What Is Eldercare?
Eldercare is an umbrella term for a wide array of services intended to help older people live as comfortably and independently as possible. Examples range from basic transportation, cooking, or cleaning to complex medical care.
Key Takeaways
- Eldercare describes a range of services meant to help older people live comfortably and independently.
- Much of the eldercare in the U.S. is performed by the person's family members, but paying others to provide help is often necessary.
- Medicare covers eldercare services only if they are considered medically necessary. Medicaid provides a wider range of services but only for people whose incomes and assets are low enough to qualify.
How Eldercare Works
Eldercare is designed to provide comprehensive support and assistance to senior citizens, ensuring their physical, emotional, and social well-being. The process is structured to adapt to the evolving needs of the elderly, promoting independence while addressing health and safety concerns.
1. Initial Assessment:
- A professional caregiver or eldercare agency conducts an assessment of the senior's health, mobility, cognitive abilities, and living conditions.
- This assessment identifies the level of care required, from basic assistance with daily tasks to more intensive medical care.
2. Personalized Care Plan:
- Based on the assessment, a customized care plan is created. This plan outlines the types of services needed, frequency of visits, and long-term goals.
What Will Insurance Cover?
The coverage provided by insurance for elder care services depends on the type of insurance plan, the level of care needed, and the specific insurance policies in question. Here’s a breakdown of what different types of insurance may cover when it comes to elder care:
1. Health Insurance (Medicare, Private Health Insurance)
- Medicare: The U.S. government provides Medicare, a federal health insurance program for people aged 65 and older (and certain younger individuals with disabilities). Medicare generally does not cover long-term care services like those in nursing homes or assisted living, but it does cover some elder care-related services, such as:
- Short-term stays in skilled nursing facilities (SNFs): medically necessary after a hospital stay (up to 100 days in some cases).
- Home health care: Medicare will cover certain in-home care services, including skilled nursing care, physical therapy, and occupational therapy, if prescribed by a doctor and if the individual is homebound.
- Hospice care: Medicare covers hospice care for individuals who are terminally ill, including nursing care, pain management, and support for the family.
- Durable medical equipment (DME): Medicare may cover equipment like walkers, wheelchairs, and oxygen therapy, depending on medical need.
2. Long-Term Care Insurance
Long-term care (LTC) insurance is specifically designed to cover the costs of long-term care services, including help with activities of daily living (ADLs) like bathing, dressing, eating, or mobility. The extent of coverage depends on the policy, but typically, LTC insurance can cover:
- Nursing home care: Most policies will cover care in a licensed nursing home facility.
- Assisted living facilities: Many LTC insurance policies cover care in assisted living, which provides help with ADLs but does not require full-time medical care.
- Home care: Coverage for professional caregivers (e.g., home health aides or nurses) to provide care at home.
The Bottom Line
The bottom line on elder care insurance coverage is that it can be complex and varies greatly depending on the type of insurance and the specific circumstances. Here’s a simplified summary:
- 1. Private Health Insurance: Typically covers short-term medical needs but does not cover long-term care unless specified in a supplemental plan.
- 2.Medicaid: Provides more comprehensive coverage for long-term care services, but only for those who meet strict income and asset eligibility requirements. This can cover nursing home care and some home-based services.
- 3. Long-Term Care Insurance: Designed to specifically cover long-term care costs (e.g., home care, assisted living, or nursing home care). It provides more flexibility, but premiums can be expensive, and benefits are subject to the terms of the policy.
- Veterans Benefits: Veterans may qualify for additional financial support for long-term care services through the VA, including in-home care or care in VA-operated nursing homes.