Real Life Stories…

My colleagues in the Long-Term Care National LTC Network wrote the following scenarios. They offer personal stories to illustrate the need for Long-Term Care and the types of Long-Term Care that we have available.

Family in Crisis: Why I Sell Long-Term Care Insurance Today

It is heavily ingrained in my mind, even today, after actively managing long-term care facilities as a nursing home administrator, that there is a need to have long-term care insurance in one's portfolio.

I vividly recall, on one occasion, when a wife was admitting her husband for Alzheimer's disease care. At one point in the admission process I had to ask the question, "How do you plan to pay for your husband's care in our facility?" Her response was, "Oh, I'm not worried about it. Medicare will be paying the billing." When I heard that answer, I knew I had to explain to her that Medicare would not pay for custodial care, which is the level of care he would be receiving in our facility. To this day, I remember the look on her face when she realized what I was saying - that she would be responsible for the cost of her husband's care.

She sat there for a moment without saying anything. I could see that she was in turmoil. With a look of horror on her face, she told me, "What funds we have are tied up. I will need to mortgage our house to pay this nursing home bill. I'm no sure how I am going to do all this. I've never had to make any financial decisions, nor have I ever had to pay any of our bills."

As I sat there watching her anxiety, I thought to myself, "Why isn't there an insurance policy on the market to pay for the cost of long-term care not covered by Medicare?" Now that there is insurance for this level of care, I have a personal mission to tell people about the need, the cost, and the financing of long-term care and to sell policies to people while they qualify for the coverage. I don't want to experience another wife admitting her husband to a facility without immediate means of being able to pay for the cost of care. The long-term care policy can be a vehicle that prevents any future looks of turmoil and stress on a family, since use of a long-term care policy can prevent unplanned changes in lifestyle and help provide the necessary care.

In 1984, I became aware of nursing home insurance plans that even paid for custodial care. As soon as I learned about the coverage, I sold my first policy to my mother. To my amazement, she had a stroke a year later. She required the services of a nursing home after her stroke and her long-term care insurance policy paid the full cost of care while she lived in the facility. They provided her excellent care, they cared for all her needs, and it was all paid for by the insurance company!

I've been a provider of long-term care through my mother's experience, and now I sell long-term care insurance so people will not have to experience the turmoil and stress I've witnessed during the admission process into a nursing home. The general public doesn't realize how often families are denied benefits by Medicare and major medical insurance plans for long-term care. In fact, based on information from Employee Benefit News, only about eight percent of all costs for a long-term care stay are reimbursed by Medicare(1). Additionally, Medicare does not pay for custodial care(2) and most major medical insurance plans also do not pay for custodial care services. Custodial care services are what the majority of people require when a prolonged illness places them in long-term care situations. People should consider long-term care insurance to help pay for these services.

If more people understood how often patients do not receive Medicare or major medical insurance benefits for their long-term care stay in a facility or for long-term care at home, they would run to find an agent that offers long-term care insurance while their health permits a policy to be issued. The need is real. A long-term care insurance policy can help a family avoid a stressful financial crisis. A long-term care insurance policy can help a family avoid having to pay out-of-pocket for the cost of long-term care. A long-term care insurance policy can allow a family to select a facility of their choice or receive care at home. A long-term care policy can prevent another spouse from experiencing agony and financial stress during the admission of a husband or wife into a long-term care facility. That's why I sell long-term care insurance.

Home Health Care. Who is willing to give care? Who is able to give care? Who will pay for care - can you do it?

The Two-Edged Sword of Long-Term Care

Why aren't spouses or other family members adequate in providing home health care? An example of the two-edged sword associated with home health care by family members is my own family's experience with home health care for my wife's mother - which is occurring at the very same time this chapter is being written. "Katy," as she is affectionately known to our four children and seven grandchildren, was in great spirits this past October when she traveled from Southwest Arizona to Petoskey, Michigan, for her annual fall visit with family and friends back home. After her visit, my wife and daughter drove her south to Kalamazoo for a brief stopover prior to her return flight to Arizona, and that's when the persistent cough was noticed.

Katy delayed visiting the doctor, but did so in early November, when CAT scans and other tests confirmed the diagnosis of cancer. But the medical community (probably fearful of mistaken diagnosis) was not definitive about answering specific questions. Is it terminal? How long? What will her capabilities be? Will she be hospitalized? (Rule that out, Katy says.) No hope for a cure? What else can we do to help her? But the information provided was soft and ambiguous. After receiving a delayed "no hope" decree, Katy was given an alternative, last-ditch approach. The doctor said, "We can give you chemotherapy and/or radiation, but it won't really help or change your condition. It's too advanced." So, in a desperate attempt to achieve a miracle, Katy chose radiation (because one loses one's hair with chemo!). We sought expert advice from an experienced, professionally licensed caregiver who had experience with the results of radiation therapy administered to the chest area.

