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wonderful KFF Health News/New York Times Series If you’ve read “Dying Broke” or attended an HJ24 session reporting on the deepening crisis in long-term care, you may already have some understanding of just how broken the U.S. long-term care system is.
Reporting on long-term care can be a bit tricky because of overlapping payment sources, differing federal and state regulations, and a mix of local and state programs, services, and supports. Here are some things to keep in mind when writing an article on this topic:
Payment Options
- Medicare
Many people think that nursing home care is covered by Medicare or Medicare Advantage plans. However, Medicare does not pay for long-term nursing home costs. Medicare only pays for skilled care in a rehabilitation or nursing home for a limited period of time (100 days per benefit period) and for care that is “necessary to improve or maintain your existing condition, or to prevent or delay the deterioration of your condition,” according to the following: Eligible hospitalization For serious conditions (such as hip fractures, heart surgery, head injuries, etc.). Skilled nursing facilities are often associated with nursing homes, which can be confusing. Original Medicare Covering home medical care It is provided in conjunction with skilled nursing care and therapy, but not as a stand-alone service, and does not cover assistance with activities of daily living such as bathing, dressing, or toileting. - Medicaid
This is a joint federal and state health care program that covers health care for people below certain income levels, including adults and children under age 65. Eligibility varies by state, but most states offer Expanded eligibility restrictions Under the Affordable Care Act. Many seniors are covered by both Medicare and Medicaid and are considered dual eligible. (This January 2024 tip sheet provides more specifics.) Medicaid is: 60% of nursing home care In the United States - Long-term care insurance
Although coverage varies by policy, long-term care insurance typically pays in full or in part for nursing home care, assisted living expenses, home health care, day care, and other services that seniors need. Premiums vary and coverage includes: difficult to getFew insurance companies offer this coverage, and insurance companies often limit coverage or charge higher premiums because of pre-existing conditions.
Housing and nursing care support
- Nursing Homes
These facilities offer the highest level of care, including nursing care, 24-hour monitoring, three meals a day, and assistance with activities of daily living. Rehabilitation services such as physical, occupational, and speech therapy are also available. According to a Genworth Financial study, the average annual cost of a nursing home in the United States in 2023 was $104,000 for a semi-private room and $116,000 for a private room. Nursing care cost surveyCosts are paid by self-payment or with the assistance of Medicaid or long-term care insurance. - Assisted Living
These are suitable for people who need assistance with daily care, but do not receive as much assistance as nursing homes. Facilities vary in size from 25 residents to over 100 residents. Residents usually live in their own rooms or apartments and share living and dining spaces. Different levels of care are offered, and residents pay extra for extra services. The average cost of assisted living in the United States is $4,500 per month or $54,000 per year. According to the National Council on Aging:Costs vary by state, type of community/facility and level of care needed. Genworth Financial Nursing care cost survey This cost is estimated to be $5,300 per month, or $64,000 per year based on 2023 data. - Board and Care Home
These are also called group homes or residential facilities and usually have 20 or fewer residents. Rooms may be private or shared, and residents receive personal care and assistance with meals. Skilled nursing or medical care is not usually provided. Costs are primarily borne by the residents or their families. Medicare does not cover these costs, but Medicaid may partially cover them depending on your state and eligibility. - Continuing Care Retirement Community
Also known as a CCRC or life care community, this option offers different levels of care on one campus, depending on your needs. Many residents live in independent housing initially, then move into assisted living or receive in-home care in a separate unit. If needed, you can move into a nursing home in the community. CCRCs can be very expensive. Communities usually charge a one-time entry fee and monthly fees thereafter. Most of the costs are out-of-pocket, but Medicare, Medicaid, and long-term care insurance may cover some services, depending on the level of care provided. - Home medical care
Do not confuse home health with home nursing care. These are two different types of services. Home health is a variety of clinical services provided by licensed nurses and therapists in the home for illness or injury. This can include intermittent nursing care, physical therapy, speech therapy, occupational therapy, or other skilled medical services. Home health is usually only needed for a short period of time as an alternative to inpatient care. Medicare includes Strict Eligibility Criteria For home medical services. - Home Care
