Long-term care
Encyclopedia
Long-term care is a variety of services which help meet both the medical and non-medical need of people with a chronic illness or disability
who cannot care for themselves for long periods of time.
It is common for long-term care to provide custodial and non-skilled care, such as assisting with normal daily tasks like dressing, bathing
, and using the bathroom. Increasingly, long term care involves providing a level of medical care that requires the expertise of skilled practitioners to address the often multiple chronic conditions associated with older populations. Long-term care can be provided at home
, in the community
, in assisted living
or in nursing home
s. Long-term care may be needed by people of any age, even though it is a common need for senior citizens.
The Centers for Medicare and Medicaid Services
(CMS) estimates that about nine million men and women over the age of 65 in the US will need long-term care in 2006. By 2020, 12 million older Americans will need long-term care. It is anticipated that most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that four out of every ten people who reach age 65 will enter a nursing home at some point in their lives. About 10 percent of the people who enter a nursing home will stay there five years or more.
Residents of LTC facilities may have certain legal rights
depending on the location of the facility.
levels. Most Western European countries have put in place a mechanism to fund
formal care and, in a number of Northern and Continental European countries,
arrangements exist to at least partially fund informal care as well. Some countries
have had publicly organized funding arrangements in place for many years: the
Netherlands
adopted the Exceptional Medical Expenses Act (ABWZ) in 1967, and
in 1988 Norway
established a framework for municipal payments to informal
caregivers (in certain instances making them municipal employees). Other
countries have only recently put in place comprehensive national programs: in
2004, for example, France
set up a specific insurance fund for dependent older
people. Some countries (Spain
and Italy
in Southern Europe, Poland
and Hungary
in Central Europe) have not yet established comprehensive national programs,
relying on informal caregivers combined with a fragmented mix of formal services
that varies in quality and by location. (Saltman et al. 2006)
is a government program that will pay for certain health services and nursing home care for older people. In most states, Medicaid also pays for some long-term care services at home and in the community. Eligibility and covered services vary from state to state. Most often, eligibility is based on income and personal resources.
does not pay for long-term care. Medicare pays only for medically necessary skilled nursing
facility or home health care. However, certain conditions must be met for Medicare to pay for even those types of care. The services must be ordered by a doctor and tend to be rehabilatative in nature. Medicare specifically will not pay for custodial and non-skilled care. Medicare will typically cover only 100 skilled nursing days following a 3 day admission to a hospital.
A 2006 study conducted by AARP found that most Americans are unaware of the costs associated with long-term care and overestimate the amount that government programs such as Medicare will pay. Medicare clearly states that they do not pay for any Long-term Care services.
, drug therapy, physical therapy
, and even physical construction (installing hydraulic lifts, renovating bathrooms and kitchens) activities. Home HEALTH Care is usually Doctor ordered and his only for a limited period of time and is usually covered by Health Insurance. Home care is not covered by health insurance but is covered by Long-term Care Insurance. However 90% of all home care is provided by a loved one at no cost.(Saltman et al. 2006) Informal care plays an important part in many countries across the world.
In many countries, the largest percentages of older persons using services are those who rely on informal home care. Estimates of these figures often are in the 80 to 90 percent range; for example, in Austria
, 80 percent of all older citizens (OECD 2005). The similar figure for dependent elders in Spain
is 82.2 percent (Costa-Font and Patxot 2005).
and Denmark
allowing relatives and neighbors who were providing regular home care to become municipal employees, complete with regular pension benefits. In Finland
, informal caregivers received a fixed fee from municipalities as well as pension payments. In the 1990s, a number of countries with social health insurance (Austria
in 1994, Germany
in 1996, Luxembourg
in 1999) began providing a cash payment to service recipients, who could then use those funds to pay informal caregivers. In Germany, the long-term care fund may also make pension contributions if an informal caregiver works more than 14 hours per week. (Saltman et al. 2006)
Disability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...
who cannot care for themselves for long periods of time.
It is common for long-term care to provide custodial and non-skilled care, such as assisting with normal daily tasks like dressing, bathing
Bathing
Bathing is the washing or cleansing of the body in a fluid, usually water or an aqueous solution. It may be practised for personal hygiene, religious ritual or therapeutic purposes or as a recreational activity....
