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Basically, long-term care covers
helping people function -- do things
that they can no longer do for themselves. And, in fact, most seniors
are interested in LTC because they fear that one day they may need help
with bathing, eating, dressing, toileting, continence, transferring.
This type of personal assistance is central to long term care, although
there could be medical conditions involved, requiring skilled medical
personnel, possibly throughout a 24 hour period. And the type of the
medical condition may very well determine whether the person can remain
at home or belongs in a nursing home, with available skilled medical
care. The need for custodial or personal care was not the eligibility
requirement in most early LTCI policies, issued up to about 1990 but,
instead, a skilled nursing requirement had to be satisfied, certified
by a physician, and custodial care would be covered after a period of
skilled nursing home care. This feature has been removed from almost
all new LTCI policies, so the most common method for determining when
benefits are payable is based upon the insured's inability to perform
two or three of the activities of daily living (ADLs), enumerated at
the beginning of this paragraph.
As I stated earlier, I ask the client at the beginning of our meeting
to step back from long-term care
insurance, as follows:
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The first is to make a decision -- one that will be
central to the quality of the client's LTC if and when it is needed
-- is where (geographically) the long-term care will take place. This
point is also important in deciding the dollar coverage of LTCI. I
suggest to the client that the care should take place near person or persons who have been close, loving and
interested in her welfare -- and the
younger, the better -- which may eliminate her sibling(s). I also
suggest she make an alternate choice. We may be planning for the next
ten to twenty years and, as we know, nothing remains the same, so we
need alternates. The quality of care will be enhanced if a family
member or friend "checks on things." For example, is the
nursing home following the resident care plan set up at the time of
admission? If not, why not? Has the nursing home staff noticed
changes in the resident's condition which have caused them to alter
the original care plan? These things must be questioned so the staff
becomes aware that outside persons are interested in how matters are
going with the resident ("monitoring duty" of a sort).
Likewise, if the care is at home by an attendant, the home
attendant(s) needs to know that there are other "parties"
very much interested in the patient -- "a mediator" for
personal disagreements or someone to call regarding medical
questions. As you can see, even with the best LTCI policy, the
insurance can become benefit-less, if we don't pay attention to those
other factors.
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