May 22

Assisted Living


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  1. tom skinner

    My 90 year old mother in law has been paying Genworth for 30 years. The policy was written as a “Nursing Home Policy” as assisted living was not yet in existence. Genworth has agreed that she qualifies for nursing care but refused to accept any of the facilities we have proposed even though they have Florida assisted living licenses with “Limited Nursing Care” and 24 hour nursing coverage. They also refuse to provide us with a list of acceptable facilities so we must submit proposed facilities and then wait 30 days while they do their research and then refuse coverage. All this time we are paying out of pocket for assisted living. There are three facilities in our area that have “Skilled Nursing” but she does not require that level of care and would be out of place in that environment. Are there any other suggestions for finding a facility acceptable to Genworth or strategies to convince Genworth that these excellent Assisted Living Facilities meet the intent and definition of “Nursing Home”?

    1. Phyllis Shelton

      Saw your email that you received notice from Genworth that they WILL accept your mother’s claim at the facility where your mother is currently residing, after evaluating her and approving her as a dementia related exception. I’m so glad it worked out! Genworth added $1.2 billion in 2014 to its claim reserves and added $435 billion more in 2016 for the claims that last longer than 7 years. (Forbes, 11/30/16)

  2. Pam Calvert

    My dad bought a LTC policy about 20 years ago. He was in an assisted living facility in MO until April when he was hospitalized. The physician there refused to release my dad back to that facility stating he had been emotionally abused. I had 24 hours to move him. I live in TN and moved him her to an assisted living facility much like where he was in MO. Dad has to have assistance with five ADLs and medication delivery and the LTC say they will not pay for him to live where he is although all guidelines are being met except it is call an assisted living facility as was the one he moved out of. They are saying he has to go to a nursing home. Where he is is an assisted living facility but has four levels of care and he can age in place and be there until he passes. The policy holder is dug in and I need some guidance. I looked into a nursing home and it is over twice the cost and we can’t afford to pay it. It doesn’t seem fair that just because assisted living facilities weren’t around when he bought the policy that he will have to move. Is there help available? We truly are at the end of the money and we can’t find answers.

    1. Phyllis Shelton

      Hi Pam – I’m glad you found me. I think you could be running into state definitions of what an assisted living facility is. From your description, your dad does sound like nursing home level as assisted living facilities typically aren’t equipped to take care of that level of care. Another thing that could have happened is that your dad got worse after he was evaluated for his long-term care insurance benefits. Moving him to a different facility caused the insurance company to evaluate him again. This time they saw that he requires nursing home level of care, and they won’t approve him for care in an assisted living facility for his own safety. If the company was paying for “assisted living” in Missouri and not here, I don’t think assisted living facilities are excluded. It sounds like he needs to apply for Medicaid (TennCare in TN). The requirements are on my website at What Your State Lets You Keep. Basically, if he is not married, his resources must be spend down to $2,000, which it sounds like you are there. His income will go to the facility to pay for his care, except he is allowed to keep $50 a month for personal needs. If his income is higher than $2,205 a month, he has to set up a special income trust in order to qualify. I’m happy to explain all of this in more detail if you book a time with me in the FIRST column (Telephone 1) at this link.

  3. Katherine Peel

    I could use some help. My Great-Aunt wants to return home to Minnesota (currently in Michigan) and she is 80 years old. Her only remaining family there is her own age and not capable of helping, so living on her own is not a choice. She has a Long Term Care policy but they said they will not cover assisted living home in town because she only has 1 ADL she is unable to perform.

    How do I find her more flexible insurance? What are my options?

    1. Phyllis Shelton

      It is typical for LTC insurance policies to require help with at least two activities of daily living before paying benefits. Are you sure she isn’t failing two? They are bathing, dressing, transferring from bed to chair, toileting, continence and eating. Typically one would fail bathing and dressing first. If she only fails one, my guess is the second one is close behind. In the meantime, you might check to see if there are any bed and board homes, like foster homes, in the area that take care of 3 or 4 elderly people for a lower rate than an assisted living facility would charge. Does she have life insurance? If so, you could look into selling it for enough money to pay for assisted living privately until she qualifies for her long-term care insurance benefits. The website to check that out is http://www.lisa.org Another resource you might look into is http://www.aplaceformom.com This is a free service to help seniors find care solutions. Good luck – she is really lucky to have a niece like you who cares so much.

