Health Insurance

Long-term care insurance (LTCI) policies are very different from most other kinds of insurance. As a result, even the foundational features of these policies require taking some time to understand before making your final decision. But what about all the other options and features that are not built into the policy and require you to pay extra to get them? In my opinion, LTCI policies are best kept simple. If you have already done researching on setting up the foundational features of the policy, you have already done 90% of the work in most cases. Remember that it is always a good idea to find out more about those other options once you feel that you can afford to spend more on your care, but you should also examine whether they are truly going to be cost-effective in your case. A good way to accomplish this is to narrow down your selection to the two to three carriers that you feel most comfortable with and get quotes on a straightforward policy setup with no extras or options added.

Next thing to do is to add on the choices that you are interested in one at a time and then get a new quote. This will tell you exactly how much extra you can expect to pay for these options. Once you have those figures it’s much easier to decide if the options you are considering are really worth pursuing further. Here is a list of some of the most popular options in LTCI or Long Term Care insurance policies:

1. Return of Premium - This option allows you to receive back some or all of the premiums that you pay into the policy if you either decide to cancel the policy or if you die without using all of your benefits. {This is often a very expensive option~Be careful as this option is very expensive}.

2. Survivorship - The benefits of this option can vary from carrier to carrier, but typically it says that if the policy premiums have been paid for a specified period of time, often ten years, and one spouse dies, the surviving spouse’s policy is considered paid up with no further premiums required.

3. Restoration of Benefits - This provision restores all of the benefits paid out for care if a policyholder fully recovers and does not suffer a relapse for a specified period of time (usually six months).

4. Waiver of Home Health Care Elimination Period - This option reduces the elimination period (the amount of days that you pay for your own care before the insurance company starts to pay) to zero. This only means that it starts to pay from the very first day of services made if the care is recieved at home. There are other options that can be considered when shopping for LTCI too, but in my own experience, the most common problem is getting bogged down in these extra features that do not really impact the quality of your future care nearly as much as the foundational features.

This is one reason why getting an experienced and knowledgable agent help you with the process can often reduce much of the confusion surrounding these options so that you can select the policy and features that suit you best.

Private insurance companies sell LTCI policies to offset the costs of long-term care. LTCI, like all insurance policies, requires premiums to help recipients avoid paying large sums later on in the event of an illness or a catastrophic event. Premiums are based on the individual’s age at the time of purchase and are usually locked in for the life of the policy. LTCI covers the following, depending on the policy you choose:

Care in a skilled nursing facility

Care in an assisted living facility

Home health care

Adult day care

Buying a LTCI policy gives the policy holder to select from the many options, such as the amount of the daily benefit, the number of years the policy will pay benefits, and, once the applicant qualifies for a policy, the number of days or months before the policy will begin paying benefits. It is imperative to evaluate policies with scrutiny in order to see which one offers the benefits that you are looking for with a premium that fits your budget. Policies differ in their benefits, contract conditions, deductibles and premiums.

It is also a matter of great importance to take into account the rising expense of home care. Be sure the LTCI policy gives inflation protection for benefits to increase as health care costs continue to rise. Policies are generally labeled according to the place in which benefits are paid. Remember that home care only policies only pay for care at home and in an adult day care or adult day health care facilities. Make sure the policy includes both types of day care. Facility-only policies pay for care in a skilled nursing facility and in an assisted living facility. Comprehensive policies pay for care in a skilled nursing facility, assisted living facility, adult day care or adult day health care facility, and at home. Since the LTCI claims are always paid within many years after the purchase of the policy, it is imperative to check the following: Financial strength of the company. The industry’s major rating services are A.M. Best , Duff and Phelps, Moody’s, Standard and Poor’s and Weiss Ratings . Reputation and claims-paying history of the company.

You can contact the State Insurance Department for more information on specific private insurance companies. Click here for listings information for each state’s insurance information. Applicant must be healthy at the time of application Each insurance company has individual requirements and/or limitations Not sure when is the right time to buy an LTCI policy? Or how to assess what you will need from a policy? Visit our Expert Column on Financing Long Term Care to find out more.

