My mother is suffering from advanced dementia and we are ready to activate her long-term care policy. We prefer to go through an independent care coordinator since we have a great home health aide who is not currently working for an agency. How do you search and find the right care coordinator and are they usually independent professionals? I have done some searches but cannot find any answers. If anyone has any input in this it is greatly appreciated.
In order for the LTC policy to pay, you as DPOA for mom the policy owner, have to make sure that mom has been assessed to qualify for & meet the type of care covered (like cannot do 4 out of 6 ADLs) and has done whatever self-pay waiting period (could be 60/90/120 days) and the caregiver meets the criteria for a "care professional" under the terms of the policy. This last one is sticky as policy may require a RN or LPN or CNA or whatever was viewed as appropriate care professional at the time the policy was done years & years or even decades ago.
I'd suggest you very clearly & carefully FIRST go through the policy to see what the caregiver needs to be for policy to pay and what the policy will pay for. Unless you are fluent in health care speak (like understand ICD) id suggest you go with an agency for a care provider. And speak with an agency as to staff they have that can fit the requirements of the policy. And what the cost will be to you for those additional hours needed that are outside of whatever the LTC will pay. Like LTC pays for 18 hrs of a licensed CNA but you need 5 days a week so your paying for an additional 12 hrs a week.
As an aside in this, my moms NH would NOT take any LTC policies. This due to just what Ginach posted. The NH billing office told me that since each insurer has policies unique that there was always always ALWAYS something else needed to process a claim and send payment. Like insurer wanted certification, professional education info, etc on caregivers; how time sheets done varied; ditto for the assessment done both initially and for recertification. Basically a series of hurdles to get paid. Flat not worth the NH to take as they could just as easily fill beds with Medicare, Medicaid (& get paid in real time) or private pay.
Oh also the start date of the waiting period (for policy to pay) is critical. If there's a hospitalization the day 1 of admission usually can start the count down. But for those living still on their own it may not be as easy of a fixed date to determine. If it is that mom needs MD orders for care and she gets that order this week then court down starts then. Yeah, even though she has been having caregivers for months prior. You really really need to get your documents to fit the slot required by the LTC insurer. The bigger ones, like Genworth (which is industry leader & very solid company), have existing documents that you or the agency fills out & will be tailored for the different type of policies. They have to be done just right for policy to pay.
I'd look at policy first & foremost.
You can and should do background check on people. In some cases they will pay and in some cases you might pay. It's about $85. Do lots of exploration into the path of anyone you might hire.
Make sure you have clear direct non-politically correct understanding of what you want and what you will do. Like - allow no cell phone use while caring for the person, arrive 5 minutes early so you are ready to go to work at the time we agreed not arrive just in a nick of time. Be clear on duties for the day and have written list ..... you get the point. Clear specific communications so you don't loose a good workers over miscommunications.
Check with the insurance company as sometimes they require the person to be a CNA or they won't pay. Sometimes the insurance company requires you hire through a agency. However often there is a clause in the contract that you don't have to use an agency or follow the rules IF there are special reason. That can be helpful.
If you are not in a support group I encourage you to join one because the people there know lots to help you and you may well be able to help educate them.
Hope these ideas help you.