Long-Term Care: Services, Settings, Financing & Planning Guide

Long-term care (LTC) encompasses services supporting individuals with chronic illness, disability, or age-related functional limitations who need ongoing assistance with daily activities.

Core Service Components

• ADL assistance: Bathing, dressing, toileting, transferring, eating.
• IADL support: Medications, meals, housekeeping, finances, transport.
• Medical/nursing care: Wound care, injections, monitoring, therapy.
• Psychosocial: Engagement, cognitive stimulation, emotional support.

Care Settings

Setting	Level of Care	Typical Residents
Home-based	Non-medical to skilled nursing	Prefer aging in place; family/caregiver support
Assisted Living (ALF)	ADL help, meds, meals, social	Need assistance but not 24-hr nursing
Memory Care	Specialized dementia care	Alzheimer's/dementia with behavioral needs
Skilled Nursing Facility (SNF)	24-hr nursing, rehab, medical	High acuity, post-acute, long-stay
CCRC (Life Plan Community)	Continuum: independent → ALF → SNF	Want guaranteed future access; entrance fee + monthly

Financing LTC

• Medicare: Only short-term skilled care (post-hospital, ≤100 days). NOT custodial.
• Medicaid: Primary payer for long-stay LTC; strict income/asset limits; state variation.
• Long-Term Care Insurance (LTCI): Best bought 50s–60s; covers home, ALF, SNF; read benefit triggers, inflation rider.
• Personal funds: Savings, home equity (reverse mortgage), retirement accounts.
• VA Benefits: Aid & Attendance, Housebound, state veterans homes.
• Life insurance hybrids: LTC riders, asset-based policies.

Planning Steps

1. Discuss preferences with family (values, setting, end-of-life).
2. Assess financial resources; model scenarios.
3. Research local facilities; visit, review surveys (Nursing Home Compare).
4. Complete advance directives: POA (financial/medical), living will, POLST/MOLST.
5. Consider LTCI if assets >$200K and <$2M (the "middle market").
6. Revisit annually or after health/life changes.

LTC planning is an act of love—for yourself and those who'll care for you. Start the conversation today.