I interrupt the story at this point, to say the first edge of the sword has struck. Affairs at home, family relations, business matters, the upcoming holidays raised a constant cacophony of emotions. Give attention to our immediate family and business after an absence of three and a half weeks? Or, continue caring for Katy, who is slowly and painfully dehydrating and starving herself because the radiation has burned her throat and esophagus so badly she can't swallow, and who now requires daily care just to move from the couch to the lavatory to the bed and back again?

What to do? What to do? A quick return to Michigan and family and business, then another call for help from the temporary caregiver (she charges only $100 per part-time day; and full-time, twenty-four-hour caregivers charge $360 per day.) So, a return to Arizona prior to Christmas was appropriate, hoping to provide a family-type last Christmas for Katy, but she was too weak to travel the few miles to join us and asked if we could postpone the celebration and gifts to a day when she felt a little bit better. Holidays are the worst time to find yourself in a caregiver position with someone you love. It's emotionally debilitating I can assure you, but, considering the challenges, stress, and pain Katy was facing every day, hour, minute, we had no right to complain. Damn! The helplessness and despair were beginning to overcome our usually positive attitudes.

Now, the other side of the sword edge becomes apparent… we cannot continue neglecting our Michigan family and business, so we're guided to seek twenty-four-hour care arrangements. Nice, accommodating people, these professional caregiver organizations. So, to Hospice as an interim answer. With their help, a plan is worked out for Katy to get 24-hour home health care from four different sources: Monday through Friday for eight hours during the day; a home health care aide during the night; an RN to perform catheter changes, etc. several times a week; and Hospice support two to three times a week. "How much will this cost?" we asked. A calculator was needed to figure the various sums, and a rough estimate was provided -- $10,000 to $12,000 per month! Damn again! Katy can't afford this, not for very long anyway. O.K. It's pony-up time. If needed, we'll pick up the cost differential needed. We're lucky. Many other Katy's don't have family in a position to help financially. Another bite of the sword blade is our frustration at having to dissipate principal (particularly after working so hard to accumulate it in spite of the plethora of taxes on income by federal, state, city, social security, and Medicare taxes.) The only alternative, though, would hurt Katy, made her condition worse, and intensify the suffering she is already bearing.

So, it's now February, Katy is slipping away fast. My wife is still at her side daily, keeping Katy's personal affairs in order (bills still have to be paid, groceries bought, oxygen supplied, other errands the caregivers don't do). It goes on day after day. The other side of the two-edged financial sword cuts into our love, commitment, and desire to help on one side, and the cost in dollars, emotions, time, and sacrifice on the other. Would Katy have been better off in the hospital? No - they don't accept chronic care patients. A nursing home? She absolutely refused to be "dumped there" - her words. Or at home, where she could find some peace and comfort. Our saga continues at this time, the final chapter to be written some time later.

We are indeed fortunate to have been able to give the time and financial support Katy needed, and we have the support of our Michigan family to aid in caring for her. Many families are unable to do this. And, if those families do not have long-term care insurance, including full coverage for Home Health Care, they face a story similar to the one I've just shared with you.

Community Care Settings

After living in the same home for fifty-two years, Steven S., age 87, wants to move. Yard care for him is overwhelming. The extra space in his two thousand square-foot home is more than he needs or can maintain. He has already taken a fall in his garage and spent six months recuperating from a broken hip. If he stays, he risks more physical injury and certainly more mental anxiety trying to cope with a life he can no longer handle. This is a very common scenario facing seniors.

Ruth G. had an unfortunate tragedy of the type we all hope to avoid. Fifteen years ago, her husband Sy was struck by a paralyzing stroke. Because of this misfortune, Sy was confined to a wheelchair and unable to speak, requiring a considerable amount of home health care. Ruth, being a committed, loving wife, acted as her husband's primary caregiver. It totally exhausted her, and the toll on her health since his passing has manifested itself. At age 87, Ruth could no longer function independently because of her declining intellectual capacity. Consequently, she was no longer able to stay at home. Since her children lived three hours from her, it was difficult for them to manage her bills and see that her personal needs were attended to.

As Ruth's agent, I research her long-term care policy and began the claim process. Evaluations were done to determine her cognitive abilities. Because it was concluded she was impaired (in need of supervision, and reminders to take her medications), her claim was approved. We had a care coordinator make arrangements for her to move into an assisted living facility, which was a tremendous relief to her family. She calls it her home away from home, and her life is very comfortable now.