Understanding Long-Term Care

April 2017


The aging of baby boomers has led to a national discussion of the increased demand for long-term care services. It is estimated that 70 percent of individuals over the age of 65 will need some type of long-term care. Long-term care includes different kinds of assistance you may need if you ever have difficulty caring for yourself in performing everyday activities for an extended period of time.

What is Long-Term Care?
Sometimes the need for assistance starts with the death of a spouse. The surviving spouse needs help with activities other spouse regularly took care of such as:
•    taking care of the yard,
•    repairs needed around the house, and
•    paying bills.

Other times, the need for assistance is due to health problems. Reaching for something or opening a jar becomes more difficult. You may have trouble lifting a gallon of milk or walking up the stairs. You sometimes forget where you put your car keys or where you parked the car. These may be normal signs of aging. They may also be caused by chronic diseases like arthritis or being overweight.
In these situations, you require help with what are called Instrumental Activities of Daily Living or IADLs. These activities are not necessary for fundamental functioning, but they let you live independently in a community.


Simple devices such as levered door handles or a specially designed pair of tongs can enable you to do what you need with less effort. Making modifications to your home such as adding grab bars or putting in a ramp entrance to your house can help you remain independent longer.


Generally, the government and long-term care insurance will not assist you in paying for help in performing IADLs. If you have to hire someone to do some housework or mow the lawn, then you have to pay for that yourself. You need to budget for this. You may ask a family member or close friend to help you with these activities. You need to think about the emotional and financial toll this places on your loved one. You may also take a course to learn how to do these activities yourself.
To qualify for long-term care insurance or some government programs, the requirements for assistance are limited to six Activities of Daily Living or ADLs:
•    eating,
•    bathing,
•    dressing,
•    toileting,
•    incontinence hygiene,
•    transferring (getting out of a chair or bed).

In order to qualify, you must need substantial assistance with performing two or more ADLs. If you have a cognitive impairment such as Alzheimer’s disease, you must need substantial supervision to protect your own safety.

Types of Long-Term Care
To understand what long-term care is, it helps to know the difference between custodial care and skilled care. Custodial care and long-term care mean the same thing. Many people think that Medicare will pay for custodial care. While Medicare does cover expenses related to skilled care, it does not cover expenses for custodial care. Skilled care is provided in relation to an injury or illness from which you are expected to recover. Medicare covers these expenses as long as you continue to recover.
When you reach a point where there is no further improvement, you are considered to need custodial care. The majority of the cost of custodial or long-term care is paid by the individual needing the care. Part of the reason for confusion is that skilled care can be provided in the same place as custodial care.
Individuals requiring long-term care have non-physical needs as well.
•    Many can feel isolated from their family, friends and communities.
•    They continue to need social interaction, emotional support and cultural and intellectual stimulation.
•    Dealing with all the financial and legal aspects of long-term care can be overwhelming.

Addressing these types of needs is just as important as providing physical care.

Options for Long-Term Care Services
Many people think that needing long-term care means wasting away in a nursing home. Nothing can be further from the truth. Currently, more than 80 percent of long-term care is provided for at home by unpaid caregivers, either in the individual’s home or at a family member’s home. According to the U.S. Department of Health and Human Services (HHS), unpaid family caregivers will likely continue to be the largest sources of long-term care services in the U.S. and are estimated to reach 37 million caregivers by 2050.
•    The Family Caregiver Alliance (FCA) reported that in Oklahoma alone during 2006, there were 370,000 caregivers who provided 400 million hours of care at a value of $3.5 billion.
•    According to the FCA, two-thirds of caregivers are female, but the number of male caregivers is increasing. The typical caregiver is a 48-year old woman.
•    Caregivers in Oklahoma may be eligible for vouchers to help pay for respite care (a temporary break from caregiving duties). For more information, contact the Oklahoma Department of Human Services at 405-521-4358 or http://www.okdhs.org/programsandservices/aging/resp.

Even if you do not have family members or friends who are able to provide care at home, you can still stay in your home and receive long-term care. There are many home and community-based services available. Some of the most common are:
•    adult day care centers,
•    home care services,
•    geriatric care managers,
•    Meals-on-Wheels, and
•    senior community centers.

Your local Area Agency on Aging can help you find out what services are available where you live. In Oklahoma, you can call the Senior Info Line at 1-800-211-2116 to reach the office that serves your local area or visit the Oklahoma Area Agencies on Aging website at http://www.okdhs.org/programsandservices/aging/aaa.
If you find you can no longer safely live in your home, there are plenty of options available. Some examples include:
•    adult companion services,
•    board and care homes,
•    assisted living facilities, and
•    continuing care retirement communities.

In an assisted living facility, you can live in your own apartment or room. But you also enjoy the support services that a community setting makes possible:
•    regular meals,
•    housekeeping and laundry services,
•    24-hour security,
•    emergency medical care, and
•    social programs.

Continuing care retirement communities offer the opportunity for you to age in one location. They offer independent housing, just like a typical retirement community. If you need a little help, home-based care may be provided. They also have assisted living housing and one or more skilled nursing facilities all on one campus for those that need greater levels of care and supervision. The fee arrangements for these communities vary. You will pay a monthly fee, but you may also be charged a one-time entrance fee.
Last, there is the independent skilled nursing facility. It is also called a nursing home or convalescent care facility. This is the most expensive form of long-term care. Some people need these services for a short period of time for recovery or rehabilitation after a serious illness or operation. Others may need to live in this type of housing for longer periods due to chronic illnesses. These people need constant care or supervision.

