Long-term care refers to assistance with everyday activities like bathing, dressing, eating, and transferring—not medical treatment. This fundamental distinction is why Medicare, which covers medical care, does not pay for long-term care.
In the first installment of a new series on long-term care, the basics are laid out: the six Activities of Daily Living (ADLs), eight Instrumental Activities of Daily Living (IADLs), the 100-day window for skilled nursing care under Medicare, the difference between skilled and custodial care, the five main care settings, and the widely cited statistic that 70% of people turning 65 will need some form of long-term care.
Medicare's coverage is limited to medically necessary services, such as hospital stays and doctor visits. It only pays for short-term skilled nursing or therapy following a hospitalization, and only if the care is deemed rehabilitative. Custodial care—help with daily living tasks—is explicitly excluded. For ongoing long-term care, individuals must rely on alternatives such as Medicaid (for those with limited assets), long-term care insurance, or personal savings.
The episode also introduces the concept of "anchor" events—health incidents like a stroke or fall that trigger the need for long-term care—and emphasizes the importance of planning ahead, as the costs can quickly deplete retirement savings.