Wheelchairs: Mobility Options for You

Proving To Your Insurers That You Need Long Term Care

When you find yourself in need of long term care at a facility like St. Joseph's Ministries, you will need to prove to your insurers that you truly need it. This means you will have to go through a qualification process. Your need for long term care will be measured by your ability to perform activities of daily living (ADLs). The list of ADLs is quite comprehensive and includes many activities. These activities are sometimes referred to as benefit triggers.

What benefit triggers do I need to have to prove I need long term care?

If you are incapable of performing at least three of the following actions on your own, then your insurers are likely to agree that you need long term care.

  • Inability to bathe yourself and inability of getting in and out of a bathtub
  • Inability to feed yourself or to use a device that assists you with feeding such as a feeding tube
  • Lack of control over bowel movements or lack of bladder control
  • Inability to go to the toilet for bowel movements or to urinate without help
  • Inability to put on or remove all your clothing without help
  • Inability to get in and out of your bed without assistance
  • A diagnosis of a cognitive disorder that renders you incapable of remembering to carry out the basic ADLs even if you are physically capable.

Each policy and each insurer is different. Some long term care insurers will require that you are only incapable of completing two ADLs to qualify. Other insurers may insist on three. The list of ADLs may vary with insurance companies as well.

What benefits will be excluded from my long term care policy?

Certain mental or nervous disorders will not be covered by some insurers. These may include mental conditions brought on by drug use or suicide attempts. However, mental disorders such as Alzheimer's and dementia are usually covered by insurers. Other ailments that may not be covered by long term care insurers include illnesses that are associated with war, alcoholism and treatment that the government will pay for.

Long term care often means that you are now dependent on someone else to help you to carry out or to help you to remember to carry out some important everyday functions. The psychological impact can be tremendous especially if you have been used to your independence. Be sure to choose someone who is not only qualified to help you perform daily tasks, but someone with whom you feel extremely comfortable.