are bathing, dressing, eating, ambulating/transferring (moving from place to place, or from standing position to chair), grooming, and toileting. Activities of daily living are metrics used within the healthcare system, but families can also think about them when calibrating how much care their loved ones need.
Instrumental Activities of Daily Living: More complex self-care tasks, including shopping and meal prep, navigating transportation systems, and personal financial management. Slips in IADLs are usually the first signals that an elderly parent or loved one needs more help.
Skilled Nursing Facility (sometimes called a SNF or "Sniff"): A type of facility that provides skilled nursing care, usually medical care and/or rehabilitation services. Such rehab care is covered, in whole or in part, by Medicare for up to 100 days. Some skilled nursing facilities do double-duty, providing short-term rehab for patients who have had a qualifying hospital stay while also serving as long-term residential facilities.
Nursing Home: A facility that helps individuals with the activities of daily living, including eating, bathing, and getting dressed. Nursing homes are also likely to coordinate and/or provide medical care for individuals who need it, but their central focus is to help residents with their daily lives. In contrast to care provided in a skilled nursing facility to people who have had a qualifying hospital stay, nursing-home care (sometimes called "custodial care") is not covered by Medicare. Instead, costs are covered out of pocket, by long-term care insurance (for those who have such policies), or Medicaid for individuals with limited assets.
Assisted Living Facility: A type of facility geared toward people who need assistance with ADLs and IADLs but who do not need the type of extensive care provided in a nursing home. Most assisted living facilities, like nursing homes, help patients coordinate medical care, but providing medical care to sick individuals is not the central focus. Many ALFs now have locked "memory care" units geared toward people with Alzheimer's disease or dementia. As with nursing homes, stays in ALFs are not covered by Medicare; instead, such care is covered out of pocket, by long-term care insurance (for those who have it), or Medicaid.
Independent Living Facility: A type of facility geared toward individuals who can live independently and do not need assistance with activities of daily living, but want access to assistance to certain services such as meals and transportation. As with assisted living facilities, stays in independent living facilities are not covered by Medicare.
Adult Day Services: Services, including social activities and assistance with activities of daily living, provided during the day to individuals who otherwise reside at home. Approximately half of the individuals who take part in adult day services have some form of dementia, according to the National Adult Day Services Association; thus, adult day services frequently focus on cognitive stimulation and memory training. Medicare may cover adult day services in certain limited instances, but generally does not.
Hospice Care: Care provided to individuals at the end of their lives; the focus is on keeping the patient comfortable rather than extending life. Such care may be provided at home, in the hospital, or in a skilled nursing facility. Hospice care is covered by Medicare if your doctor and the hospice director certify that you're terminally ill and have less than six months to live. To be covered by Medicare, hospice care cannot be delivered in conjunction with any curative treatment. This document provides more details on the interaction between hospice and Medicare.
Insurance
Long-Term Care Insurance Covers long-term care, including custodial/personal care not covered by Medicare. Depending on the policy, the type of care covered may be delivered in a facility, at home, or through adult day-care services. Owing to insurers' negative claims experiences (people who have purchased the policies tend to use them and don't let them lapse), many insured individuals have confronted huge premium spikes in recent years; other insurers have gotten out of the long-term care business altogether.
Elimination Period: Similar to a deductible for other types of insurance, this is the amount of time during which one must pay long-term care costs out of pocket before insurance kicks in. The longer the elimination period, the lower the premiums will be.
Medicaid Eligibility
Exempt (or Noncountable) Assets: Assets that can be owned by the institutionalized person without affecting Medicaid eligibility. Specific parameters depend on the state where you live, but exempt assets typically include $2,000 in cash, a vehicle, personal belongings, and household goods. In most states, a primary residence is also considered an exempt asset, even if an individual ends up moving into a nursing home, so long as a spouse or child lives there. The individual's equity in the home cannot exceed certain limits; for 2017, it's $560,000 in most states.
Lookback Period: The five-year period prior to an individual's application for Medicaid benefits. If assets were transferred to children or any other individuals during this five-year period, it will trigger a period of ineligibility for Medicaid benefits. The length of the penalty period is calculated by dividing the amount of the transfer by the average monthly nursing-home costs in the region or state where the individual resides. The goal of this provision is to keep otherwise-wealthy individuals from transferring assets to qualify for long-term care coverage under Medicaid.
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75 statistics about long-term care
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