Apr 21, 2016 - 09:17 AM
It is challenging to give one broad answer since each long term care insurance (LTCi) policy is unique, so the answer is technically that “it depends.” However, there are some general rules from insurance carriers that FHS encounters when we help seniors use their LTCi policies for long-term care (mostly for home care, but we help people who move into Assisted Living Facilities also). Needing assistance with Activities of Daily Living, or “ADL’s” are the factors or “triggers” the insurance companies are looking for to determine your eligibility for home care. Usually the requirement is needing assistance with at least 2 of 6 ADL’s. The ADL’s are: bathing, eating, dressing, toileting, transferring, and continence management. Another factor that is typically approved by insurance companies is cognitive impairment (Alzheimer’s, dementia, etc.) If you or your loved one is suffering from a cognitive disease and you want to use ar LTCi policy to help pay for care, your insurance carrier will most likely require a Cognitive Impairment test or some other form of proof by a nurse or physician.