Long Term Care and Dementia

[Thomas McCurnin]

+1 on Bruce's answer. Having worked in risk management for several major corporations, the whole business practice is to deny claims on any plausible basis, and with some luck, the claimant will go away. Granting claims will not make the insurer a profit and may impact whether dividends can be paid that year. Read the policy to determine what your rights are, and what procedures you have to follow before lawyering up. My assumption is there a claim process, an appeal process, and perhaps a second appeal process before having standing to file suit. If you are not good with reading such documents (try reading with a ruler or reading aloud on a sentence by sentence basis), then by all means give the document to a professional (lawyer) who is familiar with those things. I used to practice law in Iowa, so PM me and I may be able to give you a referral depending on which of the 99 counties you guys live in.

[jared herbert]

I see you live in Iowa as do I. Years ago I had a grandparent that had a similar problem, insurance company refused to pay her valid claims. The company had her buffaloed for some time but my aunt eventually figured out what was going on. A call to the state insurance commissioner and the problem was solved quite quickly. I hope your problem can be solved like this. Insurance always seems to work very well as long as you are paying the company but it seems like the reverse doesn’t work so well.

[Tom M King]

How is elder care handled in countries that have universal health care? Maybe some of our Canadian members know.

[Michael Schuch]

So do you all think she has to have both conditions for her LTC? The way we read it, it's an OR situation. That she does not need to have issues with ADL in addition to her dementia.

Thank you all for the information. Any and all helps! According to the primary doctor that specializes in Senior care, she said she can tell the "smart" people because they have creative ways for making up for their lack of memory. Such as my MIL giving a detailed answer on how she stores all her pills in pill organizers 3 weeks in advance. The question was "What time of day do you take your medicine?" and "Do you take X medicine on an empty stomach?" (She was skipping daily meds, as well as taking too many on some days and her pill organizers did not have the same quantities in them.)

It's John Hancock LTC. A quick google search shows they have many 1-star reviews and how reluctant they are to pay claims. They no longer sell LTC.

I have dealt with several people with cognitive issues in their 80-100 years of age but never dealt with initiating Long Term Care claims. I agree. Going into a Memory Care Facility is rough. Cleanliness is not a high priority in many of them we looked at.

Such organizations specialize in giving people a run around. It IS their business model!
1) Document everyone you speak to. Date/Time of the call and persons name.
2) Record all calls if you are able to. In Oregon only 1 party has to know a call is being recorded for the recording to be admissible. Even if a call recording is not admissible in court it can be very helpful.
3) Google "File complaint against insurance company in {your state}"
4) File complaints through ALL possible agencies, not just the first one to pop up.

There are agencies out there that are supposed to assist people getting the run around from insurance companies. Make friends with them, they are your allies not the people giving you the run around.

I don't believe I shared my story here about my internet problems. I spent nearly 10 years battling Centurylink over Internet connectivity issues. 2 weeks after I filed complaints with the FCC, PUC and Oregon state attorney general I have a new cable between the street and my house. Trying to get anything done through Centurylink itself is the definition of ineffectual.

https://www.hobby-machinist.com/thre...urylink.99156/

Personally, I would ONLY contact a lawyer after all other avenues have been exhausted.

[Stan Calow]

The LTCPs we looked at required you to meet at least two of the five conditions to qualify for payment. We dropped it when the annual premium tripled at age 65.

[Mike Chance in Iowa]

Thank you again for all the suggestions! I will be reading the link later about the FCC and internet. The first post sounds is very similar to what we have been going through since moving to this property in 2014.

I have been on calls for most of the day so far. I found a phone number for a Plan Administrator near the back of MIL's policy. The woman who answered said I needed to call a different number for the Benefits & Resources. Understandable the number changed with it being such an old policy. After reaching Benefits & Resources, there was no LTC option in the phone tree. The "other reason" representative was extremely helpful, but she was having a lot of difficulty finding anything on LTC. She found a number to call John Hancock and when she called it, a casino that answered. She finally found some info stating their company no longer managed LTC plans. Reaching out to her supervisor, they put me in touch with someone who is going to try to find a US based contact with John Hancock and will get back to me later whether she has an answer or not.

