Five steps to help you avoid being
Trapped in a Long Term Care policy
The following article is not a criticism of any insurance company that offers a long term care policy. The insurance company is not identified because we believe that most long term care policies cover essentially the same services and benefits. My purpose is to warn those thinking of spending large sums of money on a long term care policy, that it would be wise to carefully evaluate the cost versus the potential benefits.
Here are five steps to follow to assure that you will not become trapped in a long term care insurance policy:
1. Read the entire policy and be certain that you understand it – before you buy it.
2. Carefully review the services offered in the policy.
3. Understand the qualifications for receiving services.
4. Evaluate the cost of the policy vs. the potential financial benefits.
5. Explore alternative solutions before putting all your eggs in the long term care insurance package.
By the time my wife, Jean, and I hit our seventies, we began to think about what we would do if we got sick or one of us became infirm somewhere along the way. No one wants to go into a nursing home, and our objective was to remain in our own home. With that objective in mind we explored the possibility of moving to a one-level home. But because of the costs of selling and moving, we decided to remodel our home to make it more livable and easier to get around in. We had to accept the fact that we were a couple of senior citizens who weren’t getting any younger.
Our first step was to redo some rather steep steps to the entrance to our home making it much easier to carry in groceries from our driveway. We even had all three of our toilets replaced with the higher, handicap, models (since both of us were finding it more and more difficult to stand up again once we were seated on the older models). Altogether we spent around $25,000 on home improvements – all designed to further our goal of staying in our home during our fast approaching old age.
Requesting a visit from a representative of a major insurance company offering long term care was our next step. Although the policy we finally selected would pay around $50 a day if either of us were confined to a nursing home, we were most interested in what was available in home services.
What really appealed to us was the highly intelligent approach used by the insurance representative who exuded concern for our well being. His major emphasis was that this policy was designed to help us stay in our home which, of course, was our primary goal. And, I do believe that he was sincere in his presentation of the various aspects of a long term care policy.
Following is an abbreviated list of the services covered by the policy we purchased:
a) Adult Day Care—social and health-related services provided during the day in a community group setting.
b) Chore services – simple household tasks.
c) Home Health Aide and Personal Care – helping manage activities of daily living.
d) Homemaker services such as preparing meals, doing laundry and other incidental household tasks.
e) Hospice Care to alleviate a person’s physical, emotional and spiritual discomforts during the last phases of life.
f) Respite Care provided to relieve an insured person’s primary informal (unpaid) caregiver.
Everything appeared to be what we were looking for, so we signed up for this long term care insurance. Premiums were $640 a quarter. I figure we have paid more than $25,000 into this policy during the past ten years.
I am 88 years old; my wife is 83. She is diabetic, has severe neuropathy, and wherever we go, she takes her cane. For me, while I still get around fairly well, I have a heart condition with recurring angina, which obviously restricts physical activity. The bottom line is that we believed that some kind of support was needed.
A call to the home office of the insurance company resulted in a fairly rapid response. We were at this time only seeking information on what services we might expect and how we should go about requesting them. We were almost immediately assigned a “claim number” and were told to use this number on all future contacts. Then came an evaluation session by a professional nurse. The purpose of this independent evaluation was to determine whether or not we qualified for any of the services listed in our policy.
A very nice, highly professional nurse from a nearby hospital came to our home to perform the evaluations on both Jean and me.
This nurse was hired by the insurance company as an independent contractor whose sole job was to give us an intensive interview, by way of a multi-page questionnaire, concerning our physical and mental status.
We were asked our birth date, what day of the week it was, the name of our current president, and how to spell “world” backwards.
The questioning then became a bit more personal. I was asked whether I needed help getting dressed, cutting up my food, or bathing. Was I incontinent and did I need help going to the toilet?
Somewhere along the line, the nurse named three objects: a book, an apple, a car (I think). A few minutes later she wanted me to name those objects. I could only remember one of them! It was sort of embarrassing. She asked Jean to start with the number 100 and subtract the number seven five times. Jean didn’t do so well. I wish she had asked me that question because I am real good at math.
To me the important questions pertained to my health, and this was fairly easy to report. I have experienced double bypass open heart surgery, removal of my lower intestine (colon cancer), a smashed nose and subsequent nose operations all the result of a fall, to name a few. I failed to mention that my left leg sometimes cramps up at night, the result of my having driven a golf cart into a tree.
Jean went through a similar evaluation of her current health status.
I was fairly confident that on the basis of the home evaluations that we would receive some help with such things as light housekeeping and perhaps some periodic assistance for handyman tasks such as installing handrails where needed, or changing light bulbs or smoke detector batteries. I used to do these chores by myself but Jean won’t let me stand up on a chair any more.
Several days passed before we received a call from a “claims adjuster” from the long term care insurance company. Bottom line: Neither Jean nor I qualified for any of the services.
Apparently one needs to be unable to perform in at least two of the basic activities of daily living. Did we need assistance bathing, dressing, eating or getting in or out of bed? Were we incontinent or did we need help in “toileting?” On the one hand I am eternally grateful that I can still get around and can take care of my basic personal needs. And, so can Jean. On the other hand, this totally shot us out of the saddle when it came to any kind of help from our long term care policy.
If I ever get into another situation like this one, I am going to exclaim that Franklin Delano Roosevelt is our President, and then I’ll pee my pants. In a way, I don’t fault the insurance company. I realize now that our understanding of “available services” is a bit different than the insurance company’s. It’s like that old insurance joke where the agent says, “I’m sorry, sir. Your car was covered by fire AND theft.”
I was told by the claims adjuster that I could appeal but I would need supporting data provided by our family doctor. The form for the doctor to fill out is an awesome document that would only verify what I had reported during the nurse’s evaluation. Nothing the doctor would report would have changed the “failure to qualify” decision.
My final words to the insurance representative was that a) I had no plans to ask my doctor to simply reiterate what I had already reported and b) I have a decision to make and that is whether or not to cancel the policy. I was immediately warned that at my age it would be impossible ever to get another long term care policy.
My thought is, at $640 a quarter, I can purchase a lot of local services. I am paid up for a couple of months, so this is not a decision I have to make today. To me, a long range care policy’s only value would be if either Jean or I are forced into a nursing home. As far as I am concerned, I am not going there. After all, I am a senior citizen, and I decide what I will do!
To anyone contemplating long term care insurance, decide before you buy why you really need or want it. And, above all, be sure you understand the details of your policy. Do this before you get trapped into a program that does not serve your needs.
One final note. In today’s mail Jean and I each received letters from our long term care insurance company letting us know that our claim request “has been completed” and our “claim file has been closed.” Each letter ended up thanking us for choosing this company for our long term care needs. I thought that was real nice of them.
