Many Americans associate health care with medications, surgeries, and visits to primary care doctors. But did you know there's a separate type of care for those who need help in their daily lives due to illness, accident, or disability?
This is called long-term care. Individuals may need long-term care for help with personal care needs, including help with daily activities or supervision due to cognitive decline.
LTC News wants to educate individuals on everything long-term care related, including caregiving and insurance. We rely on experts for the most accurate and up-to-date information available. We believe access to information is key to helping individuals make the best decisions about long-term care.
In this article, we'll help define what long-term care is and what it isn’t. We'll also explain a few common long-term care services and facilities so you can better understand what care looks like in the real world.
What Is Long-Term Care?
Long-term care is care expected to last longer than 90 days due to illness, accident, disability, or aging. Long-term care comes in many forms. You can receive long-term care at home or in a facility, depending on your preference.
Long-term care is primarily non-medical. Instead, most long-term care services focus on helping individuals with personal needs, such as dressing or eating. Another name for care that helps with your personal needs is "custodial care."
What Is Custodial Care?
Custodial care is non-medical care for those who can't perform daily activities due to health conditions or memory loss. Most of the time, this involves helping with activities of daily living (ADLS) and instrumental activities of daily living (IADLs).
Activities of daily living can include but are not limited to:
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Bathing
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Dressing
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Transferring
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Eating
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Toileting
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Continence
Instrumental activities of daily living can include but are not limited to:
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Cooking & meal prep
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Cleaning
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Grocery shopping
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Housekeeping chores & house maintenance
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Laundry
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Medication management & reminders
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Transportation
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Planning outings, events, and visits
Custodial care focuses on improving quality of life and helping individuals live independently. This care can happen in an individual's home or a long-term care facility.
Custodial care comes in the form of hands-on and stand-by assistance. Hands-on care may involve physically helping someone complete daily tasks. Stand-by care may involve being in the room while someone completes tasks—in case they need help.
Medical professionals usually recommend custodial care. However, you don't have to be a professional to provide custodial care. The loved ones of long-term care recipients often provide custodial care without even realizing it.
Custodial care is not considered skilled care or health care. In fact, custodial care is what separates long-term care from health care. Long-term care differs because it centers around personal care rather than skilled or medical assistance.
What Is Skilled Care?
Long-term care has another component called skilled care. Skilled care is not the focus of long-term care, but it's often associated with it.
Licensed or registered health professionals provide skilled care. This type of care can involve but is not limited to:
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Administering medications
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Wound care
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Injections
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Various types of therapy (physical, speech, occupational)
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Monitoring vitals
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Intravenous (IV) therapy
Health professionals can provide skilled care in many settings, including at a patient's home or long-term care facilities.
Skilled care is a very high level of care. And because it's technically medical care, most health insurance policies (including Medicare and supplements) cover up to 100 days of skilled care.
However, once a patient's need for skilled care exceeds 100 days, health insurance no longer covers it. To continue receiving skilled care, a patient has two options:
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Pay for care out of pocket
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Use existing Long-Term Care Insurance coverage
RELATED: What Is Long-Term Care Insurance & What Does It Cover?
Who Might Need Long-Term Care?
Long-term care can help individuals with disabilities, frailty from aging, or chronic medical conditions who need ongoing care. It's also important to note that anyone can develop a need for long-term care.
However, there are certain demographics of people who are more at risk, including:
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The elderly
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Those with existing disabilities
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Those with pre-existing conditions, such as high blood pressure and diabetes
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Those with unhealthy habits, such as drinking, smoking, and excessive or unhealthy eating
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Individuals with a family history of dementia
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Individuals with a family history of longevity or those who expect to live past 80
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Those with mental illnesses
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Those who have been in an accident, such as a motor vehicle accident or a fall
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Those in the final stages of an illness
The scariest part of long-term care is that any of us could need it at any stage of our lives. It's difficult to predict when or how long someone will eventually need care or if they'll ever need it at all. It can help to be prepared for care if the need ever arises.
Many Americans underestimate the risk of needing long-term care services. The U.S. Department of Health and Human Services estimates that roughly 52% of Americans turning 65 today will develop a need for long-term care. However, many people will need care before then, usually due to accidents or injuries.
What Are Common Long-Term Care Services?