I gritted my teeth and called John Hancock again. All their calls typically involve at least a 20 minute wait time before anyone answers. I asked to be transferred to someone in the United States. When I reached someone in the US, she too was from a call center. I asked for documentation that defines "substantial supervision for a severe cognitive impairment" and she said there is no documentation. That she could mail me a copy of the policy. I told her I have the policy in my hands and there is no definition of what "substantial" and "severe" is. She did say this policy is set up to trigger with either the need for 2 of the ADL OR "severe cognitive impairment." It does not need to be both. I asked her what needs to be provided in order to claim her cognitive impairment. Her answer was "A letter from her doctor stating she has dementia." I already faxed that letter to them on 3/10/22. This girl was not making policy decisions. Her job is to answer calls for probably dirt cheap. She tried to be helpful and really encouraged me to fill out the appeal documentation.

The next step is I am waiting for the doctor (DNP) and her boss (MD) to write their letters indicating MIL has dementia and needs supervision. They will have the letters notarized. Then I will fax the letters and the appeal letter to John Hancock. Instead of an appeal letter, I'm creating an itemized list including dates. Things like She responds with "Yes Mommy" and "Yes Daddy"; She can't manage her daily meds; She cannot remember what food she ate for lunch 15 minutes ago; She does not remember how to lock/unlock the brakes on her 4-wheel walker, etc. I'm up to 47 items so far. Both my LOML and I will sign the appeal and have it notarized for good measure.

Since I am self-employed, I'm the one with more flexibility in my schedule to make calls, meet with Senior Facility staff, as well as run MIL around to her various appointments. Dealing with all her finances and medical insurance and life matters has been fairly easy. Dealing with Long Term Care is turning into a full time job for me.

I agree 100% about documenting everything including what number was dialed. I kept casual call notes when I started managing all her care, but once I started dealing with John Hancock, that all changed.

I will update this when I have more information and/or progress. It's going to be useful for someone else at some point.

[Bruce Wrenn]

Food for thought, Social Security is a form of elder care. Grips me to have to pay taxes on half of it, when for most of my working life (self employed) I couldn't deduct payments from my gross income. Tom, I'm sure you are in the same boat.

[Warren Lake]

Tom I wrote a paragraph or two last night and deleted. If our education system was smart it would have taught us things we need to know and one of the most important would be elder care, a thing we will all face. Ive done that from late 2015 for my mom, then the old cabinetmaker then back to my mom. One of his sons died at 32 and the other was scizophrenic, he had no one but he had already become my father long before. A thing that happened without either of use realizing it. Or maybe he tricked me, he was the smartest man ive ever known. I stopped working and was there for them. Id the same again only better now that ive learned so much.

After he passed focused on my mom and his son. Been a long road and lucky for the most part but you have to be on the system all the time. If an elder doesnt have an advocate for them constantly I hate to think what would happen.

I may write up more. It was all learn as I go. A doctor who was not smart caused damage to my mom with his bad choice. Then a doctor at a top hospital in Toronto that was very smart we worked and he solved the issue. If any of you know anyone that is having mini strokes make damn sure you get them checked for sleep apnia. Once that was figured out there was never another mini stroke for years till the end. Too bad some damage had been done from the past.

Im not much for labels, even after my mom was labelled with Dimensia around 90 she great to 94 1/2. More sane than any woman in my family and a better memory than me. She was joy, covid made a number of new challenges and it nearly killed her keeping us away from her. Then a whole adventure from that alone too long to go into. It became very clear the only reason she stayed alive was that one of us was there every day. Lucky we were in a good Long Term care home. We had tried three Retirements to get to one which did the job but mom labelled it as a clip joint. Another one we tried first she said she thought it was fake, I looked at her and said it reminded me of Las Vegas and got a smile.

Mom ended up in a different area so we no longer went to that one top Toronto Hospital so even hospital care changed and had to watch that. We nearly lost her one night just because of an emergency room doctor who wrote her off. A CCAC lady and Geriatric nurse listened to me that she had bounced back from stuff in the past they over road the doctor. Didnt even know that was possible but when I said we have to learn the work the system we do.

Three weeks later She was ready and being sent to a new Dimensia home. When I picked her up a nurse told me she didnt want to give her back. How nice was that.

The Dimensia place was great but it cost a Martin Table saw. Lucky in one week got a call and had to move her to long term. That was a blessing. The home was no hell but the group of ladies were amazing and worked together so well. We had many more good years. All that after emergency room guy wrote her off.

