The website defines long-term care as “a range of services and supports you may need to meet your personal care needs. Most long-term care is not medical care, but rather assistance with basic personal tasks of everyday life, sometimes called Activities of Daily Living (ADLs)…Other common long-term care services and supports are assistance with everyday tasks, sometimes called Instrumental Activities of Daily Living (IADLs).”

Activities of Daily Living

Activities of Daily Living (ADLs) generally include:

  • Walking and ambulating (getting around the house)
  • Transferring (getting in and out of bed or a chair)
  • Toileting
  • Bathing
  • Dressing
  • Feeding
  • Continence

The number of Activities of Daily Living that one needs assistance with is often a guide for the level of caregiving that may be needed. In addition, the coverage under most long-term care policies is triggered when a policy owner needs assistance with at least two Activities of Daily Living. Some policies may not include walking/ambulating as an Activity of Daily Living.

Instrumental Activities of Daily Living

Instrumental Activities of Daily Living generally include:

  • Cleaning and home maintenance
  • Bill paying and managing finances
  • Meal preparation
  • Shopping for groceries and other necessities
  • Managing and taking medication
  • Managing transportation, either by driving or arranging for transportation
  • Managing communications such as mail and telephone

Instrumental Activities of Daily Living are often used when assessing appropriate living environment and caregiving needs for an individual and developing a care plan.

Levels of Long-Term Care

From a medical and service perspective, long-term care generally falls into three levels of care:

Skilled Care

Skilled care is generally used to refer to “around-the-clock” care to treat a medical condition. Skilled care is ordered by a doctor and is performed by medical personnel such as registered nurses or professional therapists.

Intermediate Care

Intermediate Care is for those that may need intermittent nursing and rehabilitative care supervised by a doctor and performed by medical personnel such as registered nurses, licensed practical nurses, and nurse aides.

Custodial Care

Custodial Care is for assistance with Activities of Daily Living and Instrumental Activities of Daily Living or supervision needed due to cognitive impairment. Generally, Custodial Care can be provided by someone that does not have professional medical skills, though they may be supervised by a doctor. Most of what we think of as “long-term care” is custodial care.

Long-Term Care Environments

Many equate the term “long-term care” with nursing home care, but long-term care is a general term that is used to address a whole spectrum of potential care options and care environments.

Home Care

Home care refers to long-term care services delivered in the home. There is a broad range of home care services available to assist with activities of daily living, instrumental activities of daily living, and limited skilled care.

Adult Day Care Centers

Adult day care is non-skilled care provided in a community setting. It is usually for those that have light to moderate cognitive impairment and may need supervision. Patients attending Adult Day Care usually can walk but may need assistance with other Activities of Daily Living.

Independent Living with Home Care

As the name implies, an Independent Living Community is for those who can live independently but may want access to the amenities that an Independent Living Community provides such as laundry services, maintenance and utilities, transportation, meals, and activities. Often the living units are similar to an apartment, though some communities also have single-family homes.

In an effort to help residents age in place, most Independent Living Communities partner with Home Care providers to arrange for residents to receive home care services within their apartment at the Independent Living Community.

Assisting Living

Assisted Living Communities are equipped to assist with Activities of Daily Living and some Instrumental Activities of Daily Living, generally while attempting to maintain as much independence as possible for residents.  

Memory Care

Memory Care is designed for patients with Alzheimer’s, dementia, and other forms of memory problems. Memory Care is also sometimes referred to as a “Special Care Unit” (SCU). Memory Care usually includes 24-hour supervised care. Often the wing or building is locked to protect residents that may be prone to wandering.

Skilled Nursing Facility (a.k.a. Nursing Home)

A Skilled Nursing Facility or Nursing Home is for residents needing skilled medical care. Skilled nursing facilities have 24-hour nursing care supervised by a physician.

Continuing Care Retirement Community (CCRC)

Continuing Care Retirement Communities (CCRCs) are designed to help patients “age in place”. Generally, a Continuing Care Retirement Community will have independent living, assisted living, and skilled nursing care available within the same community. As a patient’s care needs progress, the patient will be moved to the appropriate section of the community.

Hospital Care

Hospitals provide medical care—not custodial care. Often, a hospital may serve as the “gateway” to other long-term care settings. The most common example being a hospital stay due to a broken hip, followed by rehabilitation in a Skilled Nursing Facility.

We Can Help You Develop a Long-Term Care Plan

Having assisted many Wake County clients with long-term care planning, our team at Carolina Family Estate Planning understands that developing a long-term care plan is about not just protecting your own independence and dignity, but also protecting those you love from the physical, emotional, and financial toll that caring for a loved one can take.

We’ve helped many clients take an interdisciplinary approach to their long-term care planning by exploring both legal and financial options. Usually, a well-rounded long-term care plan will involve a combination of legal, health care, and financial tools to meet your goals and maximize your protection. To get started, register an upcoming seminar to learn more or call our office at 919-443-3035.

Jackie Bedard
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Attorney, Author, and Founder of Carolina Family Estate Planning