Long-term health care

Posted by joybringer1 @joybringer1, Jan 3 2:46pm

Does anyone have experience with long-term health care insurance? I have a friend who had to put her husband who has dementia and other health issues into an assisted living facility. She was certain that insurance they have been paying for, for years, would cover the costs. They have denied her claim. Apparently they conducted an "interview" on the phone with her husband. He said he was fine, etc. etc. Having dealt with dementia in my mother-in-law, I can imagine such a scenario. Every time we took her to the doctor, "Oh, everything is fine." We then corrected everything she said. I wish I could offer some advice to my friend. She said she has hired a lawyer, but he does not return her calls. And the assisted-living facility is no help either. She confided in me that she could pay for one more month of the facility and then her savings are gone. At that point, she would have to bring her husband home. She and her daughter had tried to take care of him for a long time before she moved him. They had two beds in the dining room instead of dining furniture. I wondered how long she could do this because she finally (after years of misery) was diagnosed with granulomatosis with polyangiitis. (I might have misspelled that.) She is wiped out after her chemo sessions and her daughter just had surgery and is asking her place of employment for half-time status. My friend told me she is teetering on the brink of despair. Supposedly, the insurance company is reviewing her claim. I am extremely worried about my friend and her husband, too. He refused to sign up for the vaccine.

I am asking for any suggestions/advice I can give her. Thank you, John Bishop for your instructions on how to post. I hope I did this correctly. Thanks to anyone for can point me/her in the right direction. It just seems so wrong not to pay out when the help is so needed. @joybringer1

Joy, I don't but I would like to hear anything anyone has to offer! Both my wife and I have the possibility sooner that later!
From The Land of Enchament!
Sundance(RB)

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Joy –
Long term care insurance is as rare as hens' teeth and can be very expensive if you try to acquire when you actually need it. Most health insurance, including Medicare, offers very limited options for long term care -generally only very short term "rehab" after a hospital stay, or hospice/end of life care under separate rules is covered.

Joy, if your friend has a long term care policy, she should talk to the patient advocate at her husband's facility to get in touch with the Senior Ombudsman or Office on Aging in your state for help. They can help her or their daughter get his Power of Attorney, or arrange a guardianship – either can be done through family court, with or without his consent, if he refuses to sign. They can also teach her the language to use in dealing with the insurance company. Most policies require that you need assistance with a certain number of ADL's – activities of daily living, or be incapable of being left unattended, to qualify for payment.

If she does not have a policy, she should start with the same people I named above to find out how to apply for Medicaid for her husband's care. In most states now, if the care exhausts the family savings, the other person doesn't have to sell the home they still occupy, or the car, etc for him to get care. If he is a military veteran (including reserves/National Guard) she should contact her state department of Veterans' Affairs (easier than the VA – I know from experience.) If all else fails, if she, her husband, or the facility, are affiliated with a church or fraternal organization, they can sometimes step in to render temporary assistance while she works through all of the details. Based on their combined incomes, state law and federal rules, she will still make some payments for his care, but will be left enough money to (hopefully) handle her needs as well. If Medicaid is involved, her daughter will be required to contribute rent to the household too, based on her income.

In case it isn't obvious, I have been involved in caregiving for family members for over 40 years, and have been down ALL of these avenues once or more.

@sundance6 My advice to anyone anticipating long-term needs in the future, either in a facility or at home, is to do your research NOW and get whatever coverage you can afford. My husband and I purchased ours when we were in our 50's so we have been paying premiums for a long time. But, if we tried to get this insurance now, we would be denied due to our current health and the number of companies that have stopped issuing these policies. A friend our age recently tried, and the premiums she was quoted were over three times what we pay per year.

I wish your friend good luck as she pursues this. I am sorry she has to deal with this at the same time as cancer treatment, because it is time-consuming and can be frustrating. Remind her that she needs to keep complete records of all contacts, documents and promises, including dates, times, names & numbers… Also a COMPLETE record of all payments she makes for her husband's care from now on, including incidentals, lodging, meds, etc, because if their savings are gone she may be entitled to some reimbursement when everything is finally decided.

