My husband has LTC Insurance for 5 years. I wonder when one should start using it. Right now I pay for companions to be with him privately. He still showers, dresses himself (although sometimes in layers). He is physically active and we walk almost every day. However, he is getting more confused and cannot hold a coherent conversation. I don't want to start too early. How are others dealing with this?
I unfortunately don't have long term care insurance for my husband, but if you have investments that you need to sell to pay for care then you might consider using the insurance sooner and hope the stock market recovers more. Check the terms of the policy--depending on how much they pay for what, if it limited to a number of years you may want to wait until you qualify for the maximum amount. The other question would be, how good is your husband's health otherwise and how old is he?
It seems that all LTC policies are different, depending on the insurance company and when the policy was first purchased. Our policies require a 90 day “elimination period” (90 days of care) before it starts paying for care and then will pay for life. I have started three days of in home care and two days of day care per week for my DW (early stage six). So by this Fall, I will be able to increase the amount of care per day and or place her when that time comes. I don’t know you will be able to judge when to start care with the time limit of five years of care your LTC insurance will provide.
All LTC policies are different. DH's has an elimination period of 90 days (after diagnosis). Once the 90 elim period is met (w/ or w/o care) then the policy pays. It has a lifetime limit which equates to 5 years at the daily maximum benefit (100% for ALF/NH care; 50% for in-home care). Right now we have in-home care which means we pay out of pocket 50%. If he stays home and never goes into a NH, then at 50% payment he will have coverage for 10 years. I was advised to start using the LTC benefit when he was released from hosp. to home and we needed in-home care. DH is still very functional (mid-stage 5 for 1.5 years) but a condition of release to home (due to physical violence towards me) was meds and a 24/7 caregiver. Maybe consult a geriatric care manager in your area (will most likley charge for consultation) for guidance. Good Luck!
Several years ago, AFTER John was discovered to have dementia, he was turned down for a long-term care policy. We only checked with Aflec. I was turned down too, because of my "extreme sport" and numerous injuries, head traumas in my youth. Should I continue to search for some company that will look more closely at the risk and be willing to write a policy? Guess I've learned to be a good girl and lie down and play dead.
Our policy has 60 days out of pocket within a six month period, but you must need help with 2 out of 6 activities of daily living. When the say need help feeding oneself they do not mean driving to get the food, cooking the food. They mean putting the spoon in your mouth. That is a long way down the road.
My LTC Insurance insists that I would be unable to do 3-4 activities of daily living...such as unable to feed myself, dress myself, bathe myself, walk without assistance, etc. They are very strict...but thank God it's in place .because if and when I get to that stage, God knows I'll need it.
Monika: Check your policy to see if it has an alternative to the 6 activities of daily living----when i first applied against my DH's last spring, he could still do all his ADLs, but he clearly needed full-time supervision due to his poor judgment, ie, I could not leave him alone. That was the alternative that we met, but obviously his neurologist had to fill out the form that 24-hour supervision was needed. And, I think the first converasation that I had with the insurance person who was reviewing our application, I had to point out that was an alternative standard. She seemed surprised someone could need full-time supervision but still be able to do all his ADLs. I had to explain to her that was actually fairly common in early-onset cases, and in my husband's case, because they suspect some FTD and not just AD. I recall his policy had a 90 day elimination period, and when I first started the application process, I had one paid caregiver in the afternoon, and my office was letting me do some work from home in the mornings. Then, once his coverage started, I hired someone in the morning, and went back to working more hours. GOOD LUCK! We've been getting the LTC benefits for a year, and of course, his doctor had to fill out all new paperwork for the insurance company this spring, as if my DH might get better? When his doctor's assistant called me to confirm that she had sent in the paperwork, we chuckled about that! Also check to see at what point you can get the premiums waived. As long as my DH is at home, I have to keep paying premiums, but apparently if he is moved into a facility, the premiums are waived after a period of time. Hope this helps.
My husband's policy is written exacty as Texasmom described. Started using it for daycare when he was still in the early stage, doing all ADL's independently. But he qualified on the basis of needing supervision. I think the assistance with ADL's may be the standard used for qualifying when there are strictly physical disabilities, not dementia. Re premium waiver: it must vary from policy to policy. As soon as the 90-day elimination period was over, the premiums on his policy were waived (he is still living at home).