This is unskilled care provided by professional caregivers, such as bathing, eating, dressing, helping with meals, walking, transferring, and other daily tasks. These services may be covered by Medicare if they are part of a broader home health insurance plan. For example, if you are unable to leave your home due to illness or injury and need help bathing or dressing. Some Medicare Advantage plans and long-term care insurance plans pay for home health aides or attendants, but there are usually limits on the number of hours or days of this care. Many people hire home health aides privately or through a home health agency. Licensed Home Care Agency or by word of mouth, which may be cheaper but are unregulated. Privately funded home care can get expensive quickly. On average, 44 hours of home care per week costs It could cause harm to someone Approximately $75,000 per year. - Some Medicare Advantage Plans cover the cost of home care services, including: Companion Care They provide assistance with activities such as transportation and shopping. Some plans offer a limited number of hours of in-home care, meal delivery, and other support, but for those who need more care, these options can quickly run out. In addition, Research in 2024 A study from the University of Washington School of Medicine found that Medicare Advantage beneficiaries actually receive fewer doctor visits and have worse health outcomes than Original Medicare beneficiaries.
- Adult Day Services/Day Care
These services can be a boon for seniors, people with disabilities, and their caregivers. They are a safe, community-based environment for those who need supervision during the day and who may benefit from social interaction and engagement. According to the National Association of Adult Day Services, these day centers can address many of the health and nutritional needs of seniors, as well as any cognitive or physical limitations, in a group environment staffed by professional staff. There are more than 7,500 adult day services centers across the United States, providing a supportive culture for those in need. These centers allow caregivers to continue working during the day and Average cost At $2,000 per month, this service is a more affordable option than other long-term services. NASDA Center Locator They help families find a suitable center near them. - Community Service and Support
These are specific programs or services provided to older adults in the community who need assistance. Older adults who need assistance may have cognitive decline, frailty, an inability to drive, chronic illness, or other age-related reasons that make them unable to do household chores like cooking or shopping. Local elderly support organizations Alternatively, your city, county, or state aging office is a great place to learn about various community services, including: medical care, Home maintenance and repairs, Transportation facilities, mealAnd many more. Many programs have waiting lists, income eligibility may apply, and it can take time to find and enroll in many of these services. But community programs like these can help: pace and Competent Among those who help seniors retire at home instead of in institutions: Reduce healthcare costs In the same way.
The reality is that for many older adults, long-term care and support comes from family, friends, neighbors, and a patchwork of community services, e.g. Meal delivery service or Friendly Visitor ProgramAlthough older adults may not be sick or infirm enough to need nursing home care, nursing homes are financially out of reach for many, and most Elderly people prefer to spend their retirement years in familiar places Whenever possible.
When reporting on long-term care for seniors, it is important to keep in mind differences in payment, housing, and service options. Services and programs vary by state, insurance plan, and community. For example, in-home care is often harder to find in rural areas, and people who live in cities may pay more for care than those who live in suburban areas.
Story Ideas
- Ask your local agency on aging. Do certain programs, such as PACE, have waiting lists? Why? Is there a shortage of participating clinicians, state budget cuts, high demand, or some other reason?
- Create a profile of a caregiver (or caregivers) who are juggling caring for an elderly parent with a second job. How do they manage it? Do they have outside help, like aides or daycare? How is this impacting their work? Consider both the financial and emotional strain.
- Is there such thing as “affordable” assisted living? How much would it cost on average to live in such a facility in your area? What options are there for people who can’t afford that level of care?
- Nursing homes are regulated and licensed by each state, not the federal government. Are nursing homes in your area meeting staffing and other requirements? How often are they inspected and by who? What violations have they been penalized for and have they been publicized? If not, why? Where can consumers get information?
- Many communities are struggling to find staff for home care and nursing homes. What is the situation in your community? Do agencies and facilities offer incentives, additional training and real career paths?