Many people may assume you'll go to a nursing home or care facility if you need care, but this couldn't be further from the truth. Today, a significant percentage of long-term care happens outside traditional care facilities. Most people today avoid facilities altogether and receive care at home.
This section focuses on various long-term care services, including in-home care. We'll explain available care options outside of facilities and discuss situations when you might want to use each service.
What Is In-Home Care?
In-home care has become one of the most common ways people receive long-term care services. As the name suggests, in-home care happens within the privacy of your home. It's for those with long-term care needs that can be managed safely without formal facility care.
In-home care typically focuses on routine help with activities of daily living or supervision for those who need it. On top of custodial care, there are also options to receive skilled services at home.
Most states require all in-home care workers to be licensed or certified to provide care. To learn more about what type of professional might be caring for you, read this article about the different types of caregivers in long-term care.
What Are Homemaker Services?
Homemaker services may co-occur with in-home care. Homemaker services mainly focus on cleaning and taking care of the living area.
Homemaker services may offer help with:
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Chores
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Grocery shopping
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Meal preparation
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Organization
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Laundry
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Basic level home maintenance
What Are Companionship Services?
Many Americans struggle to create and maintain connections as they age. As a result, many older adults experience loneliness, especially if they need long-term care. Companionship services can help with this.
Companionship services provide non-medical, emotional support to those in need. This usually involves a caregiver who may come to a patient's house as a friend would. Companions can play games, chat, and eat meals with patients.
But it isn't just any random stranger coming over. Companions are chosen based on shared interests and personality traits. The goal is to create a robust, compassionate bond and friendship to help combat loneliness.
What Are Transportation Services For Long-Term Care?
Some areas may offer non-emergency, free, or affordable transportation services. These services usually come directly to your house.
They're typically mobility aid-friendly and offer accessible seating, rails, and wheelchair lifts. Many people use transportation services for their daily needs, like doctor's appointments or grocery shopping.
What Are Medical Alert Systems?
Medical alert systems can be a great way to ensure your safety in an emergency. Many individuals wear medical alert systems such as bracelets or necklaces with a button connected to a phone.
When you push the alert button, the phone will call 911 and, in some cases, a trusted loved one. Trained professionals will assess the problem and contact family or emergency responders as needed. You can also program medical alert systems to send out loud distress noises for neighbors to hear.
What Is Palliative Care?
Palliative care is care used to treat the symptoms of a health condition. Symptoms can include fatigue, pain, shortness of breath, nausea, anxiety, and stress.
Individuals tend to receive palliative care on a long-term basis, especially when they're battling a long-term condition. Care professionals often use palliative care treatments in conjunction with illness-curing treatments.
Palliative care is available to anyone who needs or wants it at any point. However, this care is usually only provided at hospitals, outpatient centers, and occasionally the patient's home.
What Is Hospice Care?
Hospice care is a compassionate type of care for those with incurable and advanced illnesses. Hospice care typically only occurs before an individual passes away. It aims to help patients and families enjoy their last moments together.
Hospice care focuses on mitigating symptoms and pain rather than trying to treat conditions. This care is usually custodial and therapeutic. Depending on the severity of the situation, a registered nurse may also need to supply intravenous (IV) medication to make the individual as comfortable as possible.
Hospice care is also typically used to help loved ones and patients emotionally. Care can occur at home or in health care facilities.
What Is Respite Care?
Respite care provides temporary relief for informal family caregivers and professional in-home care providers. In short, respite care is when the care recipient goes to a facility to let their informal caregiver rest.
Respite care can take many forms, including home care, daycare, and overnight stays. Depending on the caregiver and patient's wishes, care can last for a few days or weeks.
Caregiving can be stressful. In some cases, it can even be a 24-hour job. Getting a break from that job can improve mental health and help caregivers reconnect with their loved ones.
What Are Caregiver Support Groups & How Can They Help?
In addition to respite care, informal caregivers may need support groups. Caregiver support groups help informal caregivers who may suffer from caregiving-related stress.
One of the best ways to access caregiver support is to join a local support group. Caregivers can discuss their needs, feelings, and experiences in safe and supportive environments.
Support groups can give caregivers reassurance and validation. They help caregivers create a network of contacts and feel less alone in their struggles. Support groups can also provide caregiving resources, advice, and ideas for care.
What Are Common Long-Term Care Facilities?
Many people may think nursing homes are the only type of long-term care facility. However, there are several types of facilities.
