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I think the big sticky is the RN supervision as most NH are heavy on assistants and outside of the DON (director of nursing who is THE GOD or goddess @ a NH) there may not be RN's for all shifts for the requirement of the LTC policy. A RN can make oodles more $ working hospice than working in a NH even if they are working at the same NH. + less stress. DItto for home health RN's.
My mom is Lewy Body Dementia, mid 90's and in a NH (for 2 years) and to this day still can do most ADL: walks with a walker, potty, eat, and on a good day is totally lucid and know's who's who both staff & family. Now there is no way she could live on her own because she had hallucinations on occasion, cannot do her medications or be aware of the weather to dress appropriately and many other things needed for living at home on her own. But if she had a LTC policy, they wouldn't pay a dime as my mom is still good on ADL's.
My mom's NH does private pay & takes Medicare & Medicaid BUT DOES NOT take any LTC policy. Mom is on Medicaid. When I asked why no LTC policies, he told me that the reporting requirements by the insurance companies are so detailed as to staffing, the qualifications needed on staffing, time sheets, etc just flat require too much time for the often pitiful amount of reimbursement that they don't do it. One of our friends mom has a very good LTC policy but she is one of those who absolutely hates having "strangers" in her apt, so forget actually using the policy, as the policy requires a certified or other legit nursing or health care service provider. So they pay out of pocket for a low wage with no medical training sitter. I know I'm rambling, but my point is that LTC insurance is a gamble. That's why I think the "hybrid" life insurance/LTC policy's are the best best in that it allows for more flexibility for the family. But realize these cost lots more.
As with all these things, understanding the fine print is critical and many policies require documented assistance needed with 2 or more ADL's and often beginning dementia folks don't meet this level of documentation or have a waiting period for cognitive loss from dementia before payment.
My husband and I are only 48 and 50 and we have begun the process so we get in on the great rates. FIL waited til he was 71 and his rates are about $500/mo. The other thing we learned is to not put each other as "responsible party", we only put "self", I do not want him to get saddled with any medical debt that may be incurred that isn't covered by any insurance.
When purchasing a policy it is good to look at the options -- how much per day, how long, and how much it costs. Are the premiums going to stay the same or increase with age?
For people who cannot afford LTC insurance, most states have a partnership program with Medicaid. The premiums are less that other LTC insurance plans. You can only qualify for Medicaid. The good things, though, is there is no spend-down or recovery for partnets. It is a good way to go for people who are still fairly young and not wealthy.