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Long-Term Care Guide

The LifeWorx Guide to Long-Term Care

People often need long-term care as they age and particularly when they have a serious, ongoing health condition or disability. This resource guide will answer your questions and our dedicated Care Consultants are available to help find a solution that fits your family’s individual needs.

Long-Term Care Questions

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 facilities or non-institutional care such as home health care, personal care, adult day-care, long-term home health 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

People often need long-term care when they have a serious, ongoing health condition or disability, as they get older. Reasons to consider long-term care insurance may include:

  • Your age
    As you get older, you are more likely to need long-term care.
  • Your gender
    Women tend to live longer than men and are therefore more likely to need care.
  • Living alone
    If you live with a spouse, partner, or family member, you are less likely to need paid care.
  • Your lifestyle
    If you are obese, smoke, or drink excessively, you are more likely to need long-term care.
  • Family history
    If you have a history of medical conditions or disability, you may be at a greater risk.

About 70% of people aged 65 or older may require long-term care at some point in their life. The probability of needing personal care and health-related services increases with age if someone is disabled or has a chronic illness such as diabetes or high blood pressure that requires monitoring and regular medication. Long term care can help maximize health hand safety, protecting you or your loved one and providing professional medical care as soon as it’s needed.

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. The nursing aids residents with these actions in long-term care.
  • 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.

LifeWorx provides private caregiver services ranging from home health aides, Alzheimer’s care, 24/7 live-in care, companion care, personal care, and beyond. We provide private caregiver services including home-based long-term care includes health, personal, and support services to help people stay at home and live as independently as possible.

Home Health Aides
Home Health Aides care involves full-time or part-time services ordered by a physician for a specific condition. These services include care to help a person recover from surgery, an accident, or illness. Each of our home care aides is equipped to care for and prevent such complications, as well as to institute a daily routine of good hygiene. Once an elder has been properly cared for, including having been showered and groomed, their self-esteem rises. They’re more likely to be active and to venture outside, which is essential for psychological and physical well-being.

Alzheimer’s & Dementia
No illness is more debilitating and worrisome than Alzheimer’s or dementia. When your loved one has Alzheimer’s or memory loss, LifeWorx professionals are here to help seniors. Our caregivers provide in-home care and companionship for seniors with memory loss. Our Alzheimer’s home care aides help seniors with maintaining health and keeping medical appointments, establishing regular routines, eating schedules and tasks of daily living, as well as performing light-housekeeping, medication reminders, and meal preparation.

24 Hour Home Care
Our in-home caregivers are expertly trained in care for seniors to help maintain their individuality improve quality of life, everyday routine, and engage them in activities that will stimulate them mentally, physically, and emotionally. People who can benefit from a live-in caregiver include those with mild dementia, frailty, depression, or loss of faculty. Our 24-hour care services include:

  • Maintaining a safe and comfortable environment
  • Medication reminders & tracking
  • Personal care such as grooming and dressing
  • Meal preparation
  • Light housekeeping including laundry
  • Interactive caregiving
  • Running errands

Companion Care
LifeWorx caregivers are available for as little as a few hours per day or as much as live-in when needed. In addition to taking care of basic household chores like cooking and cleaning, they provide conversation and companionship, accompanying your loved one on errands and to lunches, dinners, and shows. They can also communicate with other family members to let them know how your loved one is doing, imparting joy and peace of mind to the individual and his/her relatives.

Personal Care
With personal care, a personal care attendant can help with the activities of daily living (ADLs). This type of home care is helpful for older adults who need extra help to live safely at home, but who do not need medical services.

Luxury Services
LifeWorx is the premier provider of local elder care, nannies, and housekeepers. In addition, our luxury and lifestyle management services provide clients with the highest levels of service including the finest private chefs, personal assistants, household staff, and even estate managers.

Long-Term Care Insurance 101

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. Hybrid policies, using the long-term care coverage 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.

You may not know if your parents or loved ones have long-term care insurance—a policy that helps cover the costs of care when a person has a chronic medical condition, disability, or a disorder such as dementia or Alzheimer’s disease. This may even be the first time you’ve even heard the term. However, many of our clients invest in senior long-term care coverage. Whether it was because their employer offered it or they decided to plan for their future on their own, the sooner someone begins to explore long-term care options, the better for them and their family.

Long-term care for the elderly can be complex to navigate, especially when it comes to insurance. Each long-term care provider and policy is different. Waiting periods can vary, as well as the conditions required to activate the insurance coverage. The daily, monthly, and lifetime maximum caps can also vary. In addition, policies may differ in whom they cover—some couples have dual or spousal insurance that allows the benefits to transfer from one partner to another if necessary. Still, long-term care options for seniors do exist.

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 Policies & Claims

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, including muscular dystrophy, cystic fibrosis, and dementia. That’s 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 is 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.

The ideal time to plan for long-term care is in your 40s to mid-50s. As you get older, by comparison, visits to the doctor’s office may result in new diagnoses and prescriptions that can either cause you to pay more long-term care insurance or make you completely uninsurable.

The goal is to buy long-term care insurance before you develop a preexisting medical condition. Then the policy will help cover the cost of long-term care should you develop that condition later.

