Which level of care do you need?
As a resident’s need for assistance increases, there is a higher level of care available. Sometimes this comes with a price increase, but a properly designed care plan can ensure the proper amount of care at the most affordable price. Below are different levels of care written out in what we believe is in chronological order from zero Activities of Daily Living (ADL) assistance to higher needs. Please note that the information below will vary depending on state requirements, e.g. income/asset requirements and ADL requirements. Feel free to contact us to learn more about your local requirements and to discuss your options.
Activities of Daily Living (ADL): Includes eating, bathing, dressing, toileting, transfer, and continence.
Medicare Myth
Many people assume that Medicare covers the following services. While there are limited coverages for short-term care, Medicare does not pay for long-term care services.
Planning techniques to consider
- Coordinate one or more of these options to ensure the proper level of care at the most affordable price. Some people in independent living communities can coordinate a home health care provider instead of going to assisted living.
- No one size fits all
- Consider resources that will assist you in paying for some of these options when designing a care plan.
Caregiving Options
55+ communities
- Offers social aspects for the resident.
- Paid for by the resident.
Independent living communities
- Meal preparation (usually 2-3 meals/day)
- Social aspects
- Staff on premises (not necessarily medical staff)
- Secure environment
- Promotes an independent lifestyle with the option of some assistance
- Paid for by the resident. Traditionally not paid for by long-term care insurance, Medicare, or Medicaid, as most residents in this situation don’t need help with ADLs. Some states may offer vouchers for people with low income/assets.
Family member/friend
- Sometimes can be more affordable than hiring professional or licensed help, but consider the caregiver’s time off of work, the potential cost of benefits they may lose from their job (e.g. health insurance, 401k matches, paid vacation time), and that they are not earning Social Security credits when typically they may be at the top of their pay scale. [[LINK TO SOCIAL SECURITY LANDING PAGE]]]]]]]]]]]]]]]]] These lost benefits and wages could be more costly than hiring professional help.
- Emotionally, this can put a strain on family relationships. Many caregivers in this situation suffer from burnout.
- If the caregiver gets hurt, the resident may be liable if the caregiver is not insured. Most homeowners insurance does not cover hired help.
- Not regulated – no background criminal checks or regulatory oversight.
- Lack of scheduling flexibility.
- May be covered by resident’s long term care insurance.
- How to File a claim
- Not covered by Medicare or Medicaid.
Adult day care
- Allows caregiver respite time during the day to run errands, etc.
- Provides mental and social stimulation for the resident.
- Paid for by the resident, may be covered by long-term care insurance. How to file a claim. [[[[[[LINK]]]]]]. Some states or charities may offer vouchers for low-income/assets.
- Not covered by Medicare or Medicaid
Personal care home
- A residence offering protective care and oversight of a person who needs a watchful environment, but does not have an illness, injury, or disability requiring chronic or convalescent care such as medical or nursing services.
- Generally have about 2-10 residents, and they provide varying levels of care in private or semi-private rooms.
- For people who need some daily assistance, but prefer to share a private home with another family or small group as opposed to a larger group.
- Can be more affordable than most assisted living communities.
- Paid for by the resident, may be covered by long-term care insurance. How to file a claim. [[[[[[LINK]]]]]]. Some states may offer vouchers for low-income/assets.
Home health care
- Custodial/companion care: non-medical ADL assistance, e.g. light cooking and cleaning. Traditionally paid for by residents.
- Skilled care: includes ADL and medical-based care, e.g. bandages and medications.
- Some limited costs may be paid for by Medicare/Medicaid for a short period of time if you meet restrictive requirements.
- Most long-term care insurance policies with a home health care provision will cover these services if you need help with two or more ADLs. How to file a claim. [[[[[[LINK]]]]]]
Assisted living community
- For people who need some assistance with ADLs
- Have staff and medical staff available
- Generally have 3 meals prepared/day
- Most states don’t allow them to have a stove in their apartment
- Generally paid for by residents.
- Some limited costs may be paid for by Medicare/Medicaid for a short period of time if you meet restrictive requirements.
- Most long-term care insurance policies will cover these services if you need help with two or more ADLs. Some older policies may not cover this, but most newer policies do. How to file a claim. [[[[[[LINK]]]]]]
Memory care
- Primarily for people with Dementia such as Alzheimer’s
- Promote social aspects within their community
- Most are secured or have secured wings so the resident can’t inadvertently leave
- Home health care may be an option in the beginning by using technology to monitor the resident.
- Generally paid for by resident, usually by long term care insurance. How to file a claim. [[[[[[LINK]]]]]]
Long-term skilled nursing care
- Still have home health care as an option – very expensive as these people need a lot of care
- For people who need assistance with many ADLs
- Generally have had an extreme decline in health and need a lot of personal attention
- In most states, a nursing home may be their only option for care if they’re on Medicaid.
- Usually paid for by residents’ long-term care insurance.
- If the resident is uninsured, usually paid for by the resident until they’ve spent down their assets and they then can qualify for Medicaid.
- A small portion under rehab may be paid for a short period of time by Medicare for a maximum of 100 days. Medicare does not pay for long-term care.
Hospice
- A facility or program designed to provide palliative care and emotional support to the terminally ill in a home or home-like setting so that quality of life is maintained and family members may be active participants in care.
- Generally for people in their last 6 months of life, but can vary depending on the illness.
- Can provide respite care for the family.
- Hospice is paid for by Medicare, Medicaid, the VA, or by private health insurance.