© Copyright 2004                               How long since you looked at your "A, B, Cs "? The Changing Language of Long Term Care by Laurel Stauffer-Daly, CLU, ChFC, LUTCF The following article takes excerpts from the accredited continuing education course "Basic Long Term Care from A-Z (NYCR-207894)" offered through the New York Center for Financial Studies in New York City. For a schedule, call 212-221-3500. Whether a seasoned financial services professional, or consumer shopping for long term care choices, today we need to be very conscious of language. Here is why: all of us use the Web more and more to research and shop for answers, it is common practice to "spreadsheet" a comparison of Long Term Care insurance product features that summarizes large amounts of detailed and legalistic, contractual information, insurance policies are legal contracts-rights and claims are dependent on the interpretation of terms and words This article looks at a few terms commonly found in long term care coverage and/or used in the senior care field. Are we speaking the same language?? "Accredited" services and facilities as opposed to "Certified"- an 87 year old client had to fight for her long term care company to pay for her care in an "assisted living residence." Why? Years ago, "ALRs" were not big business- in fact- many states have yet to regulate the industry. Unfortunately for this person, her insurance carrier's policy language specifically stated that ALRs must be licensed by the Department of Health. But in her particular state, such residences were in fact under the jurisdiction of the Office of Elder Affairs. Oops! The Office of Elder Affairs "certifies" residences that meet their criteria. At this time, licensing requirements vary. Start with your State Health and Insurance Departments. Many private, not-for- profit organizations also rate or give their stamp of approval to senior services and facilities. Certainly, insurance carriers should know the regulatory language in their states of operation but this did not prevent the 87 year old from having to fight for her case. "Activities of Daily Living"/"ADLs"- If you have had any exposure to long term care and senior care, you have heard about "Activities of Daily Living" which is often how we qualify for payment. The usual list includes: 1. Eating 2. Toileting 3. Dressing 4. Bathing 5. Transferring 6. Continence Federally "Qualified" long term care policies explain that the senior triggers policy benefits if he or she needs "substantial assistance" (which can be further defined as "hands on" or "stand by" help) with 2 or more "ADLS". But what do we mean by "eating"? You may be thinking and losing patience at this point. Isn't it obvious? Well, no it is not. One insurance carrier says this: "Feeding yourself by getting food into your body from a receptacle...". But the definition gets more specific- "...or by a feeding tube or intravenously." How many of us have instructed our medical team and our loved ones not to use such means to keep up alive? Aren't "toileting" and "continence" the real reasons we don't want to talk or think about getting old? Food, water and elimination are the raw basics of life. Toileting and continence get to quality of life issues. We change babies' diapers and that is acceptable. But to change your spouse's diaper...? Your mother's...? On the other hand, do you recall seeing television ads for adult diapers even five years ago? Diapers are a reality at the beginning of life and perhaps also at the end of life. Whether you are using insurance policy language or not, Activities of Daily Living are the issue (putting aside the cognitive, memory issues associated with aging). If we accept that, some day, each of will need help with daily life, we have taken the first step toward acknowledging the beginning of the end. "Acute vs. Chronic Care" The next term also brings into focus what the long term care industry is all about. People should be prepared to pay privately for help with basic living necessitated by normal aging or "Chronic Illness". This is as opposed to needing help immediately after a stroke, heart attack, or surgery, which is classified in the medical sense as "Acute Care" -a health crisis. Medical and disability insurance's are designed to help people get back on their feet. But Medicare and medical plans don't continue to pay when someone is not going to get better. Do our minds get sharper as we get older? Do we get more robust? No, the body slowly declines until an "acute" event such as a final heart attack or pneumonia takes us. Long term care protects assets from depletion as we pay for help with ADLs and the effects of chronic illness. "Alzheimer's Disease" An entire article could be dedicated to "Alzheimer's Disease" which can now be diagnosed and distinguished from other forms of dementia. Some facts to be aware of: Only about twenty percent of hospitals have special units for Alzheimer patients The average patient will live three to twenty years after onset Seventy percent of Alzheimer patients live at home The disease affects about fifty percent of those over 85! "Respite" care (a break) is one of the biggest needs of spouses and families of Alzheimer's patients "Care Coordinator"/"Care Management"- The meaning of these titles varies greatly. Normally, a "Care Manager" is a paid professional who helps develop and monitor the senior's "Plan of Care" which usually needs to be authorized by the long term care insurance company if a claim is to be processed. The Coordinator may be an employee of the insurance company (this raises conflict of interest issues in some people's minds) or privately hired by the family. She is often a Registered Nurse, or has a social work background. There are several professional organizations such as the National Association of Professional Geriatric Care Managers, to name just one. These people serve many roles in coordinating services at all levels, and knowing who will pay for what and when. Contrast the Coordinator's role with that of the "Caregivers". Read the contract language carefully here. "Informal Caregivers" are usually unpaid family. Check to see which caregivers are reimbursable by the policy- is the definition broadly defined like "health care services provided by a Nurse or licensed professional" or does it list nursing credentials- "expenses incurred for nursing care services provided by a registered nurse (R.N.) or a licensed practical or vocational nurse (L.P.N. or L.V.N.)"? Does the second definition preclude help from a "C.N.A." (Certified Nurses Assistant) or "N.A." (Nurse's Assistant)? "Community Based Care"- In the early days of the long term care industry, policies paid for nursing home services only or a combination of "Home Health Care" and/or nursing home care. Today's contracts are now much more liberal. "Community Based Care" can include Adult Day Care, outpatient rehab and therapies, Meals on Wheels etc. Anything designed to help seniors stay independent and in their own homes may be reimbursable, but check what your specific contract says. Does your policy allow for yet undiscovered treatments and services?? "Custodial Care"- Again, this IS what long term care is about. Medical insurance doesn't pay for personal care and hygiene. Assistance with bathing, dressing & eating can be given by an untrained person. These "ADLs" are not medically based. That is why long term care insurance was designed. Home attendants are paid very low wages but agencies charge a surcharge. Even a minimum wage of $5.15 multiplied out by twenty four hours a day is $123.60. In case you don't have your calculator next to you, this becomes $45,114 for 365 days and nights of care and would deplete someone's assets by almost a half million dollars if the senior needed such assistance over a ten year period. In conclusion, be nice to your kids, get to know what support services exist in your community, talk to your family, and watch your language! Laurel Stauffer-Daly, CLU, ChFC, LUTCF came into the financial services industry in 1987. She has a Masters (in Education) from Columbia University and this forms the foundation for all of her work. Her mission is to facilitate adult learning and peak performance through clearer communication- in fact- her corporate name and logo (Continuum... "learning for life") reflects that, as adults, we still must, and are, continually learning. Continuum trains both financial service professionals and their clients how financial products and services change lives. If financial service reps really know their products, and can explain them clearly to the public, this can have a huge impact in the world, because--- at least for right now--- money makes a difference! Laurel is a master trainer and coach. She has worked in large corporate settings, and managed the sales and training needs of insurance agencies. She works with people privately to improve their sales results. She also speaks regularly and gives seminars for the public, corporate and non-profit clients. Laurel is active in several trade associations, serving several terms on their boards. She holds three insurance designations and her NASD Series 7. Laurel may be reached at 212-717-8607 or continuum@nyc.rr.com Additional credit for this article goes to David Dreifuss, JD, MBA, CEO and EVP for The Alliance of Insurance and Financial Professionals. He can be reached at the NY Center for Financial Studies (see article header) or at ddreifuss@taifp.com