How and when do long term care policies kick in?

My mom is in her second AL facility. The first one was beautiful, but unfortunately they told me what I wanted to hear in order to get me to sign. They had real issues with staff turnover including 3 DON's during the 22 months mom lived there. The only staff member I could call by name was the bath assistant and I was there at least twice each week. I rarely saw anyone come into mom's apartment and they made no effort to get her out to activities.

She has been in the second AL for almost three years. It is a continuing care community with independent living, assisted living, advanced assisted living (people with more health issues or mobility problems) and a memory care wing. The only thing they don't have is skilled care (nursing home).The staff has been very stable. I know most of them by name, and they know who I am when I call the nurse's desk. This facility is a none-profit, owned by a church denomination, and is about $800 per month cheaper that the first one.

Visit several facilities, and after getting the sales pitch and a tour, try to talk to some of the residents and family members of some of the residents. Look carefully at the price list to see what is included and what is extra. Ask if you can eat a meal there to assess the food and the dining room service.

As far as the long term care policy, these can vary greatly. You will need to read the policy to see what it covers and for how long. There also might be a waiting period before benefits start. You do not need to spend down her assets to use LTC policies. In fact, that is the point of them - to preserve assets while still getting care.

LTC insurance does not require the spend down, its not Medicaid. She will simply have to comply with the terms of the contract. For example, my mother's LTC policy requires two doctors to agree that she needs care, and a certain level of care, before it takes effect. It has a limit to daily cost (My moms is $250), and a limit to the length of time it can be used (my mom's is 5 years). Check out the terms of the policy for clearer answers.

Angel

MidKid -with the older LTC policies look carefully as to what the inflation rider is. Some old LTC are based on health care costs at time written which doesn't even come close to todays cost.

Wow--thanks for the very quick responses! I have no experience with this at all. I am going to tour a few facilities that are in mother's neighborhood. It's a ways off, I think, but I do want to know what it's going to cost.
SO GOOD to know she doesn't have to spend down, that will help my brother feel easier--he's counting on an inheritance (which he richly deserves!!) and I know he thinks moving mother to an ALF will eat up everything she has.
Brother with POA is seeing mother this weekend to go over the policy and he will share pertinent info with me.

I've got quite a bit of experience with LTC insurance. That said they can vary greatly from policy to policy. But here's what I know about my parents policy. First they must qualify. In my parents case there were a number of self help criteria that had to be met - 3 out of 7. They included things like transferring, ability to feed ones self - not cooking, literally getting spoon to mouth. Incotinence care - not incontinence but the ability to clean/change own Depends. Dressing, bathing etc. There was also a dementia type qualifier. In my dads case they sent someone out to assess him as other than a rehab stay he had no medical history of problems. In my moms case they are reviewing medical and caregiver records. Then there is a qualifying period where we have to have been paying for "qualifying" care on our own. I refer to this as a deductible as that's how it works. It varies from policy to policy but in my parents case it was/is a six month period where they must have received care at least once a week. It does not have to be consecutive. Then they pay one amount for in home care, one for AL/foster care and yet another for Skilled Nursing Facility. In my dads case this all went pretty fast and easy. In my moms case they are dragging their feet - I started the process late September and as of today - January 15th I still don't have an answer. This is due to their own "look back" period. They are figuring out from which date my mom would have first qualified (regardless of when I started the claim) as she's been getting in home care for a few years. If they determine she would have qualified say in May they will start the 6 month deductible from then and then look at care bills to back pay from the end of the deductible period. Normally I would be hounding them to get on it however - we are able to pay the bills for now AND - and this is important and does not apply in most policies, but my dad was a cautious guy - when my mom dies and if the money that was spent on premiums does not get paid back in benefits, the difference gets refunded to moms estate upon her death. So it's like a savings account without intrest - and really does any savings account pay interest these days? We have to continue paying premiums until they make the decision to activate benefits. My moms policy has no lifetime limit of paid benefits - but really to met the requirements you can't be in the greatest shape and "lifetime" isn't gonna be years and years. Hope this helps - let me know if you have any questions.

Wow, Rainmom--I am perplexed now. I am going to start checking out a few facilities close to where mother lives now. Just to have an idea what's there and what we can look forward to in costs. My brother was going to meet with mother this weekend and go over the policy with a fine tooth comb (he works in large company insurance, so this will be easy for him to understand). I hope he shares the info with all of us sibs, but in the past has remained very quiet about any and all financials. Mother has had this policy for ages, they've kept it up, so even tho she's adamant she's never going "anywhere" in the back of her mind she has to know that it's a possibility. Also, I know my daddy made my brother DPOA so he would keep these things up to date and away from my thieving older brother (now deceased, so well, we can all breath easier).
I think mother will just very slowly deteriorate until she can't walk or stand. She's gone downhill very rapidly in the last year. I'm "home shopping" so when the time comes, and I think it will, we will NOT have a ton of drama. Well, I can hope, right? It's going to be horrible.
I'll have to have a sit down with brother this week or next. He's really non-confrontational---drives his wife nuts! (But then, nobody gets mad at Dr. No-Shot!

Igloo--
Thanks for you comment. This is exactly what DOPA is looking at. HE *thinks* there was an inflation rider, as this policy was written in 1998. He KNEW that it would pay $200 a day, w/o any inflation rider, so we're really OK financially. Most likely, this is going to be used as in-home care (which is qualifies for) at some point in the future. Time will tell.
I appreciate the comment, tho. Mother and Dad were the tail end of the population that thought SS would see them comfortably into their dotage.