Memory clinic doc’s started mom on 5mg Aricept in July and I’m concerned she will score better on MMSE and lose dementia diagnosis for ALF claim. (LTC policy states substantial help with 2 ADLs or severe cognitive impairment like ALZ.) Yes, she needs help with ADLs -shower, dressing, wears Depends, but she might tell their RN, “I’m fine!” because she’s still ambulatory. Ovarian cancer surgery, stage 3C and chemo in 2018, but no recurrence yet; macular degeneration; COPD; 86 years old. LTC has paid ALF claims since this past February, but I’m suspicious right now with their evaluation coming next week. Maybe I shouldn’t be worried, but as only child, this is stressful! Thanking everyone in advance!

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Yes, she should ask mom to show her; " show me what you do when you get dressed in the morning". If she simply asks mom"can you do this", please tell her to ask your mom to demonstrate. You can say "my mom is an unreliable reporter".
Helpful Answer (1)
Reply to BarbBrooklyn

Make them give you an actual diagnosis and not an opinion, those are subjective and can lead to problems. Diagnosis on the other hand can not be denied.

Insurance companies do their best to deny coverage, it is just dreadful to have to fight them and this awful disease.
Helpful Answer (2)
Reply to Isthisrealyreal

I would think that part of their assessment is to view the chart and/or talk with staff regarding what services she is getting, and what medications she is on...Aricept. Don't worry until you have something to worry about, it will most likely be ok.
Helpful Answer (2)
Reply to SofiaAmirpoor

Any RN worth their salt is not going to accept what your mom says about her ADLs; she's going to ask for a demonstration. Will you be there for the new evaluation?

Aricept does not improve; it slows down the decline, in some cases.

And if LTCi days no, you appeal with substantial evidence from the AL professional staff. You've got this!
Helpful Answer (3)
Reply to BarbBrooklyn
Nimbus Aug 12, 2019
Yes, I will definitely be there for eval and ALF Director will be in building for backup. Demonstrate?? She can walk unassisted. Will RN make mom show how she goes to toilet or get dressed?

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