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I believe they can. One we dealt with called for the patient to require assistance with four out of five activities of daily living! If you need that much assistance, you probably need skilled nursing care. So, although the policy stated it would cover in home help, it would be pretty hard to use it for in home help.

I'm not impressed with long term care policies I have seen. There are too many ways for the company to insure they never have to pay you. And you don't see them coming unless you've already been through this before! What non medical person even knows what an Activity of Daily Living is until someone gets sick? We all learn as we go.
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The problems with many LTC policies is that you get the bad news, the fine print, when you need it. There are many wiggle-room ways they do this. Some even exclude a place that doesn't have 24 hour RN on duty. Guess what? NONE have that. So you need a careful reading of the policy and you need to speak to those managing to find out the skivvy.
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It depends upon how the policy is written.

If the policy specifies the level of care it will cover in terms of "need for skilled medical care and management" then even though the words "assisted living" are not used in the exclusion, they are telling you what they will pay for.

There are lawyers who fight this sort of thing all the time. Hire one.
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