Long term care (LTC) services address the health, social and personal care needs of individuals who have lost the ability to care for themselves. While a certain degree of public support is available, government programs are not comprehensive and long term care services can be costly.
Long term care insurance helps to pay for the care or services that government or other plans don't provide, or bridges the gap between what is provided and the extra care or services you might prefer. With long term care insurance:
· you have more choices about the quality and amount of care you receive
· you have more choices around where to receive care and by whom
· your savings and investments are more likely to be preserved
Long term care may include:
· nursing care
· rehabilitation and therapy
· personal care (help with activities of daily living like dressing, eating and bathing)
· homemaking services (meal preparation, cleaning, laundry)
· supervision by another person
Care may be provided in the home, in the community (e.g. adult day care), or in a facility that provides long term care.
Each year, thousands of Canadians face the reality of needing long term care services - either for themselves or for a family member. At every stage of our lives we are vulnerable to accidents and illnesses that can change the way we live:
· About 50,000 strokes occur in Canada each year. Stroke is the leading cause of transfer from hospital to long term care.
· The average age of diagnosis for Multiple Sclerosis is 30.
· 1 in 13 Canadians over age 65 is affected by Alzheimer Disease or a related dementia.
· 7% of Canadians age 65 and over reside in health care institutions.
· An additional 28% of Canadians age 65 and over receive care due to a long term health problem, although they who do not live in a health care institution.
There are many misconceptions about what the government provides and pays for, and what extended health care benefits cover. It's important to understand exactly what benefits you have through your employer or association, and what the limitations are. Do they end when you turn 65, or when you leave the group? Is your spouse covered?
Just like disability insurance has a definition of disability to determine if you are eligible for benefits, long term care insurance has a definition to determine if you are functionally dependant. The definition is:
1) The inability to perform 2 of the 6 activities of daily living without substantial assistance from another person. Activities include: eating, bathing, dressing, transferring, toileting, and maintaining continence; or
2) A cognitive impairment where the insured requires supervision.
Once you meet the definition, care can be received in the home or in a facility. You choose the amount of insurance you want to purchase for both scenarios. For example you can choose to purchase $4500/month of facility care and $2500/month of home care under the assumption home care will be less expensive. Some carriers let you purchase only facility care.
Method of benefit payment can differ by insurer. Some insurance companies will pay the benefit like a disability policy. Once the definition of functionally dependant is met, they pay the monthly benefit regardless of expenses incurred according to whether care is received in your home or in a facility. Other carriers pay on a reimbursement basis. They require you to submit receipts of eligible expenses and they reimburse up to the maximum daily/monthly limit purchased.
You can also choose the elimination period, benefit period and premium payment period. This helps you customize the policy to fit into your budget. The longer the elimination period and the shorter the benefit period the lower the premium will be.
How much long term care insurance do I need?
Costs of long term care in Ontario
Long Term Care statistics to consider
