Dad with dementia has been placed into a memory care facility. He does not need help eating or bathing. He was living with mom but does not know who she is, wanted to kick her out of the house, then started wandering around the neighborhood. He is paranoid, delusional, can no longer be contained at home. Mom is burnt after 1-2 years of this and if it were to go on much longer she will be in poor health. They have a "Cadillac" LTC policy they've been paying on for almost 20 years. Hoping they won't get scr*w*d.
My Dad could talk a good line,
I suggested to the person doing the evaluation...
take the recent electric bill and the check book. Ask my Dad to write a check to pay that bill.
Yeah, my Dad got really mad and yelling...trying to cover up his deficency.... he could not do it. And it really showed the insurance guy the real truth.
Talk is far too easy.
The insurance company will send you the applications. They should also have a help line for you to call with questions.
The biggest issue was that I needed to demonstrate that they could not perform 5 specific tasks..could walk alone, couldn't feed themselves, couldn't shower by themselves, couldn't dress themselves, couldn't toilet by them selves. I was in distress about that...because they were not totally bed ridden.
Then, the family lawyer told me that dementia trumps all that. Dementia is the sole diagnosis required to invoke the insurance!!
So...get that from the doctors.p to include in the application package.
Then...re-read everything in that policy. Every single detail is exactly what and how that policy will pay. Get to know it every well.
That elimination period is the actual days you self pay. So..it doesn't start till he is in the AL. And will exclude any days he is out "visiting" at home.
For instance - my parents made certain choices about their coverage that were designed to keep the premium reasonable.
First there was what I called "the deductible". It stated that my parents had to pay 24 weeks of care themselves before the policy would kick in. It was weird because what qualified was even just once a week and over an indefinite period of time. However - we started right away with conservative weeks and 3-5x a week but - this was in-home care at first, which had to be provided by a licensed agency.
Then the policy paid a daily amount but a different one for inHome care, AL and Nh. For us, as we graduated to a higher care the transition of payment went smooth enough. As to how we were paid - in my dads case we paid and they sent us a check - in my moms case they paid directly to the agency or facility. My parents had identical policies so I don't know why the difference.
Both parents had to met a criteria for the policy to start based on about seven different ADL's of which they had to not be able to met at least three. There was a cognitive criteria that if met, the other ADL criterias didn't matter.
As far as the company being easy to deal with - I really have no complaints although it did take around four months for them to activate my moms policy - but in the end it was worth it - they did a lot of research and actually went back and retro paid us for over a year. I had not asked for that so it was a pleasant surprise.
The last thing I can think of is that paying premiums stops when the policy activates.
That's it off the top of my head - let me know if you have specific questions.
I'm sorry your family is going through this, but it sounds like memory care is the best option for both of your parents. We have an article on how to use a LTCI policy that I think could be of assistance:
Long-Term Care Insurance: How To Use a Policy and File a Claim
https://www.agingcare.com/articles/how-to-use-a-long-term-care-insurance-policy-198336.htm
Another point worth noting is that some service providers accept "assignment of benefits" aka direct payments from the insurance company (making things much easier on you and Mom). Providers that do not accept assignment require you to pay up front and then handle being reimbursed by the insurance company. Since your dad is already in the facility, this is definitely something to inquire about as you move forward in this process.
I'm sure other members will come along and share their personal experiences. Hang in there!
-AgingCareEditor
Not trying to worry you but just telling you to be very very careful. You may need legal help to sort this.