Filing for Long Term Care Insurance too early?

pokefan6016

Hi, I am posting for the first time regarding my 83 year old Grandma. She has had cognitive and memory issues for years, but in the past month she was properly diagnosed with dementia. I had previously lived with her 3 years ago after she was a scam victim, but after about a half of year, I moved back home. I am now staying with her again after she received the diagnosis since we have seen a gradual decline in her overall mental ability.

My grandma owns her home and has a long-term care insurance policy with Unum. This policy has no limits on compensation (it has a monthly limit but no lifetime cap based on amount or time). This plan supports assisted living, in-home care, and caretaking provided by a family member. This plan has the standard tax-exempt LTC plan requirements (2 ADLs need assistance or severe cognitive impairment). She is still very independent involving all ADL's and her daily routine, but it is the IADL's that I am stepping up and helping her take care of, even though she does her best to try to do them. Because of this, when filing the claim it would be under the "severe cognitive impairment" claim. I am also here to ensure her safety, as we have had incidents where she has fallen, and we have only found out through happenstance or from other people who happened to call her on the day of the fall. It is getting to a point where we are not comfortable with her being alone for an extended period.

My main question is, with her still being able to do a lot for herself (cooking, cleaning, light reading), is it too early to attempt to file a claim under family care for her LTC? I see little downside in doing it since her plan has no limits, but I have read that if a claim is denied by LTC, it may be harder to get coverage in the future if their condition worsens since the denial will always be part of her file. I am also concerned because her neurologist has her condition listed as early/mild dementia (the neurologist is not the best… he has not done any full cognitive tests. I think her primary care physician is more aware of her true condition/ability). I'm not planning on caretaking and living with her forever, I am in college and finishing my online degree, but after I graduate I don't want my future to be dictated by her LTC plan denying her based on me making a claim too early when I need to hire potential help or get her placement in assisted living or memory care.

I don't absolutely need the money that would come from the LTC plan, but since she has been paying into it for years, if she is eligible to start using it, I want to help her to do so. The money from the LTC plan going to me as a family caretaker would also help me to be able to dedicate myself to being there, rather than stressing about not having an income source while I am with her.

Thank you so much in advance for the advice.

SDianeL

I haven’t had to use LTC insurance but I would consider how long she would probably live with dementia. For a woman 85 years old when diagnosed, I read that a study showed their average life span was 4.5 years. Many elderly diagnosed with dementia die from other things not the dementia. Based on that info I would consider filing sooner than later. I would make a list of the things she can no longer do. Also stress in the claim that she can no longer safely be left alone. Please keep us posted.

Carl46

I see no reason not to claim the money she is due. In fact, she may even be able to stop paying premiums when she begins receiving benefits, depending on the terms of her policy.

--Rebecca--

It is extremely hard to get LTC to begin paying. They won't care about your evidence, but rather that of a doctor, especially a neurologist. Get a neurologist assessment. Make a list of your own evidence, and submit it to your doctors and have them add it to their notes. Of course add your own evidence to your application, too. Do not let the nurses lead your grandma's answers when she is being assessed. This happens more than most people would think.

So yes, start the application process now. It may take 6 months before it starts paying. They will make it very difficult. Make them back pay for the months they delay. Begin with carefully reading the policy. This is boring, hard work. After several rejections, in the end I threatened a lawsuit for a breach of contract. Suddenly, we were approved.

pokefan6016

Thank you all for your responses. We had a call with their nurse evaluators, and we are now waiting for a decision from them. They said they may just go off of the nurse's evaluation, but they also said they may reach out to her doctors. If we are denied, I am planning on sharing a document with our observations with our doctor and Unum to further detail her condition and need for care.

pokefan6016

https://alzconnected.org/discussion/comment/239768#Comment_239768

An update, we were approved for long term care coverage and payments are scheduled to start in May/June (after the 90 day elimination period, thank you everyone for the responses and information!