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VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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My experience has been that most long-term care insurance policies were purchased 10 to 15 years ago with benefits of $100/day with no inflation rider. Most are limited in duration by either the bucket of money approach or by a stipulated benefit period.
What most don't know or recognize is that it is possible to receive public benefits (Medicaid and/or VA) while simultaneously making claim on an LTC insurance policy (depending on expenses and assets).
For instance, I presently have a Florida client living with her spouse in Independent Living. She has a policy that pays $150/day for Home Health Care; not enough to cover the 24 hour cares she requires. The family does NOT want to place her in Assisted Living or a Nursing Home. The policy and the couple's income are not enough to provide the needed care and cover room and board.
She has less than $2,000 and her spouse has less than $123,600 in countable assets. Her income is under the $2,250 per month Medicaid eligibility limit (her spouse's income is higher but in Florida there is no income limit for the Community Spouse).
We applied for and she is receiving Medicaid Home and Community based services which is providing 40 hours of personal home care per week.
The husband is a wartime veteran who does not require care. Still, because of the couple's high unreimbursed medical expenses, He will qualify for a VA Improved Pension Basic award of $1,097 per month.
This combination of all three benefits, plus the couple's income and a small amount from savings is supporting the couple's needs.
I just thought I would give you and others, an example of how long my mom's LTC with Genworth lasted. (and how much was paid out of pocket)
It was a $150,000 policy with max of $100 per day. Dad paid all of the first 90days of home care. ($16,000) Genworth paid the next 3 yrs of home care at $80/day ($2400 of a $7400/mo fee) Genworth paid the next 3 yrs of Memory Care at $60/day ($1800/mo of a $5000/mo fee)
These policies are not for the poor! It definitely helped, but had she not had a good retirement plan, she would have been better to use up all of her funds & end up on Medicaid. (which is what will probably happen now)
Mom has Vascular Dementia and has not declined or had any further strokes/TIAs, in the last 4 years. At 83yrs, with a history of 3 strokes and many TIAs, she is amazing us all.
I agree with everyone's advice so far. The LTC policy can be a godsend depending on the policy and care level needed. I do feel you should call the insurance company and have them explain exactly what the policy covers and under what circumstances. For instance: Does it cover home health care or would your mom have to live in a facility? Can you just get a CNA to come in to help out a few hours per wk or does the policy require some sort of medical person like a nurse or therapist to see her once a week? For how long do you have to pay out-of-pocket before it kicks in? What would cause the insurer to discontinue payments? What do you need to do to activate the policy, and then what?
Please note that due to privacy laws they may not be willing to divulge any info to you unless you have POA for your mom &/or you submit a document (which they can provide to you) on which your mother gives them formal permission to release info to you. You should submit a separate one of these for each person who might need to act on her behalf. Send in these forms NOW while she is hopefully still able to sign them even if you don't activate her policy just yet. It will make things easier for you later on.
Good luck to to you and your mom.
Also, some policies are like a clock, once a claim is triggered they continue until the time's up. So if she has a 2-yr policy but she only needs to use it for a short time it might be best to wait until she needs it for a longer period.
You have been given some spot-on advice from others.
The only things I’d like to add is that should the day come that your mom needs to go into a LTC facility - like a NH or MC - you do need to clearly ask IF the place will accept your mom’s LTC insurance policy as payor on her bill. Like Shady Acres NH does NOT have to accept your mom’s Genworth policy she’s been paying on last 20 years. My mom’s NH did not take any LTC insurance and had a large sign as to that in the lobby, admissions and billing offices. The NH ( small chain) was private pay, MediCARE or Medicaid only. My mom was a “dual” (on MediCARE & Medicaid) and one day I was in billing office adding $ to my mom’s personal needs account I ask why the no LTC insurance. The billing guy told me that it wasn’t worth their time to deal with the myriad of requirements from the various LTC policies..... every insurer had their own forms and requirements as to data needed (like how many hours of RN, CNA, LPN, etc) in order for a bill to get paid and there just was always, always, always something to delay payment. That the older policies from last millennium tended to require actual RN doing 1-on-1 care, so they wouldn’t meet the staffing requirements for the policy, yada yada. That it was more efficient & financially better to take a M&M resident as payment was assured and payed timely and he knew to the penny what my mom’s account was getting paid.
