About Long Term Care

Long-term care (LTC) is a variety of services which help meet both the medical and non-medical need of people with a chronic illness or disability who cannot care for themselves for long periods of time.

It is common for long-term care to provide custodial and non-skilled care, such as assisting with normal daily tasks like dressing, bathing, and using the bathroom. Long-term care may also include medical care that most people do for themselves, such as diabetes monitoring. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. Long-term care may be need by people of any age, even though it is a common need for senior citizens. The Centers for Medicare and Medicaid Services (CMS) estimate that about nine million men and women over the age of 65 in the US will need long-term care in 2006. By 2020, 12 million older Americans will need long-term care. It is anticipated that most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that people who reach age 65 will likely have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home will stay there five years or more.

Medicare (US)

Generally, Medicare doesn't pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, certain conditions must be met for Medicare to pay for even those types of care. Medicare specifically will not pay for custodial and non-skilled care.

Medicaid (US)

Medicaid is a government program that will pay for certain health services and nursing home care for older people. In most states, Medicaid also pays for some long-term care services at home and in the community. Eligibility and covered services vary from state to state. Most often, eligibility is based on income and personal resources.

Activities of Daily Living

Activities of daily living (ADLs), is a way to describe the functional status of a person. It is a tool in the biopsychosocial model of medicine, and is useful for assessing the elderly, the mentally ill, those with chronic diseases, and others. This is seen to include a number of components, though these are not strict rules.

  • 1 Basic ADL
  • 2 Mobility
  • 3 Instrumental ADL

Basic ADL

Occupational therapists typically look at 11 categories of ADLs. These are the activities that are fundamental for self care.

  • Bathing/Showering
  • Bowel and bladder management
  • Dressing
  • Eating
  • Feeding
  • Functional mobility
  • Personal device care - Includes items like hearing aids, glasses, prosthetics, adaptive equipment, etc.
  • Personal hygiene and grooming
  • Sexual activity
  • Sleep/Rest
  • Toilet Hygiene

Many of the above are consider to be a given. Physicians and occupational therapists are typically interested in the ability to: dress, eat, ambulate (walk), do toileting and take care of their own hygiene. These five tasks are remembered with the mnemonic DEATH: dressing, eating, ambulating, toileting, hygiene.


Refers to a person's ability to move around, including: walking (independently or with the assistance of another person or a piece of equipment, such as a cane, walker), wheeling a wheelchair, being able to get in and out of their bed, bathtub, vehicle, etc

Instrumental ADL

This includes activities not necessary for fundamental functioning, but still very useful in a community. Cooking, shopping, housework and transport are in this category. Occupational therapists also look at IADLs when completing assessments. They include 11 areas of IADLs that are generally optional in nature, and can be delegated to others. These areas are:

  • Care of others (including selecting and supervising caregivers)
  • Care of pets
  • Child rearing
  • Communication device use
  • Community mobility
  • Financial management
  • Health management and maintenance
  • Meal preparation and cleanup
  • Safety procedures and emergency responses
  • Shopping

There are systems (such as the Katz ADL scale) that seek to quantify these functions and obtain a numerical value. These systems are useful for the prioritising of care and resources. Generally though, these should be seen as rough guidelines for the assessment of a patient's ability to care for themselves.

A simple assessment of the IADLs is frequently done by asking about the ability to do shopping, housekeeping, personal finances, food preparation, and get around (e.g. driving). These tasks can be remembered with the mnemonic SHAFT: shopping, housekeeping, accounting, food preparation, transportation.