Long-Term Care Resource Page
The Texas Health Information, Counseling and Advocacy Program, known as HICAP, is a partner in the State Health Insurance Assistance Program (SHIP). SHIP assists persons on Medicare, including seniors and persons with disabilities.
HICAP benefits counselors recently participated in national training on the topic of "Long-Term Care Options for Care and Payment." The following information summarizes some of the key aspects related to long-term care. Extensive information about long-term care is now available on the Medicare Home Page at www.medicare.gov
The information found here is intended as a resource to benefits counselors. It includes the PowerPoint presentations and an audio tape of each session.
Consumer Information
If you are a consumer or caregiver in immediate need of long-term care services, call 2-1-1 or contact a HICAP benefits counselor in your area.
If you are seeking information about long-term care planning, begin by visiting the Long-Term Care page on www.medicare.gov or read our consumer publications on long-term care insurance.
If your question is about a long-term care insurance policy you have or are buying, call our Consumer Help Line, 1-800-252-3439.
Other Resources
- Referrals, Resources, and Publications | MS Word | PDF
What is Long-Term Care?
- Long-term care is the kind of care you would need to help you perform "activities of daily living" (ADLs) - tasks such as feeding yourself, taking a bath, getting dressed, moving from a bed to a chair (transferring), using the bathroom, and remaining continent (toileting issues). It´s needed when chronic illness, injury, or age prevents people from performing these everyday tasks by themselves.
- Many people think of nursing homes when they hear the words long-term care. However, most long-term care is provided by friends and family members at home. To understand long-term care, it is important to also understand what it is not. It´s not medical care. It´s generally not provided by doctors, registered nurses, or other skilled medical professionals. It is not intended to cure a disease, and it´s not provided in a hospital.
- The insurance industry assesses one´s need for long-term care in terms of the ability to perform activities of daily living. Whether or not a person can perform a designated number of ADLs without help is an important part of the criteria used to determine if you qualify for benefits. Another measurement used to assess need for long-term care services is cognitive impairment, like that caused by Alzheimer´s disease, severe enough to require substantial supervision.
Who Needs Long-Term Care?
- Long-term care is not just for older adults. In fact, 40 percent of Americans currently receiving long-term care are between the ages of 18 and 64. Growing older, however, increases your chances of needing long-term care. According to the Centers for Medicare and Medicaid Services (CMS), 60 percent of Americans who reach age 65 will need long-term care at some point in their lives. More women than men need long-term care because women live longer on average, and the older you get, the higher the odds of needing long-term care.
- One out of four Americans age 85 or older lives in a nursing home. Nursing home care is the most expensive type of long-term care. And this age group is the fastest growing segment of the U.S. population. During the next 30 years, the number of Americans over 85 will more than double, from approximately 4 million to 8.4 million, according to the U.S. Census Bureau. Nearly half of them will need help with activities of daily living.
- Americans are living longer. The number of older Americans who need care will increase quickly as the Baby Boom generation ages.
- Texas Demographics at a Glance: Older Adults in Texas
How Much Does Long-Term Care Cost?
- The costs of long-term care vary greatly, depending on the type of care you need, the facility and the region where you receive care. For instance, when averaged nationally, the cost of a five-hour visit by a home health aide is $90. And the national average for one day of residence in a nursing home is $143. That´s over $52,000 a year.
- The Texas Department of Insurance estimates that nursing home care in Texas can range from $30,000 to $50,000 or more per year.
How Does One Pay For Long-Term Care?
Private Financing
Public Financing
Caregivers Needing Assistance
Caring for a senior with long-term care needs can be challenging and stressful on the caregiver. The Texas Department of Aging and Disability Services estimates that providing support for family members can cost an employee $660,000 in lost income, pensions, wages, and Social Security throughout their career.
If you are caring for a senior age 60 or older, and you need assistance, call your Area Agency on Aging Caregiver Support Program at 1-800-252-9240. While Caregiver Programs vary and are tailored to meet the needs of seniors and caregivers in a particular area, these programs often can provide a variety of needed services to caregivers. Some of these services include "respite care." "Respite" is designed to give the caregiver a temporary break from providing care. Some of the programs also provide caregiver training and education. Through such programs, caregivers may learn coping skills, talk about the emotional and financial impacts of caring for a senior age 60 and older, and may find a needed support group in the caregiver´s area.
