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D. Places where Services are Generally Provided

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Places where services are generally provided include the following.

1. Nursing Home

Nursing home care coverage usually pays a specified amount for the time the insured spends in a nursing home, or for medical services received in a setting other than a hospital. Nursing home care is usually provided as one of the following:

  • Skilled nursing care — the highest level of nursing care that requires the greatest expertise from the caretaker;
  • Intermediate nursing care — similar to skilled nursing care, except for the patient does not require continuous attention; or
  • Custodial care — the most basic level of nursing care, which normally requires assistance with the activities of daily living.

2. Assisted Living

Assisted Living offers help with nonmedical aspects of daily activities in an atmosphere of separate, private living units. In addition to providing meals, transportation for medical appointments, activities, and pleasure trips, assisted living may provide:

  • Linens and personal laundry service;
  • Assistance with dressing and bathing;
  • Reminders regarding medication; and
  • Assistance with eating.

3. Residential Care Facilities

Residential Care is provided while the insured resides in a retirement community or a residential care facility for the elderly (RCFE). In some arrangements, the degree of independence is the same as living in one's own home; however, this care provides a physical and social environment that contributes to continued intellectual, psychological and physical growth. These facilities are commonly for the middle and upper classes because of the costs.

4. Home Setting

Home health care is care provided by a skilled nursing or other professional services in one's home. Home health care includes occasional visits to the person's home by registered nurses, licensed practical nurses, licensed vocational nurses, or community-based organizations like hospice. Home health care might include physical therapy, occupational therapy, speech therapy, and medical services by a social worker.

5. Home Care

Policies with benefits limited to home care services (including residence and community-based) must be clearly labeled "Home Care Only" on the policy first page and the outline of coverage.

6. Hospice

Hospice is a facility that provides short-term, continuous care in a home-like setting to terminally ill individuals with life expectancies of 6 months or less.

7. Respite Care

Respite Care is designed to provide relief to the family caregiver, and can include a service such as someone coming to the home while the caregiver takes a nap or goes out for a while. Adult day care centers also provide this type of relief for the caregiver.

8. Adult Day Care

Adult day care is care provided for functionally impaired adults on less than a 24-hour basis. It could be provided by a neighborhood recreation center or a community center. Care includes transportation to and from the day care center, and a variety of health, social and related activities. Meals are usually included as a part of the service.