Long-Term Care Insurance: Understanding ADLs and Eligibility
Hello everyone,
I hope you’re doing well. My parents are currently residing in assisted living together. My dad qualifies for long-term care insurance, and my mom has her own policy as well. At 88, she is dealing with osteoporosis and relies on a walker to move around. She experiences incontinence but is able to feed herself, get out of bed, and dress independently. However, she struggles with using the phone beyond answering calls and has always depended on my dad for handling bills and similar tasks.
Since the onset of COVID, I’ve taken on the responsibility of managing everything for them due to their limited mobility, as they have been homebound. My mom doesn’t move without her walker, weighs around 100 lbs, and lacks physical strength. While she doesn’t have dementia, her ability to make decisions is quite limited, and I find myself doing everything for them.
I’m curious if anyone knows if she might still qualify for her insurance benefits under these circumstances. While she may not meet certain ADL criteria, I’m unsure if there are other factors that could impact eligibility for a payout. Any advice or insights would be greatly appreciated! My dad’s recent interview with a nurse was quite stressful, especially over Zoom, and I would like to only pursue this if there’s a reasonable chance for her qualification.
Thank you very much for your help! I truly appreciate any suggestions or input.
It sounds like you’re in a challenging situation, and I understand your concern about your mom’s long-term care insurance. While the specific criteria for qualifying for long-term care insurance can vary by policy, most typically consider assistance with Activities of Daily Living (ADLs) like bathing, dressing, toileting, transferring, and eating.
In your mom’s case, if she does not meet the minimum number of ADL requirements as per her policy, it might be tough to establish a claim purely based on those criteria. However, many policies also include other considerations related to cognitive impairment or the inability to perform daily tasks independently, even if they do not specifically fit into the typical ADL categories.
Since she relies heavily on your dad for decision-making and daily management, that aspect of her care may also be relevant. It may be worthwhile to closely review her policy or speak with a representative from the insurance company to clarify if there are additional factors that could support a claim.
Also, consider discussing with a financial advisor or insurance expert who can provide tailored advice based on the specifics of her policy. You’re doing an admirable job caring for your parents, and getting the right support for them is crucial. Wishing you all the best in navigating this process!