I need definitions and laws RE: Custodial care vs. assisted living.

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INMYPRIME Asked December 2022

I need definitions and laws RE: Custodial care vs. assisted living.

I have older LTC policies that I took out in 1993 and '95. Assisted living wasnt a thing then like it is today. No one had even heard of custodial care at the time. My LTC claim forms require 2 ADLs needing help, but if I need full time help with 2 ADLs they don't accept you in assisted living. If you progress to that level of care needed, you will be asked to leave as they are not licensed for that. So, it's a catch 22 for me. Any ideas?

Activities of Daily Living Assisted Living Long Term Care Insurance Paying for Care

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score 2 · Answer 1

Call your state's Commissioner on Insurance. These policies have become problematic in many instances. See what the state regulators tell you.

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score 0 · Answer 2

INMYPRIME: Seek the counsel of an elder law attorney.

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score 2 · Answer 3

Contact local lawyer that deals with elder law and/or family law.

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score 2 · Answer 4

3 comments.
1. contact the provider/insurance company and ask what the criteria is. And ask as many questions as you can.
2. Not all AL facilities are the same and what one requires another may not. So interview several facilities and determine from that what the best option might be.
3. You might even want to ask if your LTC insurance will cover In Home Care.

Some may have a policy that as a person declines they will allow you to remain a resident if you are on Hospice. this might be another thing to ask about.

Many AL facilities can no longer use "equipment" to transfer a person. Once a person requires equipment to allow safe transfer for both resident and staff they may require transfer to Skilled Nursing. (this may depend on State Law.)

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score 1 · Answer 5

Again, do contact the provider you are insured with. It should have been verified annually for the life you have been insured. Changes in circumstances and places to cover do happen.

I am going to share what I understand about custodial care insurance coverage: It does cost less to buy into care insurance in earlier years when healthier or more into the later years when not so healthy.

There's just one issue buying into custodial care or LTC care insurance years before using it: the businesses want only money for their profits. And, many facilities may go out of business or merge with other facility names. Could also be that many policies bought were never used because the policyholder died before they could use it. That's money down the drain.

These policy companies are meant primarily for one thing: to protect assets for inheritance. Policies are expensive, and not everyone interested is eligible to get one. It takes at least $250,000 in assets for one to afford the insurance coverage. There is care at home or a facility to sign up for, also inflation protection at extra costs at very complicated choices, indeed.

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score 2 · Answer 6

Have you brought your policy to the AL that you're considering moving into? They are used to these long-term care contracts with insurance companies. They may have a way of working with the insurance company.

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score 1 · Answer 7

You can ask the area counsel on aging and long term care. A good source is the Agingcare website itself.

Yes, this is a tough, frustrating situation. These LTC policies get complicated. Have you tried contacting your policy? Costs so much to have one. No one is available to anwser the phone any more, but have you tried online chat service with your provider? I also think go with our other readers' ideas.

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score 2 · Answer 8

What kind of help do you need at this point that has you contemplating assisted living? I know assisted living places that will accept people in need of assistance with two ADL's, for example bathing and dressing. So I don't think you would be kicked out if you need more help, but might have to pay more if you have additional personal care (non-medical) services that they can provide, e.g., medication management. I've seen people in wheelchairs in assisted living who need to be wheeled to the dining room. It's true that if your needs become more medical in nature you would need to go to a different type of living situation than assisted living. The problem I see with LTC policies and assisted living is that the company may balk about paying the rent and meals portion of the assisted living fee, though they might be willing to pay for the personal care portion. My husband's LTC policy was similar to yours, needing assistance in 2 ADLs, but it paid for aides to come to our home and they did a lot more than helping him with bathing and dressing, for sure -- they did laundry, light cleaning, meals, and would have done shopping and transport to appointments if needed. Does your LTC policy cover home care? for now could you get by with staying where you are and hiring ades to come in for a certain number of hours per week?

(ZippyZee said not t yell at us because you typed your qustion in all caps which is a no-no for a lot of people in communicating online.)

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Most AL facilities automatically administer all medications which can count as 1 ADL.

(6)

score 2 · Answer 9

Required ADL's vary by state in order to receive compensation. They may vary by one or two. A good facility generally makes the situation work out with insurance but if you need alot of help you may not qualify for AL.

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score 7 · Answer 10

Inmyprime, custodial care is any non-medical care that can reasonably be provided by non-licensed caregivers.

Check with the ALs you are interested in. That's why people move to Assisted Living, they need assistance! You don't get kicked out for needing help, you just get charged more.

I recommend having your policy reviewed by an insurance broker that can explain what coverage you actually have and how it kicks in.

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Thanks for responding so quickly. I know that much about Custodial Care.. they are non-medical providers.. they don't need licensed employees... Assisted living does, plus RNs and Certified Assisted Living Directors.. with follow-up RN assessments done consistently, updating your Plan of Care. I agree that if your Plan of Care needs upgrading.. there is additional charges, but when you progress far enough that you need more care than they are licensed to provide, they can (and do) ask that you leave, and more into a higher level of care, they help you find a better match for this level of care (intermediate care, or skilled nursing home). I spent almost 2 months checking out my local Assisted Living facilities, and narrowed it down to two. If I could have taken one feature from each one, and put them together, it would have been perfect.. but after much consideration I decided on the one I felt more comfortable in, I just had to wait until I got the approval from my LTC policy.. Since that is still ??? I'm going to have to make my decision based on what I can afford with my savings alone.. and hope I can get this approved in a decent time frame. I do see that there are "claim specialists" who I can work with that might make this process easier and less frustrating for me. I've already dealt with a couple of panic attacks going back and forth with the "computer system" and not being able to TALK TO A REAL PERSON... for over and hour... I'll do anything not to have to go through that again!!!

(1)

score 2 · Answer 11

Please don't yell at us :(

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I'm sorry, I didn't realize I was yelling. I just type in caps when I want to get my thought across as important, not yelling.

Again, I'm sorry. I'll try to do better.

(7)

I need definitions and laws RE: Custodial care vs. assisted living.

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