What is Long-Term Care?
Long-term care encompasses personal and medical assistance for people who cannot independently perform daily activities due to chronic illness, disability, or aging.
Services range from in-home help with bathing and medication to comprehensive nursing home care, typically lasting months or years rather than short recovery periods.
Does Medicare Cover Long-Term Care?
Most Americans mistakenly believe Medicare will cover their long-term care needs in retirement. This critical misunderstanding can lead to devastating financial consequences when care is eventually needed.
Medicare’s Limited Long-Term Care Coverage
Medicare provides restricted coverage for long-term care services:
- Skilled nursing facility care: Up to 100 days maximum
- Requires a qualifying 3-day hospital stay first
- Days 21-100 require a daily copayment ($200+ per day in 2025)
- Must show continuous improvement to maintain coverage
- Home health services: Limited coverage
- Requires doctor certification of medical necessity
- Must be skilled nursing care (not custodial)
- Care must be part-time or intermittent only
The Custodial Care Gap: What Medicare Won’t Cover
Over 90% of long-term care services fall under “custodial care”, the assistance with activities of daily living that Medicare doesn’t cover 
:
- Bathing and personal hygiene
- Dressing and grooming
- Mobility assistance and transfers
- Eating and meal preparation
- Toileting and incontinence care
- Medication management
These services become essential following:
- Stroke or physical impairments
- Dementia or Alzheimer’s disease
- Chronic progressive conditions
- General age-related decline
Who Needs Long-Term Care?
The need for care generally falls into these two categories:
Physical Impairment
When someone requires assistance with their Activities of Daily Living (ADL’s) such as: walking, bathing, continence, dressing, eating, toileting and transferring.
Cognitive Impairment
May be caused by Dementia or Alzheimer’s disease. An individual may be able to physically take care of their Activities of Daily Living, but forget to turn off the stove or cannot remember where they live.
How Many People Need Long-Term Care?
➤ Those turning age 65 today have about a 70 percent chance of needing some type of long-term care in their lifetime.
➤ Women need care longer (3.7 years) than men (2.2 years). The average length of time people need long-term care services is 3 years.
➤ One-third of people may never need long-term care, but 20 percent will need it for longer than 5 years.1
➤ Not only seniors need long-term care. Over 35 percent of people currently receiving long-term care services are between 18 and 64.2
Personal Factors Increasing Your Risk
Age – The older you are, the more likely it is you will need assistance.
Living Alone – If you live alone it is more likely you will need paid care. It is less likely if you live with a spouse or partner.
Gender – Women are more likely to need long term care than men. Mostly because women live 5 years longer than men on average.
Lifestyle – Poor diet and exercise habits increase the chance of needing care.
Personal History – Health and family history can increase the chances of needing long term care.
Long-Term Care Settings
Nursing Homes – This is a setting which provides 24-hour care. There are options for private rooms but semi-private rooms are most common. Over 40 percent of all long term care is provided in a nursing home.
Assisted Living – Assisted living facilities are for people who need minor assistance due to cognitive impairment or with their activities of daily living. These facilities can be a very good alternative to nursing homes and often provide many activities for their residents. Residents can have their own apartment where they may be able to bring their own furniture.
Home Health Care – A home health care provider visits your home for a few hours or up to 24 hours per day.
Adult Day Care – Adult Day Care Facilities are for those who have caregivers at home. Adult day care provides care while the primary caregiver goes to work or attends to personal matters such as shopping or banking. This option can help to keep the patient out of a nursing home.