Long-Term Care Guide

Long-term care services are designed to meet a person’s health and personal care needs, allowing them to live safely and independently in their home. There are a variety of services that would fall under the definition of long-term care. These services include institutional care in nursing homes and assisted living facilities or non-institutional care such as home health care, personal care, adult day-care, respite care and hospice care.

• Home health care
  Services provided in your home and may include skilled nursing care, speech, physical or occupational therapy, and home health aide services.
• Home care (personal care)
  Assistance with personal hygiene, dressing or feeding, nutritional or support functions and health-related tasks.
• Nursing homes
  Residential facilities licensed under the public health law.
• Adult day care
  Provides supervision and other social, recreational, and in some cases, health services during the day, in a group setting outside the home, for those who still live at home.
• Assisted living facilities
  Provides housing and ongoing care services to those unable to perform activities of daily living or who have cognitive impairment.
• Respite care
  Temporary institutional or at-home care of a dependent elderly, ill, or handicapped person, providing relief for their usual caregivers.
• Hospice care
  A care program, either in a hospice care facility or in the home, for persons who are terminally ill and have a life expectancy of six months or less.

People often seek long-term care when they have ongoing frail conditions, or the need can arise suddenly after a stroke or heart attack. The most popular type of long-term care is to assist with the Activities of Daily Living (ADLs). The most common reason for long term care is a gradual decline in health, which comes with age and prevents the individual from performing activities of daily living on their own. ADLs include:

• Bathing
  The ability to clean oneself and perform grooming activities like shaving and brushing teeth
• Continence
  The ability to control one’s bladder and bowel functions
• Getting dressed
  The ability to get dressed by oneself without struggling with buttons and zippers
• Eating
  The ability to feed oneself
• Transferring
  Being able to either walk or move oneself from a bed to a wheelchair and back again

Here are some key factors to look for when determining if you or a loved one needs Long-Term Care:

• Physical Signs
  Changes in weight, strength, energy, and balance can be dangerous to a senior, especially if he or she is living alone. This can also complicate actions like dressing and eating.
• Increasing Difficulty Managing Daily Activities
  With age, daily activities can be harder to manage. Some of the daily activities that we often do without thinking, to an elder person, might be more difficult than before. If you suspect your loved one is having increased difficulty with any of the following, expressing your concern is important.
  • Dressing
  • Bathing
  • Shopping
  • Laundry
  • Medication Management
  • Cleaning

• Mental Signs
  Memory loss or confusion could be signs of dementia and should not be ignored. If a senior is continually having trouble with memory, this can turn into a safety issue. Additionally, confusion about names, dates, and places that were once common can be frustrating and demoralizing.
  • Inability to use the bathroom or shower and forgetting to brush their teeth are detrimental to health and are other signs that they need long-term care.
  • If the house is in disarray or if things are strangely out of place, then this might signal that long-term care is required.

Long-Term Care Insurance is designed to cover the cost of assistance with the activities of daily living or additional support if you develop a cognitive disorder. Naturally, the potential need for long-term care increases with age. Beyond expenses, the need for additional or specialized care frequently creates emotional stress on family relationships, regardless of how close the family might be.

Today, long-term care insurance policies provide coverage irrespective of where you receive care: at home, in an adult day care, assisted living facility, nursing home, or even in hospice care. A long-term care insurance policy can help with peace of mind. It makes it easy for you to access the best types of care, and the ability to focus on your well-being. When it comes to long-term care, you have options to choose from.

Long-Term Care Insurance was first offered in the United States in the 1970s but became most prevalent during the late 1990s. Long-Term Care Insurance policies of that era often provided rich benefits with, for example, no limits on payments during the insured’s lifetime. Long-Term Care Insurance provides daily or monthly assistance with the costs of a broad range of long-term care services. Long-Term Care Insurance policies can be traditional or hybrid, though traditional policies are becoming increasingly rare.

Traditional polices cover some or all your costs if you need long-term care. Traditional policies have premiums that may increase over time If the benefit is not used, it is lost, unless the policy’s benefits can be transferred to a surviving spouse.

Hybrid policies serve the same purpose as a traditional policy, but they also have a built-in-death benefit (life insurance benefit) for your heirs. If the long-term care coverage is utilized, it will either reduce or eliminate the death benefit. A hybrid is designed to provide some form of benefit no matter what, whereas a traditional policy only benefits you if you become ill enough to require long-term care.

Life Insurance Policy with a LTCI Rider. This type of insurance policy is designed to provide a death benefit, also includes a rider that provides coverage for LTC costs. If the insured is certified as needing long-term care, the policy allows access to the death benefit to pay for long-term care costs.

Long-Term Care Insurance is a type of insurance coverage that is available for those who may potentially need long term care. There are different types of long-term care insurance available but as a standard it covers things that health insurance does not, and it can also protect your assets.

A long-term care insurance policy provides financial assistance specifically for long term care for persons who have persistent, ongoing health conditions, a disability, or an illness that worsens over time, like Parkinson’s disease, Lewy Body dementia, and Alzheimer’s. Long-term care insurance may cover personal care assistance, hospice care, durable medical equipment, and home modifications.