It’s always pleasing to highlight good news! Recently, the legislature in New Jersey recently passed a new law that will offer seniors on Medicaid more long-term care options. By 2008, senior citizens living in New Jersey will have a choice in the type of long-term care they receive through Medicaid, under a law by Governor Jon S. Corzine. The law provides “an extraordinary change in direction and policy in a way that makes sure our seniors have a choice,” said Corzine at a recent AARP summit on long-term care. Currently, New Jersey spends $1.68 billion of its Medicaid long-term care budget on nursing home care, which is compared with $162 million on community based care, like assisted living facilities, home health care and adult day care. That means a lot of money will be going to skilled nursing facilities. The law will now help bridge the gap between money going to nursing homes versus money going to people in the community. “Rather than requiring that nursing homes be the first stop, now nursing homes will be the appropriate stop, if necessary,” said Dr. Fred Jacobs, state health commissioner for New Jersey.

Skilled nursing facilities are the right choice for many seniors who require this type of specialized care, however, seniors should never be placed in a nursing home simply because there are no other options. On a personal level, the law provides for appropriate changes in a person’s home including the installation of bathroom handrails and other safety features. Home health aides and even respite care are now under the Medicaid umbrella of covered services. There are already so many choices to make regarding long-term care, and the passing of this law will give you better and smarter choices that will suit your needs! Most funding for adult day services comes from city government agencies, participant fees and charitable sources.

Try downloading the Private-hire Home Cargiver Application to help you outline work experience, education and references along with so much more. Employers can use this tool for assessing and comparing private-hire caregiver candidates.

Hospice services are available twenty-four hours a day, seven days a week. There is always a nurse on call at night and on weekends. The nurse will then visit a patient as often and as long as necessary to make sure that there is quality care. Because of this wonderful service, many people are under the impression that hospice care is expensive, and yet they believe that they cannot afford such a treatment. However Medicare, Medicaid and private insurance companies cover hospice care and services. This will include, but is not limited to, medications, nursing care, home health aides, social services and medical supplies. In 1983, Congress established the Medicare Hospice Benefit, covered under Medicare Part A, to ensure that all beneficiaries could receive high-quality end-of-life senior care. In order to receive the Medicare Hospice Benefit, the patient must meet three key criteria.

First, the patient’s doctor must certify, within his or her best clinical judegement, that the patient should be terminally ill with a life expectancy of six months or less. If the patient lives longer than six months, he or she can continue to receive hospice care as long as the doctor re-certifies that the patient is terminal and with declining health. The second key criterion is that the patient is willing to receive comfort care instead of curative treatments for their illness. For example, a patient could not be getting chemotherapy to cure their illness and be getting hospice care simultaneously. Hospice is intended to be used once a curative treatment is no longer a choice. Finally, the patient needs to enroll in a Medicare-approved hospice program. This should be one of the first questions you ask in determining which hospice agency to use. More than 90% of hospices in the United States are certified by Medicare.

Congregate care is the same as to independent living. Residents of congregate care live independently, for the most part. This type of housing environment is usually offered at least one communal meal per day, and it’s common for services and activities to be offered to residents. Independent living, on the other hand, typically offers only living quarters and limited services.

Based on an evolutionart standpoint, our bodies are made for short bursts of stress, just like running from a dangerous situations, like a forest fire. But today’s world is one of constant low-level stress. For most caregivers, high amounts of stress levels are continual. And frankly, the human body isn’t made to withstand such constant wear and tear. Therefore,most family caregivers cannot put aside strong feelings that is associated with caregiving, which can run the gamut from devotion to guilt, to see the importance of avoiding the problem of caregiver burnout.

I cannot stress this enough: as a senior care caregiver, you are only as good as the care you can provide. Oftentimes this is based on factors outside your control. You will get tired. You will get frustrated. You will need help. You’re allowed to have these thoughts and feelings. So how do you know when passing frustration has fizzled into a burnout situation? Well, early signs are similar to depression in that assisted care caregivers can vacillate between anger, anxiety, sadness and irritability. Feelings of exhaustion, both physically and emotionally, along with changes in weight are also hallmarks. Keep in mind that a depressed mind can make for a depressed immune system; getting sick often could be another warning sign. Additionally, perhaps the greatest irony of care giving is that the caregiver’s health concerns are often not looked into, because the caregiver isn’t the one who is “sick” or “needs help”.