Each facility serves a different purpose and demographic. Some facilities offer specialized care, while others focus on community building. This article will discuss different types of long-term care facilities.
Long-term care facilities include but aren't limited to:
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Adult day care
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Assisted living facilities
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Memory care facilities
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Nursing homes & skilled nursing facilities
What Is An Adult Day Care Center?
Adult day care centers (ADCCs) are non-residential facilities that help adults during the day. These centers care for those who need help with activities of daily living or supervision for cognitive decline.
Many people use adult day care centers to receive care while their families are at work. Family members can drop off their loved one before work and pick them up afterward. These centers help provide peace of mind, and they’re more affordable than most other facilities.
Adult day care centers can also act as rehabilitation or transitional tools for recovery from surgery. Some families may also use these centers to give at-home informal caregivers a break from caring for their loved ones.
Care recipients may also enjoy these centers for stimulation and social benefits. Adult day care centers have much to offer, including activities, socialization, help with personal care needs, and a sense of community. These can positively impact aging adults feeling isolated or lonely at home.
What Is An Assisted Living Facility?
Assisted living facilities are popular among individuals who need help with activities of daily living due to aging or health problems. These facilities usually support those who need more care than is available at home but not enough to need a nursing home.
Assisted living facilities usually mirror traditional apartment complexes or private residences. The primary difference is that assisted living facilities always have staff on-call. The goal is to make life as comfortable as possible while providing options for long-term care as needed.
When individuals move in, they'll meet with a staff member to design a plan of care. This plan can include anything the individual may need help with, such as ADLs, meals, and housekeeping.
Assisted living facilities can give individuals peace of mind about their health and safety. There are also socialization benefits to living in an assisted living facility that those with independent living arrangements may not have.
What Is A Memory Care Facility?
As the average life expectancy increases, so does the chance of dementia. Historically, nursing homes were the only option for individuals with dementia. However, more families have turned to new care options over the past two decades.
Memory care facilities specialize in memory and cognitive disorders. These facilities may be standalone or connected to a nursing home, assisted living facility, or other long-term care centers. Staff at these facilities specialize in memory and cognitive illness care.
Individuals can access mind-stimulating activities and socialization opportunities at a memory care facility. These facilities provide round-the-clock care, supervision, and a sense of community.
What Is A Nursing Home?
Nursing homes are one of the most well-known types of long-term care. These facilities are for those who need a lot of help in their day-to-day lives.
Nursing homes offer various services, including both skilled and custodial care. As you may already know, nursing homes are residential, providing room, board, and meals. They also help out with housekeeping, laundry, and transportation.
Staff at nursing homes are available 24 hours a day, seven days a week. They usually work under the direction of a registered nurse or medical doctor.
Nursing homes are for people who need significant or round-the-clock care. Most residents have constant care needs, which means they’ll spend most of their time in the facility or receiving care. Many nursing homes offer group activities and social events to help residents make friends and feel more at home.
RELATED: Finding a Quality Nursing Home
What Is A Skilled Nursing Facility?
Skilled nursing facilities focus on individuals with more intense needs. Examples could include in-patient or rehabilitative care. Stays at these facilities tend to be shorter since they focus on a patient's intense needs instead of their long-term needs.
Often, people use the terms "nursing home" and "skilled nursing facility" interchangeably. However, they're not the same. Skilled nursing facilities offer similar services but target a different demographic.
What Does Long-Term Care Mean for You?
Long-term care is a type of care expected to last longer than 90 days. Most of us will need long-term care at some point in our lives.
Long-term care includes various services that help individuals with medical and non-medical needs. It’s for anyone who struggles in their day-to-day lives, including those with illnesses, injuries, cognitive decline, and disabilities.
Care can look very different depending on your needs and preferences. Some people need round-the-clock facility care, and others only need a few hours of in-home care a week.
As you continue to learn about long-term care, here are a few articles that can help you make informed, confident decisions about your long-term care needs:
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How Much Does Long-Term Care Cost? - The cost of long-term care can vary from person to person. This article discusses the factors that affect care costs. It also includes cost estimates for different long-term care services and facilities.
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LTC News Cost of Care Calculator - We designed this calculator to help you estimate the cost of certain long-term care services and facilities. This calculator uses real data from across the U.S. to predict current and future costs of care both nationwide and in your home state.