Unfortunately, none of us knows what our future holds. If you or a loved one end up needing long term care in a nursing home or assisted living facility, how will you pay for it?

People are often surprised to find out that health insurance rarely pays for this type of long term care. And although medicare will typically pay for short stays in rehabilitation centers or assisted living facilities, they will not cover the costs of a permanent stay. Long term care insurance is an optional policy which you can choose in advance to help to cover these living expenses should the situation arise.

Venice assisted living facilities

What Will Long Term Care Insurance Cover?

Like most insurance policies, you will need to determine which level of coverage you need and which options are right for you. You can purchase a policy with flexible options whh will cover as many circumstances as possible. There may include:

  • Residency in a nursing home, assisted living facility or memory care center. These facilities offer a full range of skilled health care, rehabilitation care and personal care. Basic policies often only cover room and board, so it is important to ensure that additional services (if needed) are also available.
  • Adult day care facilities offer programs outside the home for adults who need limited care and supervised assistance with day to day tasks. These may include health, social and other support services.
  • Home care which offers in-home assistance with daily activities including bathing, grooming and help with chores and housework. Your policy may also cover skilled care coordination and expenses involved with it.
  • Modifications to your current home to accommodate changing needs, such as the installation of wheelchair ramps or grab bars.

Long term care insurance can become problematic because it must be in place before coverage is needed (most providers will not cover pre-existing situations) but it is generally not feasible for an individual to know ahead of time which services they may need. Therefore it is important to obtain a policy which offers flexibility, and also allows for policy changes as the situation evolves.

You should also speak to your provider about coverage exclusions before paying for a policy. Although some exclusions may be intuitive, such as drug and alcohol abuse, other exclusions may come as a surprise. For instance, policies may exclude mental disorders, self-inflicted injuries, Alzheimer’s disease, heart disease, diabetes or certain forms of cancer.

What are Benefit Triggers?

“Benefit triggers” are the conditions which must be present before an individual can begin to receive benefits. Most long term care insurance providers look for inability to perform certain “activities of daily living” (ADLs) to determine when paying for benefits is appropriate. Typically, benefits are initiated when and individual requires assistance with two or three ADLs. The most common ADLs which trigger the coverage are easting, bathing, dressing, using the toilet or continence and walking safely.

It is important to understand how your policy determines a trigger. For instance, a person with dementia may be physically able to perform skills, but does not have the mental capacity to determine when each activity is needed. However, if your policy indicates the loss of physical capability, the insurance may not be activated even though the patient is clearly incapacitated.

While long term insurance coverage can be a powerful resource, it is of primary importance that you understand the full policy terms – coverage, triggers and exclusions – before the care is needed so as to ensure proper care and assistance. If you need assistance or are lookin for a long term care facility in the Venice area, set up an appointment with the professional team at A Banyan Residence. We have the expertise and compassion you need to work through your options at this stage of life.