Paying for Long-Term Care
According to the Genworth Financial 2015 Cost of Care Survey, Oklahoma is considered one of the least expensive states for nursing home care and assistant living facilities. The Survey provides a summary of long-term care costs for the state.
•    The median annual cost of a semi-private nursing home room in Oklahoma was $53,250. The national median cost was $80,300.
•     The median annual cost of a private, one-bedroom stay in an assisted living facility in Oklahoma was $40,140. The national median cost was $43,200.

The most obvious way to avoid paying these costs is to stay in your home and receive long-term care there as long as possible.
•    In Oklahoma, the hourly rate for licensed homemaker services ranged from $17 to $27 per hour ($19 median hourly rate) and licensed home health aide services ranged from $17 to $27 per hour ($20 median hourly rate).


If you needed to pay for help for 15 hours a week, the annual cost could be as low as $10,608 depending on where you live in Oklahoma – less expensive than an assisted living facility or a skilled nursing facility.


As mentioned earlier, the majority of the cost of long-term care is paid by the individual needing care. You will have to rely on your retirement income and personal assets to fund the majority of your long-term care. So you will need to budget for these expenses. Here are some things to keep in mind as you plan:
•    In general, Medicare will not cover long-term care expenses for custodial care.
•    Medicaid may be available to cover nursing home costs, but you must meet limited income and asset requirements. For general questions regarding Medicaid, contact the Oklahoma Health Care Authority at (405) 522-7300 or 1-800-987-7767 or visit their website at http://www.okhca.org.
•    Medicaid has also started to cover other long-term care expenses. In Oklahoma, there are two programs to help individuals remain at home and pay for long-term care services: the Medicaid Advantage Program and the State Plan Personal Care program. Like other Medicaid programs, you need to meet the requirements. For more information, visit the Oklahoma Department of Human Services, Aging Services Division’s website at  http://www.okdhs.org/programsandservices/aging or call the Senior Info-line at 1-800-211-2116.
•    Consider long-term care insurance. Read Extension Fact Sheet T-4154, “The Basics of Long-Term Care Insurance.”  Contact the Oklahoma Insurance Department at 1-800-522-0071 (in-state only) or (405) 521-2828, or visit their website at http://www.ok.gov/oid for questions about specific long-term care insurance policies.
•    Oklahoma has joined the list of states that offer Long-Term Care Partnership plans to reduce their growing Medicaid expenses. For more information, call (405) 522-7904 or visit the website at http://www.okltcpartnership.org.
•    Some insurance companies are now offering riders to life insurance policies that are designed to help pay long-term care expenses.
•    You may also want to ask your financial planner about other options.

Will I Need Long-Term Care?
Developing healthier living habits can delay, and possibly eliminate, the need for long-term care. People who get regular exercise, don’t smoke and eat a healthy diet have 50 percent lower rates of disability than those who do not follow a healthy lifestyle (Oklahoma: Own Your Future – Planning Guide for Long-Term Care). Even if your lifestyle habits have not been ideal, it is never too late to change. Poor health is not an inevitable consequence of aging.
Also, with the help of new technology and home modifications, more people are able to remain at home and independent much longer, reducing the need for more expensive forms of long-term care. Recent trends suggest that 50 percent or more of the people who might have gone to a nursing home will in the future go to an assisted living facility.
A HHS study indicates that people age 65 will face at least a 40 percent lifetime risk of entering a nursing home sometime during their lifetime.
•    About 10 percent will stay there for five years or longer.
•    At any given time, 22 percent of people age 85 or older are in a nursing home.
•    Since women live longer than men, they tend to need more long-term care and for longer periods of time.

Thus, there is a growing national awareness to make more cost-effective, long-term care services available, particularly at the local level. There is also a national campaign to make the public more aware of the need for planning for long-term care. As part of that campaign, the Oklahoma: Own Your Future Planning Guide was created. It is now available for download from the Oklahoma Long-Term Care Partnership Program’s website at http://www.okltcpartnership.org/downloads/Final_OK_Planning_Guide.pdf . This guide can help you get started in planning long-term care needs.

Summary
No matter how hard you try, you cannot avoid getting older. But there are lifestyle changes you can make now to keep yourself healthy and reduce the need for long-term care. Improving your diet is a good first step. Next, implement an exercise program that includes:
•    aerobic activity,
•    strength training,
•    flexibility workouts, and
•    puzzles that stimulate the brain.
Helpful Websites
1.    American Association of Retired Persons: http://www.aarp.org
2.    Family Caregivers Alliance:  http://www.caregiver.org
3.     Genworth Financial 2015 Cost of Care Survey: https://www.genworth.com/dam/Americas/US/PDFs/Consumer/corporate/130568_040115_gnw.pdf 4.
4.     National Family Caregivers Association (Caregiver Action Network): http://caregiveraction.org/
5.     Oklahoma Area Agencies on Aging: http://www.okdhs.org/programsandservices/aging/aaa
6.     Oklahoma Department of Human Services, Aging Services Division: http://www.okdhs.org/programsandservices/aging
7.     Oklahoma Health Care Authority: http://www.okhca.org
8.     Oklahoma Insurance Department: http://www.ok.gov/oid
9.     Oklahoma Long-Term Care Partnership Plan: http://www.okltcpartnership.org
10.    U.S. Department of Health and Human Services National Clearinghouse for Long-Term Care Information:
http://www.longtermcare.gov/LTC/Main_Site/index.aspx


Sissy R. Osteen
, Ph.D. CFP®

Associate Professor

DASNR Extension Research CASNR
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Oklahoma State University
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