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Friday, June 3, 2011

Long Term Care Nightmares

Most people associate the terms “Long Term Care” with elderly folks that are either presently very sick or recovering from an illness or injury and unable to care for themselves. Usually this means that they need help with ADL’s (activities of daily living) such as bathing, eating, dressing, toileting, transferring, showering, etc.

But this scenario can apply to younger people. There are individuals that have been in car accidents, or suffered sports injuries or many other possibilities that need the same type of care.

As long as their illness or injury was serious enough to need skilled care, like from a hospital or skilled nursing facility, Medicare or Major Medical Insurance most likely covered their expenses up to their policy limit. But what happens when their condition is as stable as it’s going to get? Major Medical and Medicare cut off their coverage when the patient no longer needs skilled care.

This is usually when Long Term Care policies kick in and start paying benefits to help the patient who needs only custodial care to complete their recovery or to the end of their life if no recovery happens to be their prognosis. Individuals who could afford and were smart enough to purchase a Long Term Care policy will be very glad that they did. The types of facilities that they now have the ability to pay for due to their policy benefits are very nice indeed.

Assisted Living facilities which allow the patient to come and go as they please but still give them a measure of assistance are usually beautiful in structure and loaded with amenities. Medicare alone or along with Medicaid does not cover Assisted Living facilities.

Even Medicare Supplements do not cover anything that is not considered skilled care. Skilled Care means that you need a skilled professional to administer the care. This requirement eliminates many things that patients may need done for them and can’t do without help.

The options available for the owner of a Long Term Care policy are much greater when it comes to choosing where they will live now that they are unable to live alone. They may even choose to stay right at home, because their policy probably offers the services of a Home Health Aid to visit every day to cook, clean, administer medications or give them a bath and so on.

So what happens to your choices when you don’t have a Long Term Care policy? Let’s use the example of a delightful elderly couple who have been together for most of their lives.

The husband begins showing signs of Alzheimer’s and eventually he is unable to care for himself. Because his sweet little wife is petite, she can’t lift him and so they must face the inevitable decision to seek outside care.

Because he does not require skilled care, his Medicare and Medicare Supplement will not cover the very nice Alzheimer’s Unit at the Assisted Living Facility that was just built in their home town. The couple has worked hard their whole life, so they have a little savings.

The husband will be admitted to the very nice facility using their children’s inheritance to pay the $4000 a month bill. After a few years their money is gone and they must apply for Medicaid to cover the expenses. But when the facility informs them that it doesn’t accept Medicaid, the husband must be moved to a facility about two hours away that does accepts Medicaid.

Here the quality of care is disheartening, because a nursing home facility that receives most of its funding from Medicaid can only afford a nurse for every 10 patients, while the usual standard is a nurse for every 2 patients. This understaffing problem is partly responsible for unattended patients who are suffering from bed sores and other types of neglect. But there was an available bed here, so they must make do.

Where are the children when all of this is happening? Gone are the days when kids can take their elderly parents into their homes and care for them. If you are able to do this, then you are an exception and a dying breed.

Most people in today’s world whose parents are reaching the golden years are still embroiled in their careers and their families full time with nothing left over in the way of energy, time and patience for the special care that sick, aged parents can demand. It’s a very sad truth, but it’s the truth.

So in conclusion, if you want choices when you are faced with needing long term care, then consider purchasing a Long Term Care policy. Although the example in the article is fictional, it is based on true life scenarios. All you have to do is ask anyone who has faced this crisis in life and they will be glad to tell you their version of the horror story.

According to, over 9 million men and women over the age of 65 will need long term care this year alone. 40% of individuals reaching the age of 65 will likely enter a nursing home and 10% of them will be there an average of five years. With these types of odds, it’s smart to prepare for the possibility. If your budget allows for a LTC policy, then it’s well worth the money.

U.S. Department of Health and Human Services

If you are interested in more information about long term care policies, please send a request to

Suzanne Lender is a licensed insurance agent in the states of Tennessee, Arkansas and Florida

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