Over many years experience
helping clients with long-term care planning, I have found my time
increasingly dominated by efforts on behalf of people whose
pre-existing health issues make placement problematic. Individuals
with chronic conditions such as Multiple Sclerosis or Parkinson’s
face daunting prospects with respect to long-term care needs.
A frequent topic of discussion
in support groups is the difficulties of obtaining coverage for
long-term care. One of my clients recently told me that two members
of her support group were declined coverage for long-term care
insurance. And most of the others in the group simply assumed they
would not be eligible. It is important that people recognize that a
diagnosis of MS or Parkinson’s does not automatically disqualify one
for LTC coverage.
Most of the misunderstanding
surrounds a few basic questions.
What is long-term care?
Unlike other types of medical
procedures and treatments, long-term care is not primarily intended
to cure a medical condition. It focuses, instead, on helping a
person cope with a reduced level of functioning over an extended
period of time – sometimes indefinitely.
Generally, an individual in such
circumstances needs assistance with what are called “activities of
daily living,” i.e., bathing, continence, dressing, feeding,
toileting, and transferring.
Is age a factor?
Anyone of any age can require
long-term care or be declined for LTC coverage. But on average, with
conditions like MS or Parkinson’s, the earlier the diagnosis, the
better the odds of being issued a policy since the likelihood of
needing long-term care is greatest in the Golden Years. In fact,
it’s estimated that some 42 percent of Americans who reach age 70
can expect to require some type of long-term care during the
remainder of their lives.
Is long-term care always
provided in a nursing home setting?
No. Years ago, “long-term care”
was virtually synonymous with “nursing home care.” However, today
most long-term care is actually provided in the patient’s own home –
either by family or friends (called “informal caregivers”) pressed
into duty by the circumstances, or by paid, health care
professionals who visit to provide the needed services.
Long-term care is also delivered
in other settings, including “assisted living” or community-based
facilities such as adult day care centers. Only the most intensive
care is still delivered in skilled nursing homes.
Doesn’t my health insurance
cover long-term care needs?
This is a common misconception.
In fact, most health care insurance policies do not cover long-term
care costs. Neither does Medicare – except under very specific
circumstances, and following a qualifying hospital stay. Nor will
Medicaid (the federal program for the needy) provide any benefits
until one has exhausted almost all their assets and is virtually
destitute.
Are there Multiple Sclerosis or
Parkinson’s related limitations or conditions that may disqualify
one for LTC?
In general, yes. However, at
present, there are currently more than 100 companies that offer
long-term care insurance. And each has its own underwriting
standards. The general guidelines for decline include:
-
Cognitive impairment
-
Need for use of a wheelchair
-
Need for help with
activities of daily living, e.g., the need to hold onto
furniture to move around a room.
Other health conditions in
conjunction with MS or Parkinson’s can also affect underwriting, so
it is imperative to meet with a specialist to get an individual
assessment.
How can I make sure I’m
prepared?
There are several ways to do
this. You can:
-
Consult with your financial
planner
-
Meet with an insurance agent
who specializes
in long-term care insurance
-
Educate yourself through
independent research
But however you choose to
proceed, you really owe it to yourself and your family to become
“long-term care aware.” Take the time now to explore your options.
As with all insurance, the time to look is before you need it.
Jim Runestad is a long-term
care-planning specialist in the southeast Michigan area. Jim
presents workshops and group talks in various communities,
professional and settings. Jim Runestad can be reached at his
Waterford office at (866) 379-6627 or jim.run@comcast.net.
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