Long Term Care
Although UC does not offer its own long-term care plan, a wealth of helpful information is available from many sources.
Long Term Care - Frequently Asked Questions
What is Long-Term care?
Long-term care is the extended care you may need due to a serious accident, chronic illness, or the frailties of old age. Long-term care helps one live as she or he is now; it may not help to improve or correct medical problems. Long-term care services may include help with activities of daily living (such as bathing, dressing, and eating), monitoring and support for cognitive impairments such as Alzheimer's disease, home health care, respite care, adult day care, nursing home care, and care in an assisted living facility. Long-term care may also include care management services, which will evaluate your needs and coordinate and monitor the delivery of long-term services. Long-term care is different from the rest of your health care, and typically not covered by health insurance plans or Medicare.
What are my chances of needing long-term care?
Many people will need long-term care at some point in their lives. Long-term care is not just for senior citizens. Of the 13 million Americans receiving long-term care today, 40% are working age adults 18 to 64. As you age, your risk increases. 60% of people age 65 and older can expect to need long-term care for some period of time.
How much does long-term care cost?
Long-term care can be expensive. The cost depends on the amount and type of care you need and where you get it. In 2000, one year in a nursing home cost an average of $47,000 in California. In addition to the care provided by loved ones, people can pay more than $20,000 for care at home.
Who Pays for Long-Term Care?
Unless you have long-term care insurance, you will pay out of pocket for long-term care whether it is at home, in an assisted living facility, or in a nursing home. You can apply for assistance from Medi-Cal only after you have virtually exhausted all of your own assets paying for care.
Some features to look for in long term care insurance:
- Broad coverage- Be sure a long-term policy covers in-home care and "custodial care"- supervision and help with dressing, eating, bathing and other daily tasks- in addition to nursing care.
- Few restrictions- A policy should not have prerequisites for coverage, such as specifying that nursing home care be preceded by hospitalization. Coverage should be based on need, not "medical necessity"
- Adequate reimbursement-Most policies pay a fixed amount for each day of long-term care, and your parent pays the rest. Home care is usually covered at about half of the rate of nursing home care. Your parent will need to calculate how much he can afford to spend on future long-term care and then find a policy which will cover the rest.
- Inflation protection-A policy should allow for at least 5 percent inflation, compounded annually. This is more important for relatively young people (in their 60s or early 70s) who will not be needing long term care as soon as an older person.
- A reasonable waiting period- Any waiting period less than 20 days will make the policy too expensive. However, a waiting period of more than 100 days reduces the chance significantly that your parent will ever put the policy to use.
- A reasonable maximum- Policies that offer unlimited nursing home care are rare and expensive. Your parent should buy a policy with the highest maximum that she can comfortably afford.
- Waivers- A policy should include a waiver that frees your parent from paying premiums while he is receiving long-term care.
- Coverage for dementia- Check to make sure that the policy will cover Alzheimer's and other "organic diseases of the brain". Note: most policies will not cover mental illness, alcoholism, and drug addiction.
- Guaranteed renewals- A company should be allowed to cancel a policy only if the premiums are not paid, and under no other circumstances
- Fixed premiums-Because your parent is likely to be living on a fixed income, he should find a policy that has fixed premiums.
- Non forfeiture protection-This guarantees that the buyer will receive some value from the policy even if the policy is cancelled.
- A solid company- Check with the rating services listed below.
Long Term Care Resources
NAIC (the National Association of Insurance Commissioners) offers a booklet called "A Shopper's Guide to Long-Term Care Insurance." For a copy, write to: NAIC, 2301 McGee Street, Ste 800, Kansas City, MO 64108, or phone 1-816-783-8300.
State of California Department of Insurance
The Legislature requires the Insurance Commissioner to prepare a consumer rate guide for long-term care insurance annually. This guide consists of an overview of long-term care insurance, the types of benefits and policies you can buy, and a rate history of each company that sells long-term care insurance in California. You can find the "Long-term Care and History Guide" on this website, or call them for a copy (1-800-927-4357).
For information, call 1-800-CARE455, or write to California Partnership for Long-Term Care, P.O. Box 942732, Sacramento, CA 942732, Sacramento, CA 94234.
Other Long Term Care Resources
HICAP (Health Insurance Counseling and Advocacy Program) counselors provide objective information about long-term care planning, Medicare, health insurance, and other issues. Your local HICAP agency can provide you with a free copy of their long-term care booklet; their website includes other helpful information. The HICAP program was established by the California Department of Aging.
LongTermCareLiving.com provides helpful articles which you can print or order, such as "Paying for Long Term Care" and "Understanding Long Term Care Insurance". It is sponsored by the American Health Care Association and the National Center of Assisted Living.
CalPERS (California Public Employees' Retirement System) is a long-term care program is available to eligible UC employees and annuitants. You can request an application kit online or call 1-800-338-2244.