Your loved one needs a caregiver at home and has a Long Term Care insurance policy…now what?

Long-Term Care (LTC) insurance is one option many people choose to provide financial protection when they begin to need help with the activities of daily living. LTC insurance coverage in Pennsylvania provides services in your home, a medical facility or a combination of the two.

Make contact with the insurance company and get the following information:

  • Policy Number:  You will need this along with a claim number to reference all correspondence with the insurance company.  
  • Find out whether or not home care is covered: Some of the older policies only covered care in a facility.
  • Elimination Period:  This is like a deductible.  It is the number of days the individual must pay out of pocket for covered services before the insurance company will begin to make payments, usually 30, 60 or 90 days.   Some policies use calendar days and others use days of care.  This is a very important distinction.  For example, 90 calendar days could mean that you pay for care 2 days a week for 3 months (90 days), essentially paying out of pocket for 24 days of care to satisfy the 90 day elimination period.  90 days of care, on the other hand, would mean paying for 90 actual days of care, 90 days in a row or 90 days of care spread out, say 2 days a week for 45 weeks.  As illustrated there is a big difference between the two.     
  • Benefit Amount:  The amount of insurance benefits that a policy will pay per day for covered Long-Term Care expenses.  This can have stipulations as a maximum per day or a maximum pool of money.   
  • Benefit Period:  The length of time a policy will pay a benefit.  Common time frames are 1 year, 5 year, Lifetime.  Sometimes the period can be until a maximum pool of money is exhausted.  
  • Inflation Rider:  Some policies have a rider that will increase the benefit amount over time using simple or compound interest.  Simple vs. compound can make a very big difference.  
  • Benefit Triggers: Activities of daily living and cognitive impairment levels that trigger the need for Long-Term Care.  Activities of Daily Living (ADLS) are activities that measure a person’s level of dependence.  Activities could include bathing, continence, dressing, eating, toileting and transferring (mobility). The policy will pay benefits if you are unable to perform a specified number of ADLs, usually 2 or 3, and/or having cognitive impairment issues.

All of the above information should be included in the policy itself.  If you do not have the physical policy please ask the insurance company for a copy. Always a good practice.

After you have this information notify the insurance company what home care agency you will be working with or if you will be working with a consumer directed private caregiver.  The insurance company will request a copy of the agency license or a copy of the individual caregiver’s credentials.  The insurance company will also want a copy of the plan of care.  Please be advised you are not locked into any one provider, you can change as your needs and wants change, keep the insurance company informed.    

After the claim is approved the insurance company will require copies of care notes, paid invoices and any care plan changes on an ongoing basis, usually by fax.  

All of this can be a little overwhelming,  some people hire an independent Geriatric Care Manager to help and advocate and process the claim.  Some home care agencies will provide the same help and advocacy and process as well.  

Here is a link to the Aging Life Care Association where you can find a Geriatric Care Manager.

Additional Resources:

Pennsylvania Insurance Department, Long Term Care

Administration on Aging  

Please keep in mind that all policies are a little different and this information is a general framework.

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VA Pension Benefit is a supplemental income benefit for veterans, spouses and/or their surviving spouses.  The VA helps Veterans and their families cope with financial challenges by providing supplemental income through the Veterans Pension benefit. Veterans Pension is a tax-free monetary benefit payable to low-income wartime Veterans.

The Pension has three levels:

  • Pension:  over age 65
  • Pension with Housebound benefit:  disabled and confined to the home
  • Pension with Aid & Attendance benefit:  disabled and require the aid of another person to assist with activities of daily living or cognitive impairment.

The monthly benefits range from $721 to $2846, as of 2017 increase.  Click here for current rates

To qualify:

65 or older
At least 90 days of service
At least 1 day during active war time
Discharge other than dishonorable
Financially qualify

To apply as a veteran you need VA form 21P-527 or 21P-527EZ.

To apply as a survivor you need VA form 21P-534 or 21P-534EZ

The application process can be intimidating and complex.  It is recommended that you work with a VSO (Veteran Service Organization) or a financial professional to complete the application.  This should be a free service as it is illegal to charge a fee to assist in the completion of any VA benefit form or paperwork.

The pension benefit can be used to pay for a caregiver that can help a veteran and /or spouse with getting dressed, preparing meals, food shopping, driving to a Dr’s appointment, light house cleaning, laundry, bathing, companionship, etc.

Matt Read




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I need a break from providing Home Care: Respite care for family caregivers

Time to relax written in sandIf you are caring for someone else, you need to take care of yourself. No matter how much you love your job, you still need a break. A break can be something as simple as a long walk outside alone. A break can also be spending a week away at the beach with loved ones who you are not providing home care to. Taking breaks and vacations will make you a better caregiver. We can all relate to feeling over-worked, overwhelmed and tired. These feelings do not create a good caregiver. When we are well rested, relaxed and energized we are a much better caregiver. We owe it to the ones we are caring for to take care of ourselves.

So when you want to get away to the Jersey Shore for a week, what do you do? The first thing might be to have another family member step in. Have mom or dad stay with your brother or sister for the week.

This provides an economic advantage but more importantly it will give your sibling some perspective as well as empathy. Unfortunately a lot of us do not have siblings that can step in, so that leaves three other options: Home Care, Adult Day Care and Assisted Living Respite Care.

Home Care: Home Care agencies can provide a professional caregiver to be with your loved one in the home anywhere from 4 hours a day to live-in 24/7. There are full service agencies, consumer directed agencies and private hire options. The caregiver can help with all aspects of personal care, homemaking as well as socialization.

Adult Day Care: Adult Day Care is similar to going to school or day camp. Your loved one spends part of the day at the center and is involved in socialization with other seniors. They provide personal care and nursing services as well as activities and group meal time.

Assisted Living Respite Care: Assisted Living Facilities have respite programs where your loved one moves in for a set time, one week for example. During that time it’s as if your loved one is a regular resident at that facility. There are planned meals and activities. Also this option can let you and your loved one have an up-close and personal evaluation of a facility or community you may be considering for a long term solution.

Please remember, we all need a break.

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