Understanding LTC

Not much has been written about the true meaning of long-term care.  Initially, when someone thinks about long term care the natural instinct is to think three things:  senior citizen, end of life, and “I don’t want to end up a nursing home!”

Well, long-term care helps more than senior citizens, care is offered in more places than nursing homes and, there are excellent nursing homes in Maryland and the United States!

Truth is long-term care is likely best defined as:  Necessary care provided by family, friend or professional when a person (of any age) simply cannot care for himself or herself, safely at home alone.

Oftentimes long-term care is situational and acute:  provided after a car accident, a joint replacement, a specific critical trauma, or when fighting pneumonia or an infection that requires intravenous drugs.

Sometimes long-term care is necessitated by the onset of some form of dementia that means the person involved can no longer safely perform the tasks of daily life:  getting in or out of bed, preparing food or eating, dressing, taking medications, going to the bathroom.  In instances such as these, it is clear to the family and the medical team responsible for an individual’s care that, the capabilities of the person involved are not going to get better.

Dementia and loss of cognitive capacity is not the only barrier that stops people from caring for themselves; other illnesses directly or indirectly make it impossible for a person to safely care for themselves at home.  There are times too when a person will need help with activities of daily living for an extended period of time with the possibility and hope that they will again be able to gain strength and functionality to learn to safely care for themselves.

Bottom line:  When people hear long-term care, they hear end of life; truth is, long-term care helps people to live.

Paying For Long Term Care:

As recently as 50 years ago paying for long term care was not a critical issue.  People didn’t live as long as they do today. Many medical advances and miracle drugs of today were not available to extend life; people cared for people and after short, painful illness and trauma, people died.

Today, we are blessed with longer life expectancies and medical advances and treatments that improve the quality of life well into our later years.

Most people are not prepared to pay for professional long-term care. Here in Maryland over 30,000 of our friends and neighbors receive care in nursing homes.  20,000 people are provided care as part of the federal/state safety net called Medicaid. Approximately 5,200 people, mostly those receiving rehabilitation, get their care paid for as part of their Medicare benefit.  Generally about 3,200 people pay out of pocket for nursing home care.  Insurance and managed care companies generally pay for the care of 1,600 Marylanders.

For assistance in reviewing options and obtaining financial support for long-term care services contact the local Department of Social Services.

Where Is Long-Term Care Provided:

There can be many settings in which long-term care is provided to people in need:

  • Assisted Living Facilities
    Housing for those who cannot live independently but do not need skilled nursing care.  Level of assistance varies among facilities.
  • Continuing Care Retirement Communities
    Comprehensive, lifetime range of care, from independent living to nursing care.  Costs and levels of care vary widely, and most communities require new residents to be healthy and independent.
  • Home
    Can include a wide variety of healthcare and supportive services; skilled nursing and other forms of healthcare for treatment of an illness or injury that is provided in your own home.
  • Medical Adult Day Care Centers
    Socialization, activities and supervision, while family member is at work. Most include assistance with activities of daily living, and medication management.  Many may also offer physical, speech and occupational therapy.
  • Nursing Home and Rehabilitation Center
    Facility staffed by health care professionals under the direction of a physician.  Designed for individuals who need 24-hour skilled nursing care on a regular basis.


Most people at some point in their life will need some mix of formal and informal, volunteer or professionally provided, long-term care.  What is most important is for people to plan as best they can for that care, to make the financial choices to support their wishes, to have documents in place to support their decision, and to talk with family and friends to make sure their wishes are known.

The most important thing is to ask questions and understand your needs or the needs of the individual needing care.  It is critical to ensure safety and appropriate medical services.

Contact us for additional information or inquiries.