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Medical Forum / Diseases and Disorders / Alzheimer's / October 2004Long Term Care Insurance Benefits
My mother will be going to a nursing home eventually because of her alz, which is currently in the middle stages. She has LTC insurance with Met Life. She doesnt qualify for benefits using the ADL criteria (activities of daily living). She still can dress and feed herself, go to the bathroom, move about, bathe, and is not incontinent. She requires minimal assistance when washing her hair. But the ADL's represent only one of the two general criteria for eligibility: 1. You are unable to perform ... 2 ADL's ... ; or 2. You require substantial supervision to protect you from threats to health and safety due to Severe Cognitive Impairment. Severe Cognitive Impairment is defined as a deterioration or loss in intellectual capacity that places a person in jeopardy of harming him or herself or others and, therefore, the person requires substantial supervision by another individual. Deterioration or loss must be measured by clinical evidence and standardized tests which reliably measure impairment in short or long term memory; orientation to people, places or time; and deductive or abstract reasoning. That sounds good but as a practical matter I am wondering exactly how it is going to work. She has very little ability to reason, is extremely disoriented as to people, places, AND time, is completely dependent upon me. Discussions I have had with nursing home officials and others have revealed that it means the patient requires 24 hour care. But what does that mean? How will I know when that time is here? When my mother in law was diagnosed, the doctor had her see a psychometrist for a cognitive assessment. It was very similar to what they put a child through when they are trying to assess learning disabilities - they are trying to get an accurate view of the person's cognitive deficits and impairments. As I've observed, the results were shocking, because the deficits were much more extensive than were visible to the rest of us based on our every day interactions (i.e. an intact personality and the ability to carry on a social conversation makes an effective smokescreen for the gaping holes in what they know and can do). My suggestion is to get her assessed by someone who really knows what they are doing (i.e. do not get her assessed by a social worker etc. - she needs proper professional testing that will produce OBJECTIVE results, not someone's subjective and wimpy idea of what she's capable of - yeah sure, she can wash her hair, so she doesn't need assisted living...!!). That will give you hard evidence to give to the insurance company that she really does need 24/7 support and supervision. Mary G. > When my mother in law was diagnosed, the doctor had her see a > psychometrist for a cognitive assessment. It was very similar to what > they put a child through when they are trying to assess learning > disabilities - they are trying to get an accurate view of the person's > cognitive deficits and impairments. snip... Aside from the testing one might require to decide when it is time to allow LTC insurance to "kick in" there are important considerations. After doing alot of research into LTC insurance I have discovered that many policies are so restrictive as to be almost useless. It is very important to understand the limitations of LTC insurance, the length of time they cover care, and the conditions under which one is eligible. I was shocked to discover that some policies will not cover the insured should he/she become blind, for instance. If your LO already has LTC insurance make the best of it. Keep in mind that many policies have been sold to the elderly (for whom the insurance really makes no financial sense) and has bee misrepresented by unscrupulous agents. All policies are not created equal! The lesson here is that if you yourself are considering LTC insurance be cautious and stick with the tried and true carriers. Also keep in mind that it doesn't make alot of sense to enter into a plan unless you are relatively healthy, in your late forties or early fifties, are solidly in the middle class tax bracket. The premiums should not cause you to go without any other of life's needs. Dennis White > Severe Cognitive Impairment is defined as a deterioration or loss in > intellectual capacity that places a person in jeopardy of harming him [quoted text clipped - 6 lines] > That sounds good but as a practical matter I am wondering exactly how > it is going to work. She needs to have a cognitive skills test done by someone skilled at assessing cognitive impairments. She actually needs a full neuro-psychiatric examination, in order to ensure that she is screened for all possible causes of dementia-like symptoms, as well as the skills test. For an example of one possible test, see http://www.alzmndak.org/3forprofessionals/diagnosis/mmse.htm I really find it baffling that not more of you have had ANY experience with CLAIMS for benefits on long term care insurance policies on alzheimer's patients. Here in Kinfolkville, Arkinsaw, I, as an only child with no cousins have no one to talk to about anything. I would at least think that someone on this board has had actual experience with a claim of this type, considering that over 10 million long term care insurance policies have been issued. > My mother will be going to a nursing home eventually because of her > alz, which is currently in the middle stages. She has LTC insurance [quoted text clipped - 24 lines] > care. But what does that mean? How will I know when that time is > here? Bob, my husband had LTC insurance and AD. However, he went to the nursing home after having surgery that went bad and left him a complete invalid. I had absolutely no problem collecting his insurance, but our problem and yours are quite different. Gwen > I really find it baffling that not more of you have had ANY experience > with CLAIMS for benefits on long term care insurance policies on [quoted text clipped - 32 lines] > > care. But what does that mean? How will I know when that time is > > here? : I really find it baffling that not more of you have had ANY experience : with CLAIMS for benefits on long term care insurance policies on : alzheimer's patients. Here in Kinfolkville, Arkinsaw, I, as an only : child with no cousins have no one to talk to about anything. I would : at least think that someone on this board has had actual experience : with a claim of this type, considering that over 10 million long term : care insurance policies have been issued. Are there 10m policies actively in force? If my LO's experience is typical these policies are taken out and the very expensive premiums are paid for a year or two, then they lapse w/o a claim being made. > I would > at least think that someone on this board has had actual experience > with a claim of this type, considering that over 10 million long term > care insurance policies have been issued. but how many claims have been filed? or denied? unfortunately, most of us have been caregivers for folks that either didn't have such insurance available, or couldn't afford it, or (like my mother when it was offered to all state retirees) just didn't want their retirement income reduced. questions about spenddowns for medicaid qualification are much more common here. > > I would > > at least think that someone on this board has had actual experience [quoted text clipped - 10 lines] > questions about spenddowns for medicaid qualification are much > more common here. Most LTC insurance companies accept a medical professional's opinion of whether a claim is to be made. There are fairly standardized tests to determine if a cognitive impairment is there. Usually, your doctor, nurse or social worker makes that determination. Most people who buy LTC insurance are in their fifties and still healthy, even 10 years later. LTC insurance did not take off until about 1990, so there would reasonably not be many claims yet. Romeo Raabe in Green Bay, WI |
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