Yeah read that again, it was better financial decision to take Medicaid resident rather than one private pay with a LTC insurance policy. I have no idea if this is a trend but if so, a lot of folks will find that their LTC policy means it can only work IF they stay in their home and get assistance with Home Health companies that take their specific insurer.
As others posted be sure to carefully read what the required self pay period is BEFORE the policy activated. Especially look to see IF a post hospitalization rehab period (Medicare paid) does or does NOT count in the selfpay period.
In our case w LTC yes they fill a plan of care w license #. But. I am given the bill as well as them faxing to LTC & I pay the bill & our LTC reimburses me which is no more per day than contract w LTC & each pmt to me is deducted from contract total.
Please read policy repeatedly and then talk to their case worker more than once. We thought we had a good plan but discovered we were still mistaken on couple things. Those policies are complicated. On ours, Mother had to live in the facility and pay herself for 6 months before policy paid.
Same with ours my mom is panicked over running out of money, before 6 months. Even at that afterwards it pays $80/day but that’s for life. She doesn’t want to be in facility so we’re researching home health options.
I am going through the same decision process right now for my dad. I am leaning heavily toward using the funds from the LTC now, as there is no cash value should my dad pass away before using up those funds.
However, before you can make that decision, you really do need to have a clear understanding of the details of your mom’s policy. For example, my dad’s policy states it pays for two years, but, when closely asked, they told me that the 2-year period assumes maximum payout per day and actually pays until the full dollar amount of his benefit is exhausted. In most cases, in order to activate a claim, the beneficiary must be diagnosed as requiring at least 2 of the 6 ADLs (Activities of Daily Living) AND the policy issuer will send their own HHC rep to assess. (Warning: They don’t always agree on the stated level of need and can deny the claim.) Also, and I’ve heard this from just about everyone with regard to LTC plans, the plans have specific requirements as to who can provide the HHC services; they may or may not have a list of “in network” agencies, and/or they may allow non-agency aides, but most require those aides to be licensed, whether working through an HHC agency or independently.
Some like my moms have a “elimination period” that is like 180 days private pay, only THEN does a claim begin any payment. So 6 months of private pay can wipe parent out before insurance pays an 80$ a day. Many AL are much higher than that.
Honestly, it depends on the policy and how it is written. Does it cover both home care and residential placement? What is the waiting period? Is the coverage length limited by time (will cover for two years) or by total money to be paid?
We found when activating a long term care policy that there were many aspects of it that the person who bought it was unaware of. You need someone to review the policy with you to decide how best to use it.
We also found that in the county our elders lived, the Council on Aging offered a certain number of home care hours without fee. Contact your local Aging department and see what resources are available to you.
This is true in our case as we bought so board & care homes could be used & any person we hired (no relatives) could be hired at our home for his care. Also it states can’t do 2 things OR cognitive impairment. He as Alzheimer so cognitive impairment qualified him but had elimination period then good to go no more premiums. Ours says 6 yrs at $120 day which doesn’t mean only 6 yrs but total Amy. If we use $60 day we’d have 12 yrs. I hired caregiver for 4 hrs & 2 hrs times what I paid them, filled out the hourly form & days required by LTC then they reimbursed me & subtracted that amount from the contract total. I say use it so you the caregiver arn’t one of the 70% of caregiver that die or get sick before one caring for. I’ve seen it happen. Stress we don’t think we have but our kids notice it so listen &get in a support group.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
What most don't know or recognize is that it is possible to receive public benefits (Medicaid and/or VA) while simultaneously making claim on an LTC insurance policy (depending on expenses and assets).
For instance, I presently have a Florida client living with her spouse in Independent Living. She has a policy that pays $150/day for Home Health Care; not enough to cover the 24 hour cares she requires. The family does NOT want to place her in Assisted Living or a Nursing Home. The policy and the couple's income are not enough to provide the needed care and cover room and board.
She has less than $2,000 and her spouse has less than $123,600 in countable assets. Her income is under the $2,250 per month Medicaid eligibility limit (her spouse's income is higher but in Florida there is no income limit for the Community Spouse).
We applied for and she is receiving Medicaid Home and Community based services which is providing 40 hours of personal home care per week.
