Ch. 24 Long Term Care

3. An individual age 65 or older has what chance of being confined to a nursing home? A. 25% B. 50% C. 75% D. 90%

A. An individual age 65 or older has a 25% chance of being confined to a nursing home.

2. Which of the following would be least likely to be a good candidate for an LTC policy? A. George, whose law practice has allowed him to fund a generous retirement fund for himself and his wife B. Nina, a single mother whose nancial struggles raising her children have left her with few assets and no independent retirement savings C. Carla, whose 25 years of civil service have provided a generous retirement, but who worries about the legacy she will leave her children D. Darrell, whose inherited estate has provided him with over $6 million in net worth

B. Nina, A single mother whose financial struggles raising her children have left her with few assets and no independent retirement savings. - LTC insurance enables qualified individuals to maintain their independence. With adequate coverage, the individual does not have to rely on friends or family to provide custodial needs or necessary funds to help defray the costs of a nursing home stay. - Protection of person assets may be the most important reason for purchasing LTC. When an individual has substantial financial assets (and retirement income), the possibility that LTC expenses could mean a significant reduction in the person assets and standard of living is a real threat.

10. The elimination period may be thought of as A. a dollar amount deductible B. a time deductible C. a dollar amount co-payment D. a time co-payment

B. Time deductible Elimination period - Similar to a disability income policy, no LTC benefits will be paid until the elimination period is satisfied. Most long term care policies prove for a period at the beginning of confinement in a long term care facility during which no benefits are payable. The elimination period can be defined as a time deductible. Could be 30 days or longer. The longer the waiting period the lower the premium

9. Typically, the expenses incurred in a hospice will be A. surgical and room and board B. room and board and physical therapy C. surgical and physical therapy D. room and board and medication for pain

D. Room and Board and Medication for pain

11. Which of the following is NOT considered an activity of daily living? A. Transferring B. Dressing C. Bathing D. Working

D. Working is not an activity of daily living.

Exercise 24. B

1. Skilled Nursing Care - Medical or rehabilitative care performed by skilled medial personnel on a continuous basis. 2. Intermediate care - Medical or rehabilitative care performed on an intermittent basis 3. Custodial Care - Assistance with the activities of daily living performed by unskilled helpers. 4. Home Health Care - Both medical and non medical care, including housework. 5. Adult Day care - Provides companionship, supervision, and socialization during the day.

4. Early long-term care policies were A. more restrictive than current policies B. less restrictive than current policies C. the same as current policies D. prohibited by law

4. Early long term care policies were more restrictive and harder to qualify for.

7. Virtually all of the current LTC policies are guaranteed renewable. This means the insurer cannot cancel the policy A. but does reserve the right to increase policy premiums on speci ed classes of policies B. but does reserve the right to increase policy premiums on individual policies C. or increase policy premiums on specified classes of policies D. or increase policy premiums on individual policies

A. Guaranteed renewable means the insurer cannot cancel the policy but does reserve the right to increase policy premium son specified classes of policies. Guaranteed Renewable - Guaranteed Renewability and cannot be cancelled except for nonpayment of premium. -Cannot cancel policy but reserve the right to increase premiums in accordance with the policy provisions. Some LTC polices are non cancelable and the insurer has no right to make any change in policy provisions, cannot decline to renew, and cannot change the premium rate at renewal for any reason.

6. Which of the following is the type of care most people will require at some time during their later years? A. Inpatient hospital care B. Skilled nursing care C. Custodial or residential care D. Intermediate care

C. Custodial or residential care 3 Terms regarding the type of long term care an individual requires are important to understand in order to determine what an LTC policy covers 1. Skilled Nursing Care - Is nursing and rehabilitative care that is required daily and can be performed only by skilled medical practitioners on a doctors orders. 2. Intermediate Care - Is nursing and rehabilitative care that is required occasionally and can be performed only by skilled medical practitioners on a doctors orders 3. Custodial or Residential Care - Is help in performing ADLS and can be performed by someone without medical skills or training, but still must be based on a doctors orders. - This is the type that most elderly people will require at some time in their later years, and is not covered by Medicare. other important terms: 1. Home Health Care - Refers to services performed from time to time in the individuals home. it may include skilled nursing, various types of therapy, help with ALDLS, and help with housework. 2. Adult day care - Provides company, supervision, and social and recreational support during the day for people who live at home and need assistance. This service is especially useful for those who are cared for by relatives who work during the day.

1. Nursing home care is generally covered by A. Medicare B. Medicare supplements C. long-term care policies D. all of the above

C. Nursing home care is generally covered by long term care policies. Long Term Care -The kind of care needed by individuals who have chronic illness or disabilities. Often covers the cost of nursing home care and provides coverage for home based care - visiting nurses, chore services, and respite care for daily caregivers who need time away from these difficult duties. Care needed because of aging is not covered by Medicare or Medical supplements. Medicare and supplementary insurance pay for skilled nursing care, but the coverage is exterment limited (the care must immediately follow a period of hospital confinement, and no benefits are provided after the 100th day. Medicaid does cover nursing home care but provides coverage only for needy families.

8. When waiver of premium applies A. the premium is waived immediately upon disability B. the premium payment is suspended permanently once it is invoked C. the premium payment generally resumes when care ceases D. the premium payment is waived only if disability is considered permanent and total

C. When waiver of premium applies, the premium payment generally resumes when care leases. Waiver of Premium -Nearly all LTC policies include a waiver of premium that takes effect after the insured has been confined for 90/180 days depending on the policy. Some have no provision which means the insured will be required to continue premium payments no matter how long care continues. When wavier of premium applies, premium payment generally resumes when the care ceases.

5. Which of the following individuals is most likely to be rated a substandard risk under an LTC policy? A. Gerald, who lives alone and has no trouble taking care of himself, but who has been diagnosed with an inoperable brain aneurysm that, if it bursts, would almost certainly kill him immediately B. Ken, who is on medication to bring down his blood pressure, but who gets around and takes care of himself easily C. Brenda, whose diabetes is under control D. Garrison, who has been diagnosed with early- stage Alzheimer's disease

D. Garrison, who has been diagnosed with early-stage Alzheimers disease Risk -One way in which LTC policies differ from other health plans concerns how risks are rated. Although people afflicted with heart disease or diabetes would be rated as substandard risk under most health insurance plans, LTC policies, because of their focus on aging people, use a different means of classification. The key for LTC policies is whether an individual can perform activities of daily living. And if so, with what degree of proficiency. ADLS including such things as dressing, bathing, eating, walking, and similar activities to care for oneself. Thus, an individual who has a heart disease but is still able to perform ADLs is a standard risk under LTC policies. Ex. Corey, age 60, has had several strokes during the past 5 years but is completely capable of performing the activities of daily living. Under a major medical policy, it is likely that Corey would be classified as a substandard risk. Under an LTC policy, Corey would be classified as a standard risk.

Exercise 24. A

True- Medicare provides skilled nursing care incident to a period of hospitalization for up to 100 days per benefit period. False - Medicaid provides LTC benefits for all retired workers over age 65 False - Consumers are now required to purchase LTC coverage True - One half of all Medicaid spending goes to people who consumed all their resources and become impoverished while in a nursing home.