What is a Long Term Care Emergency?

A long-term care emergency is an event, generally unexpected or unanticipated, where a person who was previously able to live alone and take care of themself is no longer able to do so and is not expected to make a full recovery or such a recovery is expected to only be temporary in nature. Signs of a long-term emergency include:

  • Repeated stays in the hospital for the same condition with lessening improvement each time
  • Debilitating falls including hip injuries, pelvic fractures, and femur issues
  • Functional Eligibility Determination being requested or performed by "Aging Well"

The cause for concern and emergency is either that the person needing care will not be able to return home or that they will be able to return home but only if they have assistance while they are home. The level of assistance required and the assets with which to pay for that care and how long those assets will last determine what level of emergency is being addressed.

For instance, a person returning home from the hospital with a hip injury who has private medical insurance which can pay for their care and Medicare which will pay for part or all of their care may not have an emergency requiring immediate assistance but may want to investigate what can be done in the event that they have subsequent non-covered issues.

Compare from a person who is diagnosed with dementia. This diagnosis is terminal and there is no realistic hope of recovery currently. The day of their diagnosis they are a long-term care patient and if they are otherwise healthy physically, they may be in the nursing home for a long time. Even with family members available to assist, there may come a time where they will need to enter a nursing facility capable of taking care of them 24/7 as they degenerate. This is a true emergency on the date of the diagnosis as 24/7 care is $10,000 per month and up and without addressing the current assets and what can be done, the entire estate may be lost to the medical bills before the government will pay anything.

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