So your parents have wisely paid long-term care insurance premiums of a few hundred dollars a month for 15 years. Now they need help at home and are ready to file a claim and reap the financial rewards of their prudent planning.
The average cost of a home health aide in a retiree’s home was $ 24 per hour last year, and most providers have a minimum requirement of six hours a day. It is more if there are two people in the home, even if only one needs attention. So it’s great to have long-term care insurance reimbursement that covers a sudden and ongoing expense.
But whether you’re planning for yourself or your parents, there’s a lot to learn about getting help and filing a claim to get reimbursement checks in the mailbox. Here are some tips, warnings, and tips for communicating with insurance companies, caregivers, doctors, and retirees.
How to get long-term care instead
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 reimbursements begin. This does not mean that you should start with five days a week. A client can start with just half a day a week and get care approved by the insurance company, then move on to more.
Caregivers must be licensed
Insurance companies will not reimburse Aunt Lucille or Anna, who lives next door, to help care for your dad while you are at work if they are not licensed. This is why you generally have to find someone from an agency, who has their own insurance through their employer.
There are minimum requirements of hours to fill
Many home health care companies have a minimum of four to six hours a day. A client may need help bathing, dressing, and going to the bathroom, all of which do not take six hours. This requires clients to get used to this, who may feel uncomfortable having someone else in the house who does not 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 all be added to your “to do” list. Many older people develop different sleep patterns, sleep more during the day and less at night, and create a vicious cycle of fatigue. A caregiver can be by the client’s side by reading, playing games at all cognitive levels, or encouraging him to tell stories so that he is awake during the day and sleeps better at night.
This is time well spent and is well worth the cost, especially when long-term care insurance pays for much of it.
Independent living is generally not covered
Even if someone moves into a facility that offers assisted living, most insurance companies won’t pay a penny. Suppose your parents moved there because they want to enjoy the food preparation and social activities of a long-term care facility. Long-term care insurance will not cover services that are simply convenient, only those that are essential, such as bathing, dressing, and dispensing medications when a client can no longer do it on their own.
Start with a doctor’s referral
Most long-term insurers want to see a record from a doctor indicating that they believe the patient needs the help of a caregiver.
Paula Werk, founder of HomeWerks Home Care in Raleigh, North Carolina, found that a doctor is often more persuasive with an older person than with family members.
“Let the doctor be the bad guy. They can say that they feel it is safer for the patient to have extra help, ”he said. “Their opinion generally carries more weight and (is) less hurtful than that of children.”
Honesty is essential in a medical evaluation. Once a client has the care in place and requests reimbursement, the long-term care insurer will send a contract nurse to assess the person and make sure they need the care that they and their doctor request.
“You need to talk to your parents (or whoever is filing the long-term insurance claim) and tell them that this is not the time to be proud,” Werk said. “Even if they can barely do things on their own, but it causes them pain or they feel unsteady when dressing or bathing, they should tell the nurse that they do need help.”
Tips for Couples When Only One Person Needs Care
Couples with disabilities can get help if only one person needs more extensive care. In many situations, a husband or wife cares for their spouse in terms of bathing, dressing, transporting, feeding, and more. The spouse in need of care still qualifies for long-term care reimbursement for a professional caregiver, even if one spouse has been able to help.
“Sometimes you have to convince one spouse that you are going to break down or, worse, try to care for the other,” Werk said. “Having a caregiver will allow both of you to be in a better situation.”
Insurance companies will continue to cover that help even if a spouse or child can.
But make sure that when submitting bills and daily care reports with the insurance company, only the name of the insured is on the documents. For example, it is okay if the caregiver prepares a lunch for the husband and wife, even if the wife is not insured, because most of the work, such as bathing, dressing, going to the bathroom, etc., is for the husband.
Finding a new normal with care
Keep trying helpers until the combination is good. If you get help through an agency, ask for a couple of different assistants to come in each week, whether you need seven or two days of care. If the senior doesn’t really “fit in” with them after a few weeks, ask to try two different helpers.
Agencies want their clients and employees to be happy and should be happy to work with you to find the best match, Werk said. It’s also good to try to have at least two family caregivers in case one gets sick or has to be absent from time to time.
Long-term care insurers agree to this. It is the agency that gets approval for coverage, not the individual caregiver.
Katherine Snow Smith is a staff writer for The Penny Hoarder.