LTC Insurance: Waiting Because You Don’t Know it’s Time to Begin

As a geriatric care manager, I am sometimes asked to help families throughout Westchester County, initiate their  long term care (LTC) insurance claim. I am happy to assist in this endeavor.  But if truth be told, and I consider myself a truthful geriatric care manager (except for my necessary fiblets, see June 12, 2012 blog), I sometimes wonder why families wait so long to open these policies. Do you really want to continue to pay those exorbitant premiums? Just a reminder, once the claim is approved and the elimination period has been reached, one stops paying the premium. So what are you waiting for?

My experience has taught me that families wait because they don’t know it’s time to begin. And how do you know it is time to begin?  For starters, one should have a copy of his/her policy. It will outline the elimination period, the daily benefit amount, services available, what disabilities must be present and the places in which services can be paid for. Benefits are rendered at home using a home care agency, in an assisted living facility, a day care program or a nursing home.  A diagnosis of dementia is usually an automatic trigger that opens the policy.  Needing assistance with two of the six activities of daily living:  eating, dressing, bathing, transferring, toileting and incontinence is another trigger to get the policy going.

Once you recognize that one of these triggers is present, a call to the long term care insurance company should be made. A benefits analyst will be assigned to you.  A rather thick envelope will arrive with a slew of papers to be filled out. You will have to provide the insurance company with a Plan of Care. This form is filled out by the claimant’s physician.  The LTC insurance company will then send out their own nurse to do an evaluation.  Documents will be reviewed, and a decision made.

So what can be the worst that can happen if you endeavor to open a claim? Rejection. However, all is not lost. You will have gained a familiarity with your policy and will get a better idea when the time is right. If you excuse this geriatric care manager’s inventive analogy, it’s like having a cataract. The ophthalmologist will tell you when the time is “ripe” (their medical term, not mine) to have it removed.  The same is true for initiating a LTC insurance claim. The right time will come. And the only thing that will be removed are those costly semi-annual premiums. A win-win situation.

Just How Effective are Drugs to Treat Alzheimer’s Disease?

As a geriatric care manager, the topic of whether to try medications  to stop the progression of Alzheimer’s Disease often comes up for discussion. From an evidence based perspective, I have not been impressed with the effectiveness of Aricept, Namenda and other medications in this group.  A recent article appeared in the online newsletter, Consumer Report Best Buy Drugs that specifically addresses this question.  I share the article  with you.  Their bottom line is after three months, if there is no improvement, the medication should be stopped.

Alzheimer’s disease gradually destroys the brain, robbing people of their ability to remember, complete everyday tasks, and function on their own. Sadly, drugs to treat the disease, including Aricept and Namenda, don’t work well. And even when they do, it’s only in a few people. Since there are no other options, some will want to try these drugs anyway, but it’s a gamble most people won’t win. That’s why our new CR Best Buy Drugs report on Alzheimer’s medications doesn’t recommend any of them as Best Buy picks.

Our decision, in part, is based on a recent large-scale analysis by the federal Agency for Healthcare Research and Quality (AHRQ), which found these drugs don’t delay the onset of Alzheimer’s or improve or maintain the mental function of people who already have it. The American College of Physicians and the American Academy of Family Physicians, and another review of Alzheimer’s studies in 2007, reached similar conclusions.

Besides not being very effective, Alzheimer’s medications can have side effects too. While most caused by the drugs are relatively minor, such as nausea, vomiting, dizziness, loss of appetite, muscle cramps, tremors, and weight loss, they could be potentially debilitating to older people. In rare cases, the drugs can also cause a slowed heart beat, gastrointestinal bleeding and ulcers, and possibly convulsions or seizures.

In addition, the drugs are expensive. An average monthly prescription ranges from $177 to more than $400. Last year alone, Americans and their insurance companies spent nearly $3 billion on these medications, according to figures from IMS Health, a company that tracks pharmaceutical data.

Bottom line:
No currently available Alzheimer’s drug provides much, if any, improvement, and all can cause side effects. Still, if you feel compelled to try a drug to help someone you care for, you could consider donezepil (Aricept) or galantine (Razadyne). Neither works better than other Alzheimer’s drugs, but they might be somewhat better tolerated and are available as low-cost generics. Regardless of which drug you use, stop after three months if you don’t see any improvement.