Levels of Care
LTC needs can vary from requiring help with basic tasks to full-time assistance with more complex needs. Care can be delivered at several different levels. The levels below are arranged from the least to the most skilled care provided.
Unskilled: Non-medical care providing Personal Care Services, companion or Sitter Services, Transportation Services, or Travel Companion Services.
Custodial: Non-medical care that helps individuals with basic daily care, such as eating and bathing; providers are not required to be medical professionals.
Supervisory: Services for people with memory or orientation problems.
Skilled: Prescribed by a physician; may include physical therapy, occupational therapy, nursing care and other services.
Note: Medicare and Medicare supplements will approve up to 100 days for skilled care only in the event of an acute medical condition (requires hospitalization first). Unskilled, Custodial or Supervisory levels of care and chronic conditions needing skilled care are NOT covered. LTC policies DO cover all these levels of care.
Where is Long-Term Care Provided?
Care can be delivered in several different settings and an LTC policy can give you the option to receive care in the setting of your choosing. The options below are arranged from those providing the least to the most skilled care.
Home Health Care: Services provided at home.
Adult Day Care: Community-based, daytime supervision providing social, recreational or health assistance.
Continuing Care Retirement Community: Access to multiple care levels on a single campus. Care levels include Independent Living, Assisted Living, Memory Loss Units and Nursing Home Care.
Assisted Living Facility: Residential care setting that provides housing and support services.
Nursing Home Care: Full-time care in a dedicated facility.
When Will a Policy Pay for Care?
An LTC policy will begin to pay benefits when either one of two following criteria is met.
- You are unable to perform two of six activities of daily living (ADLs) without assistance or supervision:
- Continence: Control over bladder and bowel movements.
- Dressing: Clothe oneself.
- Toileting: Use a toilet and perform associated personal hygiene.
- Eating: Feed oneself.
- Bathing: Bathe oneself.
- Transference: Move oneself into or out of a bed or chair.
- You have a severe cognitive impairment that makes it impossible for you to live independently. Alzheimer’s would be an example.
Key Features and Benefits
When considering long-term care insurance, you should be familiar with the following terms and key components of an LTC policy:
Daily/monthly benefit: The maximum daily or monthly amount your policy will provide.
Benefit maximum: The total maximum benefit amount available under the policy (e.g., $500,000).
Elimination period: The waiting period before benefits are paid (e.g., 90 days).
Inflation rider: A feature that helps benefits keep pace with the increasing cost of care.
Shared benefits rider: A provision that allows a couple to share benefits between their policies.