For example, for 15 years, your parents intelligently paid nursing insurance premiums of a few hundred dollars a month. Now they need help in their home and are ready to file a lawsuit and receive financial repayment for their careful planning.
The average cost of a home helper in a retiree’s home last year was $ 24 an hour, and most providers have a minimum requirement of six hours a day. It’s more when two people are at home, even when only one needs care. So it is great that long-term care insurance reimbursement covers a sudden and ongoing expense.
Whether you are planning for yourself or your parents, there is a lot to learn how to get help and apply for reimbursement checks in the mailbox. Here are some tips, warnings, and suggestions for communicating with insurance companies, nurses, doctors, and retirees.
How to get long-term care
Care must be taken before filing a claim
Allow enough cash to pay for up to two months of care before reimbursements begin. This doesn’t mean you have to start with five days a week. A customer can start with just half a day a week and get the care approved by the insurance company, and then move on to more.
Nurses must be licensed
Insurance companies will not reimburse Aunt Lucille or Anna, who lives next door, to look after their father while you are at work if they are not licensed. Because of this, you usually need to find someone from an agency who has their own insurance through their employer.
There are minimum hourly requirements to fill out
Many home nursing companies have at least four to six hours a day. A client may need help bathing, getting dressed, and going to the bathroom, which does not take place every six hours. This takes some getting used to for customers who may feel uncomfortable with someone else in the house who isn’t on a job.
When the client and the caregiver get to know each other, the client is open to further help. Laundry, grocery shopping and meal preparation can be added to the to-do list. Many seniors develop different sleep patterns, sleep more during the day and less at night, and create a vicious cycle of fatigue. A caregiver can assist the client with reading, play games at all cognitive levels, or ask them to tell stories so that they are awake during the day and sleep better at night.
This time is well spent and well worth the cost, especially when long-term care insurance pays a large portion of it.
Independent living is usually not covered
Even if someone moves to an assisted living facility, most insurance companies don’t pay a penny. For example, suppose your parents moved there because they want to enjoy the meals prepared for them and the social activities of a long-term care facility. Long-term care insurance not only covers services that are only convenient, but only the essential ones, such as bathing, getting dressed and dispensing medication when a customer can no longer do this alone.
Start by referring a doctor
Most long-term insurers want to see a doctor’s record showing that the patient needs help from a nurse.
Paula Werk, founder of HomeWerks Home Care in Raleigh, NC, found that a doctor is often more convincing with seniors than with family members.
“Let the doctor be the bad guy. You can say that it is safer for the patient to get extra help, ”she said. “Their opinions usually carry more weight and are less hurtful than those of the children.”
Honesty is critical to a medical assessment. Once a customer has set up care and requests reimbursement, the care insurer sends a mandated nurse to evaluate the person and make sure they need the care that they and their doctor request.
“You need to have a conversation with your parents (or whoever is filing the long-term insurance claim) and tell them this is not the time to be proud,” Werk said. “Even if you are barely able to do things yourself but it is painful for you, or if you do not dress properly or bathe yourself, you have to tell the nurse you need help.”
Advice for couples when only one person needs care
Couples with different abilities can get help when just one person needs more extensive care. In many situations, a husband or wife will take care of their spouse with regard to bathing, dressing, transporting, feeding, and more. The dependent spouse is still eligible for reimbursement of long-term care for a professional caregiver, even if one spouse was able to provide assistance.
“Sometimes you have to convince a spouse that he or she will break down, or worse, try to take care of the other,” Werk said. “When a caregiver walks in, both of them can be in a better situation.”
Insurance companies will provide this help even if a spouse or child is able to do so.
However, when submitting invoices and daily care reports to the insurance company, make sure that only the insured person’s name is on the documents. For example, it is okay for the caregiver to schedule a lunch that both the husband and wife will eat, even if the wife is not insured, since most of the work, such as bathing, dressing, using the toilet, etc., is for the husband .
Find a new normal with care
Keep trying aides until the match is a good one. If you are getting help through an agency, ask for a few different helpers each week, regardless of whether you need seven or two days of care. If the senior doesn’t really “click” with you after a few weeks, ask for two different helpers.
Agencies want their customers and employees to be happy and should happily work with you to find the best match, Werk said. It is also good to try to have at least two trusted caregivers in case one becomes sick or has to be absent from time to time.
Long-term care insurers agree. It is the agency approved for reporting, not the individual caregiver.
Katherine Snow Smith works for The Penny Hoarder.