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My Mother has an insurance policy that was to cover Assisted Living Accommodations in a facility that went bankrupt. They were bought out of bankruptcy by a chain of Facilities with the insurance policy intact. Mother paid $1,000 per month extra for this coverage for 14 years. Her facility changed their 'Assisted Living' section to "Personal Care" somewhere along the way. What is the difference in services? Is their a difference state by state? What does round the clock Nursing Care cover? Does it cover Nurses Aids? For three months we had the equivalent with Nurses Aid taking 1 x 8 hour shift and myself taking 2 x 8 hour shifts. Should the policy have covered this?

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Mother was forced out of her Independent Living apartment to the Health Care Center and then permanently to Personal Care. On top of insult there was injury. First the Health Care Center failed in their duty to provide Mother eye drops stating their pharmacy did not carry her eye drops. It was their duty to provide them. They did not notify me. I am Mother's POA of Health Care. I had to find out by myself. How much damage was done? It was at least a week until that they were not giving her drops. It took an additional 3 days before I got approval to bring the eye drops to them. Mother was to be given AZOPT 2 x per day in each eye and Latanaprost 1 x a day in each eye a full 5 minutes after the AZOPT in the evening. We went back to Mother's I.L. Apartment but in 3 months we were forced to permanently move to an apartment in Health Care. Approximately 2 months later in Health Care, we discovered Mother was receiving only Latanaprost on Monday mornings when AZOPT should have been administered and the same Nurse conversely only gave her AZOPT in the evenings missing Latanaprost altogether after the AZOPT. We do not know what happened on the nights she was not on duty. The day Nurse stated that she gave her AZOPT in the mornings,she is on daylight 5 or 6 days a week. Mother's Glaucoma tests show that her Glaucoma has progressed to a severe stage over this period. I never missed a drop when I was staying with Mom in Independent living. Alarmed by her noticeable loss pheripheal vision, we got a Glaucoma test 3 months after her last test. Her Dr. was alarmed at her test and was afraid of a lawsuit or being involved in a controversy about administration of her eye drops at her facility. Mom went with me to my Eye Dr. He recommended laser surgery. We went to a Glaucoma Specialist who examined her eyes. He gave me a report to give to the facility showing the results of his tests and requests an intervention where I could give Mother eye drops for two months. (I am there every day from morning until 8 pm at night.) If we can get her test result numbers down he will add a drop for each eye midday. If the numbers don't go down he will do a laser treatment. It is a non-invasive procedure. I gave the report to the Administrator of the facility. I have not heard back from her. What steps would you take next. I have an agency involved in settling inappropriate behavior towards my Mother by a male employee. We are meeting soon on this matter. What agency or direction would you recommend should the facility refuse the intervention of my administering the eye drops for the next two months.
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Continued from above, I was scared so I took Mother to the Emergency and then to Health Care because I was rage-fully told by the Director of the facility to do this or she would call the police and have me arrested.) Back to topic)) When the State Inspectors got there we meet. I showed them the note sent to request them with pictures of the Glaucoma eye scans that showed over 1 1/2 years that her condition was stable until she was placed in Health Care and then to Personal Care. From June 5, 2016 to mid Dec. 2016. Her eyes deteriorated considerable. We parted, my believing that they were starting the inspection. They had been there once before, they found one morning that Mother did not receive her am meds and eye drops one day when called by the ombudsman who was with me that morning. The RN refused to give Mother her meds that day. I told them that there were huge gaps of Personal Care not giving her eye drops as prescribed. She missed at least 2 months getting only 2 of three eye drops prescribed per day for both eyes. They failed to investigate the two months of missed eye-drops as prescribed and 3 dates where eyedrops were skipped I called back after the latest glaucoma eye test result. What the inspectors did when called back was after leaving me to "inspect" they come back to Mother's apartment an hour later and told me that they had to get Mother's permission. I told them I have POA of Health Care and I had a copy in my computer case. They said that by law, that a Power of Attorney only kicks in if she is incompetent. I said not my POA for Mother of Health Care. They said they had to speak with her. (I had not yet told my Mother that her eye sight was deteriorating.) They went into her bedroom, I brought chairs and asked them to sit hen they talked to her. They refused. They were both over 6'4" and towered over her on her hospital bed set rather low to the ground. She is less than 5 feet tall. She was intimidated by their presence. When they came out of her room they said she did not want the inspection). They walked out. The director of the facility looked right at me in the Deli saying to someone she was going to court but she did not worry as the courts