There’s an increasingly common (and unfortunate) scenario I’ve been hearing about: individuals pass away without having made use of their long term care insurance benefits. However, with awareness and some proactive steps, this outcome doesn’t have to be your experience.
Past scenario: A person begins to need assistance with daily living due to age or illness, and family members and friends begin to pitch in more and more at their home to express their care for the person: food preparation and eating, help getting in and out of bed, assistance with medications, dressing and taking showers safely, monitoring catheter use, searching for specialty home equipment, and more. As these needs continue to expand over weeks and months, the caregivers begin to experience emotional burnout, their own physical health problems, time lost from work, stress between family members, and increasing frustration about how to provide quality of life care for themselves and their loved one. Although medical doctors are consulted during specific appointment times, there are little or no discussions with the physician about what the scope of home care has become. Finally, there is a ‘defining event’ such as a fall, accident, or inability to physically lift the individual one day, and then crisis mode ensues with a frantic search for a hospital, rehab facility, or assisted living arrangements. With the combination of all these circumstances, the ailing individual’s health and life quality decreases rapidly and within a short period of time they pass over. There is much grief, shock, and exhaustion – and later, the realization that out of pocket medical expenses have built up and the long term care insurance benefits were never used.
Facts: Long term care insurance benefits are available when there is a need for assistance with at least two of the six designated “Activities of Daily Living (ADLs)”: bathing, dressing, using the toilet, caring for incontinence, eating, and transferring in/out of bed or chair. Each policy has different waiting/elimination periods (example 30 or 60 days) and each company provides specific information on how to formally document what assistance is needed. Many policies provide coverage and contact information for professional care managers who can help navigate through unfamiliar care options and expense management. Most policies also cover significant in-home and community support services, as the industry understands that quality of life is generally preferred by individuals and the cost of providing those services is a lot less there than at a separate facility. Respite care time is also available to give caregivers some time to rest and tend to their own well-being.
New scenario: A person begins to need assistance with daily living due to age or illness. Friends and family members begin to pitch in to show their care for the individual, but in ways that are manageable for their own lives, health, and other obligations. The family doctor or other medical professional is also contacted early on to provide an assessment of the patient’s home needs. Documentation is provided to the long term care insurance company to begin the tracking of the policy waiting period, and a professional care manager is referred to the family to help with identifying resources and options that will provide the highest quality of life care for the patient and caregiver ease. There are out of pocket medical expenses incurred during the waiting period and for non-covered expenses, but within a short window of time the extra resources of the insurance policy can be tapped to help with the financial concerns. And the involvement of the care manager greatly expands everyone’s knowledge of options while reducing the overall stress and frustration for all. Caregivers can better focus on quality of life choices, maintaining their own mental and physical health, and reducing future financial problems they would otherwise face later on. Patients understand they have more choices available to them, can receive compassionate and effective care from engaged professionals, and maintain more independence during their experiences.
- Pull out your long term care insurance policy and make sure you understand the coverage and timing you have available for your benefits. If you need help understanding terms, contact your licensed insurance professional or the insurance company directly.
- Review educational sites such as longtermcare.gov for current objective information
- Talk with your family members and/or friends about your wishes and prepare appropriate documents. Tap into resources such as your state or county aging/health department, communication assistance sites such as fivewishes.org and www.eldercare.gov, a local professional care manager, and trusted professionals such as your estate attorney, CFP, and medical experts.
- For the caregiving spouse, partner, or friend: reach out early for assistance and information. Quality of life and communications for both you and your loved one will be much better by using available financial benefits and support services.
- If you need help choosing a new long term care policy, contact an established long term care insurance broker (to get multi-company options and underwriting criteria) or get a referral to an experienced broker from your CFP professional as part of your complete planning process. There are many options available today for scope of coverage, pricing, optional riders, state partnership programs (with tax credits and asset protection), and other customizing features to suit almost all budgets and needs.
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