What is Long Term Care?

Long-term care is unique because there is a generally accepted definition of a long-term care situation from a federal law that was passed in 1996: the Health Insurance Portability and Accountability Act of 1996. This makes long term care less complicated compared to healthcare and health insurance or car accidents and car insurance.

There are two separate causes or “triggers” for a long-term care situation:

  • Physical limitations that will prevent us from being able to fully care for ourselves for a period that is expected to last at least 90 days.
  • We have a severe cognitive impairment that will make us a threat to ourselves or others that is expected to last at least 90 days.

When we think of long term care, we usually think of someone who is 100 years old, in a coma, and living in a nursing home. We would be right! That person does need long-term care, but they are not the typical person getting long-term care. Today only 18% of people get long-term care in a nursing home.

Long-term care may be needed for a number of physical or cognitive limitations.

Physical limitation may be defined for any persons that may be unable to complete typical every day functions. The federal definition of long-term care lists six “Activities of Daily Living” which are often referred to by medical professionals as ADLs. The six ADLs are:

  • Bathing: getting in or out of a tub or shower by yourself and washing your body in a tub, shower or by sponge bath; the ability to wash your hair in a shower, tub or in a sink.
  • Continence: controlling your bladder and bowel.
  • Dressing: putting on and taking off any necessary item of clothing.
  • Eating: getting food into your mouth and includes use of utensils.
  • Toileting: getting on and off the toilet and the associated hygiene.
  • Transferring: getting in and out of a bed and chair by yourself.

We will officially need long term care when a licensed healthcare provider certifies that we need help doing at least two of the ADLs for a period expected to last at least 90 days.


1) Kevin and Ray each picks up a heavy box and hurt their back.

Kevin is in intense pain and ends up flat on his back on the sofa for 30 days. He misses work for 30 days and needs help with all six ADLs for the entire month. After 30 days of being hurt and miserable, he recovers and resumes his normal life.

Is this a long term care situation? The answer is no. It does not qualify because he was unable to do at least two of the six ADLs for only 30 days.

Ray hurts his back but not as bad as Kevin. However, his doctor says he cannot dress or wash himself for at least 90 days. Even though his injury is not nearly as bad as Kevin’s injury (remember, Kevin could not do any of the ADLs for 30 days) the fact that Ray will not be able to perform at least two of the ADLs for at least 90 days makes his situation a long-term care situation.

2) Sue is a 75-year-old college professor teaching Mandarin Chinese to her students. Sue’s brain and heart are healthy but she has severe arthritis in her hands and shoulders. For the last three years a retired friend has helped her each day with getting dressed and bathing.

Is this a long term care situation? Yes, because she needs assistance completing two ADLs for more than 90 days. Does it matter that Sue can still go to work every day? No, because she still needs regular assistance with two ADLs for an extended period of time.

The other “trigger” for long term care is when someone has a severe cognitive impairment that makes them a threat to themselves and others and is expected to last at least 90 days.

Cognitive impairment is defined as being disoriented regarding people, places, locations and time. Alzheimer’s disease, Parkinson’s disease and stroke are common causes of cognitive impairment (there are two kinds of strokes, a “regular” stroke and Transient Ischemic Attack or TIA commonly referred to as a “mini-stroke”).

Standardized tests determine the existence of severe cognitive impairment. This diagnosis is commonly made by a neurologist, psychiatrist, psychologist, or in some states, a licensed clinical social worker. If a person suffers from cognitive impairments, there is usually little question about the inability to perform ADLs.


1) A 73 year old woman recovers at home for a week after minor surgery. Her pain medicine makes her forgetful to the point that she no longer recognizes family. Two weeks after the surgery her doctor changes the medication and the situation clears up. This is not a long term care situation because the cognitive impairment did not last 90 days.

2) Your elderly mother stills lives in her own home. Nine months ago, she was diagnosed with Alzheimer’s disease and began forgetting to turn off the stove and walking aimlessly for hours forgetting how to get home. This would be a long term care situation due to her cognitive impairment brought on by Alzheimer’s disease.

Key concept: Care vs. Cure

The key to understanding who pays for Long Term Care is realizing the difference between Skilled Care and Unskilled Care (also called custodial care).

Skilled Care is trying to cure and thus make us better. It is the care we get from someone with a medical license (doctor, nurse, x-ray tech, respiratory and occupational therapists etc.)

Unskilled Care is not trying to cure us, but rather help us live each day. It is basically providing help with the Activities of Daily Living; the essentials we cannot live without.

Long-Term Care vs. Elder Care: According to the dictionary “elder care” is care for older people. Elder care is a subset of long-term care. Anyone at any age can need long-term care. So when we talk about elder care the information is fundamentally interchangeable with long-term care.