George, age 84, lived by himself in an apartment. As his care manager, I was concerned about him and so were his daughters, who lived out of state. He had diabetes and COPD, had become more frail, and was having trouble taking care of himself. During my weekly visits to check on his health, I’d begun to notice that his clothing was often stained and dirty and his hygiene was poor. His once-tidy apartment was getting to be quite a mess. When I gently mentioned my concerns, he finally admitted he didn’t have the energy anymore to keep up with cleaning and laundry, and bathing was difficult.
I knew George had a long term care insurance policy. But he had been reluctant to discuss it with me or his daughters.
“If you had a car accident, you’d use your car insurance, right?” I asked him. “If your home was damaged in a fire, you’d use your homeowners’ insurance. You’ve been paying premiums for 20 years for your long term care insurance – isn’t it time to consider using it?”
Sometimes older adults are reluctant to activate the long term care policies they’ve paid into for years, and the reasons vary. Policies can be complex and difficult to understand, and seniors may not realize that they can access services if they’re living at home or in an independent living environment. Sometimes seniors fear that acknowledging they need help means they’ll lose the independence they still have.
In George’s case, it turned out he wasn’t clear about what his policy covered or how to activate it, and he mistakenly believed that Medicare would pay for homemaker services if he needed them. I explained the difference between the services that Medicare will cover, such as in-home skilled nursing services or skilled therapy care under certain circumstances, and the services they don’t cover. For example, Medicare’s home health benefit doesn’t cover “custodial care” or homemaker services, such as light housekeeping and laundry, or assistance with activities of daily living such as dressing, bathing, meal preparation, and toileting.
However, George’s long term care policy did provide for in-home services to help him with activities of daily living. But as with most policies, there was a waiting period of 90 days, called the “elimination period,” before services could start. This was a good reason for George to activate his policy before he had a health crisis and his options became more limited.
His daughters agreed to help him pay for services until the elimination period ended, and I assisted the family with locating a reputable agency. I also helped them with the ins and outs of the process to start services, explained how to submit invoices to the insurance company, and managed other details specific to the policy.
George’s quality of life improved once he had in-home services, and I continued to monitor his care. Do you have similar concerns about a family member who has a long term care policy? A care manager can offer direction and guidance when it’s time to activate the policy.
Please reach out to us at 703.723.3737 or at firstname.lastname@example.org and we will be happy to assist.