My mom has long term care insurance, but wants to hire a private caretaker rather than an agency. Is this covered? - AgingCare.com

My mom has long term care insurance, but wants to hire a private caretaker rather than an agency. Is this covered?

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The insurance company is questioning this. Has anybody had this experience? Is this covered? Mom doesn't like the helpers that the agency sends (she needs 24/7 care).

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Also the LTC policy may require that the caregiver have a specific professional education or medical certification for reinbursement to be paid. Often individual caregivers aren't a licensed & registered LVN, RN, CNA, etc. which policies (especially older ones) require, so no payment can be made.
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Better read very carefully the terms of the Long Term Care insurance policy. I suspect there's a provision that only caregivers from licensed agencies will be paid through the LTC insurance.

I'm not that familiar with the LTC policies, but I'm guessing that the issue of a private caregiver vs. an agency caregiver has to do with liability, since the insurance carrier will in the long run be paying for the services, and given that, has the right to establish some terms and requirements.
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Long term care policies, some of them, will pay a relative, a child to provide the care. But, as FF said, their concern will be that this person is qualified, licensed, bonded, insured, and that a care agreement is setup to pay taxes, workmen's comp, unemployment, medicare, and deduct income taxes and employee contributions to benefits. She becomes an employer and will need to setup state and federal tax id numbers, and have a legal care agreement, prepared by an attorney, with each caregiver.
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So much depends on your mothers specific policy and its terms and requirements. But I'd say it's probably a given that for any caregiver to be paid either directly by the company or via reimbursement to your mom - the caregiver needs to be licensed/bonded/insured. The company wants to be sure a qualified caregiver is being used and that they aren't paying a relative or friend. In addition - there could be requirements to how and where the care is provided beyond the who. For example - my moms policy pays one rate for in-home care and another rate for a licensed group home and still another rate for a licensed facility. The first time I went through all this with my dad I called and spoke to a LTC specialist and had them explain the specifics of my dads policy. When the time rolled around for my mothers policy to be activated I just needed to re-read the policy to re-familiarize myself with the terms. So, that's my advice - read the policy over carefully and then call and ask to speak with someone in LTC with any questions.
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I read your profile where your Mom is 104 years old... amazing... imagine all the fantastic inventions she has witnessed throughout her life :)

Back to the caregiving issue... let Mom know that if she hires someone out of an Agency she would need to provide an employment contract stating how many hours the caregiver works, what is that caregiver's salary, what days does the caregiver have off, and who will be paying the payroll taxes.

Another thing, it sounds like your Mom is living in her own home, if that is the case, then your Mom would need to get a "workman's comp" rider on her homeowner's insurance to help cover in case the caregiver gets injured on the job.

The above items is probably why the long-term-care insurance is asking questions. Someone outside an Agency might not be licensed, bonded, and insured.

Have Mom ask the Agency to send over some more people. It usually takes awhile to find someone who is a good match. And with 24 hour care, there is usually 3-shifts. So it won't be easy to find perfect matches in all 3 shifts. It is always a learning curve.
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