Long-Term Care
Offers Personal Freedom


In recent years, we have all come to realize that medical technology has had great success in extending our life-spans, but what medical technology has failed to do is find a way to give better quality to the very life it is extending. The need for seniors to live as independently as possible is reshaping the way they receive care. When choosing a Long-Term Care insurance policy it is important that one's expectations of what the policy will do and how it performs are one and the same.

In the past, nursing homes were considered a place people went to die. The time has come to say good-bye to the old nursing home and hello to today's Assisted Living Facility, a place where people go to live!

Assisted Living Facilities are filling a void left by our current health care delivery system. Many seniors are not sick enough or do not require personalized 24 hour supervision usually associated with a skilled nursing home. However, these same people are either too physically or mentally frail to be at home. A good example of such a person would be an 86 year old with diabetes and a multitude of minor physical disabilities. Although functional, this senior has special dietary and medical needs and may have trouble getting dressed in the morning. This person would have slipped through the cracks of conventional health care and Long-Term Care, until now.

Most people are now aware of Assisted Living Facilities, however they are unclear as to how to define one. The Assisted Living Federation of America defines Assisted Living as "a special combination of housing, personalized supportive services and health care designed to meet the whole needs, both scheduled and unscheduled, of those who need help with activities of daily living." Some insurance policies further define an Assisted Living Facility as a "facility licensed by the appropriate federal or state agency to engage primarily in providing care and unscheduled services to resident inpatients, provide 24 hour a day care and services sufficient to support needs resulting from the inability to perform Activities of Daily Living and/or Cognitive Impairment; having a trained and ready to respond employee on duty at all times to provide care and services; providing 3 meals a day and accommodating special dietary needs; and having the appropriate methods and procedures to provide necessary assistance to residents in the management of prescribed medications."

It has always been a challenge to define many of the lower level care facilities because of the many names they were commonly referred to, such as Personal Care, Residential Care, Shelter Care and Adult Congregate Living Facilities. Now that there is a uniform title that is inclusive of all of these services, it has been easier for us to define the covered care for the services provided by these facilities.

When choosing a Long-Term Care policy, to have credibility at time of claim, the plan must pay for all of today's Long-Term Care services. Utilization is undergoing a major change because of Assisted Living Facilities. Although these facilities are medical facilities by nature, it is important to note that reasons for choosing to enter an Assisted Living Facility are not based on medical needs alone. Social needs must be taken into consideration as well. The emotional obstacle of entering a nursing home has been removed and replaced with a more palatable model.

Many of today's seniors have outlived the support system they spent their entire life building. Because of this, many of them are left at home alone to fend for themselves and every day is a struggle to perform common tasks that many of us take for granted. Their children, sometimes called the `sandwich generation, may no longer live in the general area or have difficulty meeting the emotional, physical or financial needs of their elder loved one in addition to their own children's needs. Friends have passed away or are finding themselves in similar situations. When these seniors turn to the Government for help, they find they will only receive this type of support when they are broke. Medicaid, in most cases, will only pay for a traditional nursing facility and usually doesn't cover care in an Assisted Living Facility. Furthermore, their current medigap coverage, whether through an HMO or supplemental insurance, may have left them no choice but to recover some place other than a hospital. Therefore, unless they purchase Long-Term Care insurance, they don't have comprehensive health care coverage.

One of the biggest fears seniors have is not just outliving their money while receiving care in a facility, but, maybe more importantly, the fear of outliving their dignity and value as a human being. Assisted Living Facilities provide a proper balance of care, enabling a person to live out their existence comfortably and somewhat productively. Many seniors aren't aware that insurance will cover these services. In fact an HIAA Long-Term Care Study conducted by Lifeplans Inc., revealed that 76% of seniors have never been approached to purchase a policy and 62% of seniors are not even aware of any insurance companies which offer Long-Term Care coverage. With the passage of HIPAA in 1996, the awareness level has been heightened. The greatest accomplishment of this law is that a clear and concise statement was made by our Federal Government that in order to properly prepare for care, one must care for themselves. The best way to do this, is through the purchase of Long-Term Care Insurance!

Today, our Long-Term Care policies have adapted to the many options people are afforded when requiring Long-Term Care services. We have not had the time or space necessary to discuss the many options offered by home health care. However, when choosing a Long -Term Care policy it is important that both Assisted Living Facilities and other lower levels of care, such as home health care, be defined in the policy. Our challenge as a premier Long-Term Care Professional, is to provide seniors and their families with guilt-free options which permits them access to the best care available at an affordable cost.


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