Many family caregivers are reluctant to “take up time” for their own doctor visits. If these symptoms starts to grow more frequently or intensely, then it is time to seek help. Again and again I urge caregivers to make certain they are taking care of themselves, because even though it is good to place someone else needs above yours, it is not always feasible or right. In parent-child relationships, the adult children will often feel that they must look after the parent, in order to return the favor of having raised by their parents, even they are unqualified or ill-equipped to do so. These are all honorable ideas, however, reality is that care giving situations;just like raising a child;requires a village. If you want to provide good long-term care then you need to get hooked in with family, friends and outside resources. You can be the primary caregiver and still not be there every minute of the day. Spread out responsibilities.

On the Gilbert Guide web site alone, we offer dozens of solutions and ideas to help family caregivers, including coping strategies, online resources, and information on topics such as Alzheimer’s and dementia care, and how to effectively advocate as a caregiver. There are also support groups that provide family caregivers a place where they can discuss their feelings openly, can help monitor the effectiveness of coping strategies, and let caregivers know they are not alone. But one of the simplest solutions to avoiding caregiver burnout is this; keep your sense of humor and look for the small joys that can come your way throughout the day.

Here at Gilbert Guide, we are constantly urging family caregivers to seek respite so that when they are “on-duty” they can provide the best home health care to their loved one. One of the toughest jobs we can think of is taking care of an aging loved one, which is why each of our Guides has sections on Caregiver Support, Counseling and Support Groups and Crisis Lines. But just like what one of our readers recently pointed out, what resources are available for the professional caregiver, especially those who provide live-in senior care and assume a huge amount of responsibility? The reader also asked if there was forum in which to discuss wages and other issues in regard to providing professional home health care. Her opinions have brought up a point which was recently talked on Medical News Today that reports for caregivers are some of the lowest in the country. And how this fact coupled with the aging population of baby boomers could spell trouble for the industry if it is unable to keep up the supply with the demand.

To be honest, we are not so sure as to how to help her out, so we would like you to weigh-in, please tell us if you know which of the organizations, including anything from advocacy to support groups, you have found useful. Have you had any luck with contacting the National Organization for Homecare and Hospice to see what they recommend? Which direction were you pointed in, and most importantly, do you feel like your opinions are being heard?

Board and care homes are residences for seniors who require some care or help with the activities of daily living (ADLs or IADLs). These are smaller scale assisted living facilities, usually having a resident capacity of no more than fourteen. Licensing requirements vary by state, some states require that board and care homes carry the same license as assisted living facilities

CCRCS are actually living communities for seniors. Most have three levels of residence: assisted living, independent living and skilled nursing. Each level of residence is tied to the level of care that the resident requires. The primary concept behind a CCRC is that it offers a wider spectrum of care,~The most primary concept behind a CCRC is that it gives a wider spectrum of care so that once a senior moves into the community, he or she will be able to receive the appropriate care as his or her needs change. Many CCRCs support aging in place. Searc Gilbert Guide’s CCRC listings along with more information about what CCRCs offer.

As a family caregiver, short-term hospitalization of a loved one can be a difficult situation whether he or she is living in a long-term care facility or at home. As the family caregiver, this change can be challenging at some points, especially as hospitalization normally points to an unstable medical condition or an acute condition. Here are a few pointers for how to negotiate the situation. The most important issue at this point is that you have most of the information about your loved one’s previous condition, so make sure that you share it.

Let the hospital staff know about any cognitive or physical impairments even if the information is already too obvious. For example, let the senior care assistants know that your loved one is unable to use an emergency call button at times due to arthritis or that he or she has a hard time following directions due to cognitive impairment, or even if she or he should not be given a cup of coffee even if they ask for it in the afternoon as they have dementia-related Sundowner’s syndrome. Remember to tell the hospital staff in regards to a person’s dietary considerations or preferences. Small things can mean the world when placed in an unfamiliar hospital environment. A small favor such as asking to keep meals free from red meat for a person who doesn’t like beef is one easy way to make sure that your loved one has some creature comforts. Keep notes and pay attention. Hospitals are there to relieve acute medical problems and {as such may overlook smaller background issues~because of this, it may overlook some of the smaller background issues}. However, it is your job to speak up in the event you feel your loved one is receiving improper care. {Try to get as many visitors in to see your loved one as possible~Try getting as many visitors in to see your loved one as possible}. Even short visits can raise a person’s spirits’ and provide a nice change or shift in a person’s focus.