The husband is a wartime veteran who does not require care. Still, because of the couple's high unreimbursed medical expenses, He will qualify for a VA Improved Pension Basic award of $1,097 per month.
This combination of all three benefits, plus the couple's income and a small amount from savings is supporting the couple's needs.
It was a $150,000 policy with max of $100 per day.
Dad paid all of the first 90days of home care. ($16,000)
Genworth paid the next 3 yrs of home care at $80/day ($2400 of a $7400/mo fee)
Genworth paid the next 3 yrs of Memory Care at $60/day ($1800/mo of a $5000/mo fee)
These policies are not for the poor! It definitely helped, but had she not had a good retirement plan, she would have been better to use up all of her funds & end up on Medicaid. (which is what will probably happen now)
Mom has Vascular Dementia and has not declined or had any further strokes/TIAs, in the last 4 years. At 83yrs, with a history of 3 strokes and many TIAs, she is amazing us all.
Please note that due to privacy laws they may not be willing to divulge any info to you unless you have POA for your mom &/or you submit a document (which they can provide to you) on which your mother gives them formal permission to release info to you. You should submit a separate one of these for each person who might need to act on her behalf. Send in these forms NOW while she is hopefully still able to sign them even if you don't activate her policy just yet. It will make things easier for you later on.
Good luck to to you and your mom.
Also, some policies are like a clock, once a claim is triggered they continue until the time's up. So if she has a 2-yr policy but she only needs to use it for a short time it might be best to wait until she needs it for a longer period.
The only things I’d like to add is that should the day come that your mom needs to go into a LTC facility - like a NH or MC - you do need to clearly ask IF the place will accept your mom’s LTC insurance policy as payor on her bill. Like Shady Acres NH does NOT have to accept your mom’s Genworth policy she’s been paying on last 20 years. My mom’s NH did not take any LTC insurance and had a large sign as to that in the lobby, admissions and billing offices. The NH ( small chain) was private pay, MediCARE or Medicaid only.
My mom was a “dual” (on MediCARE & Medicaid) and one day I was in billing office adding $ to my mom’s personal needs account I ask why the no LTC insurance. The billing guy told me that it wasn’t worth their time to deal with the myriad of requirements from the various LTC policies..... every insurer had their own forms and requirements as to data needed (like how many hours of RN, CNA, LPN, etc) in order for a bill to get paid and there just was always, always, always something to delay payment. That the older policies from last millennium tended to require actual RN doing 1-on-1 care, so they wouldn’t meet the staffing requirements for the policy, yada yada. That it was more efficient & financially better to take a M&M resident as payment was assured and payed timely and he knew to the penny what my mom’s account was getting paid.
Yeah read that again, it was better financial decision to take Medicaid resident rather than one private pay with a LTC insurance policy. I have no idea if this is a trend but if so, a lot of folks will find that their LTC policy means it can only work IF they stay in their home and get assistance with Home Health companies that take their specific insurer.
As others posted be sure to carefully read what the required self pay period is BEFORE the policy activated. Especially look to see IF a post hospitalization rehab period (Medicare paid) does or does NOT count in the selfpay period.
DaddysgirlinTX's answer is also very good advice. You can always call the provider of her Long Term Care policy and ask questions.
However, before you can make that decision, you really do need to have a clear understanding of the details of your mom’s policy. For example, my dad’s policy states it pays for two years, but, when closely asked, they told me that the 2-year period assumes maximum payout per day and actually pays until the full dollar amount of his benefit is exhausted. In most cases, in order to activate a claim, the beneficiary must be diagnosed as requiring at least 2 of the 6 ADLs (Activities of Daily Living) AND the policy issuer will send their own HHC rep to assess. (Warning: They don’t always agree on the stated level of need and can deny the claim.) Also, and I’ve heard this from just about everyone with regard to LTC plans, the plans have specific requirements as to who can provide the HHC services; they may or may not have a list of “in network” agencies, and/or they may allow non-agency aides, but most require those aides to be licensed, whether working through an HHC agency or independently.
I hope this helps. Please keep us posted! :>)
We found when activating a long term care policy that there were many aspects of it that the person who bought it was unaware of. You need someone to review the policy with you to decide how best to use it.
We also found that in the county our elders lived, the Council on Aging offered a certain number of home care hours without fee. Contact your local Aging department and see what resources are available to you.