Demystifying Long Term Care - When It’s Time to Make a Claim

Transcript

Sivea Key: Hello, I'm Sivea Key. I'm the Long Term Care Lady. As you know, you're on my YouTube channel. Today we're talking about the other end of the long-term care insurance process. We're talking about what happens when you need that insurance money, because there's long-term care in your future. I have with me today, Josh Zuieback, he's with Amada Senior Care, and he's going to help us understand what that process looks like. Can you tell us a little something about Amada Josh?
Josh Zuieback: Yeah. Amada Senior Care, Amada means beloved in Spanish, was started here when we realized there was really a need for financial care coordination, in really the non-medical care market. Financial care coordination can include anything from long-term care insurance, understanding and processing claims to VA benefits, really putting the whole package together, along with providing top quality care.
Sivea Key: That's wonderful Josh. I understand that the process can be a little chaotic or confusing at the beginning. Can you tell us, say for example, tell us something about a recent case.
Josh Zuieback: Yeah, the process for families can be not only confusing and chaotic, but very stressful. As you can imagine, some of the families we deal with are going through changes with their loved ones. Usually a parent or a grandparent. So the process obviously starts with a phone call. The first thing we do is talk to our clients, try and understand what their needs are. In a recent case, we had a stroke patient who had suffered a pretty severe stroke and was being discharged home. The family was really confused on what their options are, what their needs were. They knew they had long-term care insurance policy, but the first thing is to understand the client's needs and who they are and what they're looking for and make sure they're a good fit for non medical care.
Sivea Key: That sounds like a very important first step. So what would that look like? Do you show up at their home or is there a meeting at the hospital? What goes on there?
Josh Zuieback: So it really depends, every family is different and we try and be flexible for them. 90 to 95% of my meetings are in person and occur at the hospital or in the patient's home. I do have some families that are either doing this from a distance or things are just so chaotic we do it all over the phone. But most prefer to meet the person who's going to be taking care of their loved one in person.
Sivea Key: I imagine they do. And just as an aside, how do you go about choosing people that are going to be caregivers?
Josh Zuieback: Yeah caregiver screening and recruitment is tough. We obviously interview, all our caregivers are typically touched, by touched I mean three to four by people in the office, see them, talk to them. We do background checks. If they're a professional caregiver, like their CNA or medical assistant, we check their license. And then put them through our training program so we can understand their skills.
Sivea Key: Oh, that's wonderful. That would certainly be reassuring. And as I understand, is there some kind of certification or licensing process for the caregiver?
Josh Zuieback: So here in Colorado, I understand it's different in every state, there's a licensing process for the company. So I have to be licensed through the state of Colorado. There is no licensing for the individual caregivers in Colorado.
Sivea Key: So Amada ends up being the responsible party to make sure that the care is proper.
Josh Zuieback: We are, we go in and we usually meet with the clients. We create what's called our plan of care. The plan of care is what's going to happen in the home. It's a living document. Once we're in the home, it typically changes over the first two to three weeks.
Sivea Key: Oh wow. So a lot of changes to adapt to the individual person and their needs. Is that what we're looking at?
Josh Zuieback: Yeah, most of my families don't really know what their care needs are. They know social workers at the hospital or discharge planners told them they need care. But the reality at home alone is different than in a hospital or in a rehab facility with assistance.
Sivea Key: Yeah. It's hard to imagine what our life is going to be like with a new disability. No, that's true. So what would the next stage be? So you have a family, you know they're in crisis, you're going to talk to them about what it is they think they need and maybe advise them a little bit. But what about their insurance or lack of insurance? What would that look like? I know most people I talk to, they take their policy, they put it in their safety deposit box or in their file folder and then forget about it.
Josh Zuieback: Yeah, you're right. So the next process is sitting down with the family, doing what we call a thorough long-term care insurance review. So we want to make sure that our clients, the client themselves and the family fully understands what their policy covers, what their coverage limits are. But there's also other things in the policies that we look for. Some add money in for home improvements. If you now need to put in a wheelchair ramp. Some have money in them for panic buttons and pendants and things like that. So we want to uncover all of that so that our clients fully understand what their policy will and will not pay for.
Sivea Key: That's wonderful. What would be some common questions or something that most people would have to consider in this process?
Josh Zuieback: So every policy has an elimination period. The easiest way to describe that is it's deductible. But instead of being counted in dollars, it's counted in days. The most typical one I see is 90 days. So people have to know that there is an out-of-pocket period for long-term care insurance policy. There's also a lot of other benefits we can uncover including waiver premium that says once we're using the policy, you no longer pay your premium. And the list goes on and on.
Sivea Key: Yeah, and I know it can be intimidating. So it's wonderful to have folks like you to support the family, someone who has been through it a thousand times. And knows just what to look for.
Josh Zuieback: Yeah, I think the biggest things for families to ask is what will my policy cover? How long will it cover me for? And really, how many hours a day can I relate to? And I will tell you my discussions with people with long-term care insurance policies are much different than those without.
Sivea Key: Do you want to-
Josh Zuieback: Elaborate on that? Well, I think long-term care insurance policy is really valuable when you need to use it. And for somebody looking at spending $4,000, $8,000, $10,000 a month in an assisted living, or with home care to have a policy reimbursing 50%, 75%, 100% of that, not only changes the decision-making process, it also opens opportunities and doors that might not be there for people without long-term care insurance.
Sivea Key: That's wonderful. In closing, is there anything else you'd advise families maybe ahead of time, or in terms of having some planning in place?
Josh Zuieback: I think the best thing is, know what your parents' wishes are. If something happens to a parent and they're unable to communicate, do they want to stay at home? Is there an assisted living they've talked to you about? If they have a long-term care insurance policy, we do all our reviews free of charge, even if you're not going to get care. We'll come in and we'll review your policy. Do that ahead of time, call an Amada in your local area, have them come help you understand what your policy coverages are. And really just be in the know of what they want and where everything is. One of the biggest things I see honestly, is people don't... They know their parents have long-term care insurance policies, but they don't know where the policy is. They don't know who the agent is. And sometimes they don't even know what company it's through. So they have to scour through bank accounts to see where charges are coming from. So make sure you have all that information and know where all the paperwork is.
Sivea Key: Wonderful thank you. Well, this is Josh Zuieback from our Colorado Amada Senior Care. As you've heard, he's available to give you a free review. So look down here below in the description and you can find his contact information, the national Amada number for someone in your area. Josh, are you guys available in different states?
Josh Zuieback: We are, we're all throughout the country. So pretty much wherever anybody lives. If there's not an Amada where you live and you're just looking for an insurance review, give us a call and we can do one over the phone as well.
Sivea Key: Wonderful. Thanks so much, Josh.
Josh Zuieback: You're welcome.

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