What Are The Types And Costs Of Long-Term Care?
Long-term care needs can range from around the clock medical treatment to simply requiring assistance with the daily activities of life. In the past, a nursing facility was the only option for care outside the home. Today, Oregon leads the nation in providing alternatives to the traditional nursing home-type care.
Nursing Home Care. Nursing homes, licensed by the State, provide several different levels of nursing care to residents. These range from intensive nursing and rehabilitative care for people with unstable medical conditions, to routine care for people with chronic medical problems. Current estimated costs for nursing home care range from $3,500 to $7,500 per month, depending on the level of care needed.
Adult Foster Care. An adult foster home provides care to five or fewer residents. The operator or resident manager lives in the home. Personal care, cooking, and cleaning are provided. Other types of care depend upon the qualifications and license of the provider. Estimated costs range from $2,500 to $4,000 per month.
Residential Care. Residential care facilities serve six or more residents and have staff on duty around the clock. Meals and housekeeping services are provided, but the amount of personal care and supervision varies.
Assisted Living is a particular type of residential care, with its own administrative rules. The focus is on providing care through a social model that emphasizes independence. Estimated costs for residential care range from $1,500 to $5,000 per month.
In-Home Services. A range of services can be provided at home, from a short visit to meet a particular need for assistance, to live-in help. In-home services, generally, are not licensed by the State, although some providers carry their own license. Estimated costs vary according to the hours of service and the type of provider used.
Who Pays For Long-Term Care Expenses?
Health Insurance and Medicare. Medicare is covering approximately 4-6% of long-term care expenses. Health insurance, including Medicare, is primarily focused upon the payment of hospital and physician care for illness or accidents. Few health insurance carriers cover long-term care expenses. If they do, it is usually only for skilled care (the services of a doctor or nurse available 24 hours a day). Even if the insurance covers long-term care, it is often limited to a certain number of days (generally only 100 days or less).
Long-Term Care Insurance. Long-Term Care Insurance is covering approximately 2-4% of long-term care expenses. This is a relatively new form of insurance that can provide benefits for all levels of care including nursing homes, adult foster care, assisted living facilities, and in-home care services. Be sure to shop wisely and compare several policies. Most companies provide excellent coverage. However, some long-term care policies contain limitations or exclusions that prevent them from being an effective mechanism for funding care over an extended period of time. (Policies sold in Oregon must now include coverage for alternatives to nursing home care.) For more information, see Long-Term Care Insurance.
Private Pay. Approximately 40% of long-term care expenses in Oregon are paid from personal or family funds. The funds of both spouses are considered available to pay for care. The assets of adult children are not available assets unless they have signed as a guarantor for the nursing home expenses.
Medicaid. Approximately 50%+ of long-term care expenses are being covered by Medicaid making the Medicaid program the largest source of payment for long-term care in Oregon. Medicaid is a joint Federal and State program. Medicaid covers the full range of long-term care services for persons needing substantial assistance with activities of daily living in nursing and adult foster homes.
Medicaid eligibility is based upon a 'service' (or health-related) need and upon a financial need. To be eligible for Medicaid, the applicant must meet three (3) criteria for eligibility: (a) a health need; (b) an income need; and (c) an asset or resource need. Generally, individuals with severe health issues, whose monthly incomes are at or below $2,022 (since January 2009) and whose assets are below $2,000 for an individual and $21,912 (since January, 2009) for a couple will be eligible. Couples with assets above $21,912 may be required to split their assets and spend down before eligibility.
For more information, see our article on Medicaid in Oregon or contact us for an appointment to discuss these issues.