5 Factors That Predict Who May Need Long-term Care

A woman called me the other morning asking about her mother, who’s in a nursing home. She wondered if qualifying for long-term care insurance was an option. 

“She’s already in a nursing home?”

“Yes, transferred from the hospital last week. Apparently, Medicare won’t pay after the first three months.”

“You’re right about that. There’s a cap of 100 days. Unfortunately, it’s too late to buy long-term care insurance. You have to buy it when you’re healthy, not after qualifying for long-term care. And definitely not after you’re already receiving care,” I explained.

It’s kind of like trying to buy fire insurance while your house is burning down, auto insurance after your car has been totaled in an accident, or health insurance after a devastating diagnosis.

Like the old English proverb about closing the stable door after the horse has bolted – the solution has come too late.

Clearly, this woman has figured out that having mom in nursing care will place a financial burden on her and her family. Otherwise, she wouldn’t be searching for solutions.

“Do you and your husband have long-term care insurance?”

“No, but we’re not looking for us right now. We’re both just shy of 60, so we’re good.”

Sadly, there’s a good chance this couple’s children will be making the same futile phone call in twenty years.

Can We Talk about Something More Pleasant?

People don’t want to talk about reaching a stage of life where they can’t take care of themselves. I get it. It’s scary, or at least unpleasant. If only denial could stop us from aging.

According to Retirement Watch, fewer than 30% of adults have talked about long-term care. A recent research survey out of the University of Chicago found that 38% of people over 40 don’t think they need to talk about it. They believe Medicare covers long-term care. It doesn’t.

We have to start talking about our elder care options, and what qualifying for long-term care means before it’s too late like it was for this family. Because not talking leads to confusion and financial disaster.

“The lifetime probability of becoming disabled in at least two activities of daily living or of being cognitively impaired is 68% for people age 65 and older.”
– A Report to the Nation on Independent Living and Disability, AARP

Confusion about Long-term Care

One misconception about long-term care is that it means moving into a nursing home. This isn’t true. Long-term care is a set of services, not a location where the services are received. While it’s true that you can receive long-term care in a nursing home, it’s called custodial care. And is, therefore, one part of a larger nursing care plan.

Another point of confusion is that long-term care is medical care. It’s not. Long-term care focuses on personal care and daily living activities. Different levels of care are available depending on a person’s needs. It’s possible to receive medical care from a skilled nurse or therapist at home or in a facility while receiving long-term care, but they’re not the same.

Did you know that Capital Retention long-term care insurance
offers plans that cover your care in a nursing home, memory care unit, assisted living facility, or at home? Learn more here.


Who Qualifies for Long-term Care?

Long-term care is a range of services and support for daily living. It’s designed to help you live as independently as possible, for as long as possible. You receive services when you can’t fully care for yourself because of frailty, disability, or chronic illness.

There are two broad levels of care. The level of services you qualify for is determined by your needs, which change over time.

Those who need the most care require help with Activities of Daily Living (ADLs) over a long period of time.

Think of Activities of Daily Living as the personal care routine you do every morning to get ready for your day. If you can’t do two or more of these tasks on your own, it shows a need for custodial care. That means having someone who can help you all day, every day, either at home or in residential care of some kind. ADLs are listed on the left.

qualifying for long-term care
Qualifying ADLs for long-term care

Unlike ADLs, Instrumental Activities of Daily Living (IADLs) are independent living skills. You can think of these as the tasks that keep your world in order – household upkeep, errands, and the like. They are listed above, on the right.

It’s important to know the difference between ADLs and IADLs, because ADLs are used by industry professionals to decide who qualifies for long-term care. They are also used to make care referrals, and develop care plans.  

When you meet the criteria for long-term care, it’s too late to buy long-term care insurance.

What Makes Qualifying for Long-term Care Likely?

It’s widely accepted that 70% of seniors will need some level of care in their lifetimes. Five indicators that make qualifying for long-term care in the future probable are:

Age – Naturally, the longer you live, the more likely you are to require long-term care. As the world’s aging population grows, so will the need for long-term care services. This is not a problem of Baby Boomers; living longer is a permanent shift.

Gender – If you’re female, your chances for needing long-term care services increase. Women tend to live longer than men, making them more vulnerable to needing care. Also, many outlive their spouses, which leaves them living alone – another risk factor.

Disability – Developing a chronic illness or having a catastrophic event or accident that disables a person often results in needing long-term care. During the decade of their 40s, 8% of people will be disabled; by age 90 that number increases to 69%.

Health – Having an unhealthy lifestyle when you’re younger like poor eating and exercise habits increases the probability of requiring long-term care. A chronic condition like high blood pressure, or even having a family history of chronic conditions is a long-term care predictor.

Living Alone – Couples tend to care for each other as they age; one may even take on the caregiving role for the other. Consequently, being a surviving spouse or an adult orphan makes it more likely that you’ll need paid long-term care assistance.

Capital Retention hybrid long-term care plans include Care Coordination, so you don’t have to worry. Your Care Coordinator will handle details, and answer your questions.

The Need for Long-term Care Planning

Unfortunately, people who think like the woman who called me are more common than not. Although half of Americans over 40 believe everyone will need some sort of long-term care in their lifetimes, 75% think they won’t personally need it. 

While we may continue to feel invincible at 40, 50, and even 60, is beating the odds still a game we want to play?  If we don’t tackle long-term care planning while it’s still affordable and fairly easy to qualify for, our children may be making their own frantic phone calls in 25 years.

Get to know Capital Retention socially. We hang out on Facebook, Twitter, and Pinterest, but you can also find us on Google+ and LinkedIn. 

(Sources: Family Caregiver Alliance: National Center on Caregiving and LongTermCare.gov: U.S. Department of Health and Human Services)