Jen, give John Hancock a try. Don't go into any detail with the agent about what happened when you were in high school or college...in sports. You are NOT a horsewoman now...so don't claim to be. (If after you get the policy, you choose to take up hunting & jumping again, so be it!! grin)...Just say your husband's situation makes you appreciate how important their policies are...and see what they say. John Hancock has a very good "pay" reputation with the local facilities,I am told. You might ask nursing home administrators which companies they most enjoy working with...the one that pays, that doesn't nit pick every claim and pays 1/2. They will check your current medical records, but since falling off a horse is an accident and not a disease, they may not be able to hold that over you. Just like with Hospice,..keep our mouths shut and don't volunteer any info they don't ask for.
Look at the contract very closely and make sure you understand some of the what if,s. For example, my DW has LTC that covers a pure and real Nursing Home. But some of the special Alz facilities do not qualify because their nurses do not provide "nursing care" for around the clock coverage or on-call options. They are carefully worded by legal eagles and have lots of backdoors. I am disappointed in some of our policy definitions which I did not read carefully before buying the policy. bill
Yes, read the policy again and again. My policy stated 2 out of 6 or AD. I called again and asked for clarification. If they have AD then the policy will kick in based on cognetive impairment. This is a different answer than I got 2 yrs ago. I am now paying out of pocket for a Home Health Care. I have to do this for 60 days and then the policy will kick in. What I find amazing about the policy is that it pays a flat amount per month which is enough for 8 hours care a day 5 days a week or 160 hours per month. I asked if I did not need that level of care at the begining could I let those hours accure for later use when more care will be needed. The answer - NO they will pay upto the 160 hours per month but will not go over that amount later in the policy which will pay out for 5 yrs at that level. I also have a rider which extends the policy for a lifetime at that level. Once the 5 yrs is over the rider kicks in and it has the same limits. I think this is stupid. It encourages me to use the full benefit, use it or lose it mentality. I will use it being that I paid for it, but I would rather use less now and more later.
Just use it...is my advice. I found that even if I didn't have anything to do, it was rather nice having someone in the house to talk with. Gradually, we found more and more she could do, at her suggestion...and it was really nice to have perfectly organized drawers, ..nicely pressed pillow cases,.. pressing his shirts, replacing buttons.....mostly little thingsthat she suggested she would do...if it was okay You betcha it was ok!!! I was lucky to have Veronica because she enjoyed keeping busy and she LOVED Foster. When she'd leave, she'd kneel down in front of him so she could look him in the eye, hold his hand in hers..and tell him goodbye for today...and she'd kiss the top of his hand. I knew I was blessed to have her....even if I had to pay the full ticket price... Foster declined LTC insurance when he could have gotten it. Always said he had plenty of money to pay his own medical expenses whatever they were. (can you imagine?)
I was thinking it would be good for a Doctor to know this info before he gives the Diagnosis that he might better prepare the family for what is about to happen to their lives. Perhaps telling them it might be good to get long term care insurance before I run some final test and puts this in your file. Of course now that the insurace companies have got better test available to them they probably would find out anyway.
Comment Author Mary in Montana Comment Time 3 hours ago Moorsb, I'm glad that you mentioned Long Term Care Insurance. I have been meaning to look into this for my husband. I want to get something that would pay whether I need it for outside care or for help with home care. I am going to do a search here first and read up on what others have said about it.
Interesting discussion on LTC insurance. I have heard that the companies are tightening up on their approval process, and I've read that several stopped selling it because it wasn't profitable.
Mary in M--If your husband already has a diagnosis of some type of dementia on file, I doubt he would qualify. However, it is an avenue that you should look into, regardless, just to make sure.
Mimi--that's probably because someone with dementia who uses the insurance and lives a long time can cost them more than other diseases. How many patients with other conditions can live up to 20 plus years and need total care and supervision for most of it?
