My mother is 96 and lives with us. She shuffles when walking and uses a cane. She is able to do the ADLs although not easily. I manage her business, appts and medication. She has early dementia but I think it’s advanced somewhat so we will see what the Dr says. Her insurance says to trigger she has to not be able to do 2 of the ADLs or have cognitive impairment. I know it will be different with different insurance companies but I was wondering what people have experienced with LTC insurance qualification? I feel like her age and dementia should qualify her. But there is a 90 day elimination period and I can’t apply for LTC until she moves into AL. But if she doesn’t qualify she can’t afford to stay. Thoughts?
She should qualify based on that.
And the fact that you’re handling her medication‘s and other items for her indicate that she can’t be on her own. Safety is usually the key to being approved for cognitive issues. That needs to be in the medical records.
You might consider contacting an independent board certified patient advocate for help with this at www.NPAF.org. Or contact an aging professional at www.aginglife.org. I have never contacted either but have them "on my list" and think they may provide information or further guidance on what to explore?
Good on you for thinking ahead.
Hope you will update us and wishing you good luck.
My parents' LTC insurance policies had a option for in-home care that could be started immediately if unable to do 2 ADLs. Then, if they went into AL, the 90days was waived. Might you have that option?
The insurance company sent a nurse to my parents' home who evaluated my dad (first of the 2 to need help) for ADLs as well as cognitive decline (with the mini test). A doctor's assessment wasn't required.
Having difficulty with ADLs may be all you need. Both of my parents could, between the 2 of them, manage a lot, but slowly and not great results.
If I were you, I'd ask for an evaluation at home. Ask lots of questions of the insurance company, they won't necessarily tell you.
Good luck.
Does the policy define ADLs (does it include IADLs?) and does it define cognitive impairment?
Does she have a formal dementia diagnosis?
Take a look at the link below. Is she really able to perform these ADLs safely?
https://erisaattorneys.com/activities-of-daily-living-trigger-long-term-care-benefits/