Assess Your Own Personal Preparedness for Long-Term Care - How Ready Are You?
- Have you calculated your potential long-term care costs? What type of care might you need? Where would you like to receive care? How will you pay for the care? Who will provide the care? Visit the Long-Term Care Planner on the Medicare Long Term Care page at www.medicare.gov
- Have you prepared and executed a written will?
- Have you spoken with your family and/or friends about your long-term care needs?
- Have you spoken with your family and/or friends about your end-of-life wishes?
- Have you prepared your advance directives?
- Durable Power of Attorney for Health Care
- Designation of Guardian in Advance of Need
- Living Will/ Directive to Physicians
NOTE: Prior to executing any legal document relating to long-term care planning, it is strongly advised that you consult with a qualified elder law attorney.
HICAP Benefits Counselor Long-Term Care Initiative Training Workshop Materials
Other Resources
- Referrals, Resources, and Publications | MS Word | PDF
- Glossary of Long-Term Care Insurance Terms | MS Word | PDF
Trainers/Presenters - Texas HICAP 2005 Long-Term Care Training Initiative
About the Presenters
The Texas Health Information, Counseling and Advocacy Program, or HICAP, is a partner organization in the State Health Insurance Assistance Program (SHIP), a nationwide effort to assist Medicare eligible individuals, seniors and people with disabilities.
Norma Almanza, ACSR, HICAP Coordinator, Texas Department of Insurance, Austin, Texas.
Norma works within the Public Education Unit of TDI´s Consumer Protection Division. She is the agency´s administrator for HICAP grant-funded projects and provides training to lay staff and volunteers to become certified health benefits counselors. Norma also represents HICAP by giving community presentations, serving on numerous health-services related committees and providing technical advice and assistance to other HICAP partner organizations.
Koyne D. Smith, Elder Law Attorney, Law Office of Koyne D. Smith, Houston, Texas.
Koyne subcontracted with TDI to review and modify the Center for Medicare and Medicaid Services National LTC Training manual, and co-facilitated three counselor certification workshops in Dallas, Houston and Corpus Christi in March. Previously, Koyne served as a benefits counselor for two Area Agencies on Aging in Texas.
Lynda M. Hermes, ALHC, ACSR, Insurance Specialist, Texas Department of Insurance, Austin, Texas.
Lynda is a staff member of the Advertising Unit of the TDI´s Consumer Protection Division. She also works closely with the HICAP program, specializing on Long-term Care insurance. In her career at TDI, Lynda has worked in the areas of Liquidation, Market Conduct Examinations, Business Practices, and the Life/Health Policy Approval.
Roger Curme, Attorney at Law, Director of Hotline Projects, Texas Legal Services Center, Austin, Texas.
Roger manages several state and nonprofit grants for the Legal Hotline for Texans. The Hotline provides support to HICAP counselors and free legal advice and referrals to consumers. Hotline staff and volunteer attorneys focus their efforts on providing assistance to low-income Texans, whose access to legal services is often limited.
Bruce Bower, Attorney at Law, Director of Advocacy and Client Services, Texas Legal Services Center, Austin, Texas.
Bruce regularly provides training for benefits counselors on the appeals process. The Texas Legal Services Center provides legal assistance relating to Medicare, Medicaid, and Social Security matters. Bruce is also co-chair of the Texas Kincare Taskforce and Chair of Alternatives to Guardianship, Inc., a 501(c) (3) non-profit which oversees the Texas Money Management Program.
DISCLAIMER: The information contained on this website is not intended as legal, tax, or financial planning advice. Each individual´s needs and circumstances relating to long-term care will be different. Any individual planning for his or her long-term care needs must make informed, educated decisions about the options appropriate to address his or her needs.
For more information contact: ConsumerProtection@tdi.state.tx.us
Texas Department of Insurance
