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Demystifying Long-Term Care Services – Keystone Elder Law – Mechanicsburg, PA

Our office often receives calls from individuals who have mature loved ones in need of assistance with their daily routines. Often, these callers are unsure of the types of long-term care services which are available, the costs involved, and potential public benefits to help pay for services.  Following is an introduction to these services.

CARE AT HOME:  Services available to those living at home are varied.

Home Care Agencies provide non-licensed staff to assist individuals with transportation, light housekeeping, companionship, meal preparation, errands, medication reminders, and personal care tasks such as bathing, dressing, and toileting. This type of non-medical care is usually private pay, although it may be covered by some long-term care insurance policies. Medicare does not pay for care at home which is needed on an ongoing basis. The average cost of this type of service ranges from $20-$25/hour in our area.

Home Health Agencies provide licensed nurses and therapists to meet an individual’s health needs, and sometimes nursing assistants to meet personal needs as well. Agencies are able to bill Medicare and private insurance companies for the services they provide as long as certain qualifications are met.  These services are designed to be short-term and intermittent.

Waiver Programs are available through the Office of Aging which can provide limited assistance to qualified individuals who are living at home. Call your local county office for additional information.

Adult Day Services are programs which allow adults who have care needs to live at home, but receive physical care and socialization at a central location during the day. These programs provide family caregivers with time to manage other responsibilities, work outside of the home, and have a break from caregiving so that they remain physically and emotionally able to handle the tensions created by caring for another adult.  Daily rates start at about $40 for a half-day program to $50-$60 for a full day.  Rates are determined by the types of assistance which are needed.

LIFE (Living Independence for the Elderly) is an all-inclusive program designed for seniors who require a nursing home level of care but desire to remain in the community. The services provided include medical care, medications, home care, adult day services, therapies, and transportation.  This program is only available in certain counties (currently Cumberland, Franklin, and York in our area); and the state has contracted with private organizations to manage these programs.  The private pay cost is about half the cost of a nursing home, but Medicaid (also known as Medical Assistance) is also accepted.

Senior Centers do not provide physical care for older adults. Instead, they provide opportunities for socialization, education, service to others, and nutrition for independent adults who enjoy the company of others and may be at risk for isolation.  A small daily donation to help cover the cost of the meal may be requested.

PERSONAL CARE/ASSISTED LIVING: These two types of residential care are very similar. A few years ago, the Commonwealth of Pennsylvania instituted new licensing requirements for facilities who wish to call themselves assisted living, and for various reasons, most facilities providing this level of care choose to be licensed under the personal care regulations. An individual may have a private or semi-private room in the facility and furnish it with their private possessions.  Three daily meals are provided, as well as help with care needs such as bathing, dressing, and medication management.  Social activities and transportation are available.  Some facilities have secure memory care areas for those with a diagnosis of dementia. This level of care usually requires that individuals are either independent or only require limited assistance with their physical transfers and mobility. Individuals are considered mobile if they are unable to walk but can self-propel a wheelchair. Care may or may not be supervised by a licensed nurse, and residents may continue to see their personal physician for medical care.  The cost for this type of care is around $3,000-$6,000/month, which is usually private pay.  Some long-term care insurance policies may cover this cost, and for some wartime veterans and their spouses, a benefit is available which will cover a portion of the monthly fee.

SKILLED NURSING FACILITY:  This is the level of care that most people think of for long-term care.  Individuals who require close monitoring of their physical health, or have more intensive daily personal care needs require this type of care.  Licensed nursing staff are present 24/7, and all medical orders must be approved by a facility physician.  Many nursing facilities offer short term inpatient rehabilitation services in addition to long-term custodial care.  Medicare and private insurance coverage are available for rehabilitation services under certain circumstances, but they do not pay for ongoing custodial care. The private pay cost of custodial care ranges from about $9,000 to $12,000/month.  Long-term care insurance policies will cover a portion of this entire fee, depending on the specific policy provisions.  For those who qualify, Medicaid is also available to pay for this type of care.

CONTINUING CARE RETIREMENT COMMUNITY (CCRC):  These communities offer various levels of care within the same organization.  Individuals may move to a CCRC at any level of care.  Those entering at an independent living level usually pay a significant entrance fee and a separate monthly fee, but are then permitted to remain in the community even if their health declines, moving to the different levels of care as their needs dictate.  Even if their assets “run out,” the community will continue to provide care.  Some communities offer an option to pay a higher monthly fee instead of the entrance fee.  Independent living arrangements may be in cottages or apartments, and a choice of floor plans is usually available.  Dining services may or may not be included.  A variety of social activities are also available.

Karen Kaslow, RN