  4. Jess Fischer

    Great post.

  5. Mary Zrubek

    Dear Phyllis: Can you please help me. I live in Montana and am 70 years old. I am doing good now but would like to look into insurance assisted living or if ever need it nursing home insurance. My brother is currently in assisted living in CO and it is outrageous in cost. My father was in a nursing home for several years. Can you help me with what kind of insurance I should look in and perhaps suggestions for companies that are very good to look into? Thank you sincerely for any help suggestions you can offer me. Mary Zrubek

    1. Phyllis Shelton

      I will be happy to help you, Mary. Fortunately Montana is a little lower cost area than Colorado for LTC. I know my staff has already reached out to you to set a time for a consultation with me and I’m really looking forward to talking with you. Just email lawrence@gotltci.com if you haven’t already to work out a time.

  6. Brock Dezayas

    Assisted living as it exists today emerged in the 1990s as an eldercare alternative on the continuum of care for people, for whom independent living is not appropriate but who do not need the 24-hour medical care provided by a nursing home and are too young to live in a retirement home. Assisted living is a philosophy of care and services promoting independence and dignity.

    1. Phyllis Shelton

      That’s right Brock. Many people bought older long-term care insurance policies before assisted living facilities were introduced. Insurance carriers have been good to use the alternate plan of care provision found in most policies to pay for assisted living even when it wasn’t mentioned as a specific covered service.

      “Alternate plan of care” is intended to make a way contractually for a long-term care insurance carrier to pay outside the contract when it is cost-effective and makes sense medically for the patient. The policy language is very clear that the insurance company, the doctor and the family must agree on how this provision is used.

      A great way this provision has been used is to pay for new services that come along. As I mentioned, a great example is that it has been used often to pay for care in an assisted living facility from a policy that was sold to pay inpatient care only in a nursing home. Assisted living facilities (ALFs) are less expensive than nursing homes and patients generally are much happier in them because they don’t look anything like a nursing home. Without alternate plan of care, however, an insurance carrier could deny assisted living facility claims because an ALF isn’t mentioned as a covered service in the policy.

      So if assisted living coverage isn’t spelled out in the policy, look to see if there is an alternate plan of care provision and policyholders can ask the insurance company to pay for assisted living under that.

  7. Christine A.

    Does purchasing LTC insurance protect your assets, banking acct. etc. if you need to use assisted living or nursing home care?

    1. Phyllis Shelton

      The global answer Christine is yes but I have to qualify that with “it depends on the type of policy you buy”, and I will add two qualifiers for you to consider. First, you need to consider a long-term care Partnership policy which allows you to protect assets equal to the benefits paid out if you have to turn to Medicaid for help in the event the insurance isn’t enough. The premium is the same as for a non-Partnership policy so there is no downside to getting one. You do have to buy the appropriate inflation benefit for your age but you would want to do that anyway. You can learn more about Partnership policies by clicking here. That post will tell you the inflation requirements by age group and provide a link to a map that shows you the 40 states that are participating in the LTC Partnership. All of the states reciprocate on the asset protection except California. Second, you need to buy a meaningful benefit so you can make up the difference at claim time…otherwise a Partnership policy won’t help you. You can get some tips from “Your Customized Benefit Selection Process” but here is a quick formula: Look at the cost of care in your area, project it at 5% for 30 years, and choose a benefit that will pay the portion of that cost at that time. Do you want a plan that will pay half, 2/3, 80%? It’s most important to make sure your daily or monthly benefit pays the amount you want at claim time. How long it will pay is the secondary decision, especially if you buy a Partnership policy. If you need help going through this process and you don’t have a local professional who is knowledgeable in long-term care insurance, please complete the short questionnaire under the “Contact Us” tab. Oh yes, and a bonus answer to your question is that long-term care insurance also protects your assets if you need care at home, not just in a facility. Three-fourths of LTC happens at home and that’s really good news, isn’t it?

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