Long term care policy and receiving payment as a Caregiver

lmedlin10

I am the caregiver for my mother. She has a long term care insurance policy that will pay for in-home care however it will only pay me as her caregiver if I am employed by a approved/qualified health care agency. Has anyone had experience with becoming employed by an agency to gain some access to benefits provided by long term care?

mommyandme (m&m)

I was so disappointed by that issue.  I got my CNA license because I thought that would do it (Although so glad I got it).  Nope! Very frustrating.  We even tried to appeal their decision.  

Prior to the final result, while interviewing home care facilities, one of them would have hired me and I would care for my mother.  Some might be willing to do that.   Problem with that is almost half the monthly benefit goes to the care company, at least in our situation.  

towhee

That was beyond frustrating. Talk about unpaid, undervalued family caregivers. And worst of all, when the long term care companies won't pay, it leads to the perception by other family members that family caregivers aren't worth anything.

LovingAwareness

I don't understand this rule at all. My Dad's policy, which we haven't used yet but probably will need to soon, has a daily $ limit and a three-year time limit. However, if the full daily limit is not used, then the benefits can roll over beyond three years. Given that, as family caregivers, my brother and I, who are currently caring for Dad for free in his home and trying to fit our work in around the caregiving, if we were putting in claims to pay ourselves, we would have a vested interest in preserving as much of the LTC benefit as possible, because we don't know how long Dad will live with Alzheimer's. So if we were allowed to be paid from the policy, we would be conservative in our claims and only claim enough to cover our living expenses, which are not very high since we are living here for free. Meanwhile, if we have to pay an outside agency, then we have to meet at least their weekly minimum hours; in fact, we will probably have to have nearly full-time coverage since we'll have to keep jobs to cover our expenses. So the company will be paying close to the daily rate when they could be paying a lot less to us. Assuming that Dad's doctors certify his need for help with the ADLs - we currently have to help him shower and dress -  and whatever other qualifications were met, why wouldn't the LTC company prefer to pay out half as much to us as family caregiver than they would to an agency? Assuming Dad lives another three or four years, which might be average life expectancy for him (he's 84), then the company would end up paying a lot less in the long run, because Dad would die before using up the full benefit. It doesn't seem like sound business practice. I don't understand the rationale. Are they worried that families will "splurge" on care once the policy is footing the bill? Most policies are pretty limited, so that doesn't seem likely. Are they worried about liability, that if a family member is incompetent and harms the beneficiary, the LTC company could be held responsible if they were paying them?

towhee

No, they just think that if family members are doing the work for free, they won't end up paying out as much.

LovingAwareness

I can see that, but they're wrong. My family has been limping along for two years trying to cover Dad's needs while also working to support ourselves. I worked a 12-hour-a-day job from home through the first months of the pandemic and stayed up most of the night, every night, catching up on work after being distracted by Dad's needs all day long. Eventually I was on the verge of physical collapse and my brother had to cut way back on his work and move in to help. And now Dad's needs are even greater, and my brother's savings are rapidly depleting, so we can't do it much longer. If I can find a way to get paid to care for Dad, then I'll quit my job and care for Dad. If not, we'll have to hit up the LTC policy for near- or full-time agency care. It's their choice and I guarantee I'm a LOT cheaper.

mommyandme (m&m)

In my understanding, if your LO qualifies for Medicaid, they will pay family caregivers.

LovingAwareness

Hi Mommyandme, was the LTC company unwilling to reimburse you as a caregiver through the policy, even if you worked for an agency? Did you live with your mother at the time, or did you live somewhere else? Just wondering if that makes a difference. I would probably do this if it is possible, because even if the agency kept half, I would be paid the other half, and it would not be coming out of my Dad's income (he's been paying his LTC premium for 25 years.) Just curious why you did not go forward with it - was it because the LTC company wouldn't allow it, even through an agency, or was the money you would have earned from the agency not enough to sustain you? I'm interested in pursuing this and could get into a CNA course this summer, but I'd have to have it in writing or something from the LTC company that it is allowed, even though I live with Dad. I wouldn't want to do anything that would invalidate the policy.  

mommyandme (m&m)

Hi, 

The LTC company will pay for an approved Home Care Co.  They don’t care who the company sends or the individual’s credentials. There is small print that says I would not get a higher rate than another employee, basically.  My brother handles all the finances.  He pays the company and we submit the invoices to the LTC co to get reimbursed.

What’s especially ironic is we can hire a CNA in good standing, privately, which we did before we moved mom to CO.  Just not an immediate family member with just a CNA. I would have to go back to school to get a higher degree.  Unfortunately, the application to get an individual or company approved by the LTC read like a CNA would do it for me.  It was misleading.  We had to look deep into her policy paperwork where we found the exclusion. 

I have my own residence, different address. Fortunately my mother’s home is right behind ours,  we share a common fence. Even though, I have not slept in my home since we moved her in June.  I refuse to say I live with her, haven’t moved my toothbrush into the bathroom for example, but seriously, I do kinda live there.  The LTC definitely wouldn’t cover me in any circumstance if my mother and I resided in the same home. 

You’ve got me thinking about this.  May need to revisit our options.