CARE MANAGER'S CORNER - Author : Eileen Dunn, MS, CMC, CLTC, Geriatric Care Manager
I’ve run into this situation a few times over the last several months and thought it may be helpful to share.
I received a call from a woman who needed assistance to “just figure things out”. She had decided to move into an assisted living facility with her husband who has vascular dementia, sick sinus syndrome and had a laminectomy (decompression surgery) a few months prior. They can’t move to the facility until October 1st.
They have long-term care insurance, so when they move to the assisted living facility, most of the cost will be covered. They have a 90-service day elimination period so the first three months must be paid in full, which will be about $12,000. She thought she should wait until they were moved into the assisted living facility to begin the claims process because she thought it would save money. She mistakenly believed she needed to book a full eight-hour shift at home to account for an elimination day, which would cost over $17,000 for the 90 days. ($24/hr. x 8 hrs.= $192 per day x 90 days = $17,280)
She felt she was handling things well but she realized she was getting more and more tired. She has become very afraid, over the past few months, because he has become weaker and she is fearful of what would happen if he fell. They had inserted an Interstim implant for overactive bladder back in June but it hasn’t helped his incontinence the way she had hoped it would. I was concerned the stress of being a primary caregiver was going to start to impact her health.
I suggested that she begin the claims process now to get through the elimination days because she would incur less money out of pocket. She only has to show a minimal out of pocket expenses to a home care agency on a given day in order for the service to count as one day toward the elimination period. I have had many clients that believe it needs to be a full 8-hour shift for it to count. This is not the case. However, most agencies do have a three-hour minimum.
We initiated the claims process and she had a home care agency come in every morning for the three-hour minimum which came to $72 per day for a total of $6,480 for the 90 service day elimination period. This was a savings of $5,520 by not waiting until moving to the facility and far less than the $17,000.
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