By Patti Haddick, Director of Home Services – The wave of the future for many has come to include Long-Term Care (LTC) Insurance. Even in the recent past there are forward thinking people who have, over the years, paid into LTC insurance policies. They are now able to reap the benefits of these policies and St. John’s Home Services can help. To tap into these benefits the policy holder must meet two requirements: Eligibility Requirements and the Deductible Period.
Eligibility means that the policyholder must need assistance with a required number of Activities of Daily Living (ADL’s) or have cognitive impairment. Assistance with ADL’s means help with bathing, dressing, grooming, toileting, feeding, walking or transferring. Housework, laundry, and cooking are not ADL’s but can be part of the care plan as long as the policyholder also meets the ADL requirement.
The Deductible Period, which can vary from policy to policy, is marked in time not a dollar amount. Most insurance companies have you choose a 30, 60, or 90 day deductible at the time you purchase the policy. Usually the higher the number of days for the deductible, the lower the cost of the policy. During this deductible period you would be responsible for paying the Home Services bill. One caveat is that the Deductible Period is days of service not consecutive days. This means that if you have a 30 day deductible period and you use home services two days per week it will take 15 weeks to meet that deductible and then the LTC insurance should start covering.
Be aware that most policies also have a dollar limit as to how much they will cover per day. If the policy specifies coverage of $150 per day, then you would be responsible for any cost over that for home services.
All these specifications can look daunting to a senior or their family member who is trying to arrange for home care, usually during a time of crisis and stress. That is where St. John’s Home Services Care Coordinators can be of assistance. As a Home Services provider we have worked with a number of insurance companies to provide non-medical home care covered by LTC insurance plans.
LTC insurance usually requires that the provider be licensed, as St. John’s is through IL Department of Public Health, and have a Plan of Care. Our Care Coordinators visit a client before we start services and design a Plan of Care specific to that client’s needs and wants. LTC will ask for daily notes of the ADL’s with which the Caregivers are providing assistance. This can be documented on a form provided by the insurance company but many have accepted St. John’s Caregiver’s Daily Progress Notes which are written for each and every client we serve.
Sometimes there is a set number of days for which care can be provided and then the client will be reevaluated to see if they still meet the ADL assistance requirement. This will then determine whether the client is eligible for continued payment through the LTC Insurance.
All of these stipulations can be very confusing, especially in times of crisis, so let St. John’s Care Coordinators walk you through the steps. If you currently have a LTC insurance policy and would like to access its benefits, please call St. John’s Home Services at 344-5008. We would be happy to help you navigate the maze of Long-Term Care Insurance.