Things to Consider Before Purchasing a Long-Term Insurance

  • Long-Term Care is different from traditional medical care
    Someone with a prolonged physical illness, a disability, or a cognitive impairment such as Alzheimer’s disease often needs long-term care. Long-term care services may include help with daily activities, home health care, respite care, hospice care, adult day care, care in a nursing home or care in an assisted living facility.
  • Consider if you’ll need long-term care
    Whether you should buy a long-term care insurance policy will depend on your age, health status overall retirement goals, income, and assets. If you have a large amount of assets, but do not want to use them to pay for long-term care, you may want to buy a long-term care insurance policy. Many people buy a policy because they want to stay independent of government aid or the help of family. They don’t want to burden anyone with having to care for them. However, you should not buy a policy if you can’t afford the premium or are not sure you can pay the premium or are not sure you can pay the premium for the rest of your life.
  • Investigate the best option for you
    It’s best to talk to a specialist in long-term care to determine what options fit your circumstances, plus talk to a financial planner about where long-term care insurance fits into your retirement plan. People pay for long-term care in a variety of ways. These usually include using personal resources and long-term care insurance, and Medicaid for those who qualify. Medicare, Medicare supplement insurance and health insurance you may have at work usually will not pay for long-term care.
  • Calculate the cost of long-term care insurance
    Long-term care insurance isn’t inexpensive. The cost depends on the amount and type of care you need and where you get it. Premiums vary but may also increase over, so if you purchase a policy now, expect to pay even more to renew it.
  • Contact several companies and agents
    Be sure to compare benefits, the types of facilities covered, limits on your coverage, what is not covered and the premium. Policies from different insurance companies often have the same coverage and benefits but may not cost the same. Be sure to ask companies about their rate increase history and whether they have increased rates on the long-term care insurance policies.
  • Read the fine print
    How long is the exclusion period before the policy begins paying benefits? What capacities must you lose? How many years of care are covered? While you should investigate these policies yourself, the situation is complex enough that you should consult an expert who doesn’t sell policies to help decide.
  • Consider whether you’ll qualify
    Long-term care can be challenging to qualify for. The insurance company has strict requirements for health and mental status most people have a hard time meeting in older age. In some cases, you may still qualify with a pre-existing health condition.
  • Timing considerations
    The best age to apply for long-term care insurance is when you’re in your 40s or 50s and still in great physical and mental health. While premiums will be lower if you buy your insurance earlier, you’ll also have to maintain your coverage longer to use it.
  • Don’t keep your long-term care plans a secret
    Make photocopies of your long-term care plans and give them to someone who is going to be responsible. You may also need someone to advocate for you when it comes time to use the policy or file a claim so authorize someone to speak to the company on your behalf in advance.
  • Review your contract carefully
    When you purchase long-term care insurance, your company should send you a policy. You should read the policy and make certain you understand its contents. If you have questions about your insurance policy, contact your insurance agent for clarification. If you still have questions, turn to your state insurance department or insurance counseling program.
  • Review your long-term care plans every year
    While you probably won’t want to change your entire policy, you may have options to change coverage. Or if you elect not to buy a long-term care policy, revisit that decision periodically.

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.

When you are ready to file a claim for long-term insurance benefits, you will need to obtain and fill out an initial claim “packet” or claim initiation kit.

Each company’s insurance claim forms will be different, and some are available online. A claim packet will typically include the following five items:

  1. Policyholder Statement
    Also known as a claimant’s statement, individual statement, insured’s statement, or care support history – this set of forms will require basic information about the policyholder (e.g. – name, address, phone number, date of birth, policy number). It will also ask for explanations regarding the reasons for submitting the claim, including which activities of daily living help is needed with and how long assistance will be required. This component usually includes sections related to hospitalization and medical history as well. The policyholder (or their legal representative/agent under power of attorney) must sign this multi-page statement.
  2. Attending Physician Statement
    If a long-term care administrator feels they need additional information they will contact the attending physician or someone that knows the policyholder’s health history for additional information and verifies that the care they require is medically necessary. The physician may need to attach test results, office notes, medical records, and other supporting documentation to this statement.
  3. Nursing Assessment and Plan of Care
    Some insurance companies will not approve a long-term care insurance claim without a nursing assessment and/or a prescribed plan of care. Sometimes these components will be included in the physician’s statement mentioned above. However, if an insurance company has its own registered nurse or a third-party registered nurse, it will contact the policyholder and conduct its own assessment. The policyholder’s care provider should have a nurse on staff who can conduct and write up this initial assessment, which will include vital sign measurements, demographic information, and medical history. A physician licensed practical nurse (LPN), or social worker may have to sign to certify this information is accurate.
  4. Provider Statement
    If the policyholder is currently receiving long-term care services, each care provider will need to complete and sign these forms to verify that it is equipped to provide the services detailed in the plan of care. Providers will need to submit proof of proper licensure, certification, etc. If the LTCI policy includes an elimination period, invoices from current care providers must also be submitted to ensure these days of care count towards the waiting period needed to begin benefits.
  5. Authorization to Release Information
    This form ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) and permits the insurance company to collect health care documentation to process the policyholder’s claim. The policyholder or their legal representative must sign this form. If someone is signing this release on the policy’s behalf, a copy of their power of attorney (POA) or guardianship documentation must be included.

Once all the necessary forms and paperwork are submitted to the insurance company, a care coordinator or employee with the claims department will typically send a physical letter to the address listed on the policy with either an approval or denial.

Typically, a complete claim should be approved or denied within 30 to 45 business days. If additional information is needed (or a decision is unable to be reached) a representative of the insurance company should reach out to discuss the issue.

How can LifeWorx help with Long-Term Care Insurance?

If you believe your loved one has long-term care insurance, LifeWorx offers complimentary policy reviews or can recommend an outside professional to review your policy as well. We work with private pay clients and long-term care insurance providers only. Our in-house long-term care insurance expert takes care of all the meticulous paperwork and filing for you to ensure we bring you maximum benefit. Let us take care of the administrative aspects of long-term care for your loved one, from assessment to devising a care plan, submitting appeals, and processing invoices, payments, and reimbursements.

We believe that a full understanding of the long-term care options available is essential to family members. Visit one of our offices to pick up a copy of our complete guide to long-term care insurance and find out how to get the most out of a long-term care policy.