Before you make a choice–including whether to buy a policy at all–you may want to consider the following:

• Your overall financial condition
  Some people will look at their assets and spending and decide that they could likely cover long-term care without insurance. Some may plan to sell a second home, downsize from a family residence, or get a reverse mortgage to cover such expenses, according to advisers.
• Your ultimate financial goals
  How important is to you to leave money behind? Some people feel very strongly about leaving something for their families and are highly motivated to buy insurance to protect their assets from a catastrophic years-long need for care.
• The full range of insurance options
  Have a discussion with agents who are authorized to sell policies from multiple companies and with financial advisers who can put your options into context of your overall financial plan.
• Your age and health
  The older you are when you buy long-term care insurance, the more it will cost. Health problems also will make it more costly or, in some cases, impossible to get coverage. If you already have memory loss or trouble with daily self-care, you are unlikely to qualify. Some insurers require a physical exam or medical-record review; others only conduct telephone health interviews. While it is recommended to start shopping for long-term care insurance by your early 60’s, many now suggest sooner, in your 50s or even your late 40s.
• Ways to pay for your policy
  You may be able to cover premiums, tax-free, with money from a health care savings account.
• Additional options
  Group policies offered through employers may be more affordable than individual policies, particularly if you have health problems. Buying individual policies as a couple, rather than as a single person, often reduce premiums. Couples also may qualify for “shared care.”

Long-term care insurance costs vary widely, depending on factors like your age, health, condition, and the specific policies of your insurance carrier such as an inflation rider. That’s why it’s important to shop around to find the best rates and terms. It’s also important to speak with a financial advisor who can help you plan for the future.

Long-Term Care costs can add up over time and people rely on a variety of payment sources, including:

• Personal Funds
  Including pensions, savings, and income from stocks
• Private Financing
  Such as long-term care insurance
• Veteran’s Benefits
• Older Americans Act
  Supports a range of home and community-based services, such as meals-on-wheels and other nutrition programs, in-home services, transportation, legal services, elder abuse prevention and caregiver’s support.

The cost of long-term care insurance can vary widely, depending on several key factors such as:

• Health
  Some medical conditions will disqualify you from even being able to purchase a policy, including muscular dystrophy, cystic fibrosis, and dementia. This is because insurers will likely lose money on those policies. Generally, the healthier you are, the less likely you’ll ever need to file a claim—and the lower your premium may be.
• Age
  In general, you’ll pay more in long-term care insurance if you take out a policy when you’re older, since you’re probably less healthy and closer to needing the assistance the policy covers.
• Marital Status
  When combined, premiums tend to be lower for married couples than they would be for individuals paying for a personal policy.
• Gender
  Because women tend to live longer than men and make claims more frequently than their male counter parts, women tend to pay more for insurance premiums.
• Carrier Standards
  Each insurance carrier sets its own rates and underwriting standards. It’s important to gather quotes from various carriers or you can also work with an experienced long-term care insurance agent who can gather these for you and help you understand the differences between insurance policies. They can also help you determine the best coverage you’re likely to need.

Long-term care insurance can help cover the expenses of a nursing home, assisted living facility, in-home care, and certain other long-term care expenses for an aging person who can no longer perform certain tasks of daily living. There are many advantages of having long-term insurance care such as:

• Lessen the financial burden on family
  Many families struggle to afford long-term care for aging loved ones and deciding which family members can and should pay for care can cause ongoing strain. Long-term care insurance can help lessen this stress by covering at least part of the expenses that occur later in life, so family members don’t carry as much of a financial burden.
• Provides peace of mind
  Knowing you have a policy in place to cover aspects of long-term care like a home health aide or a stay in a nursing home or residential facility can help you rest easy. Peace of mind as you age isn’t something you can quantify financially, but it can make a huge difference as you juggle the other realities of aging. 
• Save on taxes
  There are several tax incentives by state and federal governments to encourage the purchase of long-term care insurance. Many states offer tax credits and tax deductions. Federal tax incentives include allowing the use of health savings accounts (HSAs) to pay long-term care premiums, a tax deduction for premiums paid by employers or self-employed individuals, and a tax deduction for long-term care expenses equating to over 10% of your income. It’s best to consult with your tax advisor for additional information.

While our team is available to assist you with your Long-Term Insurance claim, we are happy to provide an overview of the process here:

1. Call your insurer
   “Hello, I am __, I would like to file a claim.” This will prompt the insurance company to send you an initiation packet. Within the initiation packet, you will find a range of documents which include intake forms, physician documentation, a range of authorization forms, etc. This must be faxed to the insurance company by the client or a long-term care administrator. If you are using LifeWorx as a provider, you must list us under your provider of care in your claim.
2. Prove the recipient’s need
   Often insurance companies want claimants to prove that they need care to perform two or three activities of daily living (ADL) such as bathing, dressing, feeding, toileting, transferring, or incontinence. This can be done with a licensed health care provider confirming in writing the details of a patient’s care needs. When you speak with the insurance company, it is important to make it clear that you have documentation proving need from a physician and/or RN assessment. The insurer should also have a written demand to call the patient’s advocate or information only.
3. Determine the elimination period
   This is the number of days before benefits kick in. In the meantime, it is the family or client’s responsibility to pay. Elimination periods can range from 20 to 60 or even 100 days. The way an insurance company counts days can vary as well. Normally they count based on “calendar days,” pay for services X amount of days after you file a claim, or the company certifies you are eligible for coverage. Other insurance companies count by “service days.” This is when the insurer counts the days a caregiver visits the patient toward their waiting period. Some insurance companies will eliminate this period altogether. It can get tricky if your claim is rejected because the caregiver was not certified, you did not go through an agency, or have an assessment done prior to the elimination (waiting) period.
4. Check requirements
   Before picking a caregiver, it is important to study the fine details of your insurer’s coverage. Many policies require a licensed caregiver to aide your loved one and some insist that an agency provide the care and certify the need. If your claim is rejected, work with a LTCI insurance expert.