So your parents have smartly paid long-term care insurance premiums of a few hundred dollars a month for 15 years. Now they need help in their house and are ready to file a claim and reap the financial payback of their prudent planning.
The average cost of a home health aide in a retiree’s home was $24 an hour last year, and most providers have a minimum requirement of six hours a day. It’s more if two people are in the home, even if only one needs care. So it’s great to have the long-term care insurance reimbursement covering a sudden and ongoing expense.
But whether planning for yourself or your parents, there is a lot to learn about getting help in place and filing a claim to get reimbursement checks arriving in the mailbox. Here are some tips, warnings and suggestions for communicating with insurance companies, caregivers, doctors and retirees.
How To Get Long-Term Care In Place
Care Must Be in Place Before a Claim Is Filed
Plan to have enough money to pay for up to two months of care before any reimbursements start. This doesn’t mean you have to start with five days a week. A client can start with just a half day a week and get the care approved by the insurance company, then move up to more.
Caregivers Must Be Licensed
Insurance companies won’t reimburse the cost of Aunt Lucille or Anna who lives next door to help take care of your dad while you are at work if they aren’t licensed. This is why you usually have to find someone from an agency, who carries their own insurance through their employer.
There Are Minimum Hour Requirements to Fill
Many home health care companies have a minimum of at least four to six hours a day. A client may need help with bathing, dressing and going to the bathroom, all of which don’t take six hours. This takes some getting used to for clients, who may feel awkward having someone else in the house who doesn’t have a task.
As the client and caregiver get to know each other, the client will be open to more help. Laundry, grocery shopping and meal prep can be added to the “to-do” list. Many seniors develop different sleeping patterns, sleeping more during the day and less at night and creating a vicious cycle of fatigue. A caregiver can be at a client’s side reading, playing games on all cognitive levels or prompting storytelling so they are awake during the day and sleep better at night.
This is time well spent and worth the cost, especially when long-term care insurance pays for much of it.
Independent Living Usually Isn’t Covered
Even if someone moves to a facility that offers assisted living, most insurance companies won’t pay a dime. Say your parents moved there because they want to enjoy having meals prepared for them and the social activities of a long-term care facility. Long-term care insurance won’t cover services that are merely convenient, only those that are essential such as bathing, dressing and dispensing medications when a client can no longer do these on their own.
Start With a Doctor’s Referral
Most long-term insurers want to see a record of a doctor stating he or she believes the patient needs help from a caregiver.
Paula Werk, founder of HomeWerks Home Care in Raleigh, N.C. has found a doctor is often more persuasive with a senior than family members.
“Let the doctor be the bad guy. They can say they feel it’s safer for the patient to have some extra help,” she said. “Their opinion usually carries more weight and (is) less hurtful than coming from the children.”
Honesty is crucial in a medical evaluation. Once a client has care in place and files for reimbursement, the long-term care insurer will send a contracted nurse to evaluate the person and make sure they need the care they and their doctor are requesting.
“You need to have a talk with your parents (or whoever is filing the long-term insurance claim) and tell them this is not the time to be proud,” Werk said. “Even if they can just barely manage to do things on their own but it causes them pain or they are unsteady on their feet dressing or bathing, they need to tell the nurse they do need help.”
Advice for Couples When Only One Person Needs Care
Couples with varying abilities can get help if just one person needs more extensive care. In many situations a husband or wife is taking care of their spouse in terms of bathing, dressing, transporting, feeding and more. The spouse needing care still qualifies for long-term care reimbursement for a professional caregiver even if a spouse has been able to assist.
“Sometimes you have to convince one spouse that he or she is going to collapse or worse trying to take care of the other,” Werk said. “Having a caregiver come in will allow both of them to be in a better situation.”
Insurance companies will still cover that help even if a spouse or child is able to do it.
But be sure when filing invoices and daily care reports with the insurance company that only the name of the insured is on the documents. For example, it’s okay if the caregiver fixes a lunch both the husband and wife eat even if the wife isn’t the insured, because the majority of the work, such as bathing, dressing, toileting, etc. is for the husband.
Finding a New Normal with Caregiving
Keep trying aides until the match is a good one. If you secure help through an agency, ask to have a couple of different aides come each week, whether you need seven days of care or two. If the senior doesn’t really “click” with them after a few weeks, ask to try two different helpers.
Agencies want their clients and employees to be happy and should be glad to work with you to find the best match, Werk said. It’s also good to try to have at least two familiar caregivers in case one becomes sick or has to miss from time to time.
Long-term care insurers are fine with this. It’s the agency that gets approved for coverage, not the individual caregiver.
Katherine Snow Smith is a staff writer at Codetic.