Waco Benefits
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Group Long Term Care


Long-term care is the kind of care you need when you're no longer able to manage everyday tasks, like bathing or dressing, without assistance. Contrary to what you might think, long-term care is not just a concern for the elderly. It can be the result of an accident or unexpected illness. Long-term care services may be necessary at any age. An older adult might gradually find that day-today living is becoming increasingly difficult without help, or they may develop Alzheimer’s disease. Someone younger may have a heart attack, a stroke, a disabling accident or develop a serious chronic illness such as Parkinson’s disease. Long-term care services are generally custodial and personal in nature but, in some cases, may be rehabilitative. Because neither medical insurance nor Medicare is primarily designed to pay for long-term care services, long-term care insurance can help provide a way for you to pay for this care.

Advantages of Group Long Term Care Insurance Plans:

  • You may not have to meet any medical requirements to obtain a long term care policy.
  • Your relatives may also apply for the policy. Many group long term care insurance plans allow retirees, spouses, parents, and parent-in-law to apply for the long term care coverage.
  • Some long term care insurance companies will let you keep the coverage if your employment ends or your employer drops the group plan.
  • Group long term care insurance plans with a high proportion of young employees and with 20% or better participation, can often get premiums that are much cheaper than individually underwritten policies.
  • Adding long-term care to reliable health insurance and retirement plans could give employers a leg up on competitors, even those able to pay higher salaries.

Contrary to what many people believe, Medicare and private health insurance programs do not pay for the majority of long-term care services that most people need - help with personal care such as dressing or using the bathroom independently. Planning is essential for you to be able to get the care you might need.

What is Long-Term Care?

Long-term care is a variety of services and supports to meet health or personal care needs over an extended period of time. Most long-term care is non-skilled personal care assistance, such as help performing everyday Activities of Daily Living (ADLs), which are:

  • Bathing
  • Dressing
  • Using the toilet
  • Transferring (to or from bed or chair)
  • Caring for incontinence
  • Eating

The goal of long-term care services is to help you maximize your independence and functioning at a time when you are unable to be fully independent.

Who Needs Long Term Care?

Long-term care is needed when you have a chronic illness or disability that causes you to need assistance with Activities of Daily Living. Your illness or disability could include a problem with memory loss, confusion, or disorientation. (This is called Cognitive Impairment and can result from conditions such as Alzheimer’s disease.)
This year, about 9 million Americans over the age of 65 will need long-term care services. By 2020, that number will increase to 12 million. While most people who need long-term care are age 65 or older, a person can need long-term care services at any age. Forty (40) percent of people currently receiving long-term care are adults 18 to 64 years old.

What are My Risks of Needing Long-Term Care?

About 70 percent of individuals over age 65 will require at least some type of long-term care services during their lifetime. Over 40 percent will need care in a nursing home for some period of time. Factors that increase your risk of needing long-term care are:

  • Age - The risk generally increases as you get older.
  • Marital Status - Single people are more likely to need care from a paid provider.
  • Gender - Women are at a higher risk than men, primarily because they tend to live longer.
  • Lifestyle - Poor diet and exercise habits can increase your risk.
  • Health and Family History - also impact your risk.

How Much Care Might I Need?

It is difficult to predict how much or what type of care any one person might need. On average, someone age 65 today will need some long-term care services for three years. Service and support needs vary from one person to the next and often change over time. Women need care for longer (on average 3.7 years) than do men (on average 2.2 years). While about one-third of today's 65-year-olds may never need long-term care services, 20 percent of them will need care for more than five years.

If you need long-term care, you may need one or more of the following:

  • Care or assistance with activities of daily living in your home from an unpaid caregiver who can be a family member or friend; 
  • Services at your home from a nurse, home health/home care aide, therapist, or homemaker;
  • Care in the community; and/or
  • Care in any of a variety of long-term facilities. 

Generally, services provided by caregivers who are family or friends are unpaid. This is sometimes called informal care. Paid services are sometimes referred to as formal services. Paid services often supplement the services provided by family and friends.

How Do Care Needs Change Over Time?

Many people who need long-term care develop the need for care gradually. They may begin needing care only a few times a week or one or two times a day, for example, help with bathing or dressing. Care needs often progress as you age or as your chronic illness or disability become more debilitating, causing you to need care on a more continual basis, for example help using the toilet or ongoing supervision because of a progressive condition such as Alzheimer’s disease. 

Some people need long-term care in a facility for a relatively short period of time while they are recovering from a sudden illness or injury, and then may be able to be cared for at home. Others may need long-term care services on an on-going basis, for example someone who is disabled from a severe stroke. Some people may need to move to a nursing home or other type of facility-based setting for more extensive care or supervision if their needs can no longer be met at home.