Becoming Long Term Care Aware
By Jim Runestad 

Over many years experience helping clients with long-term care planning, I have found my time increasingly dominated by efforts on behalf of people whose pre-existing health issues make placement problematic. Individuals with chronic conditions such as Multiple Sclerosis or Parkinson’s face daunting prospects with respect to long-term care needs.

A frequent topic of discussion in support groups is the difficulties of obtaining coverage for long-term care. One of my clients recently told me that two members of her support group were declined coverage for long-term care insurance.  And most of the others in the group simply assumed they would not be eligible. It is important that people recognize that a diagnosis of MS or Parkinson’s does not automatically disqualify one for LTC coverage.

Most of the misunderstanding surrounds a few basic questions.

What is long-term care?

Unlike other types of medical procedures and treatments, long-term care is not primarily intended to cure a medical condition. It focuses, instead, on helping a person cope with a reduced level of functioning over an extended period of time – sometimes indefinitely.

Generally, an individual in such circumstances needs assistance with what are called “activities of daily living,” i.e., bathing, continence, dressing, feeding, toileting, and transferring.

Is age a factor?

Anyone of any age can require long-term care or be declined for LTC coverage. But on average, with conditions like MS or Parkinson’s, the earlier the diagnosis, the better the odds of being issued a policy since the likelihood of needing long-term care is greatest in the Golden Years. In fact, it’s estimated that some 42 percent of Americans who reach age 70 can expect to require some type of long-term care during the remainder of their lives.

Is long-term care always provided in a nursing home setting?

No.  Years ago, “long-term care” was virtually synonymous with “nursing home care.”  However, today most long-term care is actually provided in the patient’s own home – either by family or friends (called “informal caregivers”) pressed into duty by the circumstances, or by paid, health care professionals who visit to provide the needed services.

Long-term care is also delivered in other settings, including “assisted living” or community-based facilities such as adult day care centers. Only the most intensive care is still delivered in skilled nursing homes.

Doesn’t my health insurance cover long-term care needs?

This is a common misconception.  In fact, most health care insurance policies do not cover long-term care costs.  Neither does Medicare – except under very specific circumstances, and following a qualifying hospital stay.  Nor will Medicaid (the federal program for the needy) provide any benefits until one has exhausted almost all their assets and is virtually destitute.

Are there Multiple Sclerosis or Parkinson’s related limitations or conditions that may disqualify one for LTC?

In general, yes. However, at present, there are currently more than 100 companies that offer long-term care insurance.  And each has its own underwriting standards. The general guidelines for decline include:

  • Cognitive impairment

  • Need for use of a wheelchair

  • Need for help with activities of daily living, e.g., the need to hold onto furniture to move        around a room.

Other health conditions in conjunction with MS or Parkinson’s can also affect underwriting, so it is imperative to meet with a specialist to get an individual assessment.

How can I make sure I’m prepared?

There are several ways to do this.  You can:

  • Consult with your financial planner

  • Meet with an insurance agent who specializes in long-term care insurance

  • Educate yourself through independent research

But however you choose to proceed, you really owe it to yourself and your family to become “long-term care aware.”  Take the time now to explore your options.  As with all insurance, the time to look is before you need it.

 

 

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