Exploring Long Term Care

What is Long Term Care
Home and Community Based Services
Assisted Living
Skilled Nursing Facility
Existing Long Term Care Services in Albany County
Financing Long Term Care

What is Long Term Care
Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term care includes health, social, personal and supportive services.

The majority of long term care individuals receive is not medical care, but assistance with Activities of Daily Living (ADLs), such as dressing, bathing, eating, using the bathroom, household chores, meal preparation and shopping. Although functional ability of an individual may be impaired 24 hours per day, care is usually not required for the full 24 hours. Even in nursing homes, few patients receive 24/7 direct care.

The goal of long-term care is to maximize health status and independence in the least restrictive, appropriate environment for each individual’s needs.

Most long-term care relies on informal caregivers such as family and friends rather than paid professionals. A study by Robyn I. Stone for the Milbank Memorial Fund found about 95 percent of non-institutionalized elders with disabilities receive at least some assistance from relatives, friends, and neighbors.

Home and Community Based Services
Home and Community Based Services (HCBS) allow frail elderly and individuals with disabilities to live in their communities rather than nursing homes and other institutions. HCBS assists individuals to remain at home by providing assistance with activities, like bathing and preparing meals, and supports, such as transportation.

Home and Community Based Services are more flexible, more attractive to patients, and less expensive than traditional institutional care for both consumers and government payers. According to AARP, almost 90 percent of Americans age 50 and older want to remain in their homes for as long as they can.

Assisted Living
Assisted living facilities are for people needing assistance with activities such as preparing meals, bathing, dressing, performing household chores, and reminders to take medication, but wish to live as independently as possible. Assisted living facilities provide no, or very limited, medical care. Residents in assisted living facilities can not live by themselves, but do not require constant care.
Assisted Living Facilities aim to foster as much autonomy as the resident is capable of. Most facilities offer 24-hour supervision and an array of support services, with more privacy, space, and independence than many nursing homes—at a lower cost.

Skilled Nursing Facility
A Skilled Nursing Facility (SNF), or more commonly referred to as a Nursing Home, has Registered Nurses who help provide 24-hour care to people who can no longer care for themselves due to physical, emotional, or mental conditions. A licensed physician supervises each patient’s care and a nurse or other medical professional is almost always on the premises. Residents in a nursing home have limited independence.

As more home and community based services become available, the number of those going to a SNF has been declining.

Existing Long Term Care Services in Albany County
Albany County offers a variety of services, programs and informational resources for long term care options. the programs listed below can be found on the County Department for Aging website at http://www.albanycounty.com/Departments/Aging/programs_services.asp?id=90 or contact Albany County-NY Connects at 518-447-7177 for information about long term care services.

Albany County-NY Connects
Family Caregiver Support Programs
Adult Day Care
Expanded In-Home Services to the Elderly Program (EISEP)
Home-Delivered Meals
Congregate Dining
Nutritional Counseling
Health Maintenance, Socialization and Recreation
Transportation
In-Home Contact and Support
Weatherization
Legal Counseling and Assistance
Health Insurance Information and Counseling
Long Term Care Insurance Education and Outreach Program

Financing Long Term Care
Financing of long-term care is a mix of programs of the federal, state and local governments along with personal funds paid from the patient and family assets. It is substantially different from the financing of other health care in the following respects:

Standard commercial health insurance benefits primarily cover rehabilitative care associated wit ha hospitalization. Long term care insurance, which is a newer product in the commercial insurance market, is not widely purchased.
Medicare does not cover long-term care. While Medicare does cover short term nursing home and home health care, coverage only applies to rehabilitation and does not apply to custodial care.
Medicaid is the primary source of financial coverage for long term care. However, since only those who have no substantial assets and very low or no income are eligible for Medicaid, most long term care patients must exhaust their personal assets before Medicaid begins to assume the costs of their care.

Because of the above financing structure, the sequence of events for a typical nursing home patient would unfold as follows:

Hospitalization and discharge to a nursing home;
Medicare covers the first 90 days (with a co-payment) of the nursing home stay;
The patient or the patient's family then begins to pay for care out of their own assets, which, due to the high cost of nursing home care, are rapidly depleted.
Upon the exhaustion of the patient's assets, they become eligible for Medicaid, which then assumes the cost, typically until the patient dies.

As a result, in New York State, the Medicaid program accounts for 75% of patient days in skilled nursing facilities, Medicare represents 11% of patient days and 10% are paid by commercially insured patients. Less than 4% of patients are self-pay.

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