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Common Causes of Long-Term Care Insurance Claims

According to the U.S. Department of Health and Human Services, 70 percent of Americans who reach age 65 will need LTC services at some point in their lives.

Unfortunately, many Americans underestimate the likelihood of developing a disability or chronic condition that requires long-term care, and therefore do not acquire long-term care insurance.
Lincoln Financial Group’s 2016 Long-Term Care Awareness Study revealed that a majority of people approaching or in retirement have not taken any action to prepare for an “unanticipated long-term care event.”
This lack of preparedness can come from misconceptions about LTCI costs, factors contributing to your need for LTC services and the illnesses and conditions that often require such services. In the post, we will break down these misconceptions and illustrate the common causes of long-term care insurance claims.

The rising costs of long-term care

According to the Genworth’s 2017 Cost of Care study, the median costs for most types of long-term care have continued to increase over the last few years. The median monthly costs for long-term care are as follows:
  • Homemaker services: $3,813
  • Home health aide services: $3,861
  • Adult day health care: $1,473
  • Assisted living facility: $3,628
  • Nursing home care (semi-private room): $7,148
  • Nursing home care (private room): $8,121

Factors that affect your need for long-term care

The U.S. Department of Health and Human Services identifies four factors that can contribute to whether you will need long-term care at some point in your life:

 The older you are, the more likely you are to need LTC services.

 Women generally outlive men by an average of five years, therefore making them more likely to live alone when they are older and require care.

Health status/history:
 Family health history of chronic conditions may increase your likelihood of having those conditions and needing care. Poor diet and exercise habits can also be contributing factors.

 Those who have a lasting disabling illness or injury are likely to need long-term care as well.
It is important to remember these factors can also affect the cost of long-term care insurance, or even prevent you from purchasing coverage in some cases. For example, if you are already in poor health, you may not be eligible for LTCI.

Qualifying for long-term care insurance benefits

Long-term care insurance was created to cover comprehensive long-term care costs that traditional insurance usually does not cover.
In order to be eligible for benefits, a licensed health care practitioner must determine that you are unable to perform – without substantial assistance – at least two of the six Activities of Daily Living (ADLs) for a period of at least 90 days due to loss of functional capacity, or have a severe cognitive impairment.

The six ADLs are:
  1. Bathing: washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower
  2. Continence: maintaining control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, performing associated personal hygiene
  3. Dressing: putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs
  4. Eating: feeding oneself by getting food into the body from a receptacle, or by a feeding tube or intravenously
  5. Toileting: getting to and from/on and off the toilet, and performing associated personal hygiene
  6. Transferring: moving into or out of a bed, chair, or wheelchair
Long-term care insurance policies can cover various types of in-home care, including skilled nursing, assorted kinds of therapy, and personal care assistance.
In addition, LTCI may also cover some costs associated with care in a nursing home, an Alzheimer’s disease special care facility, assisted-living facility, an adult day care center or a hospice care facility.

Conditions that contribute to long-term care needs

Alzheimer’s disease and other forms of dementia
More than five million Americans are living with Alzheimer’s disease, and that number could rise to 50 million by 2050.
Alzheimer’s is the most common form of dementia and causes problems with memory, thinking and behavior. There is currently no cure for the degenerative disease.
Symptoms vary widely from person to person, but can include:
  • Memory problems
  • Difficulty with word-finding
  • Vision/spatial issues
  • Impaired reasoning or judgment
As symptoms worsen, patients may need assistance with ADLs or specialized care tailored to the specific symptoms of Alzheimer’s.

Cancer is the fastest-growing cause of disability claims and a common reason for admission into a long-term care facility, likely due to a rising rate in cancer diagnoses.
Cancer itself can be debilitating, and its treatments – like surgery, radiation and chemotherapy – can also make it difficult or impossible to care for oneself or perform ADLs without significant support.

According to the American Diabetes Association, 1.5 million Americans are diagnosed with diabetes every year.
Common diabetes symptoms include:
  • Extreme fatigue
  • Blurry vision
  • Cuts and/or bruises that are slow to heal
  • Frequent urination
  • Feeling very thirsty
  • Feeling very hungry, even though you are eating
  • Weight loss, even though you are eating more (type 1)
  • Tingling, pain or numbness in the hands/feet (type 2)
Diabetes is also a costly chronic condition – the total national cost of diabetes and prediabetes in the U.S. is an estimated $322 billion. In some cases, the expenses associated with Type 1 diabetes can climb past $1,000 a month.

Nervous system disorders
Nervous system disorders like multiple sclerosis and Parkinson’s disease, both of which are progressive and have no cure, can eventually require those afflicted to receive long-term care services.
Nearly a million people in the United States are living with Parkinson’s disease, which involves the malfunction and death of vital nerve cells in the brain, called neurons.

The Parkinson’s Disease Foundation
 says specific symptoms vary from person to person, but primary motor signs of the disease include:
  • Tremor of the hands, arms, legs, jaw and face
  • Slowness of movement
  • Rigidity or stiffness of the limbs and trunk
  • Postural instability or impaired balance and coordination
Meanwhile, an estimated 400,000 Americans have multiple sclerosis, and 200 new cases are diagnosed each week.
Often referred to as MS, this chronic and degenerative disease attacks the central nervous system. Symptoms can include:
  • Vision loss
  • Impaired coordination
  • Numbness or tingling
  • Bladder dysfunction
  • Fatigue
  • Spasticity
  • Cognitive difficulties
  • Widespread pain
  • Dizziness and vertigo

Mental illness
The National Alliance on Mental Illness reports that one in five adults in the U.S. experience a mental illness in any given year. Prevalent types of mental illness include depression, schizophrenia, drug/alcohol/substance abuse, bipolar disorder, anxiety and obsessive-compulsive disorder.
In more severe cases, the effects of mental illness may prevent those afflicted from being able to care for themselves sufficiently. In these instances, long-term care services may be beneficial.

Have questions about long-term care?

If you want to learn more about long-term care issues, explore our Long-Term Care Insurance archive for detailed information.
If you are seeking long-term care insurance benefits for yourself or a loved one, or have questions about LTCI policies, contact our top-rated, highly experienced long-term care insurance attorneys for a free consultation or free policy analysis.

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