When we retired, we chose to go with a policy that covered us for life in either an ALF or nursing home, after a 90 day wait period, but provides no assistance at all for home health care. Our choice was based solely on cost. For the same amount we could get a policy to cover both ALF/nursing home for 3 years and also cover health care aides at home, or go for the lifetime coverage in a facility but no aid at home. Since we knew of a relative who had been in a nursing home for 12 years, we opted for the lifetime coverage policy! We also chose the inflation rider, so when we took out the policy ten years ago the coverage was at $250/day. Now that coverage is up to $480/day due to the inflation rider. So you must check out EACH policy very carefully. (We were also denied coverage by about 8 companies due to my wife's pre-existing heart condition!!)
Like acvann, we purchased LTC 8 years ago. It was not a well researched purchase at the time. My husbands employer, the state, offered the option and we took it. It is a 6 year home care or 3 year institutional care plan with an inflation rider. (not as comprehensive as acvanns though.) Although it is time limited, I am still very grateful to have the safety net it provides. We also were offered and took a 10 year paid in full option. I would be surprised if companies covered those already diagnosed with dementia but I hope that I am wrong.
The companies which sell LTC are getting much stricter. I've had severe RA for over 30 years and they would not sell me a LTC policy because I've had joint replacements. All of the LTC companies will NOT write a policy for someone who has dementia.
They want to sell you a product, that hopefully you will never use and one they hope they never have to deliver. Their really needs to be some consumer protection in these policy. They are written in legalise and the company which you purchase the product from may not be willing to disclose to you all of your options. I would suggest really doing your home work before purchasing a policy. It seems to me that there needs to be an independant 3rd party invovled who will decide what the legalise means.
moorsb is right - they want to sell you a product that hopefully you'll never use. I have a lot of professional experience dealing with benefits policies, but when we bought DH's LTC policy I couldn't understand it, so we picked the plan that we thought was best for him. When it came time to use the policy, our ELA reviewed the policy for us so we knew exactly what benefits he would have. In retrospect, I would have an attorney review and explain the options BEFORE the purchase.
I have John Hancock LTC insurance myself. I was told at one facility that they pay promptly and are among the easiest for the institutions to deal with. (for what that is worth!) Mine has a 90 day waiting period (meaning that I pay for the first 90 days) before they begin to pay. That being said, Medicare will often pay for the first 90 days after hospitalization ..for rehab. That works for most people. Just buy from a reputable firm that has been in business for a long time, - and check with your local nursing homes and see what they prefer their patients to have...I have not heard one facility say anything bad about my company. That's a relief!!!! My husband CHOSE not to have LTC insurance, because, in his words, "I"ll never need it". Typical man! Famous last words, huh?
Checking back on LTC ins comments, I had to laugh at Nancy B's comments. We have JH ins also and it is a farce! I am still waiting for them to pay ONE PENNY to the caregiver service...I have been on hold forever, spoken with people who supposedly had clout and were going to "fix" this problem...and am still waiting! This has been going on since February!
kathi, DH also has JH and they have been inconsistent. The case manager was wonderful once his claim was approved, but that was 5 months after we were investigated for "fraud" by their hard driving investigators. Now that he has regular claims, they pay inconsistently. The policy says they pay claims within 10 business days of receiving the claim. Since DH has a ft aide and the agency sends in timesheets/bills every week, you would think JH would pay every 2 weeks. But they do not and I have to call to find out when they received the bills and when they will pay. They NEVER pay a claim in less than the 10 business days. I did not have the claims payment assigned to the agency because I wanted more control over it.
My DH's policy provided 365 days of coverage- not consecutively- at $100.00 per day with an elimination period. They were very specific about the type of agency that they would approve- had to meet rigorous guidelines. He was approved and as of this month, we have used up the in home care benefit. Although i am now faced with this enormous out of pocket expense that we can ill afford, I don't regret starting it "early." Having a part time caregiver saved my sanity and gave DH a feeling of autonomy as he transitioned into a dependent way of living. He referred to the caregiver as his "driver." When we began consuming the benefit, I thought that I would tear my hair out dealing with the insurance company so I completely understand everyone's frustration. I think that they hope to wear you down - hope that you will go away, but stick to it! And good luck.