There really is no place like home. Dorothy had it right in The Wizard of Oz. But, we often see confusion about Long Term Care insurance and you may very well have a benefit that will pay for home care services.
Decisions about home care – sometimes referred to as senior care or elder care – for a loved-one can be overwhelming. What is the best care setting? Who do I turn to for advice? Can I afford the services? Added to the complexity of navigating the long term care system is often a great urgency due to sudden or unexpected changes in situations. Compound these considerations with the fact that most family caregivers are balancing work obligations and family responsibilities.
Having reliable, unbiased and timely information is critical as decisions about long term care are made. Sadly, there are many “myths” associated with in-home care. While some are partially true, others are just simply not true. When considering care options for a loved one, it is important that you know the facts about in-home care.
Myth: Long Term Care insurance will NOT pay for in-home care. Those policies ONLY pay for nursing home care.
Facts: Long Term Care insurance OFTEN pays for in-home care. While some older policies might not pay, and some might pay only a fraction of what the benefit might otherwise be in an institutional setting, most policies have an in-home care option.
Long Term Care insurance can be confusing. “Deductibles” are measured in time and called “elimination periods.” Premiums can seem exorbitant until you look at the costs of long term care services; often a whole year’s worth of premiums can be recouped in only one month of service once a qualifying claim has been filed. It is essential to have an experienced agent guide you through selection of an appropriate policy. We can make referrals in that area, but that is not what this article is about.
Some of the earlier policies were designed to exclusively pay for nursing home care and there are some policies still sold that only offer nursing home benefits. As demand increased and popularity grew, many insurance companies adjusted and even created new policies that provide for in-home care. Now, it is practically the rule to include home care as the preferred option.
Typically, the same criteria must be met to trigger benefits, that is, the need for assistance with two Activities of Daily Living (or ADLs), such as bathing, dressing, feeding, transferring, walking, or toileting. There is also usually a cognitive trigger that includes those with Alzheimer’s disease or other related dementias. These benefit triggers are typically the same whether the person is receiving care in a skilled nursing facility or at home.
There are cases where the daily benefit for someone receiving care at home is less than the rate paid to a skilled nursing facility. Again, this is mostly with older policies or those that simply do not reflect where the vast majority of people choose to age – their home.
Talk to your insurance agent and contact the claims department of your insurance carrier. They will assist through the claims process and be able to provide you with information regarding benefits. You can also contact us to discuss the policy benefits and desires and values of the person to receive care. Home Helpers Home Care has served scores of individuals with Long Term Care insurance, and we are always more than happy to help you navigate through this process.