Many of you who have found it necessary to use home health care have had the experience of receiving a phone call from your long term care insurance company, or an assessment by a nurse who was sent by the company. These representatives of the company have a specific job to do which you should be aware of when communicating with them. That job is to make sure the company’s money is not being wasted on those who are actually able to take care of themselves. It is to save the company money by limiting your care or cancelling it altogether. The correct way of communicating with these company representatives can prevent you from losing the care you really need.

Helpful Facts

Most insurance companies require that you need assistance with at least two, and sometimes three, activities of daily living to qualify for benefits. Activities of daily living include mobility/ambulating, transferring, bathing, dressing, toileting, and eating. Any assistance needed to ensure your safety will qualify. For example, a person with a history of falls may be able to walk or shower himself/herself while still needing standby assistance. This means the aide is at your side to steady you and give more assistance, as needed.

It has also been recognized that the safety of a person who is cognitively impaired is compromised when left unattended/unsupervised, even when that person is able to perform activities of daily living independently. In addition, this person may be able to shower himself/herself but may need to be reminded to do so. These are called verbal cues. When speaking to a long term care insurance representative on behalf of your loved one, be sure to mention it if your doctor has said your loved one has cognitive impairment, dementia, or Alzheimer’s disease.

If you receive a call or visit from a representative, be sure to call your home health agency with any questions. Your home health agency should be willing to advocate for you and talk with your insurance company on your behalf.

Key Phrases to Avoid

By avoiding some key phrases, you can ensure you will receive all the help that you need and are entitled to.

“I can do everything by myself.”

The representative will understand this to mean that you don’t need any assistance, including standby assistance and/or assistance as needed.

“I feel just fine.”

The representative is not asking how you are to be polite. He/she is trying to determine how you really are. The representative will believe that you feel just fine and don’t need any assistance.

“I just need a housekeeper.”

If you do not require assistance with activities of daily living, you no longer qualify to receive assistance from a home health aide or CNA. Some policies will cover homemakers. Speak with your home health agency about the possibility of hiring a homemaker.

Tell the representative all the activities of daily living that you need assistance with (or your loved one needs assistance with), including those which require standby assistance and/or verbal cues and supervision.

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