WHAT ARE THE TYPES AND COSTS OF LONG-TERM CARE?
Long-term care needs can range from around the clock medical treatment to
simply requiring assistance with the daily activities of life. In the past,
a nursing facility was the only option for care outside the home. Today, Oregon
leads the nation in providing alternatives to the traditional nursing home-type
care.
1. Nursing Home Care. Nursing homes, licensed by the State, provide
several different levels of nursing care to residents. These range from intensive
nursing and rehabilitative care for people with unstable medical conditions,
to routine care for people with chronic medical problems. Current estimated costs
for nursing home care range from $3,500 to $7,500 per
month, depending on the level of care needed.
2. Adult Foster Care. An adult foster home
provides care to five or fewer residents. The operator or resident manager lives
in the home. Personal care, cooking, and cleaning are provided. Other types of
care depend upon the qualifications and license of the provider. Estimated costs
range from $2,500 to $4,000 per month.
3. Residential Care. Residential care facilities serve six or more residents
and have staff on duty around the clock. Meals and housekeeping services are
provided, but the amount of personal care and supervision varies.
4. In-Home Services. A range of services can be provided at home, from
a short visit to meet a particular need for assistance, to live-in help. In-home
services, generally, are not licensed by the State, although some providers
carry their own license. Estimated costs vary according to the hours of service
and the type of provider used.
WHO PAYS FOR LONG-TERM CARE EXPENSES?
1. Health Insurance and Medicare. Medicare is covering approximately 4-6% of
long-term care expenses. Health insurance, including Medicare, is primarily
focused upon the payment of hospital and physician care for illness or accidents.
Few health insurance carriers cover long-term care expenses. If they do, it
is usually only for skilled care (the services of a doctor
or nurse available 24 hours a day). Even if the insurance covers long-term
care, it is often limited to a certain number of days (generally only 100 days
or less).
2. Long-Term Care Insurance. Long-Term Care Insurance is covering approximately 2-4% of
long-term care expenses. This is a relatively new form of insurance that can
provide benefits for all levels of care including nursing homes, adult foster
care, assisted living facilities, and in-home care services. Be sure to shop
wisely and compare several policies. Most companies provide excellent coverage.
However, some long-term care policies contain limitations or exclusions that
prevent them from being an effective mechanism for funding care over an extended
period of time. (Policies sold in Oregon must now include coverage for alternatives
to nursing home care.) For more information, see Long-Term Care Insurance.
3. Private Pay. Approximately 40% of long-term care
expenses in Oregon are paid from personal or family funds. The funds of both
spouses are considered available to pay for care. The assets of adult children
are not available assets unless they have signed as a guarantor for the nursing
home expenses.
4. Medicaid. Approximately 50%+ of long-term care
expenses are being covered by Medicaid making
the Medicaid program the largest source of payment for long-term care in Oregon.
Medicaid is a joint Federal and State program. Medicaid covers the full range
of long-term care services for persons needing substantial assistance with
activities of daily living in nursing and adult foster homes.
Medicaid
eligibility is based upon a "service" (or health-related)
need and upon a financial need. To be eligible for Medicaid, the applicant
must meet three (3) criteria for eligibility: (a) a health need; (b) an income
need; and (c) an asset or resource need. Generally, individuals with severe
health issues, whose monthly incomes are at or below $2,022 (since January
2009) and whose assets are below $2,000 for an individual and $21,912 (since
January, 2009) for a couple will be eligible. Couples with assets above $21,912
may be required to split their assets and spend down before eligibility.
For more information, see our article on Medicaid in Oregon or contact us for an appointment to discuss these issues.
DISCLAIMER: The information contained in this website is based on Oregon law
and is subject to change. It should be used for general purposes only and should
not be construed as specific legal advice by Fitzwater Meyer, LLP, or its attorneys.
Neither this website nor use of its information creates an attorney-client relationship.
If you have specific legal questions, consult with your own attorney or call
us for an appointment.
(c) Fitzwater Meyer, LLP, 2003-2010
