Individuals who require long-term care are generally not sick in the traditional sense, but instead, are unable to perform the basic activities of daily living (ADL's) such as dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and walking.
Age is not a determining factor in needing long-term care. About 70% of individuals over the age of 65 years, will require at least some type of long-term care service during their lifetime. About 40% of those receiving long-term care today are between 18 yrs and 64 yrs. Once a change of health occurs, long-term care may not be available.
Some insurance companies require you to use services from a certified home care agency or a licensed professional, while others allow you to hire independent or non-licensed providers or family members. Companies may place certain qualifications — such as licensure, if available in your state — or restrictions on facilities or programs used.
Make sure you buy a policy that covers the types of facilities, programs and services you'll want and that are available where you live. (Moving to another area might make a difference in your coverage and the types of services available.)
Policies may cover the following care arrangements:
Nursing home: A facility that provides a full range of skilled health care, rehabilitation care, personal care and daily activities in a 24/7 setting. Find out whether the policy covers more than room-and-board.
Assisted living: A residence with apartment-style units that makes personal care and other individualized services (such as meal delivery) available when needed.
Adult day care services: A program outside the home that provides health, social and other support services in a supervised setting for adults who need some degree of help during the day.
Home care: An agency or individual who performs services, such as bathing, grooming and help with chores and housework.
Home modification: Adaptations, such as installing ramps or grab bars to make your home safer and more accessible.
Care coordination: Services provided by a trained or licensed professional who assists with determining needs, locating services and arranging for care. The policy may also cover the monitoring of care providers.