Long-Term Care Insurance in Ontario

Portrait of happy senior woman and her husband at home

Long-term care is a variety of services which help meet both the medical and non-medical needs 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. Increasingly, long-term care involves providing a level of medical care that requires the expertise of skilled practitioners to address the often multiple chronic conditions associated with older populations.

Long-term care may be needed by people of any age, although it is a more common need for senior citizens. Life expectancy is going up, meaning more and more people are living longer and entering an age when they may need care. Meanwhile birth rates are generally falling. Health care systems need to find a way to cope with the demographic shift.

When the percentage of elderly individuals in the population rises to nearly 14% in 2040 as predicted, a huge strain will be put on caregivers’ finances as well as continuing care retirement facilities and nursing homes because demand will increase dramatically.

Long-term care can be provided:

  • at home
  • in the community
  • in assisted living facilities
  • in nursing homes.

Types of Long-Term Care

Long-term care can be provided formally or informally:

  • Facilities that offer formal long-term care services typically provide living accommodation for people who require on-site delivery of around-the-clock supervised care, including professional health services, personal care and services such as meals, laundry and housekeeping. These facilities may go under various names, such as nursing home, personal care facility, residential continuing care facility, etc.
  • Long-term care provided formally in the home, also known as home health care, can incorporate a wide range of clinical services (e.g. nursing, drug therapy, physical therapy) and other activities such as physical construction (e.g. installing hydraulic lifts, renovating bathrooms and kitchens). These services are usually ordered by a physician or other professional.
  • Informal long-term home care is care and support provided by family members, friends and other unpaid volunteers.

How does Long-Term Care Insurance Work?

Whether a man buys long-term care insurance or not, someone always has to pay for it; the question is, who … the man or his family?

It’s a good idea to buy a long-term care insurance plan if you want flexibility and control on your life and don’t want to rely on the government or others for your care. You can choose the type of coverage that’s best for your needs. If you have a more flexible income-style insurance plan, you’ll be paid a pre-determined amount of money when you need care, without having to prove you had expenses. And, you can use this benefit to cover any type of service, including care that family members provide. If you expect to be a caregiver for your spouse or parent and would like to have the financial freedom to care for them, you can insure them and protect yourself.

I can help you to choose the right long-term insurance plan that is right for your needs and budget.

  • Long-term care insurance coverage ranges from as low as $10 per day to as high as $10,000 per month.
  • Your benefits can be paid to you for 1, 2, 5 years or even an unlimited number of years.
  • Some plans cover you only when you’re receiving care in a long-term care facility, while other plans will cover you when you receive care in any setting within Canada or the United States.
  • All long term care insurance plans in Canada have a period of time, usually 30 days, 90 days or 180 days, that you must wait before your benefits are payable – often called a waiting period or elimination period. However, some plans allow you to receive your benefit 30 days after you’re unable to perform 2 or more activities of daily living or require continual supervision due to deterioration in mental abilities
  • Some plans reimburse you for eligible expenses you incur on a given day, up to a pre-set maximum – you need to pay for your care costs upfront and submit receipts before you receive any benefits.

For many people, a time comes when they need help to keep living in their own homes. It may be due to illness. It may be due to age. The reason does not matter. What matters is that they get the help they need. Home care services help people maintain their health and independence at home. This list sums up four main types of home care services:

  • Visiting Health Professional Services – These services can help you after a stay in hospital, or if you need help due to illness or injury. Help includes visits to assess your needs, planning for and/or providing care for you. You may also receive supplies and equipment that you need.
  • Personal Care and Support – These services can help you with many daily living activities. Examples include bathing, dressing, toileting, eating, and more.
  • Homemaking – Homemaking services help you with routine household activities. These include menu planning, shopping, preparing meals, light housekeeping and more.
  • Community Support Services – These services help you live safely and independently at home. They include services such as meal delivery, transportation, help for your caregivers, adult day programs and more.

Keep in mind that you may last longer than your money.

Home care services are funded in different ways:

  • by the government (Ontario and/or local governments)
  • by non-profit organizations who receive donations to deliver these types of services
  • by your private insurance or benefit plans (for example, private health insurance)
  • by you (for example, when you pay for services yourself).

You have to be qualified for government-funded home care. You will need to contact your local Community Care Access Centre. Your Centre will determine if you qualify for government-funded home care.

Please remember: people who want to stay in their own homes will have to arrange a mix of services funded in a number of different ways.

Long-Term Care Insurance helps provide for the cost of long-term care beyond a predetermined period. Long-term care insurance covers care generally not covered by OHIP or health insurance.

It’s easy to take our ability to perform day-to-day activities for granted, but this can change… especially as we age. Individuals who require long-term care are generally not sick in the traditional sense, but instead, are unable to perform the basic activities of daily living such as dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and walking.

Age is not a determining factor in needing long-term care. About 40% of those receiving long-term care today are between 18 and 64. About 60% of individuals over age 65 will require at least some type of long-term care services during their lifetime. Once a change of health occurs long-term care insurance may not be available.

Long-term care insurance generally covers home care, assisted living, adult daycare, respite care, hospice care, nursing home and Alzheimer’s facilities:

  • If home care coverage is purchased, long-term care insurance can pay for home care, often from the first day it is needed.
  • Rehabilitation and therapy.
  • It will pay for a visiting or live-in caregiver, companion, housekeeper, therapist or private duty nurse up to seven days a week, 24 hours a day (up to the policy benefit maximum).
  • personal care (help with activities of daily living such as dressing, eating and bathing)
  • homemaking services (cleaning, laundry, preparing meals)
  • Many individuals may feel uncomfortable relying on their children or family members for support, and find that long-term care insurance could help cover out-of-pocket expenses. Without long-term care insurance, the cost of providing these services may quickly deplete the savings of the individual and/or their family.
  • Premiums paid on a long-term care insurance product may be eligible for an income tax deduction. The amount of the deduction depends on the age of the covered person. Benefits paid from a long-term care contract are generally excluded from income.
  • Business deductions of premiums are determined by the type of business. Generally corporations paying premiums for an employee are 100% deductible if not included in employee’s taxable income.
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