are stacked in her favor. This is politics trumping justice and rights of my Mother to her vision. If they inspect do we have to leave. I want to be able to administer her eye drops myself or be able to see the drops being given. She loves her friends in Personal Care and so do I. They are like a loving family to us both. Mother sits with them at a table for 3 meals a day. The facility has been her home since 2002 and she does not want to leave. Can I get the inspection without having to leave. I have tried to work this out with the Director of Personal Care. She has refused. If Mother loses her eye sight through their negligence or intentional acts, I don't think an attorney would take the case at Mother's age. Yesterday, I told my Mother about her eyesight problem. She does not remember if she gets her eye drops at night. She wants the inspection but does not want to leave. Is this possible? There is another facility several former residents have moved to and they say it is much more professionally run. My first choice is to bring Mother home. My brother and cousin want her in a facility. That could be her choice. Tere are options if we have to leave. Do they take away the facilities license if found negligent or culpable? That you for advice on this or any matter. It is a godsend.
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Does POA of Health Care qualify to act on behalf of the patient or do I need one specific to this issue. I also have POA of all matters outside her Trust. This brings up a new issue. The state was recently at the facility to do an investigation into Mother's medications. ( Her move there was not her or my choice. It was forced on a pretext that I left Mother in a pee soaked bed - The Nurses Aid I left her with said Mother was in a dry bed when I left, and, a dry bed when she left and another Nurses Aid took over - My choice was to take her to the emergency room in the hospital or directly to their health Care Center - The emergency room Dr stated in her notes that there was no reason for Mother to be sent to Emergency, she was angry with the facility because mother was fine, she didn't need to go to the Health Center or to the Hospital, she could go back to her room).
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Yes your state insurance department regulates LTC insurance policies. You'll need to have the original policy in hand and a POA or Guardian status to act on behalf of the patient.
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Thank you all for answering. Sorry if my posts are difficult to read. I am so stressed it is hard to remain on one topic. Many things are drastically wrong at her facility: injuries, negligence? Intentional Acts? rip off's, it all happens here. Mother's policy is in house. Will look for an attorney with LTC Insurance experience and elder law. Mother's LTC policy only covers care at this particular facility. I agree that $1,000 per month is a ridiculous amount extra to pay for insurance since 2002. She gets $450 per month discount in Personal Care because of the policy which is only part of what she should be receiving. When she needs round-the-clock care a Nurse's Aid is provided under other policies (not in house) for the same $1,000 per month for a friend of Mother's at the residence. Beside an attorney, is there a government insurance policing agency that anyone has used. I can check with Mother's attorney to see if he could handle this or recommend someone. God Bless.
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cwillie. Not all that crazy. At 65, female, in NY, buy $300/day with 4 year payout, no inflation rider would be $9000 a year.
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A lot depends on the state you are in. There are different licensing requirements for personal care vs. assisted living. There are different laws in different states.
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Supporting cwillies suggestion- as $1000 a month is a crazy, high figure for LTC insurance.
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Are you saying that your mother's LTC policy ONLY covers care at this particular facility and its successors?
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I'm thinking if mom could afford to pay an extra $1000/month for this insurance policy then she should certainly be able to afford having a lawyer review the contract. Try to find someone with experience in LTC insurance and elder care.
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As Barb says, it's impossible to know what your mothers LTC policy covers without reading it - they are all different. The policies my parents had could vary daily amount covered, vary amount covered by type of facility, vary the deductible in terms of length of self pay before coverage kicked in, vary in maximum paid - all tweaked in order to get the premiums to certain dollar amounts. When I had questions in trying to interrupt specifics in the coverage I found contacting the company that carried the policy to be the most helpful.
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Daughterlu, I don't know if you realize it, but the way you write (in all of your posts, not just this one) make it extremely difficult to understand what you're asking.

There are differences between Personal Care Homes and Assisted Living. You need to read aome articles, available online about those differences. This seems to be something that is unique to Pennsylvania, from what i see online.

A lot depends upon how the LTC policy is written.
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