Long-Term Care Insurance: Understanding ADLs for Qualification
Hi everyone, I wanted to reach out for some advice regarding long-term care insurance for my parents. They’re currently in assisted living together, and my dad qualifies for the insurance. My mom, who is 88, also has a policy. She struggles with osteoporosis, relies on a walker, and is incontinent.
While she can handle some basic tasks like feeding herself, getting out of bed, and dressing, she is quite dependent on my dad for things like managing bills—she really couldn’t handle any of that on her own. Since Covid, I’ve been helping them with everything, especially since their mobility is limited, and they’ve effectively been homebound.
My mom heavily relies on her walker due to her lack of strength—she weighs about 100 lbs. While she doesn’t have dementia, she struggles with decision-making and tends to be helpless in that regard. I’ve been doing everything for them.
I’m curious if she might still qualify for insurance payouts despite not meeting the two primary Activities of Daily Living (ADLs). Are there other criteria that might play a role in eligibility? Any insights or information would be greatly appreciated! My dad’s recent interview with the insurance nurse was quite stressful (we did it over Zoom), and I wouldn’t pursue this unless there’s a genuine chance of qualifying her. Thank you all for your help!
It sounds like you’re navigating a challenging situation with your parents’ care and their long-term care insurance policies. To determine if your mom qualifies for benefits under her long-term care insurance, it’s essential to understand the specifics of her policy, particularly the criteria for benefit eligibility.
Typically, long-term care insurance requires that individuals meet a certain threshold regarding Activities of Daily Living (ADLs) such as bathing, dressing, eating, transferring, toileting, and continence. While you mentioned that your mom may not meet the criteria regarding ADLs, there could be other factors to consider:
Cognitive Impairment: Even without dementia, if your mom’s decision-making ability is significantly impaired, some policies have provisions for cognitive impairments that might qualify her for benefits.
Assistance Needs: Depending on the policy, it may take into account how much assistance she requires in day-to-day activities, even if she is capable of performing some tasks independently.
Medical Conditions: An assessment of her osteoporosis and overall health might be relevant if it contributes to her limitations or needs for care.
Policy Review: Each long-term care insurance policy can vary in terms of coverage and definitions, so review her policy documents for specifics. Sometimes, there are alternative criteria for qualifying beyond just the ADLs.
I’d recommend reaching out directly to the insurance company to discuss your mom’s situation in detail. They can provide clarity on what they require for benefit payout and guide you through the process. As for the stressful interview process you mentioned, it may help to prepare a summary of her needs and limitations in advance to present to the assessor.
Although it might feel daunting, don’t hesitate to pursue the claim if you believe there is a chance she qualifies. Good luck, and I hope you find the support you need during this time!