Several Internet-based sites host free personal webpages specifically designed for caregivers so that they can post information with ease about their loved one who currently is hospitalized or in need of help. These pages allow concerned family members and friends to schedule visits, monitor progress and sign-up to help with any needed tasks. This ensures that a person can have several visitors over the course of a day rather than a bunch all at once.

Discharge is Just the Beginning.

Keep notes on medications and dosages for your loved one. If new medications appear on the discharge plan, make certain you understand what they’re for, dosage amounts and possible side effects. Check with the pharmacist to ensure there are no contraindications, especially with drugs already prescribed. Make certain the discharge plan has all prescriptions listed on it. Do not assume previous prescriptions have been replaced or taken off unless you have been told so in absolute terms by a medical professional. If your loved one now needs to move out from his or her home, then a list of possible long-term care facilities that meet your financial and medical, dietary and social requirements needs to be found. Discharge planners might make referrals, but make certain they are aware of all your specific needs. (And, of course, Gilbert Guide offers information on how to find and assess the care options in your area.) If you have time, visit facilities and rank them according to your needs. Gilbert Guide offers an explanation and handy checklist of issues for both skilled nursing and assisted living.

Hospitalization may result in changes to your loved one’s life. Anything that can preserve some sense of continuity will help with the transition. If you have had a doctor prescribed home, health aides before the hospitalization and they were well liked and give proper care, then please ask to keep them. If the same holds true for your homecare aides you should also voice your opinion on retaining them, if they can provide the level of care necessary. Try to learn as much as you can about your loved one’s condition if it has changed. The Internet is a helpful resource, however should be tempered with information and recommendations from your loved one’s physician. Make sure you understand all the ways in which you can provide the utmost in care for this new situation. Let’s say that your loved one needs therapy, find out what the goals of the therapy are and if there are any exercises with which you can assist. Throughout the course of your loved one’s hospitalization, remember that you are their voice. Do not be afraid to speak up and ask questions, as they may be unable or unwilling to do so. If you run into any problems you feel you cannot solve, most hospitals have an on-staff patient advocate that will be able to provide help.

When Should You Consider Buying Long-Term Care Insurance?

The short answer to this question is: the month before you need to make a claim! But since none of us have a crystal ball to tell us when we will be having a stroke or heart attack, or be diagnosed with a debilitating disease such as Parkinson’s, multiple sclerosis or Alzheimer’s, we simply can’t rely on waiting till the last minute to buy long-term care insurance. The basic truth is that anyone, regardless of age, can have an unexpected accident or a change in their health that they could not possibly have foreseen that wll require long term care. A couple of well-known examples of such a situation are Christopher Reeve and Michael J. Fox.

The problem nowadays is that most people think that long term care insurance is mainly for older folk. But that is simply not the case. In fact, almost 40% of those receiving long term care are younger than 65 years of age! This surprising statistic testifies to the unpredictability of such a need arising at almost any age. So, I suggest that the best age to purchase LTCI is at the earliest age that you:

1. Can comfortably afford the premium.

2. Have enough income and/or assets to protect that it justifies the cost of the policy.

one more reason for getting long-term care insurance earlier in life is that the premiums are much less and you will most likely easily qualify for coverage, perhaps even at a preferred rate that will save you considerable amounts of money throughout the life of the policy. The only problem is that as we age, most people stand a higher risk of developing health conditions that could cause them to become uninsurable at some point, or at least substantially drive up the cost of a good long-term care insurance policy. My recommendation is to avoid these problems by investing in LTCI at a relatively early age if you can. And since the cost of long-term care is not covered by medical health insurance, it only makes sense to protect your assets against one of the most devastating threats to your personal finances. Then, in most cases, the earlier you get coverage for long-term care, the better.

