Understanding Long-Term Care: Essential Medicare Glossary

Long-term care is a type of medical care that is provided to individuals who are unable to perform everyday tasks due to a chronic illness or disability. It is typically used for people who need ongoing assistance with these activities and can include things like nursing home care, assisted living, and in-home care.

One of the main benefits of long-term care is that it can help individuals to maintain their independence and quality of life, even if they are unable to perform everyday tasks on their own. This can be especially important for older adults or those with chronic conditions who may need ongoing support and assistance.

For individuals who are enrolled in Medicare, long-term care can be a complex and confusing topic. Medicare does not generally cover long-term care services, with a few exceptions. For example, Medicare may cover a limited amount of SNF care or home healthcare for certain individuals who meet certain criteria.

It is important to note that there are other options available for paying for long-term care, such as private insurance, Medicaid, or out-of-pocket payments. These options can vary significantly in terms of coverage, eligibility requirements, and cost, and it is important to carefully consider all of the available options before
making a decision.

ADLs are basic self-care tasks that individuals need to complete on a daily basis in order to maintain their independence and quality of life. ADLs include activities such as:

Eating/Feeding (the ability of a person to feed oneself)

Bathing

Dressing (the ability to select appropriate clothes and to put the clothes on)

Personal hygiene (the ability to bathe and groom oneself and maintain dental hygiene, nail, and hair care)

Continence (the ability to control bladder and bowel function)

Toileting (the ability to get to and from the toilet, using it appropriately, and cleaning oneself)

Transferring/Ambulating (the extent of an individual’s ability to move from one position to another and walk independently)

The ability to complete ADLs is an important factor in determining an individual’s need for long-term care. As people age or experience a decline in their health, they may need assistance with ADLs in order to continue living safely and independently.

There are several types of long-term care services that can help individuals with ADLs, including:

Home care: Home care services provide assistance with ADLs in the individual’s home. This can include help with bathing, dressing, and other self-care tasks, as well as light housekeeping and meal preparation.

Assisted living: Assisted living facilities provide housing and support services for seniors who need assistance with ADLs. These facilities may offer a range of services, including help with bathing, dressing, and other self-care tasks, as well as meals, transportation, and social activities.

Skilled nursing facilities: Skilled nursing facilities, also known as nursing homes, provide twenty-four-hour medical supervision and assistance with ADLs for individuals who are unable to live independently. These facilities may offer rehabilitation services and specialized care for individuals with chronic medical conditions.

Long-term care insurance is one option for paying for long-term care services, including those that help with ADLs. Medicare and Medicaid may also cover some long-term care services, but coverage is limited to skilled care and eligibility requirements vary.

It is important for individuals to plan for their long-term care needs as they age, as the cost of these services can be significant. Working with a certified insurance agent can help individuals understand their options and make informed decisions about their care.

Save Big on Medicare Part D 2025!

Long-Term Care

Think You Know Medicare?