In the 1970s, senior care was practically synonymous with nursing homes. And when insurance companies started rolling out long-term care insurance, that’s all they covered.

Today, elderly people have other options for care, which policies bought in the last couple of decades often pay for. But one type of facility that sometimes falls between the cracks is the residential care home.

What’s Covered and What’s Not

Long-term care insurance comes in a variety of policies. Some don’t pay for certain services, such as housekeeping and meals. Some only cover care in a facility, not in-home care.

But with most policies today, long-term care insurance does cover a stay in a residential care home, says Jesse Slome, executive director of the trade organization American Association for Long-Term Care Insurance. However, the home must meet certain requirements.

If the state, county or city licenses care facilities, the residential care home must be licensed, Slome says. If that’s not offered, care may still be covered, but, Slome says, the facility must:

• Provide care 24 hours a day
• Have a trained aide on duty in the facility at all times
• Provide three meals a day, including for special dietary needs
• Make sure residents can get medical care from a doctor or nurse in an emergency
• Keep written records of services each resident receives
• Have appropriate procedures in place to help residents manage their medications

Some of the criteria can pose a problem for small residential care homes, says Janet Rhode, R.N., education chair of the Washington State Residential Care Council of Adult Family Homes. Requirements such as 24-hour charting, and having an on-call nurse and a doctor on staff pose hurdles, she says. “You have to know how to play the game.”

In addition, many people using their policies today bought them in the 1970s and 1980s when long-term care insurance didn’t cover alternative care, Rhode says, “which is how most insurers still view adult family homes.”

The only way to figure out whether a policy purchased years ago will pay for residential care is to read the policy, Slome says. If yours doesn’t cover it, you can click here to learn about other payment options.