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Long Term Care Fundamentals: Long Term Care 101

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Long Term Care has an alphabet soup of acronyms. Here are some of the most common ones you might encounter:

•    ADL (activities of daily living)

•    ALF (assisted living facility)

•    LTC (long term care)

•    SNF (skilled nursing facility)

•    HHA (home health agency)

•    PAC (post-acute care)

•    PT (physical therapy)

•    OT (occupational therapy)

•    QAPI (quality assurance and performance improvement)

•    OASIS (outcomes and assessment information set)

•    CMS (Centers for Medicare and Medicaid Services)

•    HHS (Department of Health and Human Services)

•    CFR (Code of Federal Regulations)

•    POM (program operations manual – appendices are very useful).

LTC usually only begins after an individual is in a post-acute care (PAC) setting. Acute care refers to short-term medical care. For example, if you fall and fracture your ankle, you’ll need to go to the hospital, maybe require surgery, and then possibly some in-patient or out-patient rehabilitation / physical therapy. Post-Acute Care refers to what happens next. Typically one either gets better and goes home to live independently or does not get better and has to enter a long-term care setting (which can be at home).

Different Types of Long Term Care Settings

Home Based Care 

Often referred to as home-health care. This involves bringing someone in the home to assist with what is referred to as custodial care (bathing, dressing, assistance with meds); health care (recovery post-surgery, physical therapy, occupational therapy, wound care, disease monitoring); homemaking (cooking meals and taking care of household chores).

Medicare provides a limited home-based care benefit, but for a long-term solution: paying cash, utilizing long-term care insurance, or Medicaid is the answer.

What are Medicaid Waiver programs?

Medicaid waivers are cost-saving solutions for states (such as Florida) to try to help people stay in their own homes. This is a win-win: the elderly get to remain at home with attendant care and Florida saves money. This involves a financial partnership between the State of Florida and the federal government. While Medicaid Waiver programs can be greatly beneficial they are also subject to funding issues, which can lead to waiting lists and less predictability.

The rule of thumb is that hospital stays or short-term rehab facilities are covered by Medicare. Medicaid covers longer term rehabilitation and permanent stays in nursing homes. To read more about how to pay for home health aide or attendant, through medicaid waiver, click the link.

Community-Based Care 

Refers to anything but a nursing home (including: home health care, assisted living facility, independent living facility)

Independent Living Facility (ILF) 

ILFs are generally an apartment with a common dining room, activities directors, rides around town, etc...

Assisted Living Facility (ALF) 

ALFs provide what is known as custodial care (as opposed to skilled care). They help with what are known as activities of daily living (ADLs) such as: transferring, get out of chair, feed, shower, bathe. ALFs are licensed (on a limited basis, i.e. cannot administer medications).

Home health aides 

Some people lump home-based care into the community-based care category. Home health aids also provide custodial care. They are not RNs and do not provide skilled nursing care.

Other examples of community-based care: adult day care, senior centers, transportation services, and meal delivery. The older adult lives independently at home and requires minimal assistance (usually with family or with a caregiver) and will occasionally utilize a service in the community for some limited purpose or to provide respite for the usual caregiver.

Institutional Care

Refers to Nursing Home / Skilled Nursing Facility: more of a hospital-like setting. Nursing homes have 24-hour skilled nursing care and custodial care (as opposed to just custodial care).

How to find a good nursing home?

To compare nursing homes: https://www.medicare.gov/nursinghomecompare/search.html

We recognize that people only enter a nursing home when it is absolutely necessary. It is the goal of your Elder Law attorney to educate and provide you with options to avoid entering a nursing home as long as possible through alternatives such waiver programs. But if it becomes necessary, you will want to have planned for it and be able to select the nursing home of your choice – or the very best possible setting for your loved one.  

Limitations of LTC Services Covered by Medicare

Home Health Care: Medicare recipients are eligible for a limited medicare home-health care benefit if: confined to home (only able to leave for short periods of time for non-medical reasons, i.e. special occasions, religious services, takes significant effort to leave house), under care plan that has been established and reviewed by a doctor who opines that the patient is in need of skilled nursing, PT, OT or speech therapy; and need for skilled care MUST be intermittent (less than 7 days a week or less than 8 hours a day for 21 days or less). This is often the case after a surgery.

Hospice: refers to end-of-life care, typically focused on keeping the patient as comfortable as possible.

Skilled Nursing Facilities / Rehabilitation Centers: includes room/board, nursing care, therapy (PT, OT, Speech), social services, dietary services, necessary supplies/equipment. Medicare Part A will not cover unless patient had a 3 day stay in hospital prior to admission to SNF and patient is admitted to the SNF within 30 days of hospital discharge (these requirements do not apply to Medicaid residents). Medicare will only pay for a maximum of 100 days over the life of any individual.

Medicare does not pay for Assisted Living Facilities: ALFs “fill the gap” between home care and skilled nursing care. Provides housing, meals, assistance with ADLs (bathing, dressing, administering medication).  Some have specialized services (“memory care”/Alzheimer’s units), residents maintain independence with social events/activities.

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