One rule that I always adhere is that I don’t discuss politics and religion unless I am with my close friends and relatives, it’s just too easy to cross the line from thought-provoking to offensive, especially for someone who’s as outspoken and opinionated as I am. After reading a recent article on President Bush’s 2.9 trillion spending plan for 2008, however, I felt that I need to break my rule. President Bush recently went before Congress, controlled by the Democratic Party for the first time in his presidency, and proposed a 2.9 trillion budget that will entirely cut down 70 billion in funding from Medicare and Medicaid over the next 5 years, while increasing military spending and without affecting first-term tax cuts. While the proposed time frame happens to be in line with Democratic goals, there seems to be some dissonance in terms of federal priorities. If you are in a higher income beneficiary you could expect to pay much higher long term care insurance premiums and more for drug coverage.

Another component of the plan, according to the New York Times: ” freezing Medicare payments to home health care agencies and reducing inflation allowance paid to hospitals, nursing homes and other providers. ” Considering Congress, bad response to be president’s proposal from last year which suggested smaller Medicare reductions, it’s unlikely this plan will be accepted as is. Whether you bat for the left or the right, though, there’s no denying that the rapid increase in the retirement-age population puts a lot of pressure on the federal budget. Remember that entitlement for the older Americans come from income taxes on people of working age. It takes five working Americans to support one senior citizen’s entitlements. How would, or should, the government respond if Social Security trustees have projected accurately, and by 2030 there are only three workers for every adult older than 65?

It is entirely possible for Medicare, Medicaid and Social Security to consume federal spending. Are there options that don’t involve spending cuts or tax increases? How and where should we conserve to avoid a fiscal crisis without stripping Americans of the care to which they’re entitled?

It is no longer surprising that with age, most seniors often experience increased limitations, the loss of certain abilities and require more assistance with the activities of daily living. It is equally unsurprising that one;s finances largely influence the types of services and long-term care available to that individual. An experienced financial planner for the elderly can provide the seniors and their families with invaluable advice on money issues and more, to help seniors find the appropriate solution to their particular situation. Some of the following questions a financial planner can address include: What type of long-term care can I afford? Will I outlive my assets? How much are all my assets worth? Can I make my assets create more income to meet growing expenses? What do I sell first? What are all my options? What is the cost of selling different assets? Do I have to sell my own house? Are there other financing alternatives? What impact will this have on my spouse and dependents? Is it too late to do any estate planning? What about inheritance issues?

Listening to Your Needs - Financial planners can assist you in understanding and evaluating your decisions, which will help you avoid confusion, frustration, major errors and family dissension. Financial decisions are more than just above money matters, I know from experience how difficult it is for everyone involved. Making major financial decisions can be even more daunting when you don;t have the detailed knowledge, time, experience or ability. What are the potential impacts and benefits of making o0ne decision over another? So what are the requirements to execute such decisions? Financial planning for senior care begins with acknowledging and considering all present and possible future situations you might encounter. This can be very difficult as it requires both forward thinking as well as transitional realism. By ” transitional realism, ” I mean being realistic about your changing needs, and the impact of those needs on your life as well as the lives of your loved ones. When evaluating your needs, a financial planner should consider:

Personal care, do you need assistance with activities of daily living? Services, what types of long-term care services do you require? Safety, are there specific concerns regarding safety? Transportation;are there physical or financial considerations? Priorities, what are your limitations and desires? Interpersonal relationships;how will financial decisions affect your loved ones? Following is a list that comprises the elements you should consider in identifying and evaluating your needs. You may want to think about these things before talking to a financial planner to ensure the time you spend in conversation is well spent. If you have questions about any of these elements, a financial planner who works with the elderly will be well versed in all of these issues and should be able to address any concerns. Financial needs Insurance coverage and limitations Income sources Expenses (present and future) Assets availability Real estate needs Human resources: home health care, personal and quality-of-life issues After you’ve identified your needs, think about the resources that you will need, and the ones that you already have at your disposal.

This can help you in developing a plan of action. Make a list of the following resources that you might need: Public resources, including prepared food services, community activities, religious and charitable assistance/support, etc.Private resources, including family members and/or homecare caregivers. Planning always make a huge difference in finding the best solutions. Knowing all of your needs and resources is paramount before making any major financial changes. Financial decisions generally should be holistic in nature, therefore recognizing that everyone, seniors and caregivers, all have different needs and resources, unique to their particular situation. Making financial decisions based only on your present situation, without full consideration of everything, can have disastrous results.