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LTC: Confused about terminology

My mom has a State Farm LTC policy that forgives the annual

> premium if she's in a residential care situation. While receiving > home care she has to pay the premium and the 20% deductible. > > We worked out a budget showing that her present lifestyle is > sustainable essentially permanently if she moves into assisted > living. In addition to not paying for the policy, expenses related > to her condo disappear in that case.

This is the kind of arrangement I would like for my elderly mother. But I'm confused about the difference between "residential situation" v. a condo in an "assisted living" situation.

Would a live-in care-giver qualify as "assisted living", even if the "condo" (which might be a free-standing house) is not in a "community living" situation?

And beware: I might not be using "community living situtation" correctly. I mean a planned community, usually gated, that is intended for retirement and/or elderly living.

Or does the term "assisted living" refer only to "nursing home" situations?

Does "long-term care" apply only to care given only to someone who cannot tend to their own personal care?

Or could the term also apply to someone who just needs help with shopping, household chores, household projects because the elderly person has physical limitations -- like arthritis, difficulty breathing, etc -- that make these tasks difficult, but not impossible?

Are these terms well-defined and used somewhat in a standard manner in the LTC industry? Or must I read between the lines?

I could probably go on and on with questions, each built on the possible-false assumptions about the answers to earlier questions.

But perhaps what I really am asking is: where is the best place to start to understand the correct terms to use to apply to various stages of the "elderly" phase, beginning with when a person begins to have "difficulty" getting around and doing simple tasks due to aches and pains and we begin to be concerned about her living alone up to the point where a person is truly vegetative or at least very incapacity either mentally or physically?

Disclaimer: I hope the moderator does not feel this is too far off-topic. In my way of thinking, it is major part of the long-term financial planning task. At least, this is one of the biggest unknowns that my mother constantly brings up whenever we discuss her current financial situation and whether or not it covers her needs "later in life" -- which may not be that far off. "How much can she spend now and what investment risk can she assume now without jeopardizing her ability to support herself for another 10-15 years?"

Reply to
curiousgeorge408
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Generaly speaking, the answer would be NO. However, each CONTRACT is different, and one would have to SEE the contract to determine.

NO again, as I happene to live in one such............

NO, it means a specific enterprise, usually small in nature, wher there is primarily "HOUSING" and similar services, but NO NURSING FACILITIES.

That is a fair definition of the Terrm. It means inability to perform two or more of usually SIX types of functions (again they are LISTED in the contract)

This would generaly be LISTED as Home Care Service ! !

YES & YES

IN THE CONTRACT. Alternative would be to ATTEND Seminars, and speak to REPUTABLE Agents

Cal Lester CLU

Reply to
Cal

I was that someone.

State Farm defines 'residential care' as taking place in a facility licensed to provide it. That excludes your own home and also excludes the 'independent living' part of a full-spectrum community. From an LTC policy perspective, that independent living is simply an apartment or condo, even if home health help and some degree of community dining is available. The cost of living in the apartment is not paid; the cost of the home health help may be, if your policy includes it. There's not a lot of benefit from the LTC policy, that I can see.

As a detail of my Mom's policy, State Farm pays 80% up to the daily benefit limit of ~$210. That's true for the Assisted Living Facility (ALF, a specific type of license in Florida) that my Mom chose. Another facility markets itself as an ALF, but actually holds a Skilled Nursing Facility (SNF) license. That's a higher level of care. They had been an SNF but renovated slightly and changed their business model. Had my Mom chosen that site (a rather bleak place) State Farm would pay 100% up to the daily benefit limit, simply because of the difference in license.

A detail I didn't state in my earlier post is that, not only are the condo expenses eliminated, so are groceries and normal costs of living like laundry detergent, toilet paper, etc. It's really not a bad deal for someone requiring assistance, if the living arrangements are acceptable.

Reply to
Chris Cowles

CG,

Start with the contract you are considering. Definitions tend to vary in small, but often very important, ways from company to company. Definitions may even vary across different products offered by the same company.

In general, the standard for requiring "long term care" has to do with "activities of daily living" (ADLs). If a given number of ADLs cannot be performed by the individual they are eligible for LTC support. The condos or gated communities you refer to are primarily for individuals that can fully perform ADLs on their own and therefore require little or no support from medical professionals. Rather, individuals move there for the social network, closeness to medical facilities, and amenities. They are not covered under LTC insurance.

Reply to
kastnna

I do not have a contract to look at. I want to understand the correct jargon to use (or to avoid misusing) in conversations with professionals in the industry while I search for the right solution for my situation. I don't want to make the mistake of asking about "LTC" when, in fact, that is not what I really mean, and my misuse of the terminology would lead to confusion and misdirection.

Your response and the others have been very helpful. Thanks.

And thanks for changing the subject line back to the original. I think it was rude for someone to change the title line. I am surprised the moderators permitted it, not only on principle, but also because the modified title become unduly generic. I know the moderators are a stickler for distinctive titles.

Reply to
curiousgeorge408

We understand that you do not have an "In Force Contract" on hand. However, you CAN contact the various companies, and request a Sample Contact from them.

Cal Lester CLU

Reply to
Cal

What kind of coverage is it you're looking for?

Elizabeth Richardson

Reply to
Elizabeth Richardson

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