Janice had moved to the independent living facility two years earlier, but her health had changed since then. Several chronic illnesses were taking a toll, including diabetes and COPD, and she was having trouble taking care of herself. Bathing and dressing had become time-consuming and difficult, and she rarely went on the fun trips she used to take outside the facility with other residents. The lack of socialization was becoming just as much of a problem as her medical issues.
Janice’s children were becoming more and more concerned, especially when they visited and noticed that her apartment was no longer neat and tidy. Janice simply didn’t have the energy to clean either.
“Mom, you need some help here,” her son said. “Don’t you have a long term care policy? Isn’t it time to use it?”
“Oh, I don’t need any help yet. We’ll discuss it if I do.”
Many seniors are reluctant to activate the long term care policies they’ve paid good money for, and the reasons vary. Policies can be complex and difficult to understand. Seniors may not realize that they can access services if they’re living at home or in an independent living environment. Sometimes it’s a fear that acknowledging you need help means you’re really sick and will lose what independence you still have.
As a care manager, I help families and their aging loved ones figure out when and how to activate their long term care policies and take advantage of the services to which they’re entitled. I also explain the services that Medicare will pay for, such as in-home skilled nursing services or skilled therapy care under certain circumstances, and the services they don’t cover. For example, Medicare’s home health benefit doesn’t cover “custodial care” or homemaker services, such as light housekeeping, laundry, and meal preparation.
However, many long-term care policies do provide for in-home services to help with activities of daily living such as dressing, bathing, meal preparation, toileting, etc. There is often a waiting period, called the “elimination period,” before services can start, which is a good reason to activate the policy before a health crisis happens and options become more limited. In a situation such as Janice’s, having assistance now will improve her quality of life and make it less likely she’ll need to move to a nursing home. Elimination periods are typically 90 to 120 days, in which the client is required to pay out of pocket for services. The agency that provides services is required to submit weekly invoices paid by the client, nursing notes, and a plan of care. Some polices require 90 days of actual services. Some elimination periods begin on the first day of care, and the clock does not stop regardless of how many days of service have been received and paid for by the client.
Sometimes the reluctance to use a policy stems from confusion about how to find an approved provider. Again, this is where I can step in with recommendations about reputable home care agencies and the ins and outs of the process to start services, how to submit invoices to the insurance company if required, and other details specific to the policy.
If your house was damaged in a fire, you’d use your homeowners insurance. If your car was totaled in an accident, you’d use your automobile insurance. In a similar vein, if you’re a senior and now you need the home care services that you’ve paid premiums for, perhaps for decades, isn’t it time to use your long term care insurance?