About to start tapping Mom's LTC benefits... any advice before I call them to begin the process?

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Hcox628 Asked January 2022

About to start tapping Mom's LTC benefits... any advice before I call them to begin the process?

Mom's (89) dementia (mid-stage Alz) is getting to the point where she needs a lot more structure and supervision than she is getting. She is still fine with the ADLs so far but problem-solving, calendar management, cooking for herself, and driving are tanking fast. Here's my concern: What would you advise me before I contact the LTC insurance company to best convey to them that we need help? I know they are quick to deny coverage for any reason (it's their j.o.b. I suppose.) Mom's social skills are intact and to anyone not spending an amount of time with her, she seems extremely high functioning. She was denied access to benefits about 1 year ago, making me nervous and dreading our next attempt. Also, she barely recognizes/admits she has a problem, making it difficult to "steer" her towards any help.

I am looking for concrete help on what to say... and NOT say... to the LTC insurer. I tend to babble and don't want to shoot myself in the foot from the beginning ;-) TIA for your help!

Financial Planning Long Term Care Insurance Paying for Care

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score 2 · Answer 1

Shouldn't the policy itself explain what is and is not covered under the plan?? That may seem like a stupid statement, but in reality, your mother must have a paper policy you can look at to read the terms of. It should not be a secret as to what benefits the policy pays and it should be there to read in black & white. You ought to be able to get in home help if your mother needs it, due to her worsening dementia and need for assistance. It does not sound to me like you're planning to place her in a Memory Care AL, but that you want to bring in paid caregivers into her home to help out, right?

I'd sit down and write a list of all the activities of daily life *ADLs* she needs help with and go from there. Her doctor should be able to back up the claim that she needs help with these ADLs and that should satisfy the insurance company, I would hope.

Best of luck!

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score 1 · Answer 2

The criteria for ADL's vary by state. If you have spoken with any facilities ask them that first. Most facilities know how to fill out the forms correctly in order to receive reimbursement. As an example while most facilities provide medicine management there is also assistance with dressing. It is very easy for that to be added on even if your parent mainly dresses themselves. They may not always be able to. If there is memory loss that is also very important for a LTC policy to be activated. This is not something you should handle on your own. Companies relish denying benefits. They will also insist on reviewing at around 6 months as though our parent is not aging. You will best be served with successful benefits if you communicate well with a chosen facility and know your state rules.

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score 1 · Answer 3

Consider asking for a professional "needs assessment" from your local Area Agency on aging".

Read up on ADLs vs IADLs.

Read the policy and ascertain the criteria for "kicking in".

If you speak to them on the phone, write yourself a note that says "only answer what they ask you". No elaboration.

Can she cook a meal for herself? If there are any "buts" or "ifs", the answer is "no".

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score 0 · Answer 4

Here is another poster today asking a question on LTC?

https://www.agingcare.com/questions/need-help-with-long-term-care-insurance-claim-such-a-maze-of-information-472590.htm

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score 1 · Answer 5

Since you have applied before, surely you were given a reason as to why she didn’t qualify then. What has changed?

Below is a link of articles and others questions and answers on this topic that might be helpful from this forum.

My aunt and uncle both had LTC. Theirs paid differently because they chose different benefits knowing my aunt would most likely have Alzheimer’s. Her mother and grandmother did. Once activated, it continued to pay until her death. (Parkinson) She didn’t go into LTC but it paid her daughter a specific amount for several years. Uncles is just for a couple of years. I remember cousin had a hard time getting it activated for her mom and she was on hospice.
Policies are different and each individuals health issues are different.

Here is the link.
https://www.agingcare.com/search?term=Long+term+insurance

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score 1 · Answer 6

Interested to see the responses you receive. I just posted asking about continuing to pay for LTC insurance as my mother no longer wants the expense about a year or two out from when she may start needing it.

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About to start tapping Mom's LTC benefits... any advice before I call them to begin the process?

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