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WHAT IS LONG-TERM CARE? A wide range of services designed to manage limitations caused by a chronic condition and to minimize further deterioration of.

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Presentation on theme: "WHAT IS LONG-TERM CARE? A wide range of services designed to manage limitations caused by a chronic condition and to minimize further deterioration of."— Presentation transcript:

1 WHAT IS LONG-TERM CARE? A wide range of services designed to manage limitations caused by a chronic condition and to minimize further deterioration of physical and mental health.

2 A chronic condition that limits a person’s ability to perform Activities of Daily Living (ADLs). A chronic condition that limits a person’s ability to perform Activities of Daily Living (ADLs). WHAT IS FUNCTIONAL IMPAIRMENT?

3 ACTIVITIES OF DAILY LIVING  Bathing  Dressing  Eating  Toileting  Transferring  Continence

4 WHAT IS COGNITIVE IMPAIRMENT? COGNITIVE IMPAIRMENTis a disability due to a deterioration in mental capacity, which requires continued supervision. Alzheimer’s Disease and other forms of dementia are examples of cognitive impairment. COGNITIVE IMPAIRMENT is a disability due to a deterioration in mental capacity, which requires continued supervision. Alzheimer’s Disease and other forms of dementia are examples of cognitive impairment.

5 WHERE IS LONG-TERM CARE PROVIDED? Home Home Community Community Assisted Living Assisted Living Nursing Home Nursing Home

6 HOME AND COMMUNITY- BASED SERVICES Adult Day Health Care Adult Day Health Care Chore Services Chore Services Emergency Response System Emergency Response System Home Delivered Meals Home Delivered Meals Home Health Aide Home Health Aide

7 HOME AND COMMUNITY- BASED SERVICES Homemaker Services Homemaker Services Respite Care Respite Care Visiting Nurse Services Visiting Nurse Services Therapies Therapies

8 Charge Per Visit Charge Per Hour Skilled Nursing Visit Registered Nurse LPN Home Health Aide Physical Therapy Occupational Therapy Speech Therapy $ $ $ $32 $ $ AVERAGE HOME HEALTH RATES IN CONNECTICUT RATES IN CONNECTICUT

9 Charge Per Day Charge Per Hour Adult Day Care Chore Services Companion Services Homemaker Services Home Delivered Meals (Charge Per Meal) (Charge Per Meal) $ $ $ $7.00 AVG. COMMUNITY-BASED SERVICE RATES IN CT SERVICE RATES IN CT

10 USE OF HOME CARE IN CONNECTICUT The average length of stay is more than 4 years The average length of stay is more than 4 years About half transition to a nursing facility About half transition to a nursing facility About 35% die at home About 35% die at home

11 ASSISTED LIVING OPTIONS Congregate Housing Congregate Housing Assisted Living Facilities Assisted Living Facilities Residential Care Homes Residential Care Homes Continuing Care Retirement Communities (CCRCs) Continuing Care Retirement Communities (CCRCs)

12 Average Daily Rate $381 $139, % NURSING FACILITY RATES IN CONNECTICUT Average Annual Rate Average Annual Inflation Rate (1988 – 2012)

13 COST OF AVERAGE NURSING FACILITY STAY IN CONNECTICUT With the average cost for nursing facility care at over $138,000 per year and an average length of stay of about 2 1/2 years,the average cost for a nursing facility stay could be more than $345,000. With the average cost for nursing facility care at over $138,000 per year and an average length of stay of about 2 1/2 years, the average cost for a nursing facility stay could be more than $345,000.

14 Medi CARE Federal Health Insurance for  People age 65 years or older  People with permanent kidney failure  People under 65 with certain disabilities

15 state and federal health insurance program The state and federal health insurance program for those with limited resources or, in some cases, extremely high medical expenses. Medic AID

16 Who Pays for Long-Term Care? Out-of-Pocket 21.6% Private Insurance 11.6% Medicaid 62.3% Other Gov. Programs 4.6% Note: Out of pocket expenditures include payments made by patients and families. Source: National Spending for Long-Term Services and Supports (LTSS), 2011; National Health Policy Forum at George Washington University; February 1, 2013.

17 INCOME TAX CLARIFICATION FOR INDIVIDUALS  Premiums can count as an unreimbursed medical expense  Out-of-pocket payments for “qualified” long-term care services can count as an unreimbursed medical expense  “Qualified” insurance benefits paid will not count as taxable income

18 INCOME TAX CLARIFICATION FOR EMPLOYERS  Premiums can be deducted in same manner as health insurance  Employers can select or carve out groups of employees  Insurance benefits received by the employee are not taxable

19 WHY LONG-TERM CARE INSURANCE?

20 (1) Risk is high (2) Cost is high (3) MediCARE and health insurance do not pay for long-term care (4) While MedicAID pays for long-term care, you have to be poor and eligibility rules are restrictive (5) Potential tax benefits for individuals and employers (6) Partnership for Long-Term Care

21 UNIQUE ASPECTS State certification State certification Medicaid asset protection Medicaid asset protection Greater affordability Greater affordability Guaranteed discount Guaranteed discount Enhanced standards Enhanced standards Public Education Public Education

22 How Asset Protection Works If you continue to need care after your Partnership policy has paid benefits, you may apply for assistance from Medicaid. If you continue to need care after your Partnership policy has paid benefits, you may apply for assistance from Medicaid. When determining eligibility, the Dept. of Social Services will disregard or ignore any assets you have up to the amount the Partnership policy has paid in benefits. When determining eligibility, the Dept. of Social Services will disregard or ignore any assets you have up to the amount the Partnership policy has paid in benefits.

23 Guarantees of Medicaid Asset Protection 1.Asset protection is a life-long promise 2.Payments granted asset protection before a policy lapse will still be honored by Medicaid

24 3.The State of Connecticut cannot recover protected assets from a person’s estate 4.Asset protection can accumulate anywhere the policy pays benefits Guarantees of Medicaid Asset Protection


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