Adult Family Homes

[unic.consulting]

I have a prospective client who is balking at LTCi because of a bad experience with her mother. The mother had an LTCi plan through Genworth (not sure how long ago she got the policy, but it was quite a while). The daughter put her in an adult family home when she eventually needed assistance, but the insurance refused to pay because it was neither assisted living nor a nursing home. From what I've read about the new policies, this shouldn't be an issue because the trigger on most of the plans are ADL based not environment based.
Her issue is she and her husband would want to go into an adult family home if they need assistance later on. Since this didn't work for her mother, she's afraid it won't work for her. Is there any policies I should be looking at in particular for her?

64/F HTN
65/M kidney and CAD. Has stents several years ago

 

[Arthur Rudnick]

Your answer would be a cash-benefit policy. The cash can be used for anything.
Look into MedAmerica's Flex Cash.

 

[TwiLight]

I agree that a CASH policy is best.

Most LTCi is on a reimbursement basis and the "adult family home" is a more recent hybrid that has come from necessity due to so few people having LTCi.

It is a more affordable option of care for those paying cash.

Eventually they will be accepted as the licensing and regulation evolves. There was a similar situation for Adult Day Care models when they first came out.

In your State, the best type of organization to get behind, to promote the adult family home, would be Alzheimer's groups. They need as much help as they can get as they are undermanned and underfunded. Their voices are beginning to be heard in legislative circles though and were successful for pushing the Adult Day Care models.

 

[CALTCAgent]

Is there any policies I should be looking at in particular for her?

64/F HTN
65/M kidney and CAD. Has stents several years ago

Some considerations,

What is the stage of his kidney disease ?

Does the CAD mean carotid or coronary ?

 

[unic.consulting]

Some considerations,

What is the stage of his kidney disease ?

Does the CAD mean carotid or coronary ?

Coronary. She hasn't gotten back to me about the level of the kidney disease yet.

 

[yankee466]

I have a prospective client who is balking at LTCi because of a bad experience with her mother. The mother had an LTCi plan through Genworth (not sure how long ago she got the policy, but it was quite a while). The daughter put her in an adult family home when she eventually needed assistance, but the insurance refused to pay because it was neither assisted living nor a nursing home. From what I've read about the new policies, this shouldn't be an issue because the trigger on most of the plans are ADL based not environment based.
Her issue is she and her husband would want to go into an adult family home if they need assistance later on. Since this didn't work for her mother, she's afraid it won't work for her. Is there any policies I should be looking at in particular for her?

64/F HTN
65/M kidney and CAD. Has stents several years ago

The older Privilaged Choice product said an ALF must have 10 residents....the new products like Flex II have no head count requirement....so the adult family home will not be a problem if it meets the standard criteria of things like 3 meals/day, awake supervision, properly licensed, etc.....

Else CASH always works.......but with Simplicity no more, isn't Flex Care only cash for in home care these days if you set the switch to CASH? Haven't looked lately.

 

[Arthur Rudnick]

previously posted by yankee466

isn't Flex Care only cash for in home care these days if you set the switch to CASH? Haven't looked lately.

Cash if for home care & ALF.

Every state has different rules & regulations as to how ALF's & Adult Family Homes operate. I'm not sure what the requirements are for an AFH.
Do they have 24/7 care available? Are they capable of providing help with ADL's?

Depending upon the state, it's possible that an AFH may not qualify under a LTC contract.

 

[yankee466]

previously posted by yankee466



Cash if for home care & ALF.

Every state has different rules & regulations as to how ALF's & Adult Family Homes operate. I'm not sure what the requirements are for an AFH.
Do they have 24/7 care available? Are they capable of providing help with ADL's?

Depending upon the state, it's possible that an AFH may not qualify under a LTC contract.

Thanks for reminding me on the options......agreed.....no cash for nursing home only on FlexCare according to the flyer....at least here in Georgia. Assuming of course you pay more to set CASH = YES.

 

[Arthur Rudnick]

It's not Simplicity, but it's the only cash game in town.............

 

[ltci4sure]

I had a distinct impression that people on this forum loath Medamerica (gasp, it is not Genworth, and as I have learned, no GNW, no Mass Mutual - no business). Naturally, those who have Simplicity are in the best position... alas it is no more. Reimbursement type policies will always have limitations based on a set of criteria chosen by the actuaries at the time when the plans were designed - hence when new forms of care appear, they may not be covered (since the risk hasnt been factored for those at the time the product was designed).
Cash plan offers a measure of protection, which is tempered by rate increases... people are getting 40-60% rate increases for Simplicity II product.