, and using the bathroom. Increasingly, long term care involves providing a level of medical care that requires the expertise of skilled practitioners to address the often multiple chronic conditions associated with older populations. Long-term care can be provided at home
Home care
Home Care, , is health care or supportive care provided in the patient's home by healthcare professionals Home Care, (also referred to as domiciliary care or social care), is health care or supportive care provided in the patient's home by healthcare professionals Home Care, (also referred to as...
, in the community
Community
The term community has two distinct meanings:*a group of interacting people, possibly living in close proximity, and often refers to a group that shares some common values, and is attributed with social cohesion within a shared geographical location, generally in social units larger than a household...
, in assisted living
Assisted living
Assisted living residences or assisted living facilities provide supervision or assistance with activities of daily living ; coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being.Assistance may...
or in nursing home
Nursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
s. Long-term care may be needed by people of any age, even though it is a common need for senior citizens.
The Centers for Medicare and Medicaid Services
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(CMS) estimates that about nine million men and women over the age of 65 in the US will need long-term care in 2006. By 2020, 12 million older Americans will need long-term care. It is anticipated that most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that four out of every ten people who reach age 65 will enter a nursing home at some point in their lives. About 10 percent of the people who enter a nursing home will stay there five years or more.
Residents of LTC facilities may have certain legal rights
Nursing home residents' rights
Nursing home residents' rights are the legal and moral rights of the residents of a nursing home. Legislation exists in various jurisdictions to protect such rights. An early example of a statute protecting such rights is Florida statute 400.022, enacted in 1980, and commonly known as the...
depending on the location of the facility.
Long-term care funding
National governments have responded to growing long-term care needs at severallevels. Most Western European countries have put in place a mechanism to fund
formal care and, in a number of Northern and Continental European countries,
arrangements exist to at least partially fund informal care as well. Some countries
have had publicly organized funding arrangements in place for many years: the
Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
adopted the Exceptional Medical Expenses Act (ABWZ) in 1967, and
in 1988 Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
established a framework for municipal payments to informal
caregivers (in certain instances making them municipal employees). Other
countries have only recently put in place comprehensive national programs: in
2004, for example, France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
set up a specific insurance fund for dependent older
people. Some countries (Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...
and Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
in Southern Europe, Poland
Poland
Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...
and Hungary
Hungary
Hungary , officially the Republic of Hungary , is a landlocked country in Central Europe. It is situated in the Carpathian Basin and is bordered by Slovakia to the north, Ukraine and Romania to the east, Serbia and Croatia to the south, Slovenia to the southwest and Austria to the west. The...
in Central Europe) have not yet established comprehensive national programs,
relying on informal caregivers combined with a fragmented mix of formal services
that varies in quality and by location. (Saltman et al. 2006)
Medicaid (US)
MedicaidMedicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
is a government program that will pay for certain health services and nursing home care for older people. In most states, Medicaid also pays for some long-term care services at home and in the community. Eligibility and covered services vary from state to state. Most often, eligibility is based on income and personal resources.
Medicare (US)
Generally, MedicareMedicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
does not pay for long-term care. Medicare pays only for medically necessary skilled nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
facility or home health care. However, certain conditions must be met for Medicare to pay for even those types of care. The services must be ordered by a doctor and tend to be rehabilatative in nature. Medicare specifically will not pay for custodial and non-skilled care. Medicare will typically cover only 100 skilled nursing days following a 3 day admission to a hospital.
A 2006 study conducted by AARP found that most Americans are unaware of the costs associated with long-term care and overestimate the amount that government programs such as Medicare will pay. Medicare clearly states that they do not pay for any Long-term Care services.
Home care / Informal care
Home care and Home HEALTH care are often confused but are two completely different services. Home Care can be provided by informal (nonprofessional, Family members, usually volunteer) Home HEALTH Care has formal (professional) providers and can incorporate a wide range of clinical (nursingNursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
, drug therapy, physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
, and even physical construction (installing hydraulic lifts, renovating bathrooms and kitchens) activities. Home HEALTH Care is usually Doctor ordered and his only for a limited period of time and is usually covered by Health Insurance. Home care is not covered by health insurance but is covered by Long-term Care Insurance. However 90% of all home care is provided by a loved one at no cost.(Saltman et al. 2006) Informal care plays an important part in many countries across the world.
