How do I find a care coordinator for my mom who has LTC insurance?

In order to use my dad's LTCI I had to provide all sorts of medical records and invoices on official letterhead. There seemed to be always one more document to provide. Nevertheless I persisted and received the entire amount that the policy allowed for the covered care until he passed away. My dad was living in AL and had day sitters through an agency and it was difficult to trigger the benefits he had paid for, so I can see why mvanderm wants a professional to help navigate the claims process. Although in order to get most of the documents I had to provide, I needed to be POA and then have letters testamentary once he had passed. You might want to check with the LTCI company to see if they will allow a third party to handle the claims process before hiring one.

If you are looking for an independent care manager ... look at aginglifecare.org which will allow you search for an aging care expert in your area.

I have used several paths for finding caregivers: Ask friends, doctors staff, CNA schools, craigslist, newspaper, on-line classifieds, community newsletters, senior and health fairs, and anytime I am served well by anyone I ask if they know any health care workers. I figure if they are a good worker they are likely to know others with the same work ethic and spirit.

You can and should do background check on people. In some cases they will pay and in some cases you might pay. It's about $85. Do lots of exploration into the path of anyone you might hire.

Make sure you have clear direct non-politically correct understanding of what you want and what you will do. Like - allow no cell phone use while caring for the person, arrive 5 minutes early so you are ready to go to work at the time we agreed not arrive just in a nick of time. Be clear on duties for the day and have written list ..... you get the point. Clear specific communications so you don't loose a good workers over miscommunications.

Check with the insurance company as sometimes they require the person to be a CNA or they won't pay. Sometimes the insurance company requires you hire through a agency. However often there is a clause in the contract that you don't have to use an agency or follow the rules IF there are special reason. That can be helpful.

If you are not in a support group I encourage you to join one because the people there know lots to help you and you may well be able to help educate them.

Hope these ideas help you.

It looks as if mvanderm already has a wonderful home caregiver but is simply trying to figure out what "hoops" to jump through to get the insurance to cover the costs. To me it appears that the question is basically how to formalize a situation that's already in place (as opposed to finding someone to provide the hands-on caregiving). However, mark47 brought up a valid issue that the hands-on caregiver may be required to be certified; otherwise I think mark47 has given a great answer to a somewhat different question (i.e., how to find a hands-on caregiver in the first place), but this could become the issue if CNA status turns out to be an unavoidable requirement.

Ginach is spot-on with the biggest hurdle..... the terms of the ltc policy.
In order for the LTC policy to pay, you as DPOA for mom the policy owner, have to make sure that mom has been assessed to qualify for & meet the type of care covered (like cannot do 4 out of 6 ADLs) and has done whatever self-pay waiting period (could be 60/90/120 days) and the caregiver meets the criteria for a "care professional" under the terms of the policy. This last one is sticky as policy may require a RN or LPN or CNA or whatever was viewed as appropriate care professional at the time the policy was done years & years or even decades ago.

I'd suggest you very clearly & carefully FIRST go through the policy to see what the caregiver needs to be for policy to pay and what the policy will pay for. Unless you are fluent in health care speak (like understand ICD) id suggest you go with an agency for a care provider. And speak with an agency as to staff they have that can fit the requirements of the policy. And what the cost will be to you for those additional hours needed that are outside of whatever the LTC will pay. Like LTC pays for 18 hrs of a licensed CNA but you need 5 days a week so your paying for an additional 12 hrs a week.

As an aside in this, my moms NH would NOT take any LTC policies. This due to just what Ginach posted. The NH billing office told me that since each insurer has policies unique that there was always always ALWAYS something else needed to process a claim and send payment. Like insurer wanted certification, professional education info, etc on caregivers; how time sheets done varied; ditto for the assessment done both initially and for recertification. Basically a series of hurdles to get paid. Flat not worth the NH to take as they could just as easily fill beds with Medicare, Medicaid (& get paid in real time) or private pay.

Oh also the start date of the waiting period (for policy to pay) is critical. If there's a hospitalization the day 1 of admission usually can start the count down. But for those living still on their own it may not be as easy of a fixed date to determine. If it is that mom needs MD orders for care and she gets that order this week then court down starts then. Yeah, even though she has been having caregivers for months prior. You really really need to get your documents to fit the slot required by the LTC insurer. The bigger ones, like Genworth (which is industry leader & very solid company), have existing documents that you or the agency fills out & will be tailored for the different type of policies. They have to be done just right for policy to pay.

I'd look at policy first & foremost.

My alz spouse has LTC. All policies are different for what you bought. Ours we added to policy alternative care which allows caregiver w/o papers of cert. Or grp homes instead of asset living or memery care facility. We opted for 90 days before they pay thinking of Medicare but alz came instead. We had to have a Dr. written diagnose was cognitive impairment/alz which put him out of the 3 things he couldn't do into other rt away. Then if you bought $120 day that is all you get per day from them. We cannot use 2 diff things in one day (caregiver & day care). For getting his 90 days I went to Memory Care place & explained he needs 90 days in licensed facility but could be for 1 hr which counted as a day. So for 1 hr a day for 90 days I took him to that place oh but write to your ins that you are starting your 90 days before & get on their records. Sure was lot cheaper out of our pocket. Good luck on that one. They also had me talk to their nurse consultant in NY for day cares in CA. I could & did get same info on my computer but I guess ckd off one of their requirments. I must have called them 15 times to question & get diff people answering. Write down, date, person talked to & answer each time. Some old policies say pay for nursing homes as didn't have all these asst.living & memery care places. Could be a problem. Read what relatives cannot care for them & get paid. Have copies of DPOA ready. Can't get answers w POA. Don't be afraid to call for clarification. You've paid for their services.

I was unable to get the LTC co to pay on either of my parents. They both had a policy with the same company. On my Dad, they said it was because Hospice was called in so it would not be considered long term care and on my Mom, who is currently in a nursing home unable to do anything for herself, they said they won't pay because there is not an RN on duty at night, only on call. This policy was thru Texas Retired Teachers assn. I hope you have better luck than I have.