LONG-TERM CARE FOR YOU, YOUR PARENTS, PARTNERS
AND PATIENTS
by Beth J. Thomson, member MNA ReTIREd Nurses Role Group

In the November issue of Massachusetts Nurse an introduction to long-term care (LTC) and its cost was presented (see Nov. Reportt by Patricia Dunn). Planning for LTC was advised. Planning for LTC is best done between the ages of 50 and 65. However, the need for LTC often doesn't occur until you become 80 or 90 years old. The questions of what LTC is, how much it costs and whether or not you need it must be raised in order for you to plan effectively for its delivery. No single answer is the right one for everyone. But one primary source for LTC information is "Your Options For Financing Long -Term Care: A Massachusetts Guide".(1) It is the source for the following information.

What Is Long-Term Care?

When you think about "long-term care", you may think about care in a nursing home. Yet, long-term care includes an ever-changing array of services aimed at helping people compensate for limitations in their ability to live independently. Long-term care should meet your medical needs, as well as your social, financial and housing needs. It can range from assistance with household chores to assistance with activities of daily living to highly skilled medical care. Long-term services may be provided in a variety of settings such as the home, community sites (adult day care centers) or nursing homes.

The type and setting of long-term care services depend upon your particular needs. Those with physical illnesses or disabilities often need hands-on help with basic activities of daily living (ADLs) including bathing, eating, dressing, toileting, continence and transferring. Those who are cognitively impaired usually require supervision or verbal reminders to perform routine activities or to stay out of harm's way.

Skilled care is provided on a doctor's order by medical personnel such as registered nurses or professional therapists. Although it can be provided in a nursing home, skilled care may be provided in the home by visiting nurses or therapists. Personal care (also known as "custodial care") is provided to help people perform ADLs but is less intensive than skilled care and does not require the services of a medica l professional. Personal care may be provided in many settings, including a person's home or adult day care center.

How Much Could Long-Term Care Cost?

Nursing home care is the most expensive and intensive form of care. In 1997, the average cost of a Massachusetts nursing home exceeded $191per day. Although the average length of stay in a nursing home in 1994 was 511 days, some stays last for many years. At $191 per day, the average annual cost of a nursing home stay exceeds $69,000, but it is not unusual for an individual to pay more than $100,000 per year in some nursing homes.

Assisted living is another form of facility-based long-term care. If you lived in a single occupancy assisted living studio apartment, including the cost of rent, heat, daily meals and personal care would cost approximately $34,000 per year. There is, however, great variation in services provided in assisted living facilities and prices could vary.

The cost of long-term care services provided outside of a nursing home varies depending on the type of service, as well as the intensity and duration of the service. On average, home health care in 1997 cost approximately $45 per day. In 1999, if you received 2 hours of skilled care from a nurse in your home, three times a week throughout the year, the average annual cost would have been approximately $25,000, or an average of $160 per day. If you received 2 hours of personal care services in your home for two hours, three times a week throughout the year, the annual cost could have been approximately $7,800, or an average of $50 per day.

All the presented figures are subject to inflation. You should note that if long-term care costs were to increase by 5% annually, the overall cost would double in approximately 15 years.

Will You Need Long-Term Care? For How Long?

It is impossible to predict your individual chances of needing long-term care. For some, the need may follow a major illness, while for others the need may evolve more gradually. Some may require many years of long-term care, while others night need services for only a matter of months. The following chart outlines the probability of an individual being admitted to a nursing home at age 65.

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Probability that a 65 year old will be in a nursinghome at some time during the rest of his/her life

Nursing Home Stay of               Chances for Men                 Chances for Women
0-3 months                                            11%                                      11%
3-12 months                                           8%                                       10%
1-5 years                                               10%                                     18%
More than 5 years                                     4%                                     13%
Of any duration                                       33%                                     52%
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Please note that these figures do not include people who require home or community- based long-term care services. There are a large number of different services that are available toyou in your home which can allow you to "age in place" and never have to move intoa nursing home.

The above statistics also do not reflect the fact that as lifestyle and medical advancements allow people to live longer, more people will need long-term care. Therefore, your actual probability of needing at least some type of long-term care during you life is probably higher than these numbers suggest.

Subsequent publications of Massachusetts Nurse will continue the description of LTC issues. Some upcoming questions include what types of LTC services are available and how you can access them, who pays the costs of long-term care and how you could plan to pay for LTC. A description of LTC insurance will be provided by the Massachusetts Department of Insurance to end the series.

Bibliography: (1) "Your Options For Financing Long-Term Care: A Massachusets Guide", December 1999. Division of Insurance, One South Station, Boston, MA 02110-2208. Telephone: Boston 617.521.7777: Springfield 413.785.5526. <http://www.state.ma.us/doi>

Resources: 1. Massachusetts State Law: Chapter 211 CMR 65.00 Long-Term Care Insurance (available from the Division of Insurance address in (1) above.

2. "To Buy or Not To Buy. Long-term care insurance - is it worth the cost?", Wexler, Mark. Modern Maturity, May-June 2000, pp.91-94.

3. SOONH-DRL (Staying Out Of Nursing Homes - Discussion Resources List) To join, send mail to: LISTSERV@HOME.EASE.LSOFT.COM