Long-term care includes nonmedical personal care services and support provided over an extended period to people who cannot perform everyday functions independently. The need can arise from chronic health conditions or disabilities but is most often associated with eldercare.
Some Medicare recipients receive long-term care at home with the support of family, friends or home health aides. When aging in place is not an option, you may look for facility-based care, such as a nursing home, assisted living facility or a continuing care retirement community.
Caregivers may help with:
- Personal hygiene, such as bathing, grooming, dressing and using the bathroom
- Grocery shopping, meal preparation and eating
- Homemaker and companion services
- Mobility like transferring from a bed to a chair
Community-based services, which supplement the services at home, include:
- Adult day care
- Senior center activities like fitness and nutrition programs
- Meal delivery programs
- Transportation to medical appointments
- Emergency medical alert systems
Medicare benefits for skilled nursing facility
Long-term care is sometimes referred to as custodial care, which is not included in Medicare benefits. While Medicare recipients are eligible for skilled nursing facility (SNF) care under Part A Medicare benefits, the services must be:
- Medically necessary
- After a three-day-minimum hospital stay for a related illness or injury
- Certified by your doctor that you have a medical need for services that would only be available to you as an inpatient of a skilled nursing facility
Some Medicare recipients also have Medicaid, a joint federal and state program. Medicaid covers the cost of long-term care if you meet your state’s eligibility requirements.
The Centers for Medicare & Medicaid Services (CMS) monitors the quality of long-term services and supports (LTSS) delivered by state Medicaid authorities.
“Medicaid is the primary payer across the nation for long-term care services,” as stated on the agency’s government website. These services include institutional care and community-based support.
Institutional care in a nursing home includes room and board as well as support with activities of daily living. Medicaid covers the services but not room and board for assisted living residences. Institutions have to be state-licensed and certified, subject to ongoing oversight. The need for institutional care generally drives eligibility for Medicaid services.
Originally, long-term care benefits through Medicaid were only available in an institutional environment. In 2005, state Medicaid agencies formally began to offer the option of home and community-based services.
Home and community-based services (HCBS)
The home and community-based services Medicaid covers include:
- Homemaker services
- Adult day care
- Respite care
- Home modifications
- Home health care
Some states limit HCBS to specific populations, such as people with:
- Intellectual or developmental disabilities
- Physical disabilities
- Mental illnesses
- Medicaid office (State Medical Assistance Office)
- Eldercare Locator: 800-677-1116
- US Aging: 202-872-0888