How California Defines Long-Term Care

In California, long-term care encompasses a wide variety of services that both address a person’s social, personal, and health-related needs and makes it possible for them to function independently outside of an institution.

These services help the person perform activities of daily living, depending on their level of need. This encompasses a wide variety of services in practice. For example, a long-term care facility may help a disabled person get access to assistive technologies to help them function and interact with others; provide assistance in preparing meals, performing housework, or going grocery shopping; or assist with bathing, dressing, and eating. The possibilities are fairly broad and long-term care services need to be flexible in addressing the diverse needs of clientele.

Long-term care insurance is designed to pay for some services that are not covered under most health insurance policies in California. One of those is non-acute medical care. Health insurance, including Medicare, provides for acute medical services, but does not usually cover the support services needed along with medical care when a person becomes chronically ill or disabled. Long-term care insurance is there to fill in the gaps.

Some institutions categorized as providers of long-term care, including the Program for All-Inclusive Care of the Elderly (PACE), skilled nursing facilities, and adult day healthcare facilities do provide medical services as well as help with activities of daily living. This is usually included in their rates overall, in addition to other services.

Often, long-term care insurance will pay for care in the patient’s home; in a hospice or respite center; in an adult day care, assisted living, or Alzheimer’s care facility; or in a nursing home. The care covered may include skilled nursing care; occupational, physical, speech, and rehabilitation therapy; and non-skilled help with activities of daily living.

One important distinction in long-term care is the difference between skilled, highly skilled, and non-skilled care. Organizations that provide skilled care meet strict criteria defined by Medicare. The definition includes services and rehabilitation that requires the expertise of licensed practical nurses, registered nurses, physical and occupational therapists, and other technical and professional personnel.

Highly skilled care is defined as care provided by specially trained therapists or nurses, with a state license for 24-hour care in the patient’s home. This type of care is usually given to chronically ill people who are not able to perform at least two activities of daily living for a minimum period of 90 days.

Non-skilled care includes providing assistance with activities of daily living and companion duties. These can include assistance with bathing, dressing, eating, housework, running errands, and medication reminders. Frequently, this kind of care is provided by family members on an unpaid basis, but some people do not have family members who are able to help.

Want to learn more about long-term care insurance in California? Check out our California 8-Hour LTC Training course.

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