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How to Handle Differences of Opinion in Long Term Care »

There can be some real family issues when it comes to taking care of loved one’s long term care needs.  Whether it fighting over who spends more time with the realtive or arguing over every miniscule decision, it makes sense to take a step back and think about a few things.

1.  Be proactive and talk (and listen) before an incident occurs.  Do it when as many family members can be there as possible.  A holiday, a birthday, another event when you can all sit down and find out each others wishes and make a list of things to do or research.   The Mayo Clinic has a small section on discussing long term care with loved ones.  It stresses active listening!

2.  Make a Plan.   The previous Mayo Clinic article has some insight into planning, but AGIS.com has a more detailed article that can help you out.   It stresses that the best plans include several elements (think Plan A and Plan B).
But what if an incident has occurred without prior discussions?  Disagreements can easily arise in this situation so some things to keep in mind are:

1.  Is there a spouse involved?  The discussion should start with her/him.  What are their needs and wants for the one in long term care?  How can the family support him/her?

2.  Can the family agree on someone to take the lead?  If you can all agree that one family member can be responsible, then release all the decisions to him/her.  This alleviates the entire family having to come together for each miniscule decision.

3.  Find an attorney who specializes in Long Term Care.  This can be really helpful because sometimes not all the family members understand the issues or the options and an attorney can be an unbiased, third party who can help family members focus on the issues at hand.

4.  Always remember that the relative in long term care should be first in every decision.  You want the best care for this individual without putting undue strain on the family!


Common Litigation Concerns in Long Term Care Facilities »

 There is an older article (2003) that has some good information about what you need to watch with your loved one in long term care.  Since these are the top reasons for litigation, you can bet that these are the top complaints AND the top offenses.  Whether you are the caregiver or you have your loved one in a facility, these are some things to watch out for:
1.  Falls causing fractures;
2.  Pressure ulcers;
3.  Dehydration and malnutrition; and
4.  Elopement from the facility (leaving without supervision) resulting in injuries.

Other reasons cited in the article were “physical abuse, choking on food, medication errors, neglect of basic care hygiene, and failure to provide assisted mobility”.

Click here for the full article from the Annals of Long-Term Care.


Long Term Care Daily joins Healthcare Blog Community »

Our blog has just joined a new community of blogs on healthcare!  The community can be found at blogs.healthcare.com.  The topics are quite varied, but some that might be of interest to this group include:

Senior Care and Information

Geriatric Care Management

All About Dementia

A full list of the health blogs available in the community can be found at:

http://blogs.healthcare.com/wp-list.php


Scott Olson Speaks on the Five Foundational Features of Long Term Care Insurance Policies »

Today is the second of a three part series interview with Long Term Care Insurance expert Scott Olson.  Scott is an insurance professional with over 12 years of experience specializing in long term care insurance.  He is the author of  "Making Long Term Care Insurance Easier" which can be purchased on his website:   www.ltcinsuranceshopper.com.  To read more about Scott Olson, please see the previous posting by clicking here.

LTCD:  In your book, you talk about the 5 Foundational Features of Long Term Care Insurance Policies. Could you tell us a little about each of these?

Scott Olson:  Sure. The first is "care settings": In which settings will the policy pay benefits for qualified care that you receive?  There are 3 main types of policies:  Home Healthcare Only, Facility Care Only, or Comprehensive (which is a combination of the two).  When looking at policies, make sure the care settings are what you want and that you are comparing apples to apples. .

The second Foundational Feature is the Daily Benefit.  How much will the policy pay for each day that you receive qualified care?  When comparing policies, make sure you understand how much of the Daily Benefit is available for each care setting.  Some policies may pay a smaller percentage of the Daily Benefit for care that is received at home or in an assisted living facility.

The third Foundational Feature is the inflation benefit.  This is the most confusing part of a LTCi policy.  There are 3 different ways to structure the inflation benefit:

  1. No inflation benefit – the Daily Benefit never grows.  It remains the same for the life of the policy,
  2. Future purchase option—you have a limited right to periodically increase your Daily Benefit.  When you choose to increase your Daily Benefit you do not have to prove that you’re still healthy. When you choose to increase your Daily Benefit, your premium will go up because you are buying additional coverage,
  3. Automatic Inflation Benefit—your Daily Benefit automatically grows each year by a certain percentage which you choose when you purchase the policy.  The automatic increases in the Daily Benefit each year do not make the premium go up.  There are many different types of Automatic Inflation Benefit.  The most common are 5% Compound, 5% Simple and 3% Compound.  In my book I include a chart that compares how the different types of inflation benefit impact the Daily Benefit over a 30 year period.

Word of caution:  One of the biggest mistakes people make when comparing policies is comparing a policy with a Future Purchase Option with a policy that has an Automatic Inflation Benefit.  A policy that gives an "automatic option to increase" is not the same as a policy with an Automatic Inflation Benefit.

The fourth Foundational Feature is the Benefit Period.  How long is the policy designed to pay benefits while you qualify to receive benefits?  It is sometimes described in terms of dollars, sometimes in terms of years, and sometimes in terms of days.  It is similar to, and sometimes referred to as, the "Lifetime Maximum Benefit".   The most commonly offered Benefit Periods are 3 years,  5 years, or Lifetime/Unlimited.  A 3-year Benefit Period means that if you use up all your Daily Benefit each day, your policy would run out of benefits after you’ve been on claim for 3 years.  A Lifetime/Unlimited Benefit Period means that the policy could never run out of benefit. 

This is easy to understand but hard to decide because it requires some prognosticating. This can be very subjective.  One way that I try to make it more objective is by having my clients approximate their future net worth at retirement and choose a Benefit Period that will approximate that figure.  A policy with a starting Daily Benefit of $200 and an 8 year shared Benefit Period, would have a starting Lifetime Maximum Benefit of $584,000 ($200 x 365 x 8 = $584,000).  That Lifetime Maximum Benefit would grow each year according to the Inflation Benefit chosen.  If this couple chose a 5% Compound Automatic Inflation Benefit, then the $584,000 would grow every year by 5% compounded growth (e.g. the Lifetime Maximum Benefit would grow to $951,274 within 10 years.)

The fifth and last Foundational Feature is similar to a deductible, and is called the "Elimination Period".  It is the number of days that you receive qualified care before the policy will start to pay benefits.  As with any insurance, the higher the deductible, the lower your premium.  The most common Elimination Periods that are offered are 30, 60, or 90 days. 

To read more on the Five Foundational Features, check out Scott’s book by clicking here.