Types of Long Term Care Covered Services
A good long term care policy will cover all levels of care in nursing facilities and other residential care settings, such as assisted living.
Under home care, most policies include the community services of adult day care, respite care (temporary overnight care to relieve family caregivers) and hospice care. Policies should cover personal care.
Assisted living residence services are either covered under home
care or alternate care or may be a separate policy benefit. Some policies cover assisted living residences under nursing facility benefits. If you are interested in assisted living coverage, make sure you know how the policy handles this setting.
For a better understanding of the types of care available the following care definitions are provided;
Acute care
-Defined as care provided by a doctor or other health care professional designed to treat or cure an illness, wound, or condition, like a heart attack or stroke.
Long term care is not acute care.
Chronic care
- Defined as care provided to help maintain daily function. There is no expectation that the care recipient will improve or recover. Examples are Diabetes or Alzheimers. Long term care is chronic care.
Adult day care
- Defined as a place that provides a program of activities and services to individuals in need of long term care. It is a helpful option for individuals living at home whose family caregivers work during the day and who require someone to be with them throughout the day. Comprehensive plans under the Federal Program cover services at adult day care centers.
Skilled Care - Defined as the level of care which requires the services of a registered nurse, on a
regular basis, for treatments and procedures. Skilled care also includes services provided by specially trained professionals, such as physical and respiratory therapists.
Custodial Care - Defined as the
level of services required to maintain a resident's activity of daily living. Includes personal care, ambulation, supervision and safety. This care can be provided by a nurse aide, practical nurse, or a family member.
Skilled nursing care is that level of care that is required for acute or chronic medical conditions
of an individual. It requires nursing and rehabilitation services which can only be performed by skilled medical personnel such as registered nurses or professional therapists. Skilled nursing care must be performed
under the order of a physician. One or more professional nursing methods or procedures must be performed for your benefit on a daily basis.
Intermediate nursing care usually refers to a level of care delivered in a nursing home that is
somewhere between skilled nursing care and assisted living or custodial care. Intermediate care is similar to skilled nursing care in that it requires the orders of a physician. It also requires one or more nursing
procedures or methods to be performed for your benefit by skilled medical personnel. It is different from skilled nursing care in that procedures may be performed on an occasional basis. Both skilled and
intermediate care require a plan of medical treatment and medical records.
Medicare does not cover intermediate care.
Assisted living. or custodial care. is the type of care required to assist you in meeting daily living
requirements such as: walking, eating, bathing, dressing, and taking medicine. Custodial care can be provided by persons without medical skills or extensive training. Medicare
does not cover custodial care.
Home care: Long-term care insurance policies provide coverage on an optional basis for home care in addition to nursing
home care. Some policies may include this coverage automatically. Home care includes skilled nursing care, speech therapy, physical therapy, occupational therapy, social work, and personal care delivered
in the home. Medical services provided in the home by nurses, health aides and the various therapies are paid for by both Medicare and Medicaid if the patient is home bound and meets stringent health care
guidelines.
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