In many countries, the largest percentages of older persons using services are those who rely on informal home care. Estimates of these figures often are in the 80 to 90 percent range; for example, in Austria
Austria
Austria , officially the Republic of Austria , is a landlocked country of roughly 8.4 million people in Central Europe. It is bordered by the Czech Republic and Germany to the north, Slovakia and Hungary to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the...
, 80 percent of all older citizens (OECD 2005). The similar figure for dependent elders in Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...
is 82.2 percent (Costa-Font and Patxot 2005).
Informal care financing
In the 1980s, some Nordic countries began making payments to informal caregivers, with NorwayNorway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
and Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...
allowing relatives and neighbors who were providing regular home care to become municipal employees, complete with regular pension benefits. In Finland
Finland
Finland , officially the Republic of Finland, is a Nordic country situated in the Fennoscandian region of Northern Europe. It is bordered by Sweden in the west, Norway in the north and Russia in the east, while Estonia lies to its south across the Gulf of Finland.Around 5.4 million people reside...
, informal caregivers received a fixed fee from municipalities as well as pension payments. In the 1990s, a number of countries with social health insurance (Austria
Austria
Austria , officially the Republic of Austria , is a landlocked country of roughly 8.4 million people in Central Europe. It is bordered by the Czech Republic and Germany to the north, Slovakia and Hungary to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the...
in 1994, Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
in 1996, Luxembourg
Luxembourg
Luxembourg , officially the Grand Duchy of Luxembourg , is a landlocked country in western Europe, bordered by Belgium, France, and Germany. It has two principal regions: the Oesling in the North as part of the Ardennes massif, and the Gutland in the south...
in 1999) began providing a cash payment to service recipients, who could then use those funds to pay informal caregivers. In Germany, the long-term care fund may also make pension contributions if an informal caregiver works more than 14 hours per week. (Saltman et al. 2006)
See also
- Long term care insuranceLong term care insuranceLong-term care insurance , an insurance product sold in the United States, United Kingdom and Canada, helps provide for the cost of long-term care beyond a predetermined period...
- Activities of daily livingActivities of daily livingActivities of Daily Living is a term used in healthcare to refer to daily self-care activities within an individual's place of residence, in outdoor environments, or both...
- Assisted livingAssisted livingAssisted living residences or assisted living facilities provide supervision or assistance with activities of daily living ; coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being.Assistance may...
- Dynamic treatment regimesDynamic treatment regimesIn medical research, a dynamic treatment regime or adaptive treatment strategy is a set of rules for choosing effective treatments for individual patients. The treatment choices made for a particular patient are based on that individual's characteristics and history, with the goal of optimizing...
- Geriatric care managementGeriatric care managementGeriatric care management is the process of planning and coordinating care of the elderly and others with physical and/or mental impairments to meet their long term care needs, improve their quality of life, and maintain their independence for as long as possible...
External links
- California Partnership for Long-Term Care The State of California wants to help people navigate the complex, overwhelming and costly issue of long-term care. Offers information and free calculators to help people determine how much long-term care insurance they need.
- Medicare. US Government. Long term care information
- Medicare Part D Information University of Florida/IFAS Extension Department of Family, Youth and Community Sciences
- The SCAN Foundation An independent nonprofit foundation dedicated to advancing the development of a sustainable continuum of quality care for seniors.
- Family Factors Involved in Making Long-Term Care Financing Decisions University of Florida/IFAS Extension Department of Family, Youth and Community Sciences
- Family Caregiving Financial Resources List of county or state departments or local area social service agencies for long-term caregivers to utilize
- Long Term Care Medical Directors Association of Canada - Association canadienne des directeurs médicaux en soins de longue durée An association of medical directors in Canada committed to the development of the role of the physician in the Long Term Care setting. — A 28 page guide from The Department of Health and Human Services.
- How much does long term care cost?
- Latest Cost of long term care survey conducted for Genworth Financial
- Health-EU Portal Long-term Care in the EU