For Long Term the system is broken. The Pellicans that run it bring in some gaggle of people every year. Helps get them votes. So lets say 350,000 new people come in. There are not even enough spaces in Long Term for the people who have worked and paid into the system their whole life. Right now the niece that helped me care for the old guy is barely keeping sane caring for a mom with Alzeheimers in her family home. Her mom should have been in long term likely two years ago. She has seen a friend she taught the whole process get their parent in faster. o she is away from her family and has to hire full time to be able to get back to her own home and be with her husband or son. She is a tough woman and still has broken down some times.

I didnt read all above but there are days of the week up here there is an Employment law show. Infomercial I guess but the people are are smart as hell. Background one of them was in the system so knows the inside and out of how the companies avoid paying. I dont listen to it but past times it was on and I heard a bit it was clear alot of companies have to stop playing the game fast. When a lawyer who came from their side of the fence and is smarter than them is involved amazing how fast things change.

We have to fight for too much stuff in life that is supposed to be there to take care of us. Someone posted above who they contacted and things shaped up.

Ive had to stand up to too much over the years but stuff learned taught me enough I could help others.

I once had a lawyers ongoing propane pricing cut in half. He had fought with them and got no where. He was too nice, I stooped to their level.

In the years after if i hired him he refused to bill me.

[Mel Fulks]

Warren, good work there. I’ve written ‘term papers’ that were shorter….that’s how I “broke into woodworking ! “. You are a good son and
friend.

[Murray Roblin]

Hi Bruce,
We're beginning this process for a family member. Stroke, healing but still substantial care required. The financial advisor who helped us acquire the policy suggested documentation, escalation, and plan to use a lawyer. We shouldn't expect it to go to court, just that the insurance company has a calculus for how much the payout will cost them vs. how much trouble we cause.
As someone above noted, LTCs with the benefit structure we have are not being underwritten now.
Best to you.
Murray

[Warren Lake]

For some ball park numbers here Retirement homes are around or were approx 4,500.00 a month, it varies around and money goes up for every little thing. Dimensia care place would have been over 7,000.00 a month. The long Term Care is gov funded so they pay part and that cost 2,700.00 per month.

[Jim Becker]

For some ball park numbers here Retirement homes are around or were approx 4,500.00 a month, it varies around and money goes up for every little thing. Dimensia care place would have been over 7,000.00 a month. The long Term Care is gov funded so they pay part and that cost 2,700.00 per month.

That's consistent with my experience with my mother...and I was thankful that the 'rents did the endowed entry to the life-care community and that greatly mitigated care costs as her needs progressed. One other note about this is that after a period of time, there may be eligibility for some help from Medicaid, depending on the state, etc. In Florida where the 'rents lived, that could only kick in after a year if needs could be proven.

[Scott Clausen]

My sympathies on anyone going through this. To the OP I think it is time to lawyer up to get their attention.

On a similar note I have done a lot of reading on alzheimer's and the relationship with diet, possibly. There are some the are calling it type III diabetes now. The thinking is that ongoing high insulin levels from a high carbohydrate diet that cause insulin resistance and later T2D lead to the plaques. I will be gone before the science is in on this but have switched to a very low carb way of eating just in case it proves out.

[Warren Lake]

15 years ago coast to coast late night made statements that all our health originates in our gut. They have looked into all kind of illnesses originating there and made discoveries. Heard we have brain neurons there? Dont get that however they say promising finds and learning going on.

[Michael Schuch]

Thank you again for all the suggestions! I will be reading the link later about the FCC and internet. The first post sounds is very similar to what we have been going through since moving to this property in 2014.

My Internet connection struggles are pretty irrelevant. The point I was trying to make is that as long as you stay in their system, the system they setup to road block you at every possible turn, you will not make ANY progress. I HIGHLY recommend that you reach out to your states equivalent of the Insurance Regulation Commission and any other state agency that looks like they could possibly be of help. With some muscle that can impose fines or even shut them down behind you it is incredible the progress you can make!

A lawyers job is to make money off of you. A state agencies job is to look out for YOUR interests! I DEFINITELY recommend contacting all possible state resources before getting a reaming from a lawyer as well as the insurance company!

Edit: HERE YOU GO! Start with this online site to file an online complaint with the "Iowa Insurance Division!". For a 15 minute investment you may make huge amounts of progress:

https://iid.iowa.gov/insurance-consumer-complaint

2nd Edit: Also file an online complaint with the Iowa Attorney general:
https://www.iowaattorneygeneral.gov/...complaint-form

File complaints with both at the same time and any other agency that you can come up with!