DEFINITION: Long-term care generally refers to non-medical care (ie, custodial care) for patients who need assistance with basic daily activities such as dressing, bathing and using the bathroom. Long-term care may be provided at home or in facilities that include nursing homes and assisted living.
Medicare, generally, does not pay for custodial long-term care, whether it’s in a nursing home or provided in-home. Medicare will pay for medical care provided in addition to long-term care (for example, if a nursing home resident suffers a heart attack, Medicare will pay for the treatment necessary for the heart attack, despite the fact that Medicare is not paying the monthly nursing home bill).
And Medicare will also pay for physical therapy, occupational therapy, or other medical care received in a skilled nursing facility, provided the patient meets certain criteria (including at least a three-day stay as a hospital inpatient prior to the stay in the skilled nursing facility).
Medicaid, which is a separate program for low-income Americans, administered jointly by the states and the federal government, does cover long-term care for people who have exhausted their resources. Nearly two-thirds of nursing home residents in the US have Medicaid coverage. Seniors who qualify for both Medicaid and Medicare are called dual-eligible.