[Parker]

I have an 89 year-old family member who has tried assisted living, but decided to buy a small home and live out his days independently, as he felt imprisoned in a facility. He has paid into Long Term Care for many years. He has had difficulty qualifying for in-home help because he doesn't need such intensive care as help holding a spoon to feed himself, etc.. The rules appear designed to deny care unless one is practically helpless. He needs help with household maintenance, bathing, cooking, errand running, transportation to various doctor appointments, etc. We help him a lot, but there is a lot of help needed that we can't always provide.

Is LTC really that hard to qualify for? Where might one find an advisor or advocate to help with this? I've searched the internet and found all kinds of sites with some information, but it is too general and leaves me as frustrated as I start. I want to support his efforts to keep his independence and maintain his quality of life. Does anyone know anything about qualifying for LTC?

[jblum315]

I would love to know what you find out about this.

[JourneyOfLife]

Do you mean your family member is insured with LTC insurance policy (that is in-force)?

[Parker]

Yes, JourneyOfLife, and it is supposed to be a very good policy.

[JourneyOfLife]

Get a copy of the policy and read it (if the family member will share it with you). It will take an hour or so to read.

Has this person already gone through an assessment to see if they qualify for benefits?

[DEWRDW]

Originally Posted by JourneyOfLife

Get a copy of the policy and read it (if the family member will share it with you). It will take an hour or so to read.

Has this person already gone through an assessment to see if they qualify for benefits?

Yes, you must read the policy if it's available to you - if not, and you know the name of the company providing the insurance perhaps they can look the benefit up by name - however, it is much easier if you have the policy number when you call them and the policy in front of you - the person does have to go through an assessment - in addition, I found that when I checked on this type of benefit for my mother a person normally has to be chronically ill, functionally incapacitated or has a cognitive impairment - I think that is what the original thread may indicate that they found as well - I don't know where you can call for the assistance that this person needs -I hope someone respond that may know where you can call for help - it's difficult - wish you the best!

[rjm1cc]

You could try SHINE - Home to see if they can help. They are a state agency that help with insurance.

[jane032657]

Long Term Care should kick in when you need help with two of the activities of daily living. Dressing, Bathing, Mobility, Eating, Toileting. I am opening the new assisted living being built next to Lowe's called HarborChase of Villages Crossing. I have a lot of experience with Long Term Care policies. If you would like me to meet with your loved one and review their policy and make some phone calls for them, I am happy to do it. Sometimes long term care policies do allow for in home help instead of assisted living but you must qualify in terms of needing help in multiple functions of daily living. Maintenance and transportation and shopping are not included. You can email me at jbloom@hraonline.net
I am happy to help

[Parker]

Thank you all for the information and generous offers of help. I'll tell him about everything I learn and we'll go from there. Again, very much appreciated.

[ijusluvit]

Originally Posted by jane032657

Long Term Care should kick in when you need help with two of the activities of daily living. Dressing, Bathing, Mobility, Eating, Toileting. I am opening the new assisted living being built next to Lowe's called HarborChase of Villages Crossing. I have a lot of experience with Long Term Care policies. If you would like me to meet with your loved one and review their policy and make some phone calls for them, I am happy to do it. Sometimes long term care policies do allow for in home help instead of assisted living but you must qualify in terms of needing help in multiple functions of daily living. Maintenance and transportation and shopping are not included. You can email me at jbloom@hraonline.net
I am happy to help

This poster is correct about qualifying for LTC if impaired in two life activities. Further, if you get a doctor to attest to the two impairments in writing, that should be enough to secure coverage from the date of notification. Mental impairment is an automatic qualifier. If the client can't get a doctor's verification for the two physical limitations, I'd recommend the client agree to the simple mental tests used to assess limitations in that area. Surprisingly, many pretty normally functioning people actually have enough mental limitations to qualify. I know this sounds somewhat drastic, and perhaps scary for the client, but if this is the way to get the help they've paid for and need....

good luck!

[SusanOfWoodbury]

Parker,

I currently have a client whose long term insurance pays for help to come to the house. I go two days a week.
I write my notes so that the insurance company will pay, if this suits him.. Someone should contact his LT Co.

Notes need to say
Assisted client off chair and into bathroom
Assisted client onto toilet and off
Assisted the client with bathing
Assisted client with making there meals
Assisted client by providing a safe and secure enviorment

You may want to contact Senior Home Companions, located in the Villages. they have qualified home health workers that have passed all state requirements... The lady who runs this company also lives in the villages.

Hope this helps

[eachristy]

Has anyone used this service Senior Home Companions, Inc. and if so please reply with your experience thank you

[SusanOfWoodbury]

I am a CNA and work in the villages doing in home care. I have had many clients who have long term insurance..
Usually the client will need 2-5 adult living skills to be performed. For instance, the person needs help with bathing, dressing, food preparation, medication reminders.The persons needs assistance in performing these tasks.
Also the caregiver needs to be informed on how to write the notes... Example: Assisted the client off the chair and walked him to the bathroom. Assisted client in the bathroom, on and off toilet. Assisted client back to the chair.. Assisted the client in helping them get dressed. Prepared lunch for client and cleaned the kitchen.

But, the first thing that needs to be addressed in reading the policy and than asking the doctor to request home health care.

I would suggest you could contact SeniorHomeCompanions located in The Villages.. They can help with the insurance and providing help in the home..
Good luck

[Bill32]

these might help answer questions regarding Medicare/Medicaid/state benifits

Mid Fl. Sr. Service 352 326-3540

Elder Options 1 800 963-5337