Future Issues in Long-Term Care

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Future Issues in Long-Term Care

Long-term care itself will undergo big changes

Will the changing nature of LTC facilities and services themselves make today’s coverage ineffective? It is difficult to envision a scenario in which this could happen. That’s simply because the policy benefit triggers—assistance with the ADLs or a severe mental impairment that requires supervision—are human conditions not subject to change. It is hard to imagine how the delivery of most forms of personal care—assisting a frail person to eat or bathe, for example—could become much different.

As for the development of LTC settings different from today’s adult daycare centers, continuing care communities, assisted living facilities, and nursing homes, it appears that current policy language would cover most such places as well. The existing options vary widely and are subject to multiple broad definitions already. Again, it is hard to conceive of a future LTC residential mode that could not be included under one of these facility categories.

It is also important that a certification of the insured person’s condition and a plan of care written by a licensed healthcare practitioner be required by most policies for the payment of benefits. The certification and plan of care are the insurer’s confirmation that benefits are paid only under appropriate circumstances. For this reason, policies make eligibility for benefits far more dependent on the need and the type of long-term care to be provided than on where it is given, as long as it is not in a typical hospital bed.

The "alternate care plan"

Finally, many policies now have an "alternate care plan" feature as a basic benefit. This allows payments for facilities and services that are not specifically defined or otherwise covered under the policy. The insurer will consider such payments if the alternate care is part of a cost-effective, written plan that meets the policyholder’s needs.

For example, personal service robots might move from science-fiction novels to the living room in the not-too-distant future. Perhaps they will eventually substitute for human caregivers at lower cost, even if only to monitor a sleeping person overnight, with a family member on call.

Although the alternate plan of care feature does not formally commit the insurance company to anything specific in advance, it gives the insured additional leverage in requesting coverage for a new LTC service that might evolve. If a new idea or technology allowed more people to remain at home longer, it would surely be an "alternate" plan that both the insurance company and most policyholders would be happy with.