What Kind of Long Term Care Do You Need?

The following is an excerpt from TheStreet.com Ratings’ Consumer Guide to Long-Term Care Insurance. TheStreet.com rates the financial strength of 75 long-term care insurers. Whether you’re considering long-term care insurance for yourself or your parents, purchasing from a financially sound insurer is very important given the long-term nature of this type of insurance.

The largest long-term care insurer, Genworth Life Insurance Company of New York, a unit of Genworth Financial Inc., (Stock Quote: GNW) has a financial strength rating of C+ (Fair). But there are several other higher rated insurers such as Physicians Mutual Insurance Company—rated A+ (Excellent); Country Life Insurance Company—rated A+ (Excellent); and New York Life Insurance Company—rated A (Excellent).

If you're considering getting long-term care for yourself or a loved one, you should know there are several types of care available.

Custodial care, or supportive care, is by far the most common type of care in the U.S. Someone without medical training helps you with activities such as getting out of bed, walking, eating and bathing. Homemaker services can provide companionship and assist with activities such as shopping, transportation, light housekeeping, or similar tasks.

Intermediate care is more serious and includes occasional nursing and rehabilitative care supervised by skilled medical personnel. It also includes basic medical procedures that are required sporadically and not on a 24-hour basis.

Skilled care is the highest level of care and the most expensive. A doctor prescribes care by a skilled nurse or therapist 24 hours a day.

You can receive these three levels of care in many forms, including:

  • At home. Most people prefer to stay at home as long as possible. If you have the financial resources, you can receive custodial, intermediate and skilled care at home.
  • Adult day care center. The concept of adult day services is similar to that of child day care. Seniors are dropped off at the facility in the morning where they participate in activities and needed therapeutic services so their adult children can keep their full-time jobs.
  • Assisted living facilities. The philosophy of assisted living is to allow you the right to make choices about your health and safety. These facilities emphasize supervision and assistance as needed rather than on a scheduled basis. They typically provide help with activities of daily living, and if private nursing duty is needed, you can arrange and pay for it yourself.
  • In nursing homes. Nursing homes can be either skilled nursing facilities or intermediate care facilities. Skilled nursing facilities, in which registered nurses provide 24-hour nursing services, emphasize medical care with restorative, physical and occupational therapy. Intermediate care facilities provide less intensive nursing care by registered and practical nurses along with social and rehabilitative services. In a long-term care facility, patients receive assistance with activities of daily living such as bathing, dressing, eating, toileting and transferring in and out of chairs and beds.
  • Through hospice care. This type of care is provided in your home or in a hospice facility and is exclusively to manage pain and symptoms of terminally ill patients. Medicare covers hospice care provided in your home only.
  • Continuing care retirement communities. These types of communities combine housing, health care and social services across a continuum of independent living to nursing home care. Three types—all inclusive, modified, and fee-for-service—provide various levels of care at varying costs.


Warning: Among the 50 states, no consistent definition exists for adult day care centers, assisted living facilities, or other community-based facilities. When you’re shopping for a long-term care policy, get the definitions of the various facilities from the insurer whose policy you are considering. Then visit the facilities in your area to make sure they meet the definitions.

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