Understanding Long-Term Care

Long-term care (LTC) refers to a range of services and support needed by individuals who have difficulty performing everyday activities due to chronic illness, disability, cognitive impairment, or the frailties of aging. Understanding LTC is essential for insurance professionals because it represents one of the largest uninsured financial risks facing Americans.

What Is Long-Term Care?

Long-term care encompasses medical and non-medical services for people who need ongoing assistance with daily living activities. Unlike acute care (which treats specific illnesses), LTC focuses on helping individuals maintain their quality of life over extended periods—often years or even decades.

Key Characteristics of Long-Term Care

Who Needs Long-Term Care?

The need for LTC is more common than many people realize:

• 70% of people turning 65 will need some form of LTC in their lifetime
• 20% will need care for more than 5 years
• Average duration of care needed: 3 years for women, 2.2 years for men
• 40% of LTC recipients are under age 65 (due to accidents, illness, or disability)

The Cost of Long-Term Care (2025)

Long-term care costs vary significantly by location and type of care:

Exam Tip: Know that LTC costs are NOT covered by traditional health insurance or Medicare (except limited skilled nursing after hospitalization). This gap creates the need for LTC insurance.

Levels of Care

Long-term care is provided at different intensity levels based on the individual's needs:

1. Skilled Nursing Care

• Provided by licensed medical professionals (RNs, LPNs)
• Includes medical treatments, wound care, IV therapy
• Ordered by a physician
• Can be provided in facilities or at home
• Most expensive level of care

2. Intermediate Care

• Occasional skilled nursing and rehabilitative care
• Less intensive than skilled care
• Provided under medical supervision
• May be intermittent (not continuous)

3. Custodial Care (Personal Care)

• Assistance with activities of daily living (ADLs)
• Does NOT require licensed medical personnel
• Can be provided by home health aides or family
• Most common type of LTC
• NOT covered by Medicare or health insurance

4. Home and Community-Based Care

• Adult day care programs
• Respite care (temporary relief for caregivers)
• Home modifications
• Transportation services
• Meal delivery programs

Why Medicare Doesn't Cover LTC

A common misconception is that Medicare covers long-term care. In reality:

Key Point: Medicare's skilled nursing benefit requires a 3-day hospital stay and covers only 100 days maximum, with significant coinsurance after day 20.