Karl Steinberg (Associate Medical Director, Sharp Mission Park Medical Group) gives expert video advice on: What is long-term care?; Why should I worry about long-term care?; Who needs long-term care? and more...
What is long-term care?
It is a very broad term that applies to, essentially any services, that are provided to people that have chronic conditions. It is not really for an acute condition. It is for people who have needs for assistance over long period of time.
Why should I worry about long-term care?
Because not all of us get the exit that we pray for which is you're healthy one day, you go to bed one night, have a giant heart attack in your sleep and that's it. Some of us wind up requiring assistance no matter how good care we take of ourselves. Sometimes due to unforeseen circumstances, we wind up requiring the assistance of others to go about our business. So it's the kind of thing that everybody needs to worry about to some degree - about ourselves, about our parents, our loved ones and so on.
Who needs long-term care?
Anybody who requires the assistance of others over an extended period of time. That could be an elderly person who has medical conditions and who isn't able to perform all of their activities of daily living. It could also be younger people who have a variety of disabilities, and any of those individuals could be said to require long-term care.
What are long-term care services?
Long-term care services comprise a huge variety of both skilled services and non-skilled services. It could be just some assistance with some of the activities of daily living. For example, you can't cook for yourself, or you can't get to the store, things like that. Also, it could mean that you need assistance with actual medical conditions. For example, you've had a stroke, or maybe you're incontinent. It goes from very mild degrees of assistance to very extensive needs.
Who pays for long-term care?
A whole variety of people. I guess, the private citizens pay for a lot of long-term care. Some of the cost is not even calculated, because a lot of long-term care services are provided in people's private homes by family members. But, probably Medicaid or as we call it in California: medicow because we're different, they pay for quite a bit of it, and the skill nursing facility or nursing facility setting. Essentially, if you have no resources, then Medicaid will cover long-term custodial care. Also, Medicare pays for a small portion of it. They'll pay up to a hundred days of skilled care in a nursing facility setting. And then there are also private insurers who cover long-term care both in the home and in institutional type setting in a variety of kinds.
What is skilled care?
Skilled care is typically care that's given in a nursing facility that requires the assistance of skilled personnel. In order to meet the criteria under Medicare, or any of the Medicare HMO plans, it essentially requires that you need on a daily basis either skilled nursing assistance, for example dressing changes. Let's say you're getting an IV. Having a feeding tube is considered a skilled need even though it's not particularly complicated. Also, it could involve needing other kinds of licensed skilled care, for example, that would be provided by a physical therapist, an occupational therapist, a speech therapist and so on.
What is unskilled care?
That's basically what we call custodial care. And that just means it's the type of care that can be provided by either a layperson or maybe somebody who has just a certificate, like a certified nurse's aid or something like that. Essentially it would be assistance with activities of daily living, like grooming or ambulation, things like that, that wouldn't require a skilled professional - a licensed professional like a nurse or a physical therapist, things of that nature.
At what age do most people need long-term care?
Eighty-five and up; into the nineties and hundreds, and they constitute a majority of people who reside in nursing facilities on a long term basis. But, it can happen at any age, and there's certainly people in younger age groups, including between sixty-five and eighty-five who require some degree of assistance that would constitute long term care.
What are the chances I'll need long-term care?
It's difficult to quantify because we don't know exactly what's going to happen to us. People who have chronic illnesses like diabetes are somewhat more likely to require long-term care. It also depends on what your resources are and what kind of family support you might have. It's hard to quantify that. Probably up to sixty percent of the population at some point will need some type of long-term services. Whether they are actually medical versus just custodial assistance is variable.