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Long term care is a
range of services provided to people who either need ongoing help with
activities daily living (bathing, dressing, eating, toileting,
continence, transferring) due to a chronic condition or limited ability
to function; or, need continual supervision to ensure the safety of
themselves or others due to a cognitive impairment.
Risks of needing long term care:
- For persons who
turned age 65 in 1990, 43% will enter a nursing home at some point in
their lives. Women are at higher risk than men, with slightly more than
half entering a nursing home at some point in their lives.
Murtaugh, Kemper and Spillman, "The Risk of Nursing Home
Use in Later Life," Medical Care, October 1990.
- Single persons are five times more likely
to need nursing home care than are married persons.
- Approximately 85% of nursing home residents
are women.
- Of those who enter a nursing home, 55% will
need care for at least one year. One in five will need care
for five or more years.
Kemper and Murtaugh, "Lifetime Use of Nursing Home
Care," New England Journal of Medicine,
February 28, 1991.
- As of January 1, 1996, 1.6 million people were receiving care
in approximately 16,800 nursing homes in the U.S.
Agency for Health Care Policy and Research, Vol. 217,
July 1998.
- Over 40% of Americans receiving long term care are under age 65.
Ten percent of nursing home patients are under age 65.
Shelton, Phyllis, Long Term Care Planning Guide,
1998.
Costs of long term care:
- The average cost of nursing home care in Indiana is $126 per day or
$46,892 per year. With an average length of stay of 2.5 years,
the average cost for a nursing home stay is more than $110,000.
State of Indiana, Family and Social Services
Administration, Office of Medicaid Policy and Planning, (January,
2003).
- In Indiana, the average cost for a home health nurse (RN) is
$18.29 per hours. The average cost for a home health aide is
$8.68 per hour. The cost for a home health aide to provide
assistance for four hours a day, five days per week would cost
approximately $9,000 annually.
Hospital and Healthcare Compensation Service (1999-2000)
- Medicare pays less than 10% of nursing home costs.
Levit et al, National Health Expenditures, 1993, Health
Care Financing Review, Fall 1994.
- Medicare was not designed to pay for long term care.
Therefore, strict requirements exist in order to qualify for
Medicare coverage for nursing home care. For instance,
a person must:
(a) be in a hospital 3 days prior to
discharge before being admitted to the nursing home
(b) be admitted to a Medicare-certified
facility
(c) be placed in a Medicare-certified bed
(d) need daily skilled care (care provided
by a licensed nurse or therapist).
Should a person meet these requirements, Medicare will
pay 100% for the first 20 days of nursing home care. From day
21 to day 100, Medicare pays everything except for $124
per day in 2007 (this figure usually increases each year)
which the person must pay. Medicare stops paying after
day 100.
- More than one-third of all nursing home care is paid for by
individuals directly out-of-pocket.
Levit et al, National Health Expenditures, 1993, Health
Care Financing Review, Fall 1994.
- Although half of all nursing home care is paid for by
Medicaid, an individual must "spend down"
his/her assets to the poverty level ($1,500 in Indiana) to
qualify for assistance.
Levit et al, National Health Expenditures, 1993,
Health Care Financing Review, Fall 1994.
- Over 8.26 million long term care insurance policies have
been purchased through December, 2001.
- Over 4,700 employers offer long term care insurance.
- The most frequently cited reason for an individual purchasing
long term care insurance is to maintain independence and choice.
Health Insurance Association of America, Long Term Care
Insurance in 2000-2001, January 2003.
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