06: Financing Long-Term Care Flashcards
Which of the following is not included in Long-term Services and Support (LTSS)?
A. Health
B. Social
C. Housing
D. Transportation
E. Nutrition
E
Why is long-term care important to consider?
- Medical advancements and technology are finding more ways to maintain life
- Life expectancy is increasing
- “Baby Boomers” aging
What are the three general settings for LTSS?
- Institutions
- Home-based
- Community-based
This type of LTSS has 24 hours of high level medical care by skilled professionals, healthcare aids and orderlies.
A. Nursing home
B. Skilled nursing facility
C. Home-based care
D. Community-based care
B
This type of LTSS has 24 hours of custodial care for ADL assistance.
A. Nursing home
B. Skilled nursing facility
C. Home-based care
D. Community-based care
A
This type of LTSS can be formal or informal, and can include professional services provided in the home.
A. Nursing home
B. Skilled nursing facility
C. Home-based care
D. Community-based care
C
This type of LTSS provides shelter (shared or private rooms) and meals in a small facility.
A. Nursing home
B. Skilled nursing facility
C. Home-based care
D. Community-based care
D
A non-residential facility that supports the health, nutritional, social support and daily living needs of adults in a professionally staffed, group setting is called…
Adult Day Service(s)
A facility combining housing, personalized supportive services, and health care designed to meet the needs of those who need help with ADLS is called…
Assisted living
This type of LTSS provides care for individuals with terminal illness and their support systems during and after the dying process.
Hospice
Temporary surrogate care given to a patient when the patient’s primary caregiver must be absent is called…
Respite Care
True or false: Medicaid pays for about 48% of LTSS.
True
True or false: Medicare covers home health services (skilled care) and custodial care.
False
Covers home health care but NOT custodial care.
Private long-term care (LTC) insurance has a large deductible that is measured in nursing home days.
For a 90-day deductible that is $272 per day, what wold the cost of the 90 days be?
If the copay is $105 per day after the 90-day deductible, what would the TOTAL cost for the year be?
$24,480 for 90 days
For year: 24,480 + (275 x 105) = $53,355 for one year
True or false: Medicaid coverage of home and community-based services can be provided at the state’s discretion.
True
Which of the following is NOT covered under Medicaid for LTC?
- Home health aids
- Personal care attendant
- Transportation
- Adult day services
- Home prepared meals
- Home delivered meals
- Case management
- Rehab
- Home modifications
- Respite care
- Transportation
- Home prepared meals
All others are covered!
What is the eligibility criteria for Medicaid coverage for LTC?
- Low income
- limited assets
- Functional need
- Must be receiving SSI
What is the difference between Medicaid and Medicare coverage for LTC?
Medicare doesn’t cover personal/custodial care services
What is the most common reason for nursing home placement?
Absence of informal caregiver
What is the states’ obligation under the US Supreme Court Olmstead decision?
Provide services to persons with disabilities in community settings versus institutions
Which ACA LTC program provides additional federal payment for beneficiaries transitioning from institutional care to the community?
Money Follows the Person Demonstration
Who provides the most informal care in the home?
Family and friends
What is the largest payer of LTC services?
Medicaid
Which LTC is the most costly for the healthcare system? Why?
Nursing home/SNF - 24 hours of care
