Fast Facts and Other Long-Term Care Information
What is Long-Term Care?
Long-term care is different from the rest of your health care, and it's not typically covered under health insurance policies, HMO plans, Medicare or Medicare supplemental policies. Health care plans are designed to provide coverage when you receive care from a doctor or treatment in a hospital. Some may also cover nursing home care or home care -but typically, only on a short term or limited basis.
Long-term care includes personal care, such as help with bathing, eating or dressing that you require over a lengthy period. That's why it can be very expensive. Long-term care can range from simple assistance with activities in your own home or a residential care facility or it can mean highly skilled care in a nursing facility. The possibility of needing long-term care due to an illness or physical disability is something most people would rather not think about. But as we get older, and because we are living longer, the likelihood that we will need some kind of assistance is very real. Long-term care coverage will help you live your life with dignity and with independence.
If you require long-term care because of a chronic physical condition such as arthritis or Parkinson's disease, who will pay for it? Should you need assistance because of a degenerative mental disease, such as Alzheimer's, who will pay for care? The answer is probably you, unless you act to protect yourself.
Long-term care can be very expensive. Nursing home costs in California average $250 a day in 2011 (or $91,250 per year). Of those who enter nursing homes, 44.1% will have a total lifetime use of at least one year, 43.9% will stay between one and five years, and 12% will have a total lifetime use of five years or more, (U.S. DHHS/CDC The National Nursing Home Survey: 2004 Overview). This means that more than half the people who go into a nursing home will spend between $91,250 and $456,250 (in year 2011 dollars) and one person out of every ten will spend even more, perhaps much more, than that. And you shouldn't forget that before most people enter a nursing home, they would have already struggled for years with the cost of long-term care in their own homes. The possibility of needing long-term care is something most of us would rather not think about. Yet, "Nearly 7 out of 10 people over age 65 will require long-term care at some point in their lives", (U.S. Department of Health and Human Services, 2009) , (Paying for long-term care, either for yourself or a loved one, can mean sacrificing a lifetime of savings or losing your financial independence, unless you plan ahead.
In 1995, 35.2 million people received Medicaid benefits. 11% were elderly.
In 1995, $152.4 billion was expended for Medicaid benefits. 26.3% of the cost was for the elderly. 35.4% of the costs for the elderly were for LTC services.
Medicaid pays half of all nursing home costs and 14% of home health costs in the U.S.
Three-fourths of Medicaid LTC spending is on institutional services.
Source: "Medicaid Facts", The Kaiser Commission on the Future of Medicaid, November, 1997.
Over 12 million people in the United States require long-term care.
Nearly half of those requiring care are under 65 years of age, including 5.3 million working age adults.
Of the 1.3 million elderly who are in nursing home, half are over age 85 and more than 80% are severely impaired (requiring assistance with three or more activities of daily living). An additional 1.3 millions who have substantial long-term care needs receive care in the community.
Source: Kaiser Family Foundation, March 2001 Medicaid Facts
LTC Insurance Facts
Over 5.8 million LTC insurance policies have been purchased in the U.S. through June 30, 1998. About 450,000 of these were purchased in California.
Nationwide, there is 5% market penetration rate for LTC policy sales. California's market penetration is 7.21%.
Nationwide, over 2,100 employers offer group LTC insurance. Companies include: Nissan, Procter & Gamble, IBM, AT&T, CBS, Delta Airlines, Dow Chemical.
Two-thirds of policy purchasers have incomes of less than $35,000.
One-third of policy purchasers have assets of less than $30,000.
The most frequently cited reason for an individual purchasing long-term care insurance is to maintain independence of choice.
Source: Health Insurance Association of America, Survey, 1998
Seniors own 77% of the nation's personal wealth and 40% of the discretionary income.
Older consumers prefer "good value" while younger consumers prefer "good sales".
Older buyers rate "helpful, friendly, knowledgeable salespeople" higher than do younger buyers.
Source: Research Alert, Spring 1998
Women are disproportionately over-represented in the lower income brackets and under-represented in the higher income brackets even though women constitute 51% of the California workforce.
Of all people over the age of 65 receiving Social Security benefits in California, 6.2% of the males are also receiving Supplemental Security Income (SSI - meaning they are disabled), whereas 10.3% of the females are also receiving SSI.
Of all people over the age of 65 in California, the average total personal income is $32,300 for males and $23,900 for females ($8,400 less for females).
Of all people over the age of 65 in California, 11.8% of the males are on Medi-Cal compared with 15.3% of the females.
Source: California Department of Finance, Current Population Survey Report, March 2001
When you are admitted to a nursing home, you keep all your basic human and civil rights and liberties. Federal and State regulations list nursing home residents' rights in detail, and require the Department of Health Care Services' staff who inspect your nursing home to decide whether this home is protecting and promoting your rights.
Find additional information about your rights as a resident in a nursing home or contact the Department of Public Health's, Licensing and Certification District Office nearest you. To get a listing of the Licensing and Certification district offices, please click here, or contact the Ombudsman Program in your county. The telephone number for the local Ombudsman Program is posted in your nursing home.