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WHAT IS LONG-TERM CARE?

WHAT IS LONG-TERM CARE?. A wide range of services designed to manage limitations caused by a chronic condition and to minimize further deterioration of physical and mental health . WHAT IS FUNCTIONAL IMPAIRMENT?.

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WHAT IS LONG-TERM CARE?

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  1. WHAT IS LONG-TERM CARE? A wide range of services designed to manage limitations caused by a chronic condition and to minimize further deterioration of physical and mental health.

  2. WHAT IS FUNCTIONAL IMPAIRMENT? A chronic condition that limits a person’s ability to perform ActivitiesofDailyLiving (ADLs).

  3. ACTIVITIES OF DAILY LIVING • Bathing • Dressing • Eating • Toileting • Transferring • Continence

  4. WHAT IS COGNITIVE IMPAIRMENT? COGNITIVE IMPAIRMENTis a disability due to a deterioration in mental capacity, which requires continued supervision. Alzheimer’s Disease and other forms of dementia are examples of cognitive impairment.

  5. WHERE IS LONG-TERM CARE PROVIDED? • Home • Community • Assisted Living • Nursing Home

  6. HOME AND COMMUNITY-BASED SERVICES • Adult Day Health Care • Chore Services • Emergency Response System • Home Delivered Meals • Home Health Aide

  7. HOME AND COMMUNITY-BASED SERVICES • Homemaker Services • Respite Care • Visiting Nurse Services • Therapies

  8. AVERAGE HOME HEALTH RATES IN CONNECTICUT Charge Per Hour Charge Per Visit Skilled Nursing Visit Registered Nurse LPN Home Health Aide Physical Therapy Occupational Therapy Speech Therapy $139 --- --- $63 --- $53 --- $32 $135 --- $138 --- $138 ---

  9. AVG. COMMUNITY-BASED SERVICE RATES IN CT Charge Per Hour Charge Per Day $81 --- --- $22 --- $19 --- $19 --- --- $7.00 Adult Day Care Chore Services Companion Services Homemaker Services Home Delivered Meals (Charge Per Meal)

  10. USE OF HOME CAREIN CONNECTICUT • The average length of stay is more than 4 years • About halftransition to a nursing facility • About 35% die at home

  11. ASSISTED LIVING OPTIONS • Congregate Housing • Assisted Living Facilities • Residential Care Homes • Continuing Care Retirement Communities (CCRCs)

  12. NURSING FACILITY RATES IN CONNECTICUT $381 $139,000 5.6% Average Daily Rate Average Annual Rate Average Annual Inflation Rate (1988 – 2012)

  13. COST OF AVERAGE NURSING FACILITY STAYIN CONNECTICUT With the average cost for nursing facility care at over $138,000 per year and an average length of stay of about 2 1/2 years,the average cost for a nursing facility stay could be more than $345,000.

  14. MediCARE Federal Health Insurance for • People age 65 years or older • People with permanent kidney failure • People under 65 with certain disabilities

  15. MedicAID The state and federal health insurance program for those with limited resources or, in some cases, extremely high medical expenses.

  16. Who Pays for Long-Term Care? Other Gov. Programs 4.6% Out-of-Pocket 21.6% Medicaid 62.3% Private Insurance 11.6% Note: Out of pocket expenditures include payments made by patients and families. Source: National Spending for Long-Term Services and Supports (LTSS), 2011; National Health Policy Forum at George Washington University; February 1, 2013.

  17. INCOME TAX CLARIFICATION FOR INDIVIDUALS • Premiums can count as an unreimbursed medical expense • Out-of-pocket payments for “qualified” long-term care services can count as an unreimbursed medical expense • “Qualified” insurance benefits paid will not count as taxable income

  18. INCOME TAX CLARIFICATION FOR EMPLOYERS • Premiums can be deducted in same manner as health insurance • Employers can select or carve out groups of employees • Insurance benefits received by the employee are not taxable

  19. WHY LONG-TERM CARE INSURANCE?

  20. (1) Risk is high (2) Cost is high (3) MediCARE and health insurance do not pay for long-term care (4) While MedicAID pays for long-term care, you have to be poor and eligibility rules are restrictive (5) Potential tax benefits for individuals and employers (6) Partnership for Long-Term Care

  21. UNIQUE ASPECTS • State certification • Medicaid asset protection • Greater affordability • Guaranteed discount • Enhanced standards • Public Education

  22. How Asset Protection Works • If you continue to need care after your Partnership policy has paid benefits, you may apply for assistance from Medicaid. • When determining eligibility, the Dept. of Social Services will disregardor ignoreany assets you have up to the amount the Partnership policy has paid in benefits.

  23. Guarantees ofMedicaid Asset Protection 1. Asset protection is a life-long promise 2. Payments granted asset protection before a policy lapse will still be honored by Medicaid

  24. Guarantees ofMedicaid Asset Protection 3. The State of Connecticut cannotrecover protected assets from a person’s estate 4. Asset protection can accumulate anywhere the policy pays benefits

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