Long-term care

Long-term care (LTC) is a variety of services which help meet both the medical and non-medical need of people with a chronic illness or disability who cannot care for themselves for long periods of time.

It is common for long-term care to provide custodial and non-skilled care, such as assisting with normal daily tasks like dressing, bathing, and using the bathroom. Long-term care may also include medical care that most people do for themselves, such as diabetes monitoring. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. Long-term care may be needed by people of any age, even though it is a common need for senior citizens.

The Centers for Medicare and Medicaid Services (CMS) estimate that about nine million men and women over the age of 65 in the US will need long-term care in 2006. By 2020, 12 million older Americans will need long-term care. It is anticipated that most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that people who reach age 65 will likely have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home will stay there five years or more.

A 2006 study conducted by AARP found that most Americans are unaware of the costs associated with long-term care and overestimate the amount that government programs such as Medicare will pay.

Medicare (US)
Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, certain conditions must be met for Medicare to pay for even those types of care. Medicare specifically will not pay for custodial and non-skilled care.

Long-term care funding
National governments have responded to growing long-term care needs at several levels. Most Western European countries have put in place a mechanism to fund formal care and, in a number of Northern and Continental European countries, arrangements exist to at least partially fund informal care as well. Some countries have had publicly organized funding arrangements in place for many years: the Netherlands adopted the Exceptional Medical Expenses Act (ABWZ) in 1967, and in 1988 Norway established a framework for municipal payments to informal caregivers (in certain instances making them municipal employees). Other countries have only recently put in place comprehensive national programs: in 2004, for example, France set up a specific insurance fund for dependent older people. Some countries (Spain and Italy in Southern Europe, Poland and Hungary in Central Europe) have not yet established comprehensive national programs, relying on informal caregivers combined with a fragmented mix of formal services that varies in quality and by location. (Saltman et al. 2006)

Home care / Informal care
Home care can be provided by informal (nonprofessional, usually volunteer) or formal (professional) providers and can incorporate a wide range of clinical (nursing, drug therapy, physical therapy), social (food preparation, cleaning, shopping), and even physical construction (installing hydraulic lifts, renovating bathrooms and kitchens) activities. (Saltman et al. 2006) Informal care plays an important part in many countries across the world.

In many countries, the largest percentages of older persons using services are those who rely on informal home care. Estimates of these figures often are in the 80 to 90 percent range; for example, in Austria, 80 percent of all older citizens (OECD 2005). The similar figure for dependent elders in Spain is 82.2 percent (Costa-Font and Patxot 2005).

Informal care financing
In the 1980s, some Nordic countries began making payments to informal caregivers, with Norway and Denmark allowing relatives and neighbors who were providing regular home care to become municipal employees, complete with regular pension benefits. In Finland, informal caregivers received a fixed fee from municipalities as well as pension payments. In the 1990s, a number of countries with social health insurance (Austria in 1994, Germany in 1996, Luxembourg in 1999) began providing a cash payment to service recipients, who could then use those funds to pay informal caregivers. In Germany, the long-term care fund may also make pension contributions if an informal caregiver works more than 14 hours per week. (Saltman et al. 2006)

Medicaid (US)
Medicaid is a government program that will pay for certain health services and nursing home care for older people. In most states, Medicaid also pays for some long-term care services at home and in the community. Eligibility and covered services vary from state to state. Most often, eligibility is based on income and personal resources.