Sue

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Thank You! So in mid 70's it will be expensive?
I have Aetna so I will chack tomorrow!
Sundance(RB)

REPLY

I retired from my second employer at the end of last year and they allowed me to keep my long term care insurance through their insurance company (Unum) as long as I pay the fee. They paid it for employees as a benefit. It cost me $670/year. There is an Government Eldercare locator site that may help you find local services by ZIP code – https://eldercare.acl.gov/Public/Index.aspx

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@sueinmn

Joy –
Long term care insurance is as rare as hens' teeth and can be very expensive if you try to acquire when you actually need it. Most health insurance, including Medicare, offers very limited options for long term care -generally only very short term "rehab" after a hospital stay, or hospice/end of life care under separate rules is covered.

Joy, if your friend has a long term care policy, she should talk to the patient advocate at her husband's facility to get in touch with the Senior Ombudsman or Office on Aging in your state for help. They can help her or their daughter get his Power of Attorney, or arrange a guardianship – either can be done through family court, with or without his consent, if he refuses to sign. They can also teach her the language to use in dealing with the insurance company. Most policies require that you need assistance with a certain number of ADL's – activities of daily living, or be incapable of being left unattended, to qualify for payment.

If she does not have a policy, she should start with the same people I named above to find out how to apply for Medicaid for her husband's care. In most states now, if the care exhausts the family savings, the other person doesn't have to sell the home they still occupy, or the car, etc for him to get care. If he is a military veteran (including reserves/National Guard) she should contact her state department of Veterans' Affairs (easier than the VA – I know from experience.) If all else fails, if she, her husband, or the facility, are affiliated with a church or fraternal organization, they can sometimes step in to render temporary assistance while she works through all of the details. Based on their combined incomes, state law and federal rules, she will still make some payments for his care, but will be left enough money to (hopefully) handle her needs as well. If Medicaid is involved, her daughter will be required to contribute rent to the household too, based on her income.

In case it isn't obvious, I have been involved in caregiving for family members for over 40 years, and have been down ALL of these avenues once or more.

@sundance6 My advice to anyone anticipating long-term needs in the future, either in a facility or at home, is to do your research NOW and get whatever coverage you can afford. My husband and I purchased ours when we were in our 50's so we have been paying premiums for a long time. But, if we tried to get this insurance now, we would be denied due to our current health and the number of companies that have stopped issuing these policies. A friend our age recently tried, and the premiums she was quoted were over three times what we pay per year.

I wish your friend good luck as she pursues this. I am sorry she has to deal with this at the same time as cancer treatment, because it is time-consuming and can be frustrating. Remind her that she needs to keep complete records of all contacts, documents and promises, including dates, times, names & numbers… Also a COMPLETE record of all payments she makes for her husband's care from now on, including incidentals, lodging, meds, etc, because if their savings are gone she may be entitled to some reimbursement when everything is finally decided.

Sue

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Thank you, Sue. I will relay this information. to my friend. Perhaps there is something of use here for her. @joybringer1

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@johnbishop

I retired from my second employer at the end of last year and they allowed me to keep my long term care insurance through their insurance company (Unum) as long as I pay the fee. They paid it for employees as a benefit. It cost me $670/year. There is an Government Eldercare locator site that may help you find local services by ZIP code – https://eldercare.acl.gov/Public/Index.aspx

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John, I hope you received my thanks. @joybringer1. I think my "handle" should be "Luddite!)

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@johnbishop

I retired from my second employer at the end of last year and they allowed me to keep my long term care insurance through their insurance company (Unum) as long as I pay the fee. They paid it for employees as a benefit. It cost me $670/year. There is an Government Eldercare locator site that may help you find local services by ZIP code – https://eldercare.acl.gov/Public/Index.aspx

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Thanks John!
Sundance(RB)

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