By Susan Chaityn Lebovits

A misconception that I hear from clients is: “We should save the long-term care insurance for later.” Sometimes it’s true. But sometimes waiting costs families thousands of dollars, delays much needed care, and creates unnecessary burnout for adult children.

Long-term care insurance is complicated because most policies are not activated simply because someone is older or needs help. Policies are triggered by very specific criteria, and understanding them can help families make more informed decisions.

The goal is not to use the policy too early or too late. The goal is to use it strategically.

Most long-term care insurance policies begin paying benefits when a person needs help with 2 or more Activities of Daily Living (ADLs) such as:

Bathing, dressing, eating, toileting, transferring, or continence.
Has a significant cognitive impairment such as dementia.
Has medical documentation supporting the need for care.

Signs It May Be Time to Activate the Policy
Your parent is falling frequently
They cannot safely shower alone
Medications are being missed regularly
Memory problems are affecting safety
You are providing daily hands-on assistance
Caregiving is affecting your work, sleep, relationships, or health
You are already privately paying for aides several days a week

Many families do not realize:
Elimination periods can range anywhere from 0 to 180 days. While 90 days is standard, even a “90-day elimination period” does not always mean 3 calendar months.
An elimination period is similar to a deductible — it is the period during which your parent must pay for care out of pocket before the insurance policy begins covering expenses. More here via AARP.

A confusing rule that many families miss is that some policies count only the days care is actually received. So if your parent receives care 3 days per week, a 90-service-day elimination period can stretch far longer than 3 months. A helpful way to think about it is this: A health insurance deductible is measured in dollars, while a long-term care elimination period is usually measured in days of care.

Why Some Families Wait

• There are situations where waiting to tap into long-term policies may make sense.For example:
  
• Currently, your parent needs only minimal support.
  
• The family can comfortably afford occasional private-pay help.
  
• The policy has a limited pool of money and preserving benefits is important
  
• Care needs are expected to increase rapidly in the near future

But waiting should be an informed decision — not avoidance. Too many adult children wait until there is:
A wandering incident
A caregiver collapse
A hospitalization
A crisis move to assisted living

Before Filing a Claim, Gather These Documents

• Families are often surprised by how much paperwork is involved. Start collecting information NOW so you are prepared:
  
• The actual insurance policy
  
• A summary of benefits
  
• Contact information for the claims department
  
• Physician documentation
  
• Medication lists
  
• Care assessments
  
• Records of current caregiving needs
  
• Invoices from home care agencies if care has already started

Create and update a brief caregiving log for 1–2 weeks every few months documenting:
Missed medications
Falls
Episodes of confusion
Assistance needed with dressing or bathing
Nighttime supervision

Critical Questions to Ask the Insurance Company

When you call, ask:

1. What officially triggers benefits?
   
2. How is the elimination period calculated?
3. Does the policy cover home care?
4. Are family caregivers covered?
5. Does the aide need to come from a licensed agency?
6. Is there a daily or monthly cap?
7. Does the policy cover assisted living or memory care?
8. Is prior authorization required?
9. What forms are required from you and from our parent’s physician?

Write down the name of every representative you speak with and keep notes.
Remember: long-term care insurance was purchased for a reason.
Many older adults paid premiums for decades because they wanted to ensure they were cared for with dignity without burdening their children.
Using the policy is not “giving up.” It is using a resource your parent intentionally put into place.
Sometimes it’s best to activate benefits before there is a catastrophic event- when your family has the energy, and emotional bandwidth to make thoughtful decisions.

If your family is trying to decide whether it is time to activate a policy, or if you are overwhelmed by the process, I help adult children sort through these decisions.
You do not have to figure this out alone. Reach out with any questions or book a time to connect.

Helpful Resources
National Council on Aging — What Is Long-Term Care Insurance?
National Association of Insurance Commissioners (NAIC) Consumer Guide to Long-Term Care Insurance