Home care is
only one type of long-term care (LTC). LTC provides services to people
who need help in their everyday activities because of a chronic or
disabling health condition. "Supportive" services form the core of LTC.
They include help with bathing, eating, walking or going to the
toilet—basic functions known in the LTC literature as
activities of daily living or "ADLs." Supportive services also include
help with household chores and other activities such as shopping,
cooking, managing money and paying bills, or traveling to and from
one’s home. In the LTC literature, these are known as
instrumental activities of daily living or "IADLs."
LTC can be
delivered in a nursing home, assisted living facility or other
congregate setting, or in a person’s own home. When services
are delivered at home, they are called home care.
I learn about home care?
often think LTC is provided only in nursing homes, LTC includes many
different services, most of which can be provided at home. Yet most
people don’t know a lot about these options. In a survey of
people 45 and older, the AARP found that 85% of those over 40 years of
age couldn’t make a good guess about the cost of LTC, nor did
they know how they would pay for it if they needed it.
it’s likely they will need LTC at some point in their lives,
if only for a short time. As they age, nearly 72% of those over 65 will
at some time need home care, while nearly half will enter a nursing
However, only a small proportion of older people needs LTC at any one
point in time: 12% of people 65 or older living in the community have
LTC needs, while 5% of those over 65 receive LTC in a nursing home.
Why do people need it?
health conditions can cause someone to need help with everyday
activities. Some of these include
Congestive heart failure
Spinal cord injury
especially older people, tend to have more than one of these
conditions. Because many of these conditions are not likely to be
cured, people need help on an ongoing basis to lead the best lives they
can. Services should help people to manage their conditions and
maintain their ability to function, while at the same time allowing
them to live lives that are as full and independent as possible.
Though most of
the people who receive LTC are over 65, many are younger (see Figure 1 ).
types of services do they receive?
Some of the
services that LTC recipients need are medical (wound care and the
administration of intravenous medications, for example). However most
LTC services are non-medical and low-tech (such as help with dressing
or bathing). LTC can also include rehabilitation services aimed at
helping improve physical functioning. Other LTC services include
“palliative care”, which is aimed at making people
comfortable and is meant for those in great pain or close to the end of
Most paid LTC is
provided in nursing homes, despite the fact that many people prefer to
receive services at home. Medicaid, the primary payer for most LTC
services, directs 56% of its LTC spending toward nursing homes.Increasingly,
people are turning to assisted living facilities, which promise to
provide supportive services in a home-like setting, although the
quality of these facilities is a matter of some debate. Efforts are
also being made to expand access to services in peoples’
homes and in their communities.
does it cost?
Home care is
expensive and many people have no way of paying for it. However, on
average, the average cost of a home health visit ($65 in 1997) is
considerably less than a day in a hospital ($1078 in 1997) or nursing
home ($232 in 1997) . Because of the
cost, family members and friends provide a great deal of LTC, receiving
no payment for their services. The worth of their time was estimated at
$196 billion in 1998 , more than the
$150 billion spent on paid LTC services. It is estimated that $100
billion (or two thirds) of that $150 billion went toward nursing home
care, while $50 billion (or one third) went toward services provided at
home or in a community-based setting.
insurance does not cover LTC. Even Medicare (the health insurance
program for people over 65 and some younger people with disabilities)
does not help people who need LTC: it mainly covers short-term services
at home or in nursing homes. People who need services on an ongoing
basis often dip into their savings. Those who have no savings receive
LTC through Medicaid, the health insurance program for people with
limited means. (They often qualify because they have used up all of
their savings paying for LTC.) Some people (who can afford the
premiums) are turning to private insurance policies that cover the cost
of LTC, but as yet, only about 7% of all LTC services are paid for this
To learn more about LTC, explore these
Click here to investigate some
organizations involved in LTC
A useful overview of LTC is available here
For more comprehensive and technical information on home and
community-based services, click here
|Center for Home
Policy & Research
107 East 70th St, 3rd Fl.
New York, NY 10021