When we work with clients on long-term care expense planning, the initial focus is cost and coverage. It doesn’t matter if the funding option is insurance or another product design. Basically, clients just want to know how much expense they can afford to transfer to an insurance company or another funding resource.
As a result, meaningful provisions of these long-term care funding contracts are frequently left to the policy delivery conversation. One of the most important provisions is respite care.
Our service-for-life profile includes helping our clients file the initial claim for benefits. When the health decline has been gradual, as in the case of dementia, family members may have been caregivers for a very long time. Sometimes years. By the time we get the call for assistance, family members who have been providing care are exhausted. See the story about Claire and Elizabeth.
Electing to file a claim can be a difficult decision to make. It may signal loss of independence. Oftentimes, end of life. Family members may feel a sense of failure that promises made to care for a loved one at home can are no longer realistic given the level of care or hours required.
One of the very meaningful benefits of long-term care insurance policies is respite care. Unpaid family caregivers or friends often need a break from the stress of caregiving. Long-term care insurance provides short-term relief known as respite care.
Respite care will pay for out-of-pocket expenses, up to the maximum daily benefit amount, for temporary confinements in a facility or care received in the policyholder’s home.
This allows the family to hire a temporary caregiver for a certain number of days every year. Most policies allow between 21 and 30 days per year. And, this benefit is not subject to the elimination period (deductible). As soon as eligibility is confirmed, the respite benefit is available.
Modern long-term care insurance contracts have a bed reservation provision.
If the policyholder is residing in an assisted living community or nursing home and temporarily leaves the facility, the policy will continue to pay for the apartment or room when unoccupied so that it is not given to someone else.
A temporary absence could be the result of being hospitalized. Some policies will cover any temporary absence which could include being well enough to travel to be with family for a holiday or special occasion. This provision is generally for a 30-day period every calendar year.
Many contracts will cover services provided outside of the United States or its territories. These are usually limited to a percentage of the daily or monthly benefit amount for a shortened benefit period.
Very important to those who wish to remain in their own homes are a number of stay-at-home provisions. These may include caregiver training for family members, durable medical equipment, home modification and even medical alert systems.
Today, insurers provide a care coordinator at no cost to the policyholders. This is a valuable service to policyholders and family members. Coordinators assist with eligibility requirements, developing a plan of care, identifying qualified care providers and filing claims.
Many caregivers are managing all on their own without the assistance of insurance benefits or care coordinators and don’t know that respite care may be available to them through church or government programs.
Social workers and geriatric care managers suggest that family caregivers explore respite options as soon as they begin caring for a loved one. While it may be uncomfortable initially to engage temporary services, a break can help family members be better caregivers.