Long-Term Care Insurance: Understanding ADLs for Eligibility
Hello everyone,
I hope you’re doing well. I wanted to reach out for some guidance regarding my parents, who are currently in assisted living together. My dad is eligible for long-term care insurance, and my mom also has a policy.
At 88 years old, she struggles with osteoporosis and relies on a walker for mobility. While she can feed herself, get out of bed, and dress independently, she is incontinent and depends heavily on my dad for support with daily tasks. Since the onset of COVID, I’ve stepped in to manage their affairs due to their limited mobility and being homebound.
My mom cannot use the phone except to answer calls, and she has always relied on my dad to handle bills and other responsibilities. She’s about 100 pounds and lacks physical strength. Although she does not have dementia, she often feels overwhelmed when making decisions and is largely dependent on assistance.
I’m curious if there’s a chance she might qualify for her insurance payout under these circumstances. While I understand that she does not meet the two ADL (Activities of Daily Living) requirements, I’m unsure if other criteria might be considered for eligibility.
I found my dad’s interview with the nurse quite stressful, conducted over Zoom, and I want to ensure that pursuing this avenue is worthwhile before moving forward. Any insights or suggestions would be greatly appreciated.
Thank you so much for your help!
It sounds like you’re navigating a challenging situation with your parents’ long-term care needs. While I’m not an insurance expert, I can provide some general information that may help you as you explore your mom’s long-term care insurance policy.
Long-term care insurance typically requires individuals to meet specific criteria related to Activities of Daily Living (ADLs) in order to qualify for benefits. These ADLs usually include bathing, dressing, eating, toileting, transferring, and continence. However, since your mom is incontinent and relies heavily on her walker for mobility, it could be worth investigating if these factors play into her qualification, even if she doesn’t meet two of the ADLs directly.
Additionally, many policies also consider cognitive impairment or the inability to make decisions as part of the criteria for eligibility, even if dementia is not involved. Your description of her being unable to manage tasks without assistance may strengthen your case for her qualification.
I recommend reviewing her insurance policy closely, as every policy can define qualifications differently. It may also be beneficial to reach out to the insurance company directly or consult with a professional who specializes in elder care or long-term care insurance. They can provide a clearer picture of her eligibility based on the specific terms of the policy.
Lastly, if the process is stressful, you might consider involving a third party to help with communication between your parents and the insurance company. It could also take some of the pressure off you while ensuring that your mom receives the support she may need.
Best of luck